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UWORLD Ob/Gyn Step 2 CK
Terms in this set (168)
: Common findings seen in anorexic patients
2. Elevated cholesterol + carotene levels
3. Cardiac arrhythmias (prolonged QT interval)
4. Euthyroid sick syndrome
5. Hypothalmic-pituitary axis dysfunction resulting in anovulation, amenorrhea, and estrogen deficiency
6. Hyponatremia secondary to excess water drinking is often only electrolyte abnormality
Anorexia nervosa pt that is pregnant has a higher risk for giving birth to infants that are?
Small for gestational age (secondary to IUGR)
- miscarriage, hyperemesis gravidarum, cesarean delivery, postpartum depression
Indications for prophylactic anti-D immune globulin administration for unsensitized Rh-negative pregnant patient.
- At 28-32 wks gestation
- Within 72 hours of delivery of an Rh+ infant or a spontaneous, threatened, or induced abortion
- Ectopic pregnancy
- Hydatidiform molar pregnancy
- Chorionic villus sampling, amniocentesis
- Abdominal trauma
- 2nd and 3rd trimester bleeding
- External cephalic version
* Antepartum prophylaxis is not needed if the father is known to be Rh negative
Target blood glucose levels gestational DM
Fasting < 95 mg/dL
1 hr postprandial < 140 mg/dL
2 hr postprandial < 120 mg/dL
Tx Gestational DM
: Dietary modifications
: Insulin, oral agents (metformin, glyburide)
Uncontrolled maternal hyperglycemia is harmful for the developing fetus potential complications include?
- Congenital malformations
- Macrosomia (shoulder dystocia)
- Neonatal hypOglycemia
- Hyperviscosity due to polycythemia
___ dislocations of the shoulder commonly occur after tonic-clonic seizure with the patient holding the arm adducted and internally rotated.
Risk factors for septic abortion.
Retained products of conception
- elective abortion non-sterile technique outside of health care setting
- missed, incomplete, inevitable abortion
Fever, chills, lower abd pain, blood or purulent discharge, body & tender uterus w/ dilated cervix. Pelvic US: shows retained products of conception, INC vascularity, echogenic material in cavity, thick endometrial stripe.
- blood + endometrial cultures
- IV fluids + antibiotics
- Surgical evac uterus (suction curettage)
- Hysterectomy if no response to antibiotics, dev of abscess or signs clostidial infection
__ is the cause of 80% of postpartum bleeding that occurs w/in the first 24 hours after delivery.
- soft "boggy" poorly contracted uterus = uterine atony
- compression uterus -> expulsion of blood clots + blood from the vagina
- oxytocin infusion, methylergonovine, carboprost
The first step in management of postpartum hemorrhage is general supportive measures such as?
1. Fundal + bimanual massage (stimulates uterus to contract + resolve hemorrhage)
2. IV access
3. Crystalloid infusion to keep systolic BP > 90 mmHg
4. Notification of blood bank for packed RBCs
Risk factors uterine atony?
Uterine hyperdistention due to large fetus
HELLP syndrome pathogenesis.
Systemic inflammation, liver, activation of coagulation cascade, platelet consumption
DIC is complication
emolysis (microangiopathic hemolytic anemia) shistocytes, INC bilirubin, low haptoglobin
latelets < 100,000
RUQ or epigastric pain & nausea or vomiting
Tx HELLP syndrome
to prevent convulsions
Control of HTN
Raloxifene is contraindicated which pts?
- INC risk thromboembolism
IV hydralazine + labetolol + oral nefedipine
are the most appropriate HTN ER (systolic BP > 160 and/or diastolic > 110 > 15 min.) in pregnancy
Magnesium sulfate given to preeclamptic pts to prevent seizures
Pt presents with irregular or absent menses, heat intolerance, flushing, insomnia, and night sweats. What tests should be ordered?
TSH + FSH
- hyperthyroidism and menopause can have similar presentations
Asymptomatic pts with chlamydia detected by screening should be treated with?
Single dose of Azithromycin
7 days course Doxycycline
An intrauterine pregnancy should be seen with transvaginal US at B-HCG levels of?
< 1000 mIU/mL both B-HCG and transvaginal US should be repeated in 2-3 days
Midfacial hypoplasia, microcephaly, cleft lip + palate, digital hypoplasia, hirsutism, and developmental delay. Dx.
Fetal hydantoin syndrome
- phenytoin + carbamazepine
Management of complete placenta previa.
Delivery by cesarean section
Emergency c-section if there is extended or massive bleeding regardless gestational age
Management of preterm labor at < 34 weeks that has regular contractions (4 in 20 min or 8 in 60) AND cervical dilation &/or effacement AND no indications for delivery.
(B-agonists, Ca2+ channel blockers, NSAIDs)
for fetal lung maturity
for neuroprotection (<32 wks)
The risk of ___ INC with DEC gestation age especially < 32 wks gestation.
___ is the test of choice for dx ectopic pregnancy at B-HCG levels 1500-6500 IU/L.
- if it shows intrauterine sac + B-HCG then ectopic pregnancy is virtually r/o
Doubling of B-HCG every __ hours suggest a normal pregnancy.
Levothyroxine dose ___ (INC/DEC) during preganncy in the majority of patients with hypothyroidism.
- usually first trimester
- check TSH every 2-3 mo.
Vaginal bleeding and hyperactive + tender uterus are concerning for ____.
- risk cocaine, tobacco use, abd trauma
Tx Placental abruption
maternal vital signs/
non reassuring fetal heart tracing
at any gestational age:
maternal vital signs,
reassuring fetal heart tracing
, no placenta previa & > 34 weeks:
trial of vaginal delivery
HELLP syndrome serious liver problems include?
Centrilobular necorosis, hematoma formation, and thrombi in portal capillary system
Liver swelling w/ distension of the hepatic (Glisson's) capsule
= RUQ or epigastric pain
Pathophysiology of pulmonary edema in preeclampsia/eclampsia.
Pts sudden onset dyspnea, hypoxia, + crackles acute pulmonary edema, rare + life-threatening complication of severe preeclampsia
Fever + uterine tenderness in postpartum period associated with foul-smelling lochia. Risk factors include prolonged ROM, prolonged labor, operative vaginal delivery, and c-section.
- fever > 100.4 post 24 hours postpartum
Broad spectrum antibiotics required
Tx of choice postpartum endometritis?
IV clindamycin + gentamicin
- polymicrobial infection
What can cause early decelerations?
Fetal head compression
leading to vagal response
- symmetrical to contraction, nadir of decel corresponds to peak contraction
What can cause late decelerations?
- shallow uniform shape from contraction to contraction delayed
What can cause variable decelerations?
Umbilical cord compression
- variable shape abrupt drop in fetal heart rate
Absolute contraindications pregnancy & exercise?
- Amniotic fluid leak
- Cervical incompetence
- Multiple gestation
- Placenta abruption or previa
- Premature labor
- Preeclampsia/gestational HTN
- Severe heart or lung dz
ACOG recommends that healthy pregnant women with no contraindications participate in moderate-intensity exercise for ___ minutes __ per week.
> 30 min
___ is suspected when the patient reports disappearance of fetal movements, a DEC or stagnation in uterine size or when fetal heart sounds are no longer heard after 20 weeks gestation before the onset of labor. Most appropriate test diagnosis?
Intrauterine fetal demise (IUFD)
- real-time ultrasonogram confirm diagnosis (shows absence of fetal movt and fetal cardiac activity)
Shortly after delivery presents cardiogenic shock, hyperemic respiratory failure, DIC, coma or seizures. Dx.
Amniotic fluid embolism
- risk: adv maternal age, gravida >5, c-section/instrumental delivery, placenta previa/abruption, preeclampsia
- tx: respiratory/hemodynamic support +/- transfusion
What are the recommended tx options for stress incontinence?
Pelvic muscle exercises
Management of PID hospitalized patients that have high fever, failure to respond to oral antibiotics, inability to take oral meds (vomiting or nausea), pregnancy, risk of noncompliance (teenagers, women of low socioeconomic status).
Urinary frequency, constipation, pelvic pressure/pain (secondary to compression), heavy prolonged menses with clots, pregnancy difficulties associated with submucosal or intramural tumors (impaired fertility, pregnancy loss, preterm labor), enlarged irregular uterus.
Uterine leiomyoma (fibroids)
- Observation w/ no significant symptoms
- Hormonal contraception, embolization, or surgery if symptomatic
___ only definitive way to diagnose endometriosis it is indicated when NSAIDs and hormonal contraceptive therapy have failed.
- biopsy, ablate, or excise suspicious implants
Nulliparous women 25-35 ectopic endometrial tissue ovaries, anterior + posterior cul-de-sace, broad ligament, and round ligaments. Chronic pelvic pain. Dx.
Pts with endometriosis greatest risk of developing?
- chronic inflammation and adhesions may damage sperm and interfere with normal transfer of oocytes from the ovarian surface to fallopian tubes
Mood swings, irritability, fatigue, bloating, and breast symptoms occur 1-2 weeks prior to menses and resolve with onset of menstrual flow. Dx? Tx?
- menstrual diary
- SSRI first line tx majority of pts
Screen all women first prenatal visit which sexually transmitted infections?
Syphilis - RPR/VDRL
Should pregnant women be screened for lead toxicity?
NO, USPSTF and ACOG recommend against testing lead levels in asymptomatic pregnant women
Adequate contractions are defined as contractions summing to ____.
> 200 Montevideo units > 2 hours
Arrest of labor in the first stage is diagnosed when?
> 6 cm
w/ ruptured membranes AND cervical change for > 4 hrs despite
No cervical change for > 6 hours with
* Pts who do not meet criteria should be observed if these is no fetal distress
Stages of labor
(0-6 cm cervical dilation)
(6-10 cm cervical dilation)
- 10 cm (complete cervical dilation to delivery)
- delivery of baby to expulsion of placenta
Postpartum, low grade fever, leukocytosis, and vaginal discharge bloody. Tx.
-> during first 24 hours postpartum normal
- normal lochia rubra after 3-4 days color pale and discharge called lochia serosa termed lochia alba (yellow)
- foul smelling lochia = endometritis should be suspected
Which pathologic markers has the most impact on the future management of pt with invasive ductal carcinoma?
HER2 oncogene amplification by FISH/immunohistochemical (IHC)
- Trastuzumab, Herceptin
The __ is the most effective postcoital contraceptive of all the available methods and may be inserted up to 5 days following unprotected intercourse.
- acute cervicitis + PID contraindications
Regardless of gestational age, pts with active, uncontrolled antepartum hemorrhage, who also typically exhibit unstable signs and unreassuring fetal heart rate, should undergo?
Emergency c-section delivery
In postmenopausal women, the initial workup for an adnexal mass should include?
___ is contraindicated in postmenopausal women with an adnexal mass.
- poor sensitivity detecting malignancy
- if mass malignant, might be spillage and seeding cancer cells into peritoneal cavity can change prognosis and staging of the cancer
Women > 35 are at INC risk of fetal aneuploidy and should be offered ___ testing of maternal plasma. Noninvasive test can be performed > 10 weeks and has ~ 99% sensitivity and specificity for Down syndrome, > 92 % for trisomy 18, > 80% for trisomy 13.
Cell-free fetal DNA testing (cffDNA)
___ any hemorrhage occurring before 20 week of gestation with a live fetus. Cervix closed and there is no passage of fetal tissue.
1/2 cases a spontaneous abortion will actually occur
What is the tx for threatened abortion?
Reassurance + outpatient
- bed rest + abstaining from sexual intercourse prevent any feelings of guilt on the part of the parents in case pregnancy is lost; however, no evidence of benefit
Pt develops sudden onset of unilateral lower abdominal pain (R sided), nausea, and vomiting women reproductive age. Hx ovarian mass Dx.
Ovarian + adnexal torsion
- US using color Doppler
- Laparoscopic surgery
Copious vaginal discharge that is white or yellow, non malodorous, occur in the absence of other symptoms or findings on vaginal exam is referred to as ___.
What is the most accurate method of determining gestational age?
1st trimester US w/ crown-rump length
- EGA should not be changed based on measurement discrepancies on 2nd or 3rd trimester US
Tx for HPV genital warts?
- excision or fulguration (electric current)
HTN disorders of pregnancy: Define chronic HTN, Gestational HTN, Preeclampsia, Eclampsia, Chronic HTN w/ superimposed preeclampsia
INC blood pressure during pregnancy put the woman and fetus at risk for complications such as?
Risk factors placenta previa?
Prior c-section delivery
Adv. maternal age
Malodorous vaginal discharge > 60 y/o female, postmenopausal vaginal bleeding, irregular mass on upper 1/3 of the posterior vaginal wall. Dx test.
- suspected squamous cell vaginal cancer
___ presents with intense abdominal pain and associated with vaginal bleeding. Loss of fetal station is a red flag. Fetal heart rate abnormalities, recession of presenting part.
- risk factors: preexisting uterine scar or abdominal trauma
- delivery by emergency c-section
Palpable breast mass what testing should be done < 30 or > 30 y/o.
The most common cause of mucopurulent cervicitis is ___.
- tx Azithromycin
- Nucleic-acid amplification testing
___ is the most common complication of prolonged pregnancies.
(single deepest vertical pocket of amniotic fluid < 2 cm or an amniotic fluid index of < 5 cm on transabdominal US)
If amniotic fluid is low on US = delivery
INC risk for maternal cervical insufficiency history of ?
Maternal obstetrical trauma
Past gyno procedures cervical LEEP/cone biopsy
Hx preterm birth
Second trimester pregnancy loss
___ is considered the "gold standard" for evaluating the cervix for possible cervical incompetence.
- look for funneling of the cervix or shortening of the cervical length > 25 mm at 24 weeks
- cervical length < 10th% gestation age short cervix
Evaluation of nipple discharge based on color and if its uni or bi lateral.
Differential diagnosis of vaginitis.
An Rh (D)-negative woman with negative antibody screen is ___ and should receive___. At ___ weeks.
Unsensitized (not alloimmunized)
anti-D immune globulin
at 28-32 weeks gestation and again after delivery of the baby w/in 72 hrs
Triad of missed period (amenorrhea), acute abdominal pain, and intermittent vaginal bleeding is characteristic of ___.
- intra-abdominal bleeding from ruptured ectopic suspected due to hx syncope, hypotension, and tachy
- dx B-hCG, transvaginal US
- tx: Methotrexate/surgical
Intrapartum fetal heart rate monitoring - VEAL CHOP
Contraindications to breastfeeding.
Emergency contraception options.
___ is a rare psychiatric condition in which a woman presents with nearly all signs and symptoms of pregnancy; however, US reveal normal endometrial stripe and negative pregnancy test.
- suggested that depression caused by need to become pregnancy behind hormonal changes mimicking those of pregnancy
- form of conversion disorder, management psych eval + tx
ABO compatibility generally occurs in a group __ mother with a group __ baby.
A or B baby
ABO incompatibility causes less severe hemolytic disease of the newborn than does Rh(D) incompatibility
- affected infants are usually asymptomatic at birth w/ absent or mild anemia + dev. neonatal jaundice = phototherapy
Hirsutism, menstrual irregularities, elevated 17-hydroxyprogesterone, androgens (DHEA, testosterone), and LH, FSH consistent with?
Nonclassic Congenital adrenal hyperplasia (CAH)
= ACTH stimulation test exaggerate 17-hydroxyprogesterone response expected
First line agents for management of essential HTN during pregnancy are ___ and ___.
Labatelol + Methyldopa
Alternative: Nifedipine + Hydralazine
Presence of DEC fetal movts, fetal compromise should be suspected and the best next step in management is?
Non-stress test (NST)
- usually performed high risk pregnancies 32-34 wks gestation or when loss perception fetal movts
- reactive if in 20 min at least 2 accels of fetal HR of at least 15 beats/min above baseline last at least 15 sec.
The most common cause of nonreactive NST?
Fetal sleep cycle; vibroacoustic stimulation is used to awaken the fetus and allow a timely test
Palpation of the vertex at the fundus indicates the fetus is in __ presentation.
=> majority self-correct by 37th week of gestation, routine follow-up is the best
___ common complication in pts who have prolonged rupture of membranes (ROM) > 18 hours.
aka intraamniotic infection (IAI)
- polymicrobial ascend from the vagina into amniotic fluid
- maternal fever and > 1 of the following: uterine tenderness, maternal/fetal tachy, malodorous amniotic fluid, or purulent vaginal discharge
IV broad-spectrum antibiotics (ampicillin, gentamicin, clindamysin)
DELIVERY - oxytocin to accelerate labor
Antipyretics -> reduce maternal fever, which in turn improve fetal tachy
___ is a common cause of amenorrhea. The amenorrhea is the result of anovulation. FSH + LH levels are usually normal.
Pregnant pt has intense, often intolerable, generalized pruritus that is significant palms and soles and worsens at night. Evidence of skin excoriations may be present on exam.
Intrahepatic cholestasis of pregnancy (ICP)
- INC serum total bile acids
- Serum aminotransferases 10x normal
What are the most significant risk factors for spontaneous abortion?
Adv. maternal age
Previous spontaneous abortion
Spontaneous abortion: solid white mass covered with blood passes before 20 wks gestation
Hemophilia A is an ___ disorder. On average carrier mothers and unaffected fathers have ___ chance of having a son with hemophilia, silent carrier daughter, an unaffected son, or an unaffected daughter.
Fetal distress (repetitive late decelerations) is an indication for ___.
Symmetrical growth restriction (fetal factors) is usually caused by?
- Fetal anomalies
- Abnormal fetal karyotype
- Early maternal viral infection (malaria, CMV, rubella, toxo, varicella)
- Congenital heart disease
Asymmetric fetal growth restriction (maternal factors) appears later in pregnancy and is caused by?
- Maternal vascular dz: HTN, diabetes, smoking
- Autoimmune (SLE)
- Cyanotic cardiac dz
- Antiphospholipid syndrome
Fetal growth restriction is defined as estimated fetal weight < ___ percentile.
___ is a common SE of epidural anesthesia. Cause of __ is blood redistribution to the LE and venous pooling from sympathetic blockage.
___ presents as pelvic masses with symptoms due to compression of adjacent organs (constipation, urinary frequency) and heavy, prolonged menstrual bleeding.
Uterine leiomyomas (fibroids)
- common African American women
- compression of bladder or sigmoid colon = urinary frequency or constipation, ureter compression cause hydronephrosis
Aggravating factors for stress incontinence?
Clinical presentation history of preeclampsia, sudden vaginal bleeding, uterine tenderness, and hyperactivity. The bleeding is ongoing and fetal heart tracing is non-reassuring (bradycardia, no variability), poor fetal perfusion.
Placental abruption (abruptio placenta)
- emergency C-section stop the abruption from progressing prevent DIC
- if stable vital signs, reassuring fetal heart tracing, no previa 34 wks gestation: trial of vaginal delivery
- HTN during pregnancy important risk factor
Late-pregnancies are at risk for ___. Antenatal fetal surveillance should begin at 41 weeks gestation to detect fetal compromise suggested by ___, ___, and __.
- Abnormal heart rate patterns
- DEC fetal activity
The tx for preeclampsia-eclampsia syndrome is ___.
- fetal brady common during seizures, stabilize the patient
- continue magnesium sulfate through induction of labor
__ labor, contractions are felt in the lower abdomen, are irregular, occur at an interval that does not shorten and do not INC in intensity.
labor occurs in the last 4-8 weeks usually
- contractions are not accompanied by progressive cervical change and relieved by sedation
- reassure the patient
___ abortion is vaginal bleeding, and fluid discharge, lower abd cramps, and a dilated cervix through which the products of conception can occasionally be visualized.
Age 21-29 cervical cancer screening?
Cytology every 3 years
Age 30-65 cervical cancer screening?
Cytology every 3 years
Cytology PLUS HPV testing every 5 years
Age 65 or older cervical cancer screening?
No screening if negative prior screens and not high risk for cervical cancer
Immunocompromised (HIV, SLE/organ transplant patients on immunosuppressants) cervical cancer screening?
Onset of sexual intercourse
Every 6 mo. x2 then annually
Hysterectomy (w/ cervix removed) cervical cancer screening?
No screening if no hx of high-grade precancerous lesion, cervical cancer, or exposure to DES
HPV vaccine is recommended for all girls and women (except those who are pregnant) age __ regardless of HPV status or sexual activity.
also boys + men 9-21
Painless vaginal bleeding that occurs on rupture of membranes, fetal deterioration (sinusoidal tracing or bradycardia)
- fetus risk of death by exsanguination
- antenatal abd and transvaginal Doppler US
The _ or __ test differentiates maternal from fetal blood in patients with vaginal bleeding.
Apt test or Kleinhauer-Betke test
___ should be induced w/o delay in pts with intrauterine fetal demise who develop coagulation abnormalities. A fibrinogen and platelet levels in the low-normal range can indicate developing DIC.
___ is a radiographic test used to ID structural abnormalities in the uterus or fallopian tube that may contribute to infertility.
- Risk factors: PID important evaluating pts with infertility
: Pts with ___ present in the postpartum period with failure to lactate and other features of pituitary hormone deficiency.
- ischemic necrosis
Sudden-onset vaginal bleeding, abd pain, hypertonic/tender uterus. Painful third-trimester vaginal bleeding.
- maternal HTN, smoking, cocaine
- causes placental hypoperfusion + hemorrhage in the decidua basalis
Prolactin is stimulated by ___ and ___. Inhibited by___.
Stimulated by serotonin + TRH (hypothyroidism result in amenorrhea + galactorrhea)
Inhibited by Dopamine
Chorioretinitis, hydrocephalus, and intracranial calcifications.
The most important complication of PPROM is ___.
Pulmonary hypoplasia (immaturity)
- steroids are used to enhance fetal lung maturity when PROM occurs < 34 weeks of gestation
Pts with persistent symptoms who have a negative initial workup or risk factors for endometrial cancer (age >45, diabetes, unopposed estrogen exposure, PCOS, early menarche/late menopause) require assessment with ___.
- Endometrial biopsy (EMB)
- transvaginal US + EMB
Endometrial biopsy is indicated for evaluating abnormal uterine bleeding in?
- Women > 45 + all postmenopausal women
- Women age < 45 w/ persistent symptoms or risk factors for endometrial cancer
- Unopposed estrogen exposure (obesity, PCOS)
- Prolonged amenorrhea w/ anovulation
___ is characterized by amenorrhea, hypoestrogenism, and elevated serum gonadotropin levels in women < 40 y/o.
Premature ovarian failure
- amenorrhea needs to be 3 mo. duration w/ FSH in menopausal range (lab asssay)
- INC FSH, LH, DEC estrogen
- Pregnancy: in vitro fertilization w/ donor oocyte
TRUE/FALSE: Labor should be allowed to proceed in pts where the fetus has been diagnosed with a severe congenital anomaly incompatible with life.
TRUE, pts with B/L renal agenesis will not survive outside the uterus because of severe pulmonary hypoplasia associated with renal agenesis
Tx Candida vulvovaginitis first-line
Oral fluconazole is first-line
- intravaginal nystatin used to treat Candida vulvovaginitis
In the ___ phase of menstrual cycle, cervical mucosa is profuse, clear and thin. It will stretch to approx. 6 cm and exhibit ferning on microscope slide smear prep.
Women who miss screening (unknown GBS status) should be treated in labor if they are ___ weeks gestation, develop __, or have ___.
< 37 weeks gestation
rupture of membranes > 18 hours
* Penicillin prophylactic agent of choice prophylaxis 4 hours before delivery
Risk factors that INC likelihood of osteoporosis include?
Thin body habitus
Excessive alcohol consumption
Continue nursing, more frequently
Women risk factors for MRSA (recent antibiotic therapy, residence in long-term care facility, HIV infection, incarceration) tx Clindamycin, trimethorpim-sulfamethoxazole, or vanco
Pathophysiology of neonatal thyrotoxicosis.
Transplacental passage of
maternal anti-TSH receptor antibodies
Antibodies binds to infants TSH receptors + cause excessive thyroid hormone release
Neonate presents with maternal Hx Grave's dz, low birth weight, tachy, warm skin, irritability characteristic of neonatal ___.
- self-resolves w/in 3 months (disappearance of maternal antibody)
- more severe case: methimazole PLUS B-blocker
Dx Neonatal thyrotoxicosis
Maternal anti-TSH receptor antibodies > 500% normal
True/False: 1/5 women age 35-39 are no longer fertile.
TRUE. due to DEC ovarian reserve DEC fertility women 4th decade of life who are still having regular menstrual cycles
Infertility due to aging can be assessed using?
Early follicular FSH level
Clomiphene challenge test
Risk of combined estrogen-progestin OCPs
Very rarely stroke & MI
Patients with ___ should consider another method of contraception w/o estrogen.
UTI antibiotics in pregnancy recommended.
: Tetracycles, Fluoroquinolones, Trimethroprim-sulfamethoxazole
Sheehan syndrome (postpartum ischemic necrosis of ___ pituitary) classically presents with failure of postpartum lactation due to __ deficiency.
__ of breast should be suspected in pts with no prior history of skin disease who present with an eczematous rash near the nipple that does no improve with topical txs. The majority of pts have an underlying breast __.
All pts with chronic hepatitis C infection, including pregnant women, should be immunized against __ and __ if they are not already immune.
Hep A and Hep B = inactivated (killed) vaccines safe to administer during pregnancy
What happens to BUN and creatinine in pregnant patients?
DEC BUN + Creatinine
INC renal plasma flow + GFR
___ characterized by B/L breast tenderness and swelling, 24 to 72 hours post-partum, peaks 3-5 days after delivery and resolves spontaneously.
-> secondary to milk accumulation
-> cool compress, acetaminophen, NSAIDs for symptom control
Pt history normal internal genitalia with ambitious external genitalia, clitoral hypertrophy, high FSH/LH with low estrogen is consistent with __ .
- in utero the placenta will not be able to make estrogens = > masculinization of the mother resolves after delivery
- virilization XX fetuses
___ triad of cafe au lait spots, polyostotic fibrous dysplasia, and autonomous endocrine hyperfunction.
- gonadotropin-independent precocious puberty
- early puberty
___ occurs in 46, XX females and consists of no upper vagina, cervix, or uterus but otherwise normal female development.
- normal pubic or axillary hair and female testosterone levels
___ occurs in 46, XY males and have absent uterus & upper vagina, cryptorchid testes, minimal or absent pubic or axillary hair, due to x-linked mutation androgen receptor.
Complete androgen insensitivity syndrome
Epidural anesthesia in labor impairs bladder function, and an over-distended bladder may lose its ability to contract and result in urinary retention and overflow incontinence. Urinary retention is tx?
Short-term indwelling catheterization
- 24 hours to decompress the bladder
___ involved maneuvers to covert a breech into a vertex presentation for delivery it can be performed at __ weeks gestation.
External cephalic version (ECV) at 37 weeks gestation
+ onset of labor and has shown reduce rate of cesarean deliveries
Secondary amenorrhea is relatively common in elite female athletes and result from __ deficiency.
Tamofixen INC risk of which 2 life-threatening cancers?
, arises in lining of the uterus
, arises in muscular wall of the uterus
___ most commonly affects postmenopausal women and manifests with vulvar pruritus and discomfort. Exam shows porcelain-white atrophy. Dx.
- vulvar punch biopsy should be done to r/o vulvar squamous cell carcinoma (SCC)
- tx topical corticosteroids class I high-potency cream
__ is helpful in tx menopause-related atrophic vaginitis.
Maternal thyroid axis during pregnancy what levels are INC, DEC.
Total T4 + T3 INC
Slight Free T4 + T3 INC
___ may cause significant volume depletion and loss of gastric acid, leading to primary metabolic alkalosis pregnancy.
- severe vomiting during 1st to early second trimester
What are the steps for evaluation of secondary amenorrhea?
Primary ovarian failure results in DEC in estrogen levels and INC ___ levels.
FSH/LH > 1.0 ratio
FSH elevation in setting of > 3 months of amenorrhea in a woman under age 40 confirms the dx of premature ovarian failure
What is the earliest sign of magnesium sulfate toxicity?
Depression of DTR
- tx stopping magnesium sulfate infusion + administer calcium gluconate
Fetal + neonatal complications from maternal diabetes mellitus
Abdominal pain in young female in the middle of her cycle with benign history and clinical exam is most likely ___.
Mittelschmerz (midcycle pain)
Pregnant women with a history of genital HSV infection should receive prophylactic acyclovir or valacyclovir beginning at __ weeks of pregnancy.
- C-section should be performed at the time of delivery on women w/ active genital herpes lesions (primary or secondary)
Management of endometrial hyperplasia
Endometrial hyperplasia -> endometrial adenocarcinoma
Management of ASC-US in women age > 25.
___ presents with acute onset of unilateral pelvic pain immediately after strenuous activity or sexual intercourse. Pelvic US can confirm the dx by showing free fluid in the pelvis. Supportive care (analgesics) is recommended for uncomplicated cyst rupture, complicated cyst rupture may require surgical intervention.
Rupture ovarian cyst
___ presents with onset of unilateral lower abdominal pain. Pelvic US with Doppler velocity shows enlarged, edematous ovaries with DEC blood flow.
___ chronic pelvic pain, dysmenorrhea, deep dyspareunia, infertility, or bowel/bladder dysfunction. Pelvic US shows endometrial tissue.
Lupus before pregnancy with the appearance of proteinuria during pregnancy may represents ___.
- glomerulonephritis cause proteinuria, hematuria, RBC casts
Young pregnant woman that presents with atrial fibrillation and symptoms of pulmonary edema suggesting a dx of __.
- Rheumatic heart disease
- Streptococcus pyogenes untreated infection
- RH disease is most common in countries with limited access to antibiotics
PE: diastolic rumble at apex and/or an opening snap
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