OB GYN
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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
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| 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
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| criteria for poor dates | mostly if don't have U/S <20wks
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| determination of pregnancy--cut off | hCG 25mU/ml
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| when gestational sac visible | 5wks
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| how AFI measured | deepest vertical pockets of amniotic fluid in 4 quadrants
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| how polyhydramnios defined? Oligo? | AFI>25 it's poly, if <5 it's oligo
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| where is top of fundus if 16wk? 20wk? | 1/2 pubis to umbilicus for 16wk, at umbilicus for 20wk
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| describe measures indicating symm IUGR | abd circ, head circ, biparietal dia, femur length all decrsd
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| causes of symmetric IUGR | usu insult in 1st trimester, due to fetal problems, ie aneuploidy or early infxn
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| US measures indicating asymm IUGR | abd circ decrsd, rest of measures are nml
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| causes of asymmetric IUGR | insult occurs >20wks, placental problems incl HTN and poor nutrition
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| types of abortions (5) | threatened, missed, inevitable, incomplete, complete
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| describe threatened and missed abortions | threatened=bleeding only; missed=nonviable preg, no bleeding or dilation
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| tx for missed abortion | D
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| describe inevitable abortion | heavy bleeding, dilation, NO passing of POC
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| woman comes in with heavy bleeding, passing of some pcs--what dx? What tx? | incomplete abortion if still cramping and bleeding, need emergent D
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| tx for inevitable abortion | emergent D
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| describe completed abortion | heavy bleeding, all POC have been passed and now cramping and bleeding minimal
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| tx for completed abortion | none
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| reasons why fundal size may be too small | 1) fetal (IUGR, fetal demise), 2) amniotic fluid (oligohydramios)
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| reasons for 2nd trimester loss | usu maternal, 1) uterine duplication, septum or submucous leiomyoma, 2) incompetent cervix
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| causes for fetal demise (5) | idiopathic (MC), placental, umbilical cord, fetal death, antiphospholipid
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| placental causes for fetal demise | abruptio placenta, infxn not allowing O2 xchg, macrosomia in DM outgrowing placenta
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| 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
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| what labs indicate anti phospholipid syndrome | cardiolipin Abs, lupus anticoag, incrsd PTT
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| 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)
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| 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
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| which hydatiform mole is more concerning for cancer | complete (46XX all from dad)
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| clinical findings suggestive of hydatiform mole | bleeding <16wks (MC), pre eclampsia <20wks, severe hyperemesis, new onset hyperthyroid, very high bHCG
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| if uterus larger than dates and bHCG very high, think… | hydatiform mole
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| US showing snowstorm pattern, unrecognizable detail of gestational sac…think | hydatiform mole
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| 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
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| when use chemo in hydatiform mole? Which agent? | malignant dz or recurrent dz, use MTX or actinomycin
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| sites of ectopic preg | MC is oviduct (95%), then uterine cornu, then abd
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| risk factors for ectopic preg | salpingitis (MC), previous ectopic preg, tubal ligation/sx, IUD
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| clinical findings suggestive of ectopic preg | amenorrhea, vaginal bleeding, abd pain incl cervical motion tenderness or adnexal tenderness
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| cut offs for bHCG and US=ectopic preg | if bHCG>1500 and no gestational sac visualized
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| tx for ectopic preg | if unruptured and bHCG<500 give IM MTX, otherwise need surgical
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| what are good px factors for gestationl tropho tumor | low bCHG (<40000) and mets to lung or pelvis (not brain or liver)
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| what are screening tools for Downs | 1st tri=PAPP, nuchal translucency, and mAFP, 2nd tri=triple screen/quad screen
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| causes of high MSAFP | neural tube, ventral wall, renal…twins and placental bleeding gives false high
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| what quad screen would suggest Downs | hi bHCG and inhibin, low MSAFP, estriol
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| what PAPP value suggests Downs | low along w high bHCG
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| what constitutes a negative CST | no late deccels w 3 cxns in 10min
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| what 5 parameters are measured in a BPP | NST reactivity, gross mvmts, extremity tone (flexion/extension), breathing, AFI
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| if 4-6 on a BPP what should you do | deliver if 36wks or grtr, rept in 24hr if <36wks
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| what constitutes a reactive NST | accels (2 in 20min)
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| when should accels become apparent | 30wks
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| when is GBS test done | 36wks
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| when should see gestational sac | 5wks
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| when check for gDM if not at incrsd risk | 24-28
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| 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
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| amt of glu given and cut offs for 3hr GTT | 100g given, cut offs: 95/180/155/140 [only need 2 abnml]
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| 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"
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| management of sPreE | in patient, at 23-32wks can do expectant management as long as no end organ damage, >32 wks deliver
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| management of HELLP | stabilize pt and deliver--can't manage
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| management of preterm labor | tocolytics (Mg, terbutaline), steroids if 24-34 (24-28wks decrs risk IVH, 28-34 decrs RDS and help lung maturation)
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| cut offs for UTI | 100K CFU if midstream, 10K if cath
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| ways to manage non reassuring FHT | stop oxytocin if applicable, bolus mom 500ml so not hypotensive, change maternal position, give mom O2
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| incidence of twin w spontaneous ovulation and fertility tx | 1:90 spontaneous, 1:10 if clomiphene, 1:3 if gonadotropins
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| causes of 3rd tri bleeding (PainLESS and PainFUL) | PainLESS: placenta previa, vasa previa; PainFUL: abruptio placenta, uterine rupture
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| what's MC OB cause of DIC | abruptio placenta
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| ROM leading to VB and fetal brady cardia, diagnosis is? | vasa previa
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| 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
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| which preE/gHTN pts are most likely to develop HTN later? | gHTN (NOT preE)
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| medical problems put at risk for preE? Demographics? | DM, cHTN, renal dz, SLE (vascular or connective tissue dz); demographics: nullip, age<20 or >34
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| 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
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| name criteria for DM B, C, D | B: onset <20 duration <10; C: 10-19, duration 10-19; D: <10, >20, vascular cxns
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| what are the White cxns letters for end organ damage | F=nephropathy, R=proliferative retinopathy, T=renal transplant, H=heart disease (Athero)
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| what are the MC congenital defects seen w DM | cardiac
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| what electrolyte disturbances can see in neonate of DM mother | hypoCa+ bc of immature parathyroid (+ hypogly)
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| what are goals for glu while in preg | fasting <90, 1hr <140, 2hr <120
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| 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
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| 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
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| besides control of glu with Rx, what other Rx do DM need | 4mg/d of folate bc incrsd risk of neural tube
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| what are indications to do c/s in DM | if baby EFW >4-4.5kg
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| 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
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| 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"
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| what are lab findings for acute cholestasis of preg | incrsd bile acids, +/- ALT/AST and pruritis
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| tx for acute cholestasis of preg | ursodeoxycholic acid (helps bile flow) w cholestyramine (prevents bile reabsorption) and anti His
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| tx of Graves during preg | use methimazole or PTU to make mom euthyroid--maternal IgG cross placenta
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| 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
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| management of the preg if cholestasis is present | if severe deliver 36wks if fetal lung matures, if not severe deliver by 38
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| tx PUPP | steroids and anti His
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| what are three parts of a CVE? (xx/xx/xx) | dilation/effacement/station
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| what's ""presentation""? | which part of baby is presenting over os, ie cephalic
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| what's ""attitude""? | if chin of baby is flexed (MC) or extended
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| what's ""position""? | portion of baby ag pelvis, MC occiput anterior
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| how calculate MVU? What's adequate? | hgt of ctx over 10min, >200= adequate
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| define tachysystole | >5 ctx in 10min
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| FHR bradycardia | <110
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| what’s moderate variability for FHT? Marked? | moderate=6-25, marked>25
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| how till decel v change in baseline | change in baseline if it stays for >10min
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| what parameters define sinusoidal tracing | sinusoidal pattern w freq 3-5min and lasts >20min
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| what parameters defines early decel | 30sec to nadir, symmetric, matches ctx
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| "recurrent" decel v "intermittent" decals | recurrent if >50% in 20min, otherwise intermittent
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| parameters define variable decel | <30sec to nadir, change in 15bpm and lasts at least 15sec but less than 2 min
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| what causes variable decels? Early decels? Late decals? | variable=cord compression, early=head compression, late=uteroplacental insuffic
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| what makes cat I tracing | FHR 110-160, moderate variability, no late or variable decels, may have early decels
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| cat III tracing | absent variability AND ANY of : recurrent late or variable decels, bradycardia
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| what does cat III tracing indicate in baby | abnml acid base status
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| what are indication for c/s | nonreassuring FHT, prev c/s or myomectomy, arrest of labor, placental abnmlties, abnml presentation +/- mltpl gestations"
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| what are the 5 cardinal mvmts of labor | EDFIERE=engagement, descent, flexion, internal rotation, external rotation, expulsion
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| 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
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| 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
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| tx of prolonged latent phase | ambulation or sedation, avoid oxytocin or c/s
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| tx of prolonged active | oxytocin if ctx inadequate
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| w/o IUPC how can tell if ctx are inadequate | if last less than 45 sec and <3 in 10min
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| 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)
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| 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"
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| 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
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| definition of PROM | ROM before onset of labor (regular contraction resulting in cervical change)
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| if PROM and >36 wks | "deliver, may need to ripen cervix before IOL"
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| 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"
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| 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)"
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| describe dysmaturiy syndrome | "placental aging (postdates) leads to placental insuffic, babies come out looking very old w wrinkled skin, meconium stained, peeling skin"
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| "if mom rubella susceptible, what do" | "after delivery give live attenuated vaccine, ok for BF but make sure no preg for 1 mo"
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| "describe postpartum bladder issues, tx" | "may have postvoid residual (>250mls) from hypotonic bladder, give cholinergic ie bethanechol"
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| "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"
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| MC cause of PP hemorrhage | uterine atony
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| "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"
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| what's the cut-off amt of blood for PP hemorrhage | 500ml if SVD, 1000 if c/s
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| pneumonic for fever after c/s | "wind, water, womb, wound, walk"
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| 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"
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| 2 MC cause of painful genital ulcers | HSV (MC) and chancroid (H Ducreyi)
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| describe the ulcer for herpes | starts as clear vesicle that ruptures leaving shallow, painful ulcer w raised edges"
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| how differentiate chancroid ulcers and herpes ulcers | chancroid have ragged edges whereas herpes has raised smooth edges
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| tx for chancroid | azithro or ceftriax (same as for gonorrhea)
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| MC painless genital ulcers | "syphillis, lymphogranuloma venereum (from C trachomatis L type--rare in US), granuloma inguinale (donovanosis-rare in US)"
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| 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)"
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| treatment of lymophogranuloma venereum | "doxy 21d or erythro 3-6wks, drain fluctulant LN so don't burst"
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| beefy red painless vulvar ulcer--think what? | granuloma inguinale (donovanosis)
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| tx for granuloma inguinale (donovanosis) | doxycycline or bactrim 21 d
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| tx for condyloma acuminatum | "podophyllin, TCA, imiquimod (no systemic tx available)"
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| "tx for chlamydia, gonorrhea" | chlamydia: azithro 1 dose PO or doxy 7d; gonorrhea: ceftriaxone IM 1x or azithro 1 dose + NEED TX chlamydia
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| what plating media do you use for gonorrhea | Thayer Martin
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| tx of PID | if outpatient 14 d of ceftriax or cefoxitin and add metronidazole if suspect anaerobes
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| 3 causes of vaginal discharge and how to differentiate | "back vaginosis, candida, trichomonas vaginitis"
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| describe bac vaginosis lab findings | "vaginal discharge pH>4.5, fishy amine odor/KOH whiff test, clue cells"
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| describe trichomonas vaginitis lab findings | "profuse yellow-green discharge, pH>4.5, flagellated organisms"
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| tx trichomonas vaginitis | metronidazole (same as bac vaginosis but need to treat sex partner)
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| types of abnml placenta attachment | "previa=att is near or covering os, accreta=attach to myometrium, increta=goes through myometrium, percreta=to uterine serosa"
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| 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"
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| name types of vaginal prolapse | "cystocele (bladder, so anterior), rectocele (rectum, posterior), enterocele (small bowel upper posterior)"
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| tx for stress incontinence | "kegel exercises, urethroplexy (move urethra up back into pelvic cavity)"
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| tx for urge incontinence | "anitchol (oxybutinin, ie ditropan), propantheline (""Pro-Bantheline""), B adrenergic (Ursipas)"
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| 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
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| tx of hypotonic | cholinergic (bethanecol), a adrenergic blocker (phenoxybenzamine)"
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| 3 common sympt of endometriosis | dysmenorrhea, dyspareunia, constipation"
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| tx of endometriosis | progestin, OCPs"
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| "describe adneomyosis, sympt, treatment" | "endometrial glands and stroma in myometrial wall (ie type of endometriosis) w cyclic bleeding (dysmenorrhea or menorrhagia), tx=hysterectomy"
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| physical exam for fibromas v adenomyosis | "fibromas=enlarged, firm, nontender and asymmet uterus; adenomyosis=tender, symmetric enlarged uterus"
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| risks for endometrial hyperplasia and cancer | unopposed estrogen (nulliparity, late menopause), DM, HTN, obesity"
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| types of endometrial hyperplasia | "simple, cystic & complex w/o atypia rarely progress to cancer; complex w atypia 1/3 progress to cancer"
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| 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"
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| 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"
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| 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
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| if ovulatory and still bleeding bw cycles | usu structural ie polyps
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| MC causes of dysmenorrhea | "endometriosis (incl adenomyosis), fibroids"
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| menorrhagia in ovulatory usu due to | fibroids
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| 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)"
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| 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"
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| what give for hyperprolactin | bromocriptine
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| "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)"
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| name 2 main types of fxnl benign ovarian masses | follicular/corpus luteum cysts; theca lutein cysts
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| 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]"
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| what's a choc ovarian cyst | endometrioma (non fxnl ovarian cyst)
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| types of nonfxnl ovarian masses | endometriomas and PCOS
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| benign ovarian neoplasms | "serous and mucinous cystadenomas, cystic teratoma"
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| how differentiate serous and mucinous ovarian cystadenomas | "serous=unilocular, mucinous=multilocular, if rupture can lead to pseudomyxoma peritonei"
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| MC benign ovarian neoplasm <30yo | "cystic teratoma, any combo of germ layers, often on long pedicle"
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| risks for ovarian cancer | "BRCA gene, fam hx, grtr
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| 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"
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| w/u if ASCUS | "rep pap q4-6mos until 2x nml, if 2nd abnml then colpo"
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| 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"
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| tx for fibrocystic breast | "reduce caffeine, vit E, OCPs, bromocriptine, tamoxifen"
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| "bloody discharge from a benign tumor, think…" | "intraductal papilloma, will have unilateral discharge w/o palpable mass"
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| "non tender, rapidly enlarging firm, smooth mass" | "cystosarcoma phylloides, benign, need excision w wide margin to avoid recurrence"
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||||
| 4 types of malignant breast tumors | "infiltrating ductal (MC 80%), infiltrating lobular (more often bilateral and better px), inflammatory, Pagets"
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| describe inflammatory breast cancer course | "grows rapidly w early met potl, blocks lymph vessels leading to redness, peau d orange"
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| mammography guidelines | "start at 40yo q1-2yrs, if genetic risk start earlier "
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| when need breast bx | **need core needle bx for any nonpalpable suspicious mass on mammo or any palpable mass
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| when lumpectomy v mastectomy | lumpectomy if <4cm
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| 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]"
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||||
| "what tx if hormone receptor + (ie estrogen, progesterone)" | tx w tamoxifen (selective estrogen receptor modulator)
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|
||||
| which benign breast mass more assoc w menses | fibrocystic dz (v fibroadenoma)
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|
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| absolute contraindication to OCPs | "CVS: any thromboembolic event, CAD; Cancer: breast, endomet, melanoma; Liver: abnml LFTs, liver tumor; undiagnosed uterine bleeding"
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| relative contraindication to OCPs | "DM, SC, HTN, hyperlipidemia, migraines, depression, smoking, >35yo"
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| 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"
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|
||||
| names of IUDs | Mirena and ParaGuard (copper)
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|
||||
| how often is Depo given | q3mo IM injxn, takes 18mos for fertility to return"
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|
||||
| "subQ progestin names, advantages" | "Jadelle/Implanon/Norplant, rapid return of fertility s/p removal"
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|
||||
| what's nml semen | "2-5ml, >20million/ml, motility >50%, nml forms >70%, pH 7.2-7.8"
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|
||||
| 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)"
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|
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| 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"
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|
||||
| 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"
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| 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"
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|
||||
| tx of cervical cancer | "Ib, II in premeno=hysterectomy and LN; Ib, II if postmenopause=also radiation; III,IV=radiation"
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|
||||
| 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"
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|
||||
| what percentage of gHTN develop preE | 25%
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|
||||
| what are signs/sympt of placental abruption | "uterine tachysystole, VB, FHR very high w sinusoidal pattern (fetal anemia)"
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|
||||
| if PTL and mom has F | "look for source of infxn, incl intramnionic--so don't give steroids until r/o intramniotic infxn"
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|
||||
| when is fetal fibronectin helpful | "24-34wk, in sympt women >95% that won't deliver in next 14d"
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|
||||
| what are limits for active phase I | <1.2cm/hr in multipara, <1.5cm/hr in primip]
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|
||||
| what are limits for latent phase I | 20hrs nullip, 14 hrs multip"
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|
||||
| how define arrest of dilation | no change dilation for 2hrs
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|
||||
| signs/sympt of ROM | "nitrazine, ferning, pooling"
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|
||||
| what on amnio would indicate lung maturity | + phosphatidylglycerol (also lecithin:sphingo >2 or TDX-FLM test is mature)
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|
||||
| lab test/value most predictive of chorioamniotis | IL6
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|
||||
| "if PROM and 36wks, what do?" | IOL (lungs should be mature)
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|
||||
| what's Kelihauer-Betke test? | "Kleihauer-Betke test, which is an acid elution test (mom’s RBCs become pale while fetal cells remain stained"
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|
||||
| smoking puts at risk for | "placenta abruption, placenta previa, fetal grwth restriction, preE, infxn"
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|
||||
| dizygotic twins have how many chorions? Amnions? | always di chorionic
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|
||||
| uterine tenderness indicates | chorioamnionitis
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|
||||
| "how much RhoGAM do you give, how much fetal RBC does it cover" | "300ug given after delivery, covers 30ml of blood (15ml of RBCs)"
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|
||||
| 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"
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|
||||
| "when referring to twins, what does mono di mean" | monochorionic diamnionic
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|
||||
| "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)"
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|
||||
| when is cerclage usu placed | 12-16wks
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|
||||
| when is cerclage usu removed | 37wks
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|
||||
| 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"
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|
||||
| "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)"
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|
||||
| tx PCOS | OCPs
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|
||||
| 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"
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|
||||
| ex of pseudo precocious puberty | McCune Albright, granulosa cell tumor of ovary"
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|
||||
| 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"
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|
||||
| 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
🗑
|
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