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on US what measurements most accurate for est GA ~6-10 or 12 wks use crown rump, 12-18 use biparietal
general guidelines for accuracy of US <20wk US considered pretty accurate, 1st tri can be off by 1wk, 2nd tri off by 2wk, 3rd tri off by 3wks
criteria for poor dates mostly if don't have U/S <20wks
determination of pregnancy--cut off hCG 25mU/ml
when gestational sac visible 5wks
how AFI measured deepest vertical pockets of amniotic fluid in 4 quadrants
how polyhydramnios defined? Oligo? AFI>25 it's poly, if <5 it's oligo
where is top of fundus if 16wk? 20wk? 1/2 pubis to umbilicus for 16wk, at umbilicus for 20wk
describe measures indicating symm IUGR abd circ, head circ, biparietal dia, femur length all decrsd
causes of symmetric IUGR usu insult in 1st trimester, due to fetal problems, ie aneuploidy or early infxn
US measures indicating asymm IUGR abd circ decrsd, rest of measures are nml
causes of asymmetric IUGR insult occurs >20wks, placental problems incl HTN and poor nutrition
types of abortions (5) threatened, missed, inevitable, incomplete, complete
describe threatened and missed abortions threatened=bleeding only; missed=nonviable preg, no bleeding or dilation
tx for missed abortion D
describe inevitable abortion heavy bleeding, dilation, NO passing of POC
woman comes in with heavy bleeding, passing of some pcs--what dx? What tx? incomplete abortion if still cramping and bleeding, need emergent D
tx for inevitable abortion emergent D
describe completed abortion heavy bleeding, all POC have been passed and now cramping and bleeding minimal
tx for completed abortion none
reasons why fundal size may be too small 1) fetal (IUGR, fetal demise), 2) amniotic fluid (oligohydramios)
reasons for 2nd trimester loss usu maternal, 1) uterine duplication, septum or submucous leiomyoma, 2) incompetent cervix
causes for fetal demise (5) idiopathic (MC), placental, umbilical cord, fetal death, antiphospholipid
placental causes for fetal demise abruptio placenta, infxn not allowing O2 xchg, macrosomia in DM outgrowing placenta
how dx antiphospholipid syndrome need 1 of history: venous thrombosis, PE, stroke, reptd preg losses, fetal demise, and 1 of labs: cardiolipin Abs, lupus anticoag, incrsd PTT
what labs indicate anti phospholipid syndrome cardiolipin Abs, lupus anticoag, incrsd PTT
if fetal demise in late 2nd tri--what do need to induce labor (earlier can do D&C in 1st tri, D&E in 2nd tri)
describe hydatiform mole 1) Complete (MC): 2 sperms fertilize an egg w/o a nucleus=46XX all from dad. Grape like vesicles w/o a fetus. 20% progress to malignancy; 2) Incomplete mole: 2 sperms fertilize nml egg->69XXY. No vesicles, fetus present, only 5% progress to malignancy
which hydatiform mole is more concerning for cancer complete (46XX all from dad)
clinical findings suggestive of hydatiform mole bleeding <16wks (MC), pre eclampsia <20wks, severe hyperemesis, new onset hyperthyroid, very high bHCG
if uterus larger than dates and bHCG very high, think… hydatiform mole
US showing snowstorm pattern, unrecognizable detail of gestational sac…think hydatiform mole
what w/u needed for hydatiform mole bHCG for f/u, CXR to check for mets, D&C, need to make sure on contraception and follow bHCG ea mo for 1 yr if benign or good px malignant, 5 yrs if poor px malignant
when use chemo in hydatiform mole? Which agent? malignant dz or recurrent dz, use MTX or actinomycin
sites of ectopic preg MC is oviduct (95%), then uterine cornu, then abd
risk factors for ectopic preg salpingitis (MC), previous ectopic preg, tubal ligation/sx, IUD
clinical findings suggestive of ectopic preg amenorrhea, vaginal bleeding, abd pain incl cervical motion tenderness or adnexal tenderness
cut offs for bHCG and US=ectopic preg if bHCG>1500 and no gestational sac visualized
tx for ectopic preg if unruptured and bHCG<500 give IM MTX, otherwise need surgical
what are good px factors for gestationl tropho tumor low bCHG (<40000) and mets to lung or pelvis (not brain or liver)
what are screening tools for Downs 1st tri=PAPP, nuchal translucency, and mAFP, 2nd tri=triple screen/quad screen
causes of high MSAFP neural tube, ventral wall, renal…twins and placental bleeding gives false high
what quad screen would suggest Downs hi bHCG and inhibin, low MSAFP, estriol
what PAPP value suggests Downs low along w high bHCG
what constitutes a negative CST no late deccels w 3 cxns in 10min
what 5 parameters are measured in a BPP NST reactivity, gross mvmts, extremity tone (flexion/extension), breathing, AFI
if 4-6 on a BPP what should you do deliver if 36wks or grtr, rept in 24hr if <36wks
what constitutes a reactive NST accels (2 in 20min)
when should accels become apparent 30wks
when is GBS test done 36wks
when should see gestational sac 5wks
when check for gDM if not at incrsd risk 24-28
how is GDM checked 50g glucose, check blood glucose in 1hr and 140 is cut off…need to f/u w 3hr unless have single fasting reading 110 or grtr or was 200 on glucola
amt of glu given and cut offs for 3hr GTT 100g given, cut offs: 95/180/155/140 [only need 2 abnml]
management of mild PreE "Mg during labor and 24 hr postpartum, keep DBP 90-100, give steroids <34wk, antenatal BPP/AFI and grwth q 3wks (need to check bc IUGR counts as sPreE), c linic q1 wk; once 37wk deliver"
management of sPreE in patient, at 23-32wks can do expectant management as long as no end organ damage, >32 wks deliver
management of HELLP stabilize pt and deliver--can't manage
management of preterm labor tocolytics (Mg, terbutaline), steroids if 24-34 (24-28wks decrs risk IVH, 28-34 decrs RDS and help lung maturation)
cut offs for UTI 100K CFU if midstream, 10K if cath
ways to manage non reassuring FHT stop oxytocin if applicable, bolus mom 500ml so not hypotensive, change maternal position, give mom O2
incidence of twin w spontaneous ovulation and fertility tx 1:90 spontaneous, 1:10 if clomiphene, 1:3 if gonadotropins
causes of 3rd tri bleeding (PainLESS and PainFUL) PainLESS: placenta previa, vasa previa; PainFUL: abruptio placenta, uterine rupture
what's MC OB cause of DIC abruptio placenta
ROM leading to VB and fetal brady cardia, diagnosis is? vasa previa
what features make preE severe? if BP 160/110, 5g protein in 24hr, Cr 1.2, plt <100K, hemolysis (ie incrsd LDH), incrsd ALT/AST or sympt of epigastric pain, persistent HA, visual disturbances
which preE/gHTN pts are most likely to develop HTN later? gHTN (NOT preE)
medical problems put at risk for preE? Demographics? DM, cHTN, renal dz, SLE (vascular or connective tissue dz); demographics: nullip, age<20 or >34
contraindications for expectant management or preE contraindications for expectant management (ie need to deliver baby) incl plts <100,000, inability to control BP (DBP 90-100) on 2 anti-HTN, non reassuring fetal signs, LFTS>2x nml, eclampsia, CNS sympt, and oliguria
name criteria for DM B, C, D B: onset <20 duration <10; C: 10-19, duration 10-19; D: <10, >20, vascular cxns
what are the White cxns letters for end organ damage F=nephropathy, R=proliferative retinopathy, T=renal transplant, H=heart disease (Athero)
what are the MC congenital defects seen w DM cardiac
what electrolyte disturbances can see in neonate of DM mother hypoCa+ bc of immature parathyroid (+ hypogly)
what are goals for glu while in preg fasting <90, 1hr <140, 2hr <120
what are doses of insulin for DM in preg by trimester 0.8U/kg for 1st tri, 1.0 for 2nd, 1.2 for 3rd
how are insulin doses distributed 2/3 in am and 1/3 in eve, in am give 2/3 NPH and 1/3 regular, in eve 1/2 and 1/2
besides control of glu with Rx, what other Rx do DM need 4mg/d of folate bc incrsd risk of neural tube
what are indications to do c/s in DM if baby EFW >4-4.5kg
in which DM pts do antenatal testing if insulin dependent, macrosomia, or h/o still birth start testing at 32wk w NST and AFI 2x/wk
how tx pyelo in patient, IV Abx until afebrile and CVA tenderness resolves, then out pt oral Abx 7d (I thgt 14days? And UTD says 14d) and redo Ucx to ensure eradication"
what are lab findings for acute cholestasis of preg incrsd bile acids, +/- ALT/AST and pruritis
tx for acute cholestasis of preg ursodeoxycholic acid (helps bile flow) w cholestyramine (prevents bile reabsorption) and anti His
tx of Graves during preg use methimazole or PTU to make mom euthyroid--maternal IgG cross placenta
what syndrome can appear like acute cholestasis of preg PUPP=pruritic uriticarial papules and plaques of preg--but these appear perimbulical and don't affect preg
management of the preg if cholestasis is present if severe deliver 36wks if fetal lung matures, if not severe deliver by 38
tx PUPP steroids and anti His
what are three parts of a CVE? (xx/xx/xx) dilation/effacement/station
what's ""presentation""? which part of baby is presenting over os, ie cephalic
what's ""attitude""? if chin of baby is flexed (MC) or extended
what's ""position""? portion of baby ag pelvis, MC occiput anterior
how calculate MVU? What's adequate? hgt of ctx over 10min, >200= adequate
define tachysystole >5 ctx in 10min
FHR bradycardia <110
what’s moderate variability for FHT? Marked? moderate=6-25, marked>25
how till decel v change in baseline change in baseline if it stays for >10min
what parameters define sinusoidal tracing sinusoidal pattern w freq 3-5min and lasts >20min
what parameters defines early decel 30sec to nadir, symmetric, matches ctx
"recurrent" decel v "intermittent" decals recurrent if >50% in 20min, otherwise intermittent
parameters define variable decel <30sec to nadir, change in 15bpm and lasts at least 15sec but less than 2 min
what causes variable decels? Early decels? Late decals? variable=cord compression, early=head compression, late=uteroplacental insuffic
what makes cat I tracing FHR 110-160, moderate variability, no late or variable decels, may have early decels
cat III tracing absent variability AND ANY of : recurrent late or variable decels, bradycardia
what does cat III tracing indicate in baby abnml acid base status
what are indication for c/s nonreassuring FHT, prev c/s or myomectomy, arrest of labor, placental abnmlties, abnml presentation +/- mltpl gestations"
what are the 5 cardinal mvmts of labor EDFIERE=engagement, descent, flexion, internal rotation, external rotation, expulsion
3 stages of labor 1 latent phase=(Effacement), ends with accel of cervical dilation ~4-5; 1 active phase=when cardinal mvmts of labor begin, ends w complete dilation; Stage 2=descent (ends w delivery of baby); Stage 3=expulsion, delivery of placenta
times for ea stage of labor 1 latent=14 for multipara, 20 for primi; 1 active=1.2cm/hr for multi, 1.5 for prim; 2=2 hr primi, 1 hr for multi +1hr if epidural; 3=30min
tx of prolonged latent phase ambulation or sedation, avoid oxytocin or c/s
tx of prolonged active oxytocin if ctx inadequate
w/o IUPC how can tell if ctx are inadequate if last less than 45 sec and <3 in 10min
how define prolonged 2nd stage (from complete dilation to delivery of baby=descent), >2hrs of active pushing if primi or 1 hr multip (+1 epidural)
criteria for PTL 20-37wks GA, ctxs (3 lasting 30 sec in 20min), resulting in cervical change (dilation or effacement) **have to have all of these, can't just be having ctxs"
when deliver someone w PROM deliver right away: lungs mature (ie lecithin: sphingo >2 or + phosphatidylglycerol), chorio (ie maternal F unexplained), non reassuring FHT/BPP
definition of PROM ROM before onset of labor (regular contraction resulting in cervical change)
if PROM and >36 wks "deliver, may need to ripen cervix before IOL"
if PROM and <36wks how manage goal prolong preg: bed rest w DVT prophylaxis, steroid for lung maturity if <32 wks, Abx after swab for GBS (they give even if GBS -); monitor w NST/BPP and deliver immed if non reassuring"
tocolytic agents and who you CAN't use them in "Mg (don't use in myasthenia gravis), b adrenergic (terbutaline, ritodrine, don't use in DM bc incrs glu), indomethacin (don't use >32wks bc close PDA), CCB (nifedipine)"
describe dysmaturiy syndrome "placental aging (postdates) leads to placental insuffic, babies come out looking very old w wrinkled skin, meconium stained, peeling skin"
"if mom rubella susceptible, what do" "after delivery give live attenuated vaccine, ok for BF but make sure no preg for 1 mo"
"describe postpartum bladder issues, tx" "may have postvoid residual (>250mls) from hypotonic bladder, give cholinergic ie bethanechol"
"differentiate bw postpartum blues, PP depression, " "PP blues=<2wks, tearfulness, mood swings, feeling of inadequacy for taking care of self and infant--no tx; PP depression=<6wks feelings of despair, hopelessness, anxiety, neglect of self and baby--psychotherapy and Rx"
MC cause of PP hemorrhage uterine atony
"tx uterine atony, when can't use certain agents" "uterine massage, oxytocin, methylergonovine (methergine), PGF2/carboprost **can't use methergine in HTN or PreE, can't use carboprost in asthmatics"
what's the cut-off amt of blood for PP hemorrhage 500ml if SVD, 1000 if c/s
pneumonic for fever after c/s "wind, water, womb, wound, walk"
etiology of fever after c/s depending on time "POD 0=wind (atelectasis), 1-2=water UTI, 2-3=womb endometriosis, 4-5=wound, 5-6 walk incl septic pelvic thrombophlebitis"
2 MC cause of painful genital ulcers HSV (MC) and chancroid (H Ducreyi)
describe the ulcer for herpes starts as clear vesicle that ruptures leaving shallow, painful ulcer w raised edges"
how differentiate chancroid ulcers and herpes ulcers chancroid have ragged edges whereas herpes has raised smooth edges
tx for chancroid azithro or ceftriax (same as for gonorrhea)
MC painless genital ulcers "syphillis, lymphogranuloma venereum (from C trachomatis L type--rare in US), granuloma inguinale (donovanosis-rare in US)"
describe lymphogranuloma venereum (from C trachomatis L type) painless vulvar ulcer that heals, then painful inguinal LAD, these LN rupture become draining abscesses or fistulas (""groove sign""=depression bw groops of inguinal LAD)"
treatment of lymophogranuloma venereum "doxy 21d or erythro 3-6wks, drain fluctulant LN so don't burst"
beefy red painless vulvar ulcer--think what? granuloma inguinale (donovanosis)
tx for granuloma inguinale (donovanosis) doxycycline or bactrim 21 d
tx for condyloma acuminatum "podophyllin, TCA, imiquimod (no systemic tx available)"
"tx for chlamydia, gonorrhea" chlamydia: azithro 1 dose PO or doxy 7d; gonorrhea: ceftriaxone IM 1x or azithro 1 dose + NEED TX chlamydia
what plating media do you use for gonorrhea Thayer Martin
tx of PID if outpatient 14 d of ceftriax or cefoxitin and add metronidazole if suspect anaerobes
3 causes of vaginal discharge and how to differentiate "back vaginosis, candida, trichomonas vaginitis"
describe bac vaginosis lab findings "vaginal discharge pH>4.5, fishy amine odor/KOH whiff test, clue cells"
describe trichomonas vaginitis lab findings "profuse yellow-green discharge, pH>4.5, flagellated organisms"
tx trichomonas vaginitis metronidazole (same as bac vaginosis but need to treat sex partner)
types of abnml placenta attachment "previa=att is near or covering os, accreta=attach to myometrium, increta=goes through myometrium, percreta=to uterine serosa"
name degrees of uterine prolapse "1st degree if in vagina, 2nd degree if at introitus, 3rd degree if both vagina and cervix out of introitus"
name types of vaginal prolapse "cystocele (bladder, so anterior), rectocele (rectum, posterior), enterocele (small bowel upper posterior)"
tx for stress incontinence "kegel exercises, urethroplexy (move urethra up back into pelvic cavity)"
tx for urge incontinence "anitchol (oxybutinin, ie ditropan), propantheline (""Pro-Bantheline""), B adrenergic (Ursipas)"
contrast sympt for difft types of incontinence "stress: small amts urine lost w cough or sneeze, not at night, cystometry is nml; urge: detrusor ctx involuntarily w larger amts of urine, incl at night but also can occur when cough/sneeze, cystometry shows hypertonic bladder; hypotonic: constantly lose
tx of hypotonic cholinergic (bethanecol), a adrenergic blocker (phenoxybenzamine)"
3 common sympt of endometriosis dysmenorrhea, dyspareunia, constipation"
tx of endometriosis progestin, OCPs"
"describe adneomyosis, sympt, treatment" "endometrial glands and stroma in myometrial wall (ie type of endometriosis) w cyclic bleeding (dysmenorrhea or menorrhagia), tx=hysterectomy"
physical exam for fibromas v adenomyosis "fibromas=enlarged, firm, nontender and asymmet uterus; adenomyosis=tender, symmetric enlarged uterus"
risks for endometrial hyperplasia and cancer unopposed estrogen (nulliparity, late menopause), DM, HTN, obesity"
types of endometrial hyperplasia "simple, cystic & complex w/o atypia rarely progress to cancer; complex w atypia 1/3 progress to cancer"
tx endometrial hyperplasia "if w/o atypia cyclic progestins may reverse it, would need f/u bx 3-6mos; if done w childbearing do hysterectomy"
2 key abnml bleeding "endometriosis the bleeding isn't bw cycles, just dysmenorrhea (MC location ovaries); if bleeding bw cycles its anovulatory or endometrial hyperplasia/cancer"
how dx anovulatory bleeding if don't have reg cycles then give progestin and see if wdrawal bleeding…if get wdrawal bleeding its anovulatory and tx w cyclic progestin
if ovulatory and still bleeding bw cycles usu structural ie polyps
MC causes of dysmenorrhea "endometriosis (incl adenomyosis), fibroids"
menorrhagia in ovulatory usu due to fibroids
staging for endometrial cancer "I limited to uterus (a if <1/2, b if >1/2 myometrium), II cervix, III a=ovary or tube, b=vagina, c=pelvic nodes; IV a=bladder, bowel, b=distant incl inguinal nodes (v pelvic or paraaortic)"
tx for difft stages of endometrial cancer "I=TAH BSO don't need anything post op, I if high grade and II=pelvic radiation, III=radiation +/- chemo, IV=chemo"
what give for hyperprolactin bromocriptine
"how tell ovarian reserve, when test" "test women >35 if fertility issues, measure FSH on day 3 of cycle (if >12 then impending ovarian failure)"
name 2 main types of fxnl benign ovarian masses follicular/corpus luteum cysts; theca lutein cysts
compare follicular/corpus luteum cyst and theca lutein cyst "follicular/corpus lutein cysts=unilateral and resolve ~2cycles, theca lutein cyst=bilateral due to high bHCG or overstimulation, ie see in preg [note an early IUP will always present w corpus luteum cyst]"
what's a choc ovarian cyst endometrioma (non fxnl ovarian cyst)
types of nonfxnl ovarian masses endometriomas and PCOS
benign ovarian neoplasms "serous and mucinous cystadenomas, cystic teratoma"
how differentiate serous and mucinous ovarian cystadenomas "serous=unilocular, mucinous=multilocular, if rupture can lead to pseudomyxoma peritonei"
MC benign ovarian neoplasm <30yo "cystic teratoma, any combo of germ layers, often on long pedicle"
risks for ovarian cancer "BRCA gene, fam hx, grtr
staging ovarian cancer "I a=1 ovary, b=2 ovaries, c=limited to ovary but malignant ascites; II a=tubes/uterus, b=other pelvic, c=also malignant ascites; III=beyond pelvis, a=microscopic, b=<2cm implants, c=>2cm; IV=distant mets or pl effusion"
w/u if ASCUS "rep pap q4-6mos until 2x nml, if 2nd abnml then colpo"
differentiate bw cystic (aka fibrocystic dz) and fibroadenoma "fibrocystic=MC in young, painful, often cyclic w menses, confirm w U/S; fibroadenoma=solid, painless, smooth rubbery"
tx for fibrocystic breast "reduce caffeine, vit E, OCPs, bromocriptine, tamoxifen"
"bloody discharge from a benign tumor, think…" "intraductal papilloma, will have unilateral discharge w/o palpable mass"
"non tender, rapidly enlarging firm, smooth mass" "cystosarcoma phylloides, benign, need excision w wide margin to avoid recurrence"
4 types of malignant breast tumors "infiltrating ductal (MC 80%), infiltrating lobular (more often bilateral and better px), inflammatory, Pagets"
describe inflammatory breast cancer course "grows rapidly w early met potl, blocks lymph vessels leading to redness, peau d orange"
mammography guidelines "start at 40yo q1-2yrs, if genetic risk start earlier "
when need breast bx **need core needle bx for any nonpalpable suspicious mass on mammo or any palpable mass
when lumpectomy v mastectomy lumpectomy if <4cm
what's the diff simple mastectomy v modified radical "modified radical also take axillary nodes [radical is when also remove chest wall mscl, don't do that anymore]"
"what tx if hormone receptor + (ie estrogen, progesterone)" tx w tamoxifen (selective estrogen receptor modulator)
which benign breast mass more assoc w menses fibrocystic dz (v fibroadenoma)
absolute contraindication to OCPs "CVS: any thromboembolic event, CAD; Cancer: breast, endomet, melanoma; Liver: abnml LFTs, liver tumor; undiagnosed uterine bleeding"
relative contraindication to OCPs "DM, SC, HTN, hyperlipidemia, migraines, depression, smoking, >35yo"
how OCPs effect risks for cancers decrsd risk of endometrial and ovarian and colon, incrsd cervical and maybe breast cancer as well as CAD and thromboembolic dz"
names of IUDs Mirena and ParaGuard (copper)
how often is Depo given q3mo IM injxn, takes 18mos for fertility to return"
"subQ progestin names, advantages" "Jadelle/Implanon/Norplant, rapid return of fertility s/p removal"
what's nml semen "2-5ml, >20million/ml, motility >50%, nml forms >70%, pH 7.2-7.8"
staging for endometrial cancer I limited to uterus (a if <1/2, b if >1/2 myometrium), II cervix, III a=ovary or tube, b=vagina, c=pelvic nodes; IV a=bladder, bowel, b=distant incl inguinal nodes (v pelvic or paraaortic)"
tx for difft stages of endometrial cancer I=TAH BSO don't need anything post op, I if high grade and II=pelvic radiation, III=radiation +/- chemo, IV=chemo"
staging ovarian cancer I a=1 ovary, b=2 ovaries, c=limited to ovary but malignant ascites; II a=tubes/uterus, b=other pelvic, c=also malignant ascites; III=beyond pelvis, a=microscopic, b=<2cm implants, c=>2cm; IV=distant mets or pl effusion"
staging cervical cancer "I a=<3mm deep, b <=5mm, <7mm horiz, c=above that; II= ebyond cervix, a=parametria not involved, b=parametria involved; III a=lower 1/3 vagina, b=pelvic wall or hydronephrosis; IV=beyond true pelvis or to bladder or rectum"
tx of cervical cancer "Ib, II in premeno=hysterectomy and LN; Ib, II if postmenopause=also radiation; III,IV=radiation"
staging of vulvar cancer "I <=2cm, II= >2cm, III= + unilateral inguinal LN, spread to lower urethra, vagina, or anus; IV a=upper urethrea, bladder/rectum, pelvic bone + bilateral inguinal LN; b=any distant mets of pelvic LN"
what percentage of gHTN develop preE 25%
what are signs/sympt of placental abruption "uterine tachysystole, VB, FHR very high w sinusoidal pattern (fetal anemia)"
if PTL and mom has F "look for source of infxn, incl intramnionic--so don't give steroids until r/o intramniotic infxn"
when is fetal fibronectin helpful "24-34wk, in sympt women >95% that won't deliver in next 14d"
what are limits for active phase I <1.2cm/hr in multipara, <1.5cm/hr in primip]
what are limits for latent phase I 20hrs nullip, 14 hrs multip"
how define arrest of dilation no change dilation for 2hrs
signs/sympt of ROM "nitrazine, ferning, pooling"
what on amnio would indicate lung maturity + phosphatidylglycerol (also lecithin:sphingo >2 or TDX-FLM test is mature)
lab test/value most predictive of chorioamniotis IL6
"if PROM and 36wks, what do?" IOL (lungs should be mature)
what's Kelihauer-Betke test? "Kleihauer-Betke test, which is an acid elution test (mom’s RBCs become pale while fetal cells remain stained"
smoking puts at risk for "placenta abruption, placenta previa, fetal grwth restriction, preE, infxn"
dizygotic twins have how many chorions? Amnions? always di chorionic
uterine tenderness indicates chorioamnionitis
"how much RhoGAM do you give, how much fetal RBC does it cover" "300ug given after delivery, covers 30ml of blood (15ml of RBCs)"
which events can lead to Rh sensitization "amniocentesis, chorionic villus sampling, sp/threatened abortion, ectopic preg, D&E, placental abruption, ?PreE??, manual removal of placenta, external version, antepartum hemorrhage"
"when referring to twins, what does mono di mean" monochorionic diamnionic
"what are difft types of twins, which are identical" "di di, mono di, mono mono; di di can be identical or fraternal but any of the monochorionic (mono di or mono mono are identical)"
when is cerclage usu placed 12-16wks
when is cerclage usu removed 37wks
tx of mastitis dicloxacillin
"paper thin, bluish vulva, most likely dx? How dx? Tx?" "most likely lichen sclerosis seen in post menopause w itching, dx w bx, tx w clobestrol"
"what differentiate lichen sclerosis from, how tx the two?" "squamos hyperplasia which has more white, firm, cartilaginous lesion and tx w steroids (v high dose clobestrol for lichen sclerosis)"
dx of PCOS by lab LH/FSH>2 or 3 (also elevated androgens)
what ovarian tumors can cause elevated androgens Sertoli-Leydig and hilar cell
Cushing's disease: how respond to dexamethasone test suppressed by low doses but not high doses
"how tx hereditary hirsutism, how does it work" spironolactone; inhibits 5alpha reductase in hair follicle which causes terminal differentiation of the hair follicle
pale areola and blind pouch vagina--dx? Tx? androgen insensitivity; need to remove intra-abdominal testicles
"rireg VB PP continues for >4-6wks, think? Test for?" "gestational troph neoplasia, test bHCG if above nml its choriocarcinoma or trophoblastic tumor"
how amenorrhea defined ( mos)
at what point start tx BP during delivery if DBP consistently above 100
how is tx of breast cancer different for preg woman "same exc no radiation at all during preg and no chemo during 1st tri, can undergo surgery"
what's Asherman syndrome "endometrial scarring, ie after D&C, can cause amenorrhea afterwords"
how is precocious puberty defined "2ry sex characteristics <8girls, <9boys"
order of puberty "thelarche (breast), adrenarche (pubic/axillary hair), then hgt wgt and then menarche"
treatments for osteoporosis "alendronate (fosamax, a biphosphanate), or raloxifene (SERM where estrogen agonist in bone but antagonist in breast and endometrium)"
what's the diff bw true and pseduo precocious puberty "true or central=gonadotropin, just the hypothal-pituit-ovarian axis is activated early; pseudo or peripheral=estrogen comes from ovaries but not from gonadotropins"
ex of pseudo precocious puberty McCune Albright, granulosa cell tumor of ovary"
what's the diff premature ovarian failure and premature menopause premature ovarian failure <30 (usu autoimmune), premature menopause 30-40"
describe hypothal axis for pubertal hormones "hypothal secretes GnRH, Pit secretes FSH, LH, these act on ovary"
how does FSH level help in determining hormone trbls in amenorrhea "if FSH low it’s a hypothal problem, if high its ovarian (ie premature ovarian failure)"
adnexal mass and hyperthyroid symptoms--think? struma ovarii (dermoid cyst w >50% thyroid component)
what type of tumor has high AFP yolk sac
"besides treating hyperprolactinemia w bromocriptine, what else do?" scan brain!
"if abnml pap, when do need to do colpo in preg? What can't do?" "CIN1 can be deferred till PP, HGSIL or smthg like that should have colpo--can do everything exc ECC"
what can Rx for hyperemesis of preg doxylamine (anti His)
delayed sex develop defined as no breast by 13 and no menses by15
what progesterone level indicates nml IUP ">25, if <5 then nonviable preg"
cytotec aka misprostol
which shoulder gets stuck in shoulder dystocia anterior
tx placenta accreta usu requires hysterectomy
tx for shoulder dystocia "try McRoberts where flex mom's thighs ag abdomen w suprapubic pressure, also corkscrew 180 degrees"
"CVA tenderness, hi T s/p hysterectomy" "might not just be pyelo, can be ureteral injury from dissection around ureter during hysterectomy"
painLESS 3rd tri bleeding think placenta previa
any visualizable cervical mass should get… "bx!! Pap smear is just a screening test, if see smthg it should get biopsied!"
which HPV assoc w warts? Which assoc w cancer? "6,11=warts; 16,18=cancer"
"amenorrhea PP and low thyroid, think" "Sheehan's=infarct of pit leading to low thyr, FSH/LH, cortisol (ACTH is from pituitary along w TSH)"
tx of PE in preg "IV heparin 5-7 days, then 3mos subQ and low dose heparin for remainder of preg and up to 4wk PP"
where do ovarian arteries come off of? Ovarian veins feed into? "ovarian arteries come off of aorta, R ovarian vein goes into vena cava, L ovarian goes into L renal vein"
"dark urine, had just had UTI" "think G6PD and likely was treated w a sulfa, ie nitrofurantoin"
which UTI Abx can't be used in preg "bacterium and fluoroquinolones, also doxycycline (any tetracyclines)--so often use nitrofurantoin"
when steroids given for pts going into labor? What does it help w at difft GA? "steroids if 24-34 (24-28wks decrs risk IVH, 28-34 decrs RDS and help lung maturation)"
what need to check while preg pt on Mg "UOP (since excreted by kidney), pul edema/respir depression, loss of DTR"
which ovarian tumors secrete estrogen? Androgen? estrogen=granulosa cell; androgen=Sertoli-Leydig
how differentiate mullerian agenesis and androgen insensitivity both have absnet uterus and blind vagina and nml breast, but mullerian agenesis often has renal abnmlties should have nml testosterone and nml pubic hair (androgen insensitiv has decrsd)"
when can not use MTX for ectopic preg if >3.5 or cardiac activity
1ry amenorrhea think Turner but be sure to check preg test
MC time for mastitis "3-4wks PP, tx w dicloxacillin"
"polyhydramnios and mom had ""flu""" "think hydrops s/p Parvo infxn, most at risk infxn <20wks"
tx endometritis gent and clinda
Created by: ehstephns



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