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320 Cards in this Set
- Front
- Back
how is the bladder pushed near term?
|
anterior and superior
|
|
alk phos in pregnancy?
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elevated due to placental AP isozymes
|
|
plasma volume increase in preg?
|
50%
|
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RBC volume increase in preg?
|
20-30%
|
|
why decrease in hct?
|
plasma volume increases more than RBC volume
|
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female pseudohermaphrodites
|
females with masculinized external genitalia
|
|
clitoral enlargement
|
associated with androgen stimulation in-utero
|
|
labial fusion
|
MCC'd by congenital adrenal hyperplasia
|
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MC Congenital Adrenal Hyperplasia
|
21-hydroxylase (CYP21) deficiency
|
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What to give mother with history of CAH in previous child?
|
dexamethasone - transplacental suppression pituitary suppression
|
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hymen
|
remnant of the junction between the embryonic sinovaginal bulb and the urogenital sinus
|
|
Mayer-Rokitansky-Kuster-Hauser syndrome
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vaginal agenesis with absence of the uterus in 46, XX women (not inherited)
|
|
transverse vaginal septum
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occurs where the embryonic sinovaginal bulb and Mullerian ducts meet (Mullerian Tubereclee)
|
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VACTERL
|
vertebral anomalies
anal atresia CV anomalies TE fistula esophageal atresia renal anomalies preaxial limb abnormalities |
|
MCC of generalized pruritus in the absencee of skin lesions
|
cholestasis of pregnancy
|
|
intrahepatic cholestasis
|
process in which bile salts are incompletely cleared by the liver, accumulate in the body, deposited in the dermis
|
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PUPPP
|
Pruritic urticarial papules and plaques of pregnancy: intense pruritus and erythematous papules on the abdomen and extremities
|
|
Herpes gestationalis
|
intense itching and vesicles on abdomen and extremities
|
|
When does intrahepatic cholestasis usually occur?
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third trimester
|
|
What confirms intrahepatic cholestasis?
|
Increased levels of circulating bile acids; elevated LFTs are uncommon
|
|
Cholestasis of pregnancy, especially when accompanied by jaundice, is associated with an increased incidence of what? (3)
|
prematurity, fetal distress, fetal loss
|
|
First line treatment of intrahepatic cholestasis?
|
antihistamines and cornstarch baths
|
|
Second line treatment of intrahepatic cholestasis?
|
ursodeoxycholic acid
cholestyramine (assoc. with vit K deficiency) |
|
Labor
|
Cervical change accompanied by regular uterine contractions
|
|
Latent phase of Labor
|
initial part of labor - cervix mainly effaces rather than dilates (<4cm)
|
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Active phase - nullips and multips
|
cervical dilation occurs more rapidly (>4cm)
nullips: >1.2 cm/hr multips: >1.5 cm/hr |
|
Protraction of active phase
|
cervical dilation in active phase that is less than expected
|
|
Arrest of active phase
|
No progress of labor for 2 hours
|
|
How many Stages of Labor?
|
3
|
|
1st stage of Labor
|
1st stage: onset of labor to complete dilation of cervix
|
|
2nd stage of Labor
|
2nd stage: complete cervical dilation to delivery of infant
|
|
3rd stage of Labor
|
3rd stage: delivery of infant to delivery of placenta
|
|
How long is the normal latent phase of labor for a nullip?
|
<18-20 hours
|
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How long is the normal latent phase of labor for a multip?
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<14 hours
|
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How long is the normal second stage of labor? (nullip v. multip)
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nullip: <2hr/3hr if epidural
multip: <1hr/2hr if epidural |
|
How long is the normal third stage of labor?
|
<30 mins.
|
|
Clinically adequate uterine contractions
|
contractions every 2-3 mins, firm on palpation, lasting at least 40-60 secs or >200 Montevideo units
|
|
bloody show
|
loss of the cervical mucus plug - sign of impending labor
|
|
bloody show v. antepartum bleeding
|
bloody show has sticky mucus admixed with blood
|
|
What dictates normalcy in labor?
|
change in cervix per time; NOT the uterine contraction pattern
|
|
When to c-section in the absence of clear CPD?
|
arrest of active phase with adequate contractions
|
|
Magic number distinguishing latent labor and active labor?
|
4 cm
|
|
The 3 P's
|
Pelvis, Passenger, Powers
|
|
Causes of galactorrhea (5)
|
pituitary adenoma
pregnancy breast stimulation chest wall trauma hypothyroidism |
|
How are hypothyroidism and prolactin related?
|
TRH acts as a prolactin releasing hormone
|
|
How does increased prolactin levels lead to oligomenorrhea?
|
hyperprolactinemia inhibits hypothalamic GnRH pulsations, decreasing levels of LH and FSH, leading to oligomenorrhea
|
|
Primary action of prolactin?
|
stimulate breast epithelial cell proliferation and induce milk production
|
|
What is PPH?
|
loss of 500mL or more after a vaginal delivery; loss of 1000mL or more during cesarean
|
|
MCC of PPH
|
uterine atony - myometrium has not contracted to cut of the uterine apiral arteries supplying the placental bed
|
|
First line treatment for uterine atony?
|
uterine massage and dilute oxytocin
|
|
Methylergonovine maleate (Methergine)
|
ergot alkaloid agent that induces myometrial contraction to tx. uterine atony
*contraindicated in HTN |
|
Prostaglandin F 2-alpha
|
causes smooth muscle contraction
*contraindicated in asthmatic patients |
|
MCC of PPH in a well-contracted uterus
|
genital tract laceration
|
|
Three parts to health maintenance
|
1. cancer screening
2. immunizations 3. addressing common diseases for particular pt. group |
|
Recommendations for Pap smears
|
Annually, 3 yrs. after onset of sexual activity or after age 21
until age 30, 2-3 years if 3 consecutive neg. Pap smears until age 65-70 |
|
At what age should one start to get the influenza vaccine annually?
|
50
|
|
When does cholesterol screening begin?
|
every 5 years @ age 45
|
|
When does fasting blood sugar level screening begin?
|
every 3 years @ age 45
|
|
When does TSH screening begin?
|
every 5 yrs @ age 50
|
|
What screening begins at age 45? 50?
|
45: cholesterol every 5 years; fasting blood sugar every 3 years
50: TSH every 5 years |
|
MCC of mortality in a woman <20 years
|
MVA
|
|
MCC of mortality in a woman >39 years
|
CV disease
|
|
Major conditions in women >65 years
|
osteoporosis
heart disease breast cancer depression |
|
What cancer screening is done >50 years?
|
stool for occult blood
barium enema with flexsig q 5 OR colonoscopy q 10 annual mammogram |
|
When do bone mineral density studies begin?
|
65 years old
|
|
Four signs of placental separation:
|
1. gush of blood
2. lengthening of the cord 3. globular and firm shape of the uterus 4. uterus rising up to the anterior abdominal wall |
|
Uterine relaxation agents
|
terbutaline
mag |
|
Uterotonic agents
|
oxytocin
|
|
Climacteric
|
perimenopausal state
|
|
What are hot flashes?
|
typical vasomotor change due to decreased estrogen levels: skin temp. elevation and sweating lasting for 2-4 mins.
|
|
What is the effect of low estrogen concentration on the vagina?
|
decreases the epithelial thickness, leading to atrophy and dryness
|
|
When a woman still has her uterus, the addition of _____ to ______ ______ is important for preventing endometrial cancer.
|
progestin to estrogen replacement
|
|
FSH and LH levels are increased/decreased during perimenopause
|
increased
|
|
Treatment for hot flashes?
|
estrogen replacement therapy with progestin
|
|
menopause v. premature ovarian failure
|
menopause >40 y/o
premature ovarian failure <40 y/o |
|
Avg. age of menopause
|
50-51
|
|
Hormone levels at the beginning of menopause?
|
LH and FSH rise because oocytes are not responding and not producing estrogen
|
|
What is responsible for hot flashes, sweats, mood changes and depression in menopause?
|
Fall in estradiol
|
|
What test is diagnostic of menopause?
|
elevated FSH
|
|
During menopause, why do FSH levels rise even before estradiol levels fall?
|
ovarian inhibin levels are decreased
|
|
Why can FSH levels not be used to titrate the estrogen replacement dose?
|
FSH level responds to inhibin and not to estrogen -- FSH concentrations remains elevated with estrogen replacement
|
|
Advantages of HRT?
|
fewer fractures
lower incidence of colon cancer |
|
Disadvantages of HRT?
|
breast ca
heart disease pulmonary embolism stroke |
|
Both hypothyroidism and hyperprolactinemia may cause ____.
|
hypothalamic dysfunction which inhibits GnRH pulsations which inhibits pituitary FSH and LH release which leads to hypoestrogenic amenorrhea
|
|
MC location of an osteoporosis-associated fracture is ____.
|
thoracic spine manifested as a compression fracture
|
|
When/Why should progestin be added to estrogen replacement therapy?
|
When a woman has her uterus to prevent endometrial cancer.
|
|
What type of pelvis predisposes to persistent fetal occiput posterior position?
|
anthropoid pelvis
|
|
lower ab pain + vaginal spotting in a woman of childbearing potential
|
considered ectopic until otherwise proven
|
|
If normal intrauterine gestation, how much should the hCG level rise?
|
hCG levels should rise at least 66% every 48 hours
|
|
best tools for evaluating possible ectopic pregnancy
|
hCG levels and transvaginal US
|
|
What is hCG?
|
glycoprotein that is secreted by the chorionic villi of a pregnancy
|
|
Single progesterone level less than 5 ng/mL
|
nonviable gestation
|
|
Single progesterone level greater than 25 ng/mL
|
normal intrauterine gestation
|
|
hCG threshold
|
level of serum hCG such that an intrauterine pregnancy should be seen on US; for endovaginal sonography, this is 1500 - 2000 mIU/mL
|
|
patient with an early pregnancy who is hypotensive, tachycardic and has severe adnexal pain
|
surgery
|
|
placenta accreta
|
abnormal adherence of the placenta to the uterine wall due to an abnormality of the decidua basalis layer of the uterus
|
|
placenta increta
|
abnormally implanted placenta penetrates into the myometrium
|
|
placenta percreta
|
abnormally implanted placenta penetrates entirely through the myometrium to the serosa
|
|
placenta previa
|
implantation of the placenta over or near the internal os of the cervix
|
|
5 risk factors for placenta accreta
|
placenta previa
implantation of the lower uterine segment prior c-s scar or other uterine scar uterine curretage down syndrome |
|
Best choice treatment for placenta accreta
|
hysterectomy
|
|
blue tissue densely adherent between the uterus and bladder
|
placenta percreta
|
|
What is "transmigration of the placenta"?
|
low-lying placenta or placenta previa diagnosed in the 2nd trimester may resolve in the third trimester as the lower uterine segment grows more rapidly
|
|
gram-negative intracellular diplococci
|
highly suggestive of N. gonorrhea
|
|
Tx. of gonococcal cervicitis
|
125-250 mg ceftriaxone IM
(+ chlamydia Tx: azithromycin 1 g PO or doxycycline 100 mg 2X daily for 7-10 days) |
|
Tx. of chlamydia
|
azithromycin 1 g PO or doxycycline 100 mg 2X daily for 7-10 days
|
|
mucopurulent cervicitis
|
yellow exudative discharge arising from thee endocervix with 10+ PMNs per hpf
|
|
gonococcal and chlamydial organisms have a propensity for?
|
the columnar cells of the endocervix
|
|
MC organism implicated in mucopurulent cervical discharge
|
Chlamydia trachomatis
|
|
Gram stain of cervical discharge is negative
|
Chlamydia
|
|
MCC of septic arthritis in young women
|
gonorrhea
|
|
fishy odor
|
BV
|
|
sexually transmitted pharyngitis
|
gonococcal pharyngitis
|
|
Which is more likely to disseminate? Gonorrhea or chlamydia?
|
Gonorrhea
|
|
Which is more likely to cause conjunctivitis and blindness? Gonorrhea or chlamydia?
|
BOTH
|
|
hCG levels in completed abortions
|
halve every 48 to 72 hours
|
|
threatened abortion
|
<20 wga with vaginal bleeding and no cervical dilation
|
|
inevitable abortion
|
<20 wga with cramping, bleeding and cervical dilation; no passage of tissue
|
|
incomplete abortion
|
<20 wga with cramping, bleeding, open cervical os, some passage of tissue per vag but also some retained
|
|
completed abortion
|
<20 wga with all POCs having passed; closed cervix, no cramping
|
|
missed abortion
|
<20 wga with embryonic or fetal demise but no symptoms such as bleeding or cramping
|
|
inevitable abortion v. incompetent cervix
|
cramping leading to cervical dilation v. painless cervical dilation
|
|
uterine US with "snowstorm"
|
molar pregnancy
|
|
MCC of first trimester miscarriage
|
fetal karyotypic abnormality
|
|
What is usually the problem in shoulder dystocia?
|
impaction of the anterior shoulder behind the maternal symphysis pubis
|
|
Erb's Palsy
|
brachial plexus injury involving C5-6 nerve roots; weakness of the deltoid and infraspinatus muscles as well as flexor muscles of the forearm; arms hangs limply by the side and is internally rotated
|
|
Shoulder dystocia should be suspected with what 4 things?
|
1. fetal macrosomia
2. maternal obesity 3. prolonged 2nd stage of labor 4. gestational diabetes |
|
McRoberts maneuver
|
Shoulder dystocia: sharp flexion of the maternal hips decreases the inclination of the pelvis and frees the anterior shoulder
|
|
rationale of suprapubic pressure in shoulder dystocia
|
move the fetal shoulders from the AP to an oblique plane allowing the shoulders to slip out from under the pubic symphysis
|
|
Should fundal pressure be used with shoulder dystocia?
|
NO - increased associated neonatal injury
|
|
Si/Sx of pyelonephritis + recent hysterectomy - next step?
|
IVP (CT could also be diagnostic)
|
|
Cardinal ligament
|
attachments of the uterine cervix to the pelvic side walls through which the uterine arteries traverse
|
|
hydronephrosis
|
dilation of the renal collecting system - evidence of urinary obstruction
|
|
MC location for ureteral injury
|
cardinal ligament where the ureter is only 2-3 cm lateral to the internal cervical os; injured upon clamping of the uterine arteries
|
|
Where is the ureter in relation to the uterine artery?
|
"water under the bridge" ureter is just under the uterine artery
|
|
constant urinary leakage after pelvic surgery
|
vesicovaginal fistula
|
|
antepartum vaginal bleeding
|
vag bleeding occurring after 20 wga
|
|
placental abruption
|
premature separation of the placenta
|
|
What is usually associated with painful uterine conctractions or excess uterine tone?
|
placenta abruption
|
|
Hx. of postcoital spotting
|
previa
|
|
Vasa previa
|
umbilical cord vessels that insert into the membranes with the vessels overlying the internal cervical os and thus are vulnerable to fetal exsanguination upon ROM
|
|
Patient presents with antepartum hemorrhage - first thing Dr. should do?
|
R/O placenta previa by US (speculum or dig exam may induce bleeding)
|
|
Best plan for placenta previa at term (>35 wga)?
|
C-S
|
|
Why is multiple gestation a risk factor for placenta previa?
|
increased surface of area of placentation
|
|
Painful antepartum bleeding
|
placental abruption
|
|
Concealed abruption
|
bleeding occurs completely behind the placenta and no external bleeding is noted
|
|
Fetomaternal hemorrhage
|
fetal blood that enters into thee maternal circulation
|
|
couvelaire uterus
|
bleeding into the myometrium of the uterus giving a discolored appearance to the uterine surface
|
|
Risk Factors for Abruptio Placentae: drugs
|
cocaine
cigarettes |
|
Risk Factors for Abruptio Placentae: Diseases
|
HTN
|
|
Risk Factors for Abruptio Placentae: umbilical cord
|
short umbilical cord
|
|
Risk Factors for Abruptio Placentae: uterus
|
uteroplacental insufficiency
sudden uterine decompression submucosal leimyomata |
|
Risk Factors for Abruptio Placentae: membranes
|
PPROM
|
|
Risk Factors for Abruptio Placentae: other
|
trauma
|
|
Kleihauer-Betke test
|
tests for fetal erythrocytes in thee maternal blood using the different solubilities of maternal v. fetal Hgb
|
|
Usual management of placental abruption?
|
delivery - usually c-s; unless no active bleeding or fetal compromise, then just expectant management
|
|
MC presenting symptom of invasive cervical cancer
|
abnormal vaginal bleeding - may be postcoital
|
|
mean age of presentation of cervical cancer
|
51
|
|
best diagnostic test to evaluate a cervical mass
|
cervical biopsy (not Pap)
|
|
cervical intraepithelial neoplasia
|
preinvasive lesions of the cervix with abnormal cellular maturation, nuclear enlargement and atypia
|
|
Where do the majority of cervical dysplasia and cancers arise?
|
near the squamocolumnar junction of the cervix
|
|
punctations seen on colposcopy
|
mild vascular patter: vessels seen end-on
|
|
atypical vessels seen on colpo
|
corkscrew and hairpin vessels
|
|
early cervical cancer tx.?
|
surgery or radiation
|
|
advanced cervical cancer tx.?
|
chemo to sensitize tissue then radiotherapy consisting of brachytherapy (implants) with teletherapy (whole pelvis radiation)
|
|
Cervical cancer often spreads how?
|
Through the cardinal ligaments toward the pelvic sidewalls - can obstruct one or both ureters
|
|
MCC of death due to cervical cancer?
|
bilateral ureteral obstruction leading to uremia
|
|
Cervical Cancer: intraepithelial carcinoma
|
Stage 0
|
|
Cervical Cancer: strictly confined to the cervix
|
Stage I
|
|
Cervical Cancer: carcinoma extends beyond cervix but not into pelvic wall; involves upper 2/3s of vag
|
Stage II
|
|
Cervical Cancer: carcinoma has extended to pelvic wall; involves lower third of vag
|
Stage III
|
|
Cervical Cancer: spread to rectum/bladder
|
Stage IVA
|
|
Cervical Cancer: spread to distant organs
|
Stage IVB
|
|
Cervical Cancer: hydronephrosis or non-functioning kidney
|
Stage IIIB
|
|
What type of carcinoma accounts for 90% of all cervical cancers?
|
Squamous cell carcinoma (adenocarcinoma the rest)
|
|
amenorrhea
|
no menses for 6 mos.
|
|
Sheehan's syndrome
|
anterior pituitary hemorrhagic necrosis
|
|
Cause of Sheehan's syndrome
|
hypertrophy of prolactin secreting cells in conjunction with a hypotensive episode, usually in the setting of postpartum hemorrhage
|
|
Intrauterine adhesions (Asherman's syndrome)
|
scar tissue that forms in the endometrium, leading to amenorrhea due to unresponsiveness of the endometrial tissue
|
|
postpartum hemorrhage
|
vag delivery: >500 mL
c-s delivery: >1000 mL |
|
MCC of amenorrhea in the reproductive years
|
pregnancy
|
|
PCOS is characterized by:
|
estrogen excess without progesterone
obesity hirsutism glucose intolerance |
|
elevated FSH level is indicative of?
|
ovarian failure
|
|
amenorrhea after vag delivery: 2 most likely causes?
|
Sheehan's syndrome or intrauterine adhesions (Asherman's)
|
|
MCC of ovulatory dysfunction in a reproductive-age woman
|
PCOS
|
|
MoA of Sheehan's syndrome
|
bleeding in the anterior pituitary induces pressure necrosis
|
|
First step in evaluation of fetal bradycardia in the face of ROM
|
r/o umbilical cord prolapse
|
|
Tx. of cord prolapse
|
emergent c-s
|
|
umbilical cord accidents are more likely with what two things?
|
unengaged presenting part (usually the head)
transverse fetal lie |
|
Fetal bradycardia
|
baseline <110 bpm for >10 mins.
|
|
Initial steps after encountering fetal bradycardia:
|
Improve maternal oxygenation and delivery of cardiac output to the uterus:
|
|
How does one improve maternal oxygenation and delivery of cardiac output to the uterus after encountering fetal bradycardia?
|
1. placement of pt. on side to move the uterus from the great vessels, improving blood return to heart
2. IV bolus pt. 3. administer 100% oxygen by face mask 4. stop oxytocin |
|
MC finding in a uterine rupture
|
FHR abnormality such as fetal brady, deep variable decels or late decels
|
|
What position is associated with the highest risk of cord prolapse?
|
transverse lie
|
|
What is the first step in assessment of fetal brady?
|
differentiate FHR from maternal pulse
|
|
Tubo-ovarian abscess
|
collection of purulent material within and around the distal tube and ovary
|
|
Classic clinical triad of PID
|
lower abdominal tenderness, cervical motion tenderness and adnexal tenderness
|
|
What is the "gold standard" in diagnosis of acute salpingitis?
|
laparoscopy with visualization of purulent drainage from the fallopian tube
|
|
Fitz-Hugh-Curtis syndrome
|
salpingitis with perihepatic adhesions manifesting as RUQ pain
|
|
Tx. of acute salpingitis
|
IM ceftriaxone
oral doxycycline |
|
Tx of acute salpingits if non-adherent
|
IV cefotetan and doxycycline
|
|
Organisms responsible for salpingitis
|
polymicrobial: gonorrhea, chlamydia, anaerobes and gram negative rods
|
|
long term sequelae of acute salpingitis
|
chronic pelvic pain, ectopic pregnancy and involuntary infertility
|
|
MC reason for hysterectomy in the US
|
symptomatic uterine fibroids
|
|
MC symptom of uterine leiomyomata
|
menorrhagia
|
|
leiomyomata
|
smooth muscle, benign tumors of the uterus
|
|
leiomyosarcoma
|
malignant, smooth muscle tumor, with numerous mitoses
|
|
carneous degeneration
|
changese of the leiomyomata due to rapid growth; center of the fibroid becomes red, causing pain
|
|
irregular, midline, firm, nontender mass that moves contiguously with the cervix
|
uterine leiomyomata
|
|
PE of uterine leiomyomata is:
|
3 M's:
1. mobile 2. midline 3. moves contiguously with cervix |
|
Preeclampsia
|
HTN with proteinuria (>300mg in 24 hours) at >20 wga
|
|
What causes preeclampsia?
|
vasospasm and "leaky vessels"
|
|
severe pre-E
|
BP >160/110
24 urine protein >5g |
|
greatest risk for occurrence of eclampsia is when?
|
just prior to delivery, during labor and within 24 hr. postpartum
|
|
MCC of maternal death due to eclampsia is?
|
intracerebral hemorrhage
|
|
first sign of mag toxicity
|
loss of DTR's
|
|
core needle biopsy
|
use of a 14-16 gauge needle to extract tissue from a breast mass; preserves cellular architecture
|
|
fine need aspiration
|
use of a small gauge needle with associated vacuum via a syringe to aspirate fluid or some cells from a breast mass and/or cyst
|
|
fibroadenoma
|
benign, smooth muscle tumor of thee breast, usually occurring in young women
|
|
How do fibroadenomas feel on on palpation?
|
firm, rubbery, mobile and solid in consistency
|
|
MCC of bloody (serosanguinous) nipple discharge unilaterally in the absence of breast mass
|
intraductal papilloma
|
|
"lumpy-bumpy" breast exam
|
suggestive of fibrocystic changes
|
|
Nipple retraction or skin dimpling over a mass
|
breast cancer
|
|
young woman with a dominant nontender mass
|
fibroadenoma
|
|
Any 3-dimensional breast mass generally necessitates what to confirm the diagnosis?
|
tissue - FNA or core needle biopsy
|
|
Five basic etiologies of infertility
|
1. ovulatory
2. tubal 3. uterine 4. peritoneal factor (endometriosis) 5. male factor |
|
3 D's of enDometriosis
|
Dysmenorrhea
Dyspareunia Dyschezia |
|
Normal BBT
|
rise of 0.5 degrees F after ovulation due to release of progesterone (thermogenic) by the ovary
|
|
How long after the LH surge does ovulation usually occur?
|
approx 36 hours. (1.5 days)
|
|
Gold standard for diagnosis of endometriosis
|
laparoscopy
|
|
Clomiphene citrate
|
treatment for anovulation, particularly in PCOS
|
|
Gold standard for diagnosing tubal disease
|
laparoscopy
|
|
Common presenting symptoms of appendicitis
|
nausea
emesis fever anorexia |
|
Location of abdominal pain in a pregnant women with appendicitis
|
superior and lateral to McBurney's point -- mimicking pyelonephritis
|
|
Acute onset of colicky abdominal pain is typical of?
|
ovarian torsion
|
|
methotrexate
|
folic acid antagonist
|
|
How is methotrexate dosed?
|
one time, low dose IM injection
|
|
When is methotrexate used?
|
ectopic pregnancies <4cm in diameter
|
|
Side effects of methotrexate?
|
abdominal pain 3-7 days following therapy
|
|
plateau in hCG over 48 hr means?
|
nonviable pregnancy - no clue as to the location
|
|
What progesterone level reflects normal IUP?
|
>25 ng/mL
|
|
classic triad of ectopic pregnancy:
|
amenorrhea
vaginal spotting abdominal pain |
|
anemia in pregnant women
|
<10.5 g/dL
|
|
preterm labor
|
cervical change assoc. with uterine contractions prior to 37 competed weeks and after 20 weeks' gestation
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preterm labor in a nullip
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uterine contractions and a single cervical exam revealing 2cm dilation and >80% effacement
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MC tocolytic agents (4)
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magesium sulfate
terbutaline ritodrine indomethacin |
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antenatal steroids
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betamethasone
dexamethasone |
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When does one administer steroids?
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<34 weeks gestation with preterm labor
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Speculated MoA of mag as a tocolytic agent
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competitive inhibition of Ca to decrease its availability for actin-myosin interaction thus decreasing myometrial activity
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weekly injections of what may help prevent preterm birth in women at high risk
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17 alpha hydroxyprogesterone caproate
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T/F: uterine fibroids can be assoc with preterm delivery
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T
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side effects of terbutaline?
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beta agonist: increased pulse pressure; hyperglycemia; hypokalemia, tachy
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dyspnea occurring in a woman with preterm labor and tocolysis usually is due to?
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pulmonary edema (from tocolytics, usually beta agonists like terb)
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MCC of neonatal morbidity in a preterm infant
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respiratory distress syndrome
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negative FFN
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no delivery within 1 week
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cystitis
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bacterial infx. of the bladder
having >100,000 CFU of a singlee pathogenic organism on a mid-stream voided specimen |
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Urethritis
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infection of the urethra commonly caused by C. trachomatis
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urethral syndrome
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urgency and dysuria caused by urethral inflammation of unknown etiology
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Sy's of UTI but negative urine cultures
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urethritis caused by chlamydia or gonococcus
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Emergency contraception is most effective if given within how many hours of coitus?
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72 hrs
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major SE of emergency contraception
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nausea and/or emesis
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Mechanisms whereby combination oral contraceptives may act
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ovulation inhibition
decreased tubal motility interference with implantation |
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ARDS
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acute respiratory distress syndrome: alveolar and endothelial injury leading to leaky capillaries, clinically causing hypoxemia, large alveolar-arterial gradient and loss of lung volume
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MCC of septic shock in pregnancy
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pyelonephritis
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ARDS assoc. with pyelonephritis is caused by what?
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endotoxin release from gram-neg. bacteria
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Why is heparin preferable to warfarin (Coumadin)?
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Coumadin may cause congenital abnormalities and is more difficult to reverse.
*heparin does not x the placenta |
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What is the reason for the hypercoagulable state in pregnancy?
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venous stasis due to the uterus compressing the vena cava
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accurate method for diagnosing DVTs
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NOT PE - venous duplex doppler sonography
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MC cancer in women
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breast cancer
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most important risk factor of breast cancer
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age
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MC ovarian tumors in women <30 years
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benign cystic teratomas (dermoid cysts)
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The presence of ascites is consistent with what?
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ovarian cancer
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ToC for ovarian neoplasms is:
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exploratory laparotomy with ovarian cystectomy
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Struma ovarii
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Benign cystic teratoma containing thyroid tissue - may cause hyperthyroidism
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epithelial ovarian tumor
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neoplasm arising from outer layer of ovary: MC type of ovarian malignancy, usually in older women
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Ovarian Tumors: Epithelial Ovarian Tumors
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Serous
Mucinous Endometrioid Brenner Clear Cell |
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Ovarian Tumors: Germ Cell Tumors
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"DEEP CT"
Dysgerminoma Endodermal sinus Embryonal carcinoma Polyembryoma Choriocarcinoma Teratoma |
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Ovarian Tumors: Sex Cord Tumors
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Granulosa Cell Tumor
Sertoli-Leydig cell tumors |
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How do the sex cord tumors usually appear on US?
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solid
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Granulosa-theca cell tumors produce what? Sertoli-Leydig cell tumors?
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Granulosa-theca cell tumors produce estrogen while Sertoli-Leydig tumors produce androgens
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What ovarian tumor is characterized by its large size?
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mucinous
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MC ovarian tumor in a woman >30 y/o
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epithelial, most commonly cystadenoma
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wound dehiscence
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separation of part of the surgical incision but with an intact peritoneum
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fascial disruption
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separation of the fascial layer, usually leading to a communication of the peritoneal cavity with the skin
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evisceration
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disruption of all layers of the incision with omentum or bowel protruding through the incision
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MC reason for fascial disruption
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suture tearing through the fascia
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What can be used to distinguish between urine and lymphatic fluid?
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creatinine - significantly more elevated in urine
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MC time period in which fascial disruption or evisceration occurs
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5-14 days post-op
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In 9/10 cases, a pregnant woman with hemoperitoneum has ____?
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an ectopic pregnancy
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hemoperitoneum
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collection of blood in the peritoneal cavity
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Pts. with hemorrhagic corpus lutea usually present with?
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sudden onset of severe lower abdominal pain
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A ruptured corpus luteum can mimic?
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an ectopic pregnancy
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NONclotted blood obtained from culdocentesis is consistent with?
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intra-abdominal hemorrhage
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Clotted blood from culdocentesis is consistent with
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a leak from a blood vessel, NOT intraperitoneal blood (this would be nonclotting due to consumption of clotting factors within the peritoneal cavity
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When the corpus luteum is excised in a pregnancy of <8 wga, ______.
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exogenous progesterone should be supplemented.
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MC method for diagnosing IUA
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hysterosalpingogram
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hysterosalpingogram
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radiologic study in which radiopaque dye is injected into the endometrial cavity via a transcervical catheter; used to evaluate the endometrial cavity and/or patency of the fallopian tubes
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"Gold standard" for diagnosing IUA
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hysteroscopy
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Ideal treatment for IUA
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operative hysteroscopy/hysteroscopic resection
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Mammographic findings suggestive of cancer
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small cluster or calcifications around a mass or a mass with irregular borders
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2 accepted methods for assessing suspicious, mammographic, nonpalpable masses
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stereotactic core biopsy and needle-localization excisional biopsy
|
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androgen insensitivity
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androgen receptor defect in which 46,XY individuals are phenotypically female with normal breast development
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Mullerian agenesis
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congenital absence of development of the uterus, cervix and fallopian tubes in a 46,XX female; primary amenorrhea
|
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primary amenorrhea + congenital renal abnormality + developed breasts
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mullerian agenesis
|
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primary amenorrhea + scant/absent pubic hair + developed breasts
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androgen receptor defect
|
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Why do individuals with androgen insensitivity have breast development?
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peripheral conversion of androgens to estrogen and they lack the receptors to inhibit breast development
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MCC of delayed puberty and absent breast tissue after 14 y/o
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gonadal dysgenesis
|
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Treatment of septic abortion:
|
1. maintain BP
2. monitor BP, oxygenation and UO 3. broad-spectrum Abx 4. uterine evacuation |
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PPH + HTN: do NOT give
|
methergine, ergot alkaloids
|
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PPH + asthma: do NOT give
|
prostaglandin F2-alpha
|
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Ligation of what artery is a method for helping PPH?
|
ascending branch of the uterine arteries to decrease the pulse pressure to the uterus
|
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MCC of late postpartum hemorrhage
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subinvolution of the uterus
|
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lack of breast development means what?
|
lack of estrogen
|
|
delayed puberty
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lack of secondary sexual characteristics by age 14
|
|
delayed puberty can be subdivided based on two factors:
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gonadotropic state: FSH
gonadal statee: ovarian production of estrogen |
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hypergonadotropic hypogonadism means what?
|
high FSH
low estrogen due to gonadal deficiency (Turners) |
|
hypogonadotropic hypogonadism means what?
|
low FSH
low estrogen central defect |
|
MC time for occurrence of postpartum mastitis
|
3-4 weeks after delivery
|
|
hallmark of thyroid storm
|
autonomic instability
|
|
Tx. of thyroid storm
|
beta blocking agent
corticosteroids (prevents peripheral conversion) additional PTU |