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1426 Cards in this Set
- Front
- Back
Q001. what is the genital system developed from?
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A001. mesoderm
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Q002. what portion of the embryo gives rise to the reproductive system?
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A002. Urogenital ridges
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Q003. what portion of the ovary contains the developing follicles?
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A003. cortex
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Q004. what is the first indication of the sex in the embryo?
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A004. formation of the tunica albuginea
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Q005. the primordial germ cells can be identified during the 4th week of development where?
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A005. Yolk sac
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Q006. Embryo:; what results following the absence of the uterus?
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A006. Paramesonepheric (Mullerian)ducts degenerate
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Q007. Embryo:; what results in the formation of a double uterus?; technical name of this?
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A007. Inferior part of the Mullerian ducts do not fuse; "Uterus didelphys"
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Q008. Embryo:; what results in the absence of the vagina?
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A008. Vaginal plate does not develop
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Q009. Embryo:; what results in vaginal atresia?
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A009. Vaginal plate does not canalize
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Q010. Embryo:; what does the labia minora develop from?
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A010. Urogenital folds
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Q011. Embryo:; what does the labia majora develop from?
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A011. Labioscrotal swelling
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Q012. Embryo:; what does the clitoris develop from?
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A012. Genital tubercle
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Q013. Embryo:; what does the fallopian tube develop from?
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A013. Mullerian ducts
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Q014. Embryo:; what (2) structures does the vagina originate from?
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A014. Urogenital sinus; Mullerian ducts
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Q015. what are the innominate bones composed of?; (3)
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A015. Ileum,; Ischium,; Pubis
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Q016. what separates the false pelvis from the true pelvis?
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A016. Linea terminalis
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Q017. which pelvis does the fetus pass during labor?
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A017. True pelvis
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Q018. what plane separates the false pelvis from the true pelvis?
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A018. Pelvic Inlet
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Q019. at what plane does the arrest of fetal descent occur?
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A019. Plane of Least diameter
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Q020. what is the value of the obstetric conjugate?
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A020. 10.0 - 11.0
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Q021. what is the value of the transverse diameter of the pelvic inlet?
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A021. 13.5
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Q022. what is the value of the Bispinous diameter of the pelvic midplane?
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A022. 10
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Q023. what is the transverse diameter of the Greatest Diameter?
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A023. 12.5
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Q024. what is the most common pelvic type?
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A024. Gynecoid
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Q025. what is found in the labia majora but not the labia minora?
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A025. Hair follicles
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Q026. Name type of epithelium:; Bartholin ducts
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A026. Transitional
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Q027. Name type of epithelium:; Skene duct
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A027. Transitional
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Q028. Name type of epithelium:; Urethra
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A028. Transitional
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Q029. Name type of epithelium:; Endocervical canal
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A029. Columnar
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Q030. what is the name of the part of the uterus where the fallopian tubes enter?
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A030. Cornu
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Q031. what are the (2) main anatomic divisions of the uterus?
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A031. Corpus,; Cervix
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Q032. what (2) arteries supply the uterus?
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A032. Uterine artery,; Ovarian artery
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Q033. where do the uterine veins enter the venous system?
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A033. Internal iliac veins
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Q034. what portion of the fallopian tube boarders the ovary?
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A034. Infundibulum
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Q035. what ligament supports the ovary?
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A035. Broad ligament
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Q036. before puberty, what is the ratio of the body of the uterus and the cervix length?
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A036. 0.0423611111111111
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Q037. what is the portion of the broad ligament b/t the ovaries and fallopian tube?
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A037. Mesosalpinx
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Q038. what ligaments prevent uterine prolaspe?
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A038. Uterosacral ligaments
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Q039. when do Oogonia stop developing?
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A039. just before birth
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Q040. how are trisomy pregnancies detected?
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A040. Chorionic villus sampling
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Q041. Genetics Dx:; microcephaly, distinctive facial features
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A041. Cri-du-chat
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Q042. what occurs with failure of testicular development in a XY zygote?
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A042. patient develops as a female with uterus, tubes, vagina, and vulva (no ovaries)
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Q043. what is the most common cause of mental retardation?
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A043. Fragile X syndrome
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Q044. what amount of folic acid should be taken by a pregnant woman who already has a child with a neural tube defect?
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A044. 4 mg
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Q045. when is the developing brain most susceptable to teratogens?
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A045. 3 - 16 weeks
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Q046. when is the developing neural tube most susceptable to teratogens?
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A046. 2 - 4 weeks
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Q047. when is the developing heart most susceptible to teratogens?
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A047. 3 - 6 weeks
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Q048. Cause of Teratogenic effect:; intrauterine growth retardation, fetal hypotension, pulmonary hypoplasia
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A048. ACEi
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Q049. Cause of Teratogenic effect:; skeletal defects, cleft palate
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A049. Antiepileptics
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Q050. Cause of Teratogenic effect:; CNS and ear defects, cleft lip/palate, cardiac and great velles defects; (2)
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A050. Cyclophosphamide; Accutane
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Q051. Cause of Teratogenic effect:; nasal hypoplasia, vertebral abnormalities, CNS malformations
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A051. Warfarin
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Q052. Cause of Teratogenic effect:; limb reduction, VSD, GI atresia
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A052. Thalidomide
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Q053. Cause of Teratogenic effect:; vaginal and cervical cancer, genital tract abnormalities
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A053. DES; (Diethylstilbestrol)
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Q054. Cause of Teratogenic effect:; staining of primary teeth
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A054. Tetracycline
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Q055. what mouth problem increases with pregnancy?
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A055. Gingival Disease
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Q056. how does glucose cross the placenta?
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A056. faciliated diffusion
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Q057. how do amino acids cross the placenta?
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A057. active transport
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Q058. how does pregnancy effect appetite?; gastric motility?
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A058. apetite Increases; motility Decreases
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Q059. how does pregnancy affect GB emptying?
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A059. emptying is delayed
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Q060. how does pregnancy affect liver enzymes?
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A060. Increase
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Q061. when does "morning sickness" begin?
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A061. 4 - 8 weeks
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Q062. what causes Ptyalism?
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A062. inability for patient to swallow normal amounts of saliva
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Q063. what causes the decreased GI motility during pregnancy?
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A063. increased Progesterone
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Q064. how many additional calories is allowed daily with pregnancy?
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A064. 300
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Q065. transit time in the stomach and small intestines increases by what percent in the second and third trimesters?
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A065. 15 - 30%
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Q066. during pregnancy how does the tone of the gastroesophageal sphinctor change?
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A066. it Decreases; (GERD increases)
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Q067. Definition:; pregnancy-related vascular swelling of the gums
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A067. Epulis
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Q068. what pulmonary measurement is decreased throughout pregnancy?
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A068. Carbon dioxide pressure
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Q069. what pulmonary measurement is decreased in late pregnancy?
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A069. Functional Reserve Capacity; (FRC)
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Q070. what is the maternal acid-base balance in pregnancy?
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A070. mild Respiratory Alkalosis
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Q071. the Tidal volume in pregnancy increases by what percent?
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A071. 30 - 40%
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Q072. in a normal singleton pregnancy what is the percent increase of maternal blood volume?
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A072. 0.45
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Q073. in what position is maternal BP the highest?
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A073. Seated
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Q074. what is the BP change in the lateral recumbent position of the inferior arm of a pregnant mother?
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A074. BP in inferior arm is higher then superior arm
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Q075. pregnancy-assoc systolic ejection murmurs are heard best where?
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A075. over left upper sternal boarder
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Q076. compensation for the occlusion of the inferior vena cava by the pregnant uterus is accomplished by shunting blood through what?
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A076. Paravertebral collateral circulation
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Q077. what causes inferior vena cava syndrome?
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A077. compression by the gravid uterine corpus
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Q078. what causes the decrease in peripheral vascular resistance during pregnancy?
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A078. increased Progesterone
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Q079. plasma volume begins to increase at the sixth week of pregnancy and reaches its maximum at what time?
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A079. 30 - 34 weeks
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Q080. what hematologic parameter is decreased in pregnancy?
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A080. Hematocrit
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Q081. what lab value related to iron is increased in pregnancy?
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A081. Total Iron-binding capacity
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Q082. what CV risk increases with pregnancy?
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A082. thromboembolism
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Q083. what does lack of maternal iron ingestion during pregnancy result in?
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A083. Maternal Anemia
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Q084. what renal functions increase during pregnancy?; (3)
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A084. GFR,; Renal Plasma Flow,; Renin
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Q085. during pregnancy, what is the effect of progesterone on the ureters?
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A085. there is more dilation of the right versus the left
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Q086. what (3) urinary labs decrease in pregnancy?
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A086. Creatinine,; Uric Acid,; Blood Urea Nitrogen
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Q087. Definition:; change in facial pigmentation during preganacy
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A087. Chloasma
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Q088. what causes blurred vision during pregnancy?
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A088. swelling of the lens
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Q089. what percent of total CO is channeled to the uterus during pregnancy?
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A089. 0.2
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Q090. what is the main metabolic change that occurs with pregnancy?
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A090. Hyperglycemia
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Q091. what causes the "hemorrhoids" that develop late in pregnancy?
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A091. elevated pelvic venous pressure
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Q092. what is the thyroid change in pregnancy?
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A092. none...Euthyroid
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Q093. what is Diastasis recti?
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A093. Midline separation of the rectus muscles
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Q094. how does the CO2 gradient b/t fetus and mother change in the later half of pregnancy?
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A094. Increases
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Q095. how much does the BUN fall in the first trimester?
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A095. 0.25
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Q096. what is the urinary protein loss in pregnancy?
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A096. 100 - 300 mg/24 hrs
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Q097. how long after the delivery will the hair loss assoc with pregnancy return?
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A097. 6 - 12 months
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Q098. when does breast enlargement occur with pregnancy?
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A098. first trimester
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Q099. the vision changes in pregnancy assoc. with increased thickness of the cornea regresses within what time?
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A099. 6 - 8 weeks postpartum
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Q100. why is supplemental vitamin K given to newborns?
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A100. b/c of their fetal liver immaturity in the immediate newborn
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Q101. what is the change in serum bicarb levels during pregnancy?
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A101. significantly lower
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Q102. the umbilical blood flow represents about what percent of the combined output of both fetal ventricles?
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A102. 0.4
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Q103. the fetal kidney forms urine at what rate?
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A103. 400 - 1200 mL/day
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Q104. in the later half of pregnancy, umbilical blood flow is what?
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A104. 300 mL/mg/minute
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Q105. what is the normal constant fetal heart rate?
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A105. 120 - 180 bmp
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Q106. maternal diastolic BP and Mean Arterial volume nadir when?
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A106. 16 - 20 weeks
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Q107. an increase in breast volume of what percent is common in pregnancy?
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A107. 25 - 50%
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Q108. Definition:; the patient's initial perception of fetal movement; at how many weeks gestation is it normally felt?
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A108. Quickening; felt at 20 weeks
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Q109. Definition:; congestion and a bluish color of the vagina
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A109. Chadwick sign
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Q110. Definition:; a softening of the cervix on physical exam
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A110. Hegar sign
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Q111. when are fetal heart tones in a normal pregnancy hear by simple auscultation?
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A111. 18 - 20 weeks
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Q112. commonly used electronic Doppler devices will detect fetal heart tones at how many weeks?
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A112. 12 weeks gestation
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Q113. home urine preg tests become positive approx how many weeks following the first day of the last menstrural period?
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A113. 4 weeks
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Q114. how high should progesterone be for a viable uterine pregnancy?
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A114. > 25 ng/mL
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Q115. intrauterine pregnancy is detectable by transvaginal US when the beta-HCG is greater then what?
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A115. 1000 - 2000 mIU/mL
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Q116. in what percent of pregnant women is rubella titer positive?
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A116. 0.85
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Q117. specific screening for treponema is required following what positive test?
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A117. Rapid Plasma reagin
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Q118. when can maternal alpha-fetoprotein testing be done?
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A118. 15 - 18 weeks
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Q119. in a normal singleton pregnancy, from approx 16 - 18 weeks gestation until 36 weeks, the fundal height in cm is equal to what?
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A119. the number of weeks gestational age
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Q120. what is the prescribed recommendation for weight gain during pregnancy?
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A120. 25 - 35 pounds
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Q121. Definition:; when the patient reports a change in the shape of her abdomen and that the baby has gotten less heavy
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A121. Lightening
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Q122. what is the direct result of "lightening"?
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A122. decreased fundal height
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Q123. a breech presentation occurs in what percent of deliveries?
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A123. 0.035
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Q124. estimation of gestional age by US is least accurate at what time during pregnancy?
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A124. 36 - 38 weeks
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Q125. what is the normal fetal heart rate at term?
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A125. 120 - 160 bpm
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Q126. a reactive nonstress test is characterized by a fetal heart rate increase of how many beats per minute?
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A126. 15
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Q127. what is an abnormal contraction stress test?
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A127. fetal heart rate decreases in response to uterine contraction
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Q128. what is the number of contractions in a ten minute window that must occur for a contraction stress test to be measurable?
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A128. 3
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Q129. a biophysical profile in which there is one or more episodes of fetal breathing in 30 min, 3 or more descrete movements in 30 min, opening/closing of the fetal hand, a nonreactive nonstress test and no pockets of amnioticfluid greater then 1 cm would have a total score of what?
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A129. 6
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Q130. exclusive of the fetal HR reactivity, what is the biophysical profile considered most important?
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A130. qualitative amniotic fluid volume
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Q131. repetative decelerations following each contraction when three contractions occur in a 10-min window is an indication of what?
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A131. nonreassuring fetal status
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Q132. tests of fetal lung maturity are generally used when delivery of a fetus is contemplated at a gestational age of less then how many weeks?
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A132. 36
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Q133. at how many weeks does phospholipid production increase resulting in a positive phosphatidyl-glycerol test?
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A133. 32 - 33 weeks
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Q134. during a normal pregnancy, the patient should be encouraged to engage in non-weight-bearing activity at what interval?
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A134. three times a week
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Q135. in pregnancy, psyllium hydrophilic mucilloid is used to manage what?
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A135. constipation
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Q136. because of the position of the fetus, round ligament pain is more pronounced where?
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A136. on the right side
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Q137. which Pregnancy Risk Factor indicates that human controlled studies do not exist?
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A137. PRF B
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Q138. which Pregnancy Risk Factor means that the drug should only be given if the benefits outweigh the risks?
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A138. PRF C
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Q139. which Pregnancy Risk Factor means that there is evidence that the fetus is at risk?
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A139. PRF D
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Q140. which Pregnancy Risk Factor indicates that animal and human studies demonstrate fetal abnormalities, such that the risk outweighs any possible benefit?
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A140. PRF X
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Q141. Definition:; progressive effacement and dilation of the cervix, resulting from rhythmic contractions of the uterine musculature
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A141. Labor
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Q142. Definition:; Uterine contractions without cervical dilation
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A142. False Labor; (Braxton-Hicks contractions)
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Q143. what is "bloody show" associated with at term?
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A143. extrusion of endocervical gland mucous
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Q144. lower abdominal and groin pain are usually assoc with what type of labor?
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A144. False labor
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Q145. Definition:; the descent of the fetal head into the pelvis and the changing contour of the abdomen late in pregnancy
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A145. Lightening
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Q146. what is the definition od "fetal lie"?
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A146. relationship of the long axis of the fetus with the maternal long axis
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Q147. what is the "Presentation" determined by?
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A147. portion of the fetus lowest in the birth canal
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Q148. what is "Position" defined as?
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A148. relationship of the fetal presenting part of the right and left side of the pelvis
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Q149. the descent of the presenting part is identified by which Leopold maneuver?
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A149. Third maneuver
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Q150. the location of the small parts is determined by which Leopold maneuver?
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A150. Second maneuver
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Q151. determining what occupies the fundus is accomplished by what Leopold maneuver?
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A151. First maneuver
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Q152. identifying the cephalic prominence is accomplished by what Leopold maneuver?
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A152. Fourth maneuver
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Q153. what is the most common "fetal lie" found during early labor?
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A153. Longitudinal
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Q154. what is the most common "fetal presentation" found in early labor?
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A154. Vertex
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Q155. Definition:; the turning of the fetal head toward the sacrum
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A155. Anterior Asynclitism
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Q156. what is the station of a patient in labor with the vertex at the level of the ischial spines?
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A156. Zero
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Q157. At Zero station, where is the biparietal diameter of the fetal head in relation to the pelvic inlet?
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A157. Passed below the pelvic inlet
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Q158. the clinical significance of the fetal head presenting at zero station is that the biparietal diameter of the fetal head has negotiated what?
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A158. Pelvic inlet
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Q159. what is cervical effacement?
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A159. the degree of cervical thinning
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Q160. how is the First Stage of Labor described?
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A160. Onset of labor to full cervical dilation
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Q161. how is the Second Stage of Labor described?
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A161. Complete dilation of the cervix to delivery of the infant
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Q162. how is the Third Stage of Labor described?
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A162. Delivery of the infant to delivery of the placenta
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Q163. how is the Fourth Stage of Labor described?
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A163. period extending up to two hours after delivery of the placenta
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Q164. the Active Phase of the first stage of labor is defined to begin when the cervix is how dilated?
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A164. 4 cm
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Q165. what describes the cardinal movement of labor that allows the smaller diameter of the fetal head to present to the maternal pelvis?
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A165. Flexion
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Q166. what describes the movement of the fetal head as it reaches the introitus?
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A166. Extension of the fetal head
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Q167. what describes the movement of the fetal head to "face forward" relative to the shoulders?
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A167. External rotation
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Q168. Definition:; movement of the presenting part through the birth canal
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A168. Descent
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Q169. Times in Nulliparas:; 1) Latent phase of stage 1; 2) Active phase of stage 1; 3) Second stage of labor
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A169. Nulliparas:; Latent phase of stage 1: 6.5 hours; Active phase of stage 1: 4.5 hours; Second stage of labor: 1 hour
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Q170. Times in Multiparas:; 1) Latent phase of stage 1; 2) Active phase of stage 1; 3) Second stage of labor
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A170. Multiparas:; Latent phase of stage 1: 5 hours; Active phase of stage 1: 2.5 hours; Second stage of labor: 0.5 hours
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Q171. during the active phase of labor, if electronic monitoring is not used, the fetal heart rate should be auscultated how often?
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A171. every 15 min
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Q172. during the second stage of labor, if electronic monitoring is not used, the fetal heart rate should be auscultated how often?
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A172. each uterine contraction
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Q173. an external tocodynamometer provides information about what?
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A173. Contraction frequency
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Q174. the sensory nerves form the lower birth canal and the perineum enter the spinal cord where?
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A174. S2 - S4
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Q175. What is an epidural best used for specifically compared to a spinal and pudendal?
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A175. Epidural:; Active phase of labor and delivery; Spinal:; short-term for vaginal and abdominal delivery; perineal anesthesia for vaginal delivery
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Q176. what is the major cause of maternal mortality from OB anesthesia?
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A176. Aspiration of vomitus
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Q177. what is the MC result of compression of the fetal head during delivery?
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A177. Molding
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Q178. what is the usual postpartum blood loss in a vaginal delivery?
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A178. 500 mL
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Q179. what is the First-degree vaginal laceration at birth?
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A179. involves the vaginal mucosa and perineal skin
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Q180. what is the Second-degree vaginal laceration at birth?
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A180. involves the underlying fascia or muscle but not rectal sphinctor or rectal mucosa
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Q181. what is the Third-degree vaginal laceration at birth?
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A181. extends through rectal sphinctor but not into the rectum
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Q182. what is the Fourth-degree vaginal laceration at birth?
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A182. extends into the rectal mucosa
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Q183. during the delivery of the fetal head the likelihood of laceration or extension of episiotomy is decreased by what maneuver?
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A183. Ritgen maneuver
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Q184. how many minutes should one wait for the spontaneous extrusion of the placenta?
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A184. 30 minutes
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Q185. IUGR - What is it
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A185. Wt. < 10th percentile; suspect if > 4 between fundal ht. (cm) and GA (weeks); asymmetric - 80%, placenta mediated: HTN, poor nutrition, maternal smoking; symmetric - fetal problem: cytogenetic, infection, anomalies
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Q186. IUGR - Dx
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A186. Serial exams,; US every 3-4 weeks; NST, CST, BPP; Doppler
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Q187. IUGR - Tx
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A187. Steroids; consider early delivery - esp. asymmetric; continuous FHR monitoring during labor; C-section if decelerations persist
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Q188. Oligohydramnios - What is it
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A188. Excess loss of fluid - ROM (amniotic leak); decreased in fetal urine produced; fetal urinary tract abnorm; obstructive uropathy; chronic uteroplacental insufficiency; maternal HTN; severe toxemia; AFI < 5 on US
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Q189. Oligohydramnios - Complications
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A189. Pulmonary hypoplasia; club foot; flattened facies; IUGR; fetal distress; fetal hypoxia - (umbilical cord compression)
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Q190. Oligohydramnios - Tx
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A190. Rule out inaccurate gestational dates; Tx underlying cause,; if possible, amnioinfusion - NaCl
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Q191. Polyhydramnios - What is it
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A191. Excess of fluid; AFI > 20 on US; Maternal DM; "baby can't swallow": esoph atresia, TEF, duodenal atresia; anencephaly; multiple gestations; twin-twin transfusion syn
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Q192. Polyhydramnios - Dx/Tx
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A192. US for fetal anomalies; glucose test; Rh screening; Tx depends on cause
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Q193. Polyhydramnios - Complications
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A193. Preterm labor; cord prolapse; fetal malpresentation
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Q194. Rh Isoimmunization - What is it
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A194. Ag protein on RBC; AD; maternal anti-Rh IgG ab => erythroblastosis fetalis; 2nd pregnancy - fast production by memory plasma cells
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Q195. Rh Isoimmunization - History/PE; What do you ask on History
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A195. Ask about - prior delivery of Rh+ child, ectopic pregnancy, abortion, blood transfusions, amniocentesis, abdom trauma
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Q196. Rh Isoimmunization - Evaluation
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A196. Maternal - on 1st visit, check ABO & Rh; if Rh- then check dad's Rh,; if dad Rh+ then, check mom's titer at 26-28 weeks; if pos., test serially for high titers (> 1:16), fetal - amniocentesis or US-guided umbilical bld sample, blood type, Coombs' titer, bilirubin level, HCT, reticulocytes; postnatally - fetal cord blood, Rh,HCT
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Q197. Rh Isoimmunization - Tx
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A197. Prevention - . at 28 weeks, if mom Rh- and dad Rh+ or status unknown, give RhoGAM (IgG anti-D); if baby Rh+, give RhoGAM postpartum, too; give RhoGAM to Rh- moms if have had abortion, ectopic pregnancy, amniocentesis, vaginal bleeding, placenta previa, placental abruption, sensitized Rh- moms with titers > 1:16; monitor closely, serial US, amniocentesis in severe cases - enhance lung maturity, intrauterine blood transfusion, init preterm delivery
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Q198. Rh Isoimmunization - Complications
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A198. Fetal hypoxia => lactic acidosis => heart failure => hydrops fetalis, death; kernicterus; prematurity
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Q199. Gestational Trophoblastic Dis - What is it
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A199. Prolif of trophoblastic tissue, range of diseases, benign or malignant; risk factors: age < 20 or > 40, def. in folate or B-carotene; hydatidiform mole - 80%, benign, may progress to malignant; complete, sperm fertilize empty ovum, 46XX; paternal derived incomplete/partial fertilized by 2 sperm, 69XXY; has fetal tissue; choriocarcinoma; placental site trophoblastic tumor
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Q200. Gestational Trophoblastic Dis- History/PE
|
A200. History - 1st trimester uterine bleeding; hyperemesis gravidarum; preeclampsia-eclampsia <24 weeks; excessive uterine enlargement; hyperthyroidism; PE - no fetal heartbeat, enlarged ovaries with b/l theca-lutein cysts, expulsion of grapelike cluster, blood in cervical os
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Q201. Gestational Trophoblastic Dis- Dx
|
A201. High B-hCG (> 100,000 mlU/mL); "snowstorm" on pelvic US; no fetus; CXR - may have lung mets
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Q202. Gestational Trophoblastic Dis- Tx
|
A202. D&C; monitor B-hCG; no pregnancy for 1 yr; if malignant – methotrexate, dactinomycin; residual uterine disease - hysterectomy
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Q203. Gestational Trophoblastic Dis- Complications
|
A203. Malignant GTD; pulmonary or CNS mets; trophoblastic PE, acute respiratory insufficiency
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Q204. Placenta Abruptio - What is it
|
A204. Premature separation of normally implanted placenta; any degree of separation; MCC of late-trimester bleeding; MCC of painful late-trimester bleeding
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Q205. Placenta Abruptio - Risk factors
|
A205. HTN; abdominal/pelvic trauma; tobacco; coke; previous abruption; premature membrane rupture; rapid decompression of; overdistended uterus
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Q206. Placenta Abruptio - Sx
|
A206. Painful, dark vaginal bleeding that doesn't spontan stop; abdom pain; fetal distress
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Q207. Placenta Abruptio - Dx
|
A207. Mainly clinical (US sensitivity 50%); check for retroplacental clot
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Q208. Placenta Abruptio - Tx
|
A208. Mild – admit, stabilize, IV, fetal monitoring, type and cross blood, bed rest; moderate to severe - immediate delivery; if both stable: amniotomy, vaginal delivery; if distress: C-section
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Q209. Placenta Abruptio - Complications
|
A209. Hemorrhagic shock; DIC => ATN; fetal hypoxia; couvelaire uterus
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Q210. Placenta Previa - What is it
|
A210. Abnorm implant of placenta:; total - covers internal os; partial - partially covers; marginal - at edge of os; low-lying - near os without reaching it
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Q211. Placenta Previa - Risk factors
|
A211. Prior C-sections; multiparity; advanced maternal age; multiple gestation; prior placenta previa
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Q212. Placenta Previa - Sxs
|
A212. Usually first occurs in late preg; painless, bright red bleeding; may be heavy; usually no fetal distress
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Q213. Placenta Previa - Dx
|
A213. US
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Q214. Placenta Previa - Management
|
A214. No vaginal exam; premature fetus - stabilize; tocolytics (MgSO4); serial US; detect fetal lung maturity - by amnio and augment; Delivery indicated if - persistent labor, life-threatening bleeding, fetal distress, fetal lung maturity, 36 weeks GA; deliver by C-section; vaginal - lower edge of placenta > 2cm from internal os
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Q215. Placenta Previa - Complications
|
A215. Increased risk of pl. accreta; vasa previa; preterm delivery; PROM; IUGR; congenital anomalies
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Q216. PROM - What is it
|
A216. ROM before onset of labor; > 37 weeks gestation; may be due to - vaginal or cervical infections; abnorm membrane physiology; cervical incompetence
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Q217. PPROM (preterm PROM) - What is it; Risk factors
|
A217. ROM < 37 weeks gestation risk factors:; low socioeconomic status; young maternal age; smoking; STDs
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Q218. Prolonged ROM - What is it
|
A218. ROM > 24 hours prior to labor
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Q219. PROM - History/PE
|
A219. Gush of clear or blood-tinged vaginal fluid; may have uterine contractions
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Q220. PROM - Evaluation
|
A220. Sterile speculum exam - amniotic fluid (in vaginal vault); meconium; vernix caseosa; positive nitrazine paper test; positive fern test; US - assess fluid volume; cultures; smears; no digital vaginal exam; check for chorioamnionitis - fetal heart tracing; maternal temp; WBC count; uterine tenderness
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Q221. PROM - Tx
|
A221. Balance risk of infection when delivery is delayed with risks due to fetal immaturity; if no sign of infection - tocolytics: B agonists, MgSO4, NSAIDs, Ca2+ ch blocker, prophylactic Antibiotics, corticosteroids; if signs of infection or fetal distress – Antibiotics, induce labor
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Q222. PROM - Complications
|
A222. Increased risk of; preterm L&D; chorioamnionitis; placental abruptio; cord prolapse
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Q223. Preterm Labor - What is it; Risk factors
|
A223. Onset of labor bet. 20-37 weeks; primary cause of neonatal M&M; risk factors - multiple gestation, infection, PROM, uterine anomalies, previous preterm L or D, polyhydramnios, placental abruptio, poor maternal nutrition, low socioeconomic status; Most patients have no identifiable risk factors
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Q224. Preterm Labor - History/PE
|
A224. May have menstrual-like cramps; onset of low back pain; pelvic pressure; new vaginal discharge or bleeding
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Q225. Preterm Labor - Dx
|
A225. Regular contractions >3, 30 sec. each, over 30 min. concurrent cervical change; sterile speculum exam; US; UA/UC; cultures for – chlamydia, gonorrhea, GBS
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Q226. Preterm Labor - Tx
|
A226. Hydration; bed rest; tocolytics; steroids; GBS prophylaxis - PCN or ampicillin
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Q227. Preterm Labor - Complications
|
A227. RDS; IVH; PDA; NEC; ROP; BPD; death
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Q228. Fetal Malpresentation - What is it; Risk factors
|
A228. Any presentation not vertex (Normal is vertex); MC malpresentation - breech Risk factors; prematurity; prior breech delivery; uterine anomalies; poly- or oligohydramnios; multiple gestations; PPROM; hydrocephalus; anencephaly; placenta previa
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Q229. Fetal Malpresentation - What are the subtypes
|
A229. Frank - thighs flexed and knees extend; footling - 1 or both legs extended below the butt; complete - thighs and knees flexed
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Q230. Fetal Malpresentation - Dx
|
A230. Leopold maneuver
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Q231. Fetal Malpresentation - Tx
|
A231. Follow external version - risks of placental abruptio, cord compression; prepare for emergency C-sect; elective C-section; breech vaginal delivery only if delivery imminent
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Q232. Postpartum Hemorrhage - What is it; MCC; MC Risk Factor
|
A232. > 500 mL for vaginal delivery, > 1000 mL for C-section; MCC - bleeding at placental implantation site; MC risk factor - uterine atony due to overdistention
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Q233. Postpartum Hemorrhage - Dx
|
A233. Palpation of soft, enlarged, "boggy" uterus; explore for lacerations and retained placental tissues
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Q234. Postpartum Hemorrhage - Tx
|
A234. Bimanual uterine massage; oxytocin infusion; methergine - if not HTN; prostin (PGF2a) - if no asthma
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Q235. Mastitis - What is it
|
A235. Cellulitis of perigland tissue; caused by - nipple trauma from breastfeeding & staph from baby's nostrils => nipple ducts
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Q236. Mastitis - History/PE
|
A236. Sxs start 2-4 weeks postpartum; usually unilateral; breast tender erythema, edema, warmth; maybe purulent nipple drainage
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Q237. Mastitis - Dx
|
A237. Sxs; possible breastmilk culture; increased WBC; fever
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Q238. Mastitis - Tx
|
A238. Continue breastfeeding!; po Antibiotics - PCN, diclox, erythro; incise and drain abscess (if present)
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Q239. Sheehan's Syndrome - What is it
|
A239. Postpartum pituitary necrosis; pituitary ischemia & necrosis => ant. pituitary insuff. due to massive obstetric blood loss & hypovol shock; decreased prolactin
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Q240. Sheehan's Syndrome - History
|
A240. No lactation; menstrual disorder; fatigue; loss of pubic & axillary hair
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Q241. Postpartum Fever- What is it
|
A241. Genital tract infection; temp >= 38 C at least 2 of 1st 10 postpartum days; not including 1st 24 hrs.
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Q242. Postpartum Fever- Risk Factors
|
A242. MC - endometrial infection; C-section; emergent C-section; PROM; prolonged labor; multiple intrapartum vag exams; intrauterine manipulations
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Q243. Postpartum Fever- Causes (7 W's)
|
A243. Wind - atelectasis, pneumonia; water - UTI; wound - incision, episiotomy; walk - DVT, PE; wonder drug; womb - endomyometritis; weaning - breast engorgement, abscess, mastitis
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Q244. Postpartum Fever- Dx
|
A244. UA/UC; BC; pelvic exam - rule out hematoma; rule out lochial block
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Q245. Postpartum Fever- Tx
|
A245. Admit; broad-spectrum IV Antibiotics - clindamycin, gentamicin until afebrile for 48 hrs. if complicated - add ampicillin; if 3 drugs not effective after 48 hrs. - consider other Dxs
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Q246. Breastfeeding - What inhibits prolactin rel.
|
A246. Hi levels of progesterone & estrogen during pregnancy; high levels also cause breast hypertrophy
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Q247. Breastfeeding - Why can physiologically; breastfeed after birth
|
A247. Levels of progesterone and estrogen drop after delivery of placenta; infant sucking stimulates rel. of prolactin & oxytocin
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Q248. Breastfeeding - What gives passive immunity; what gives active immunity
|
A248. Colostrum has hi IgA; IgA - passive immunity; hi leukocyte levels - active
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Q249. Breastfeeding - Contraindications
|
A249. HIV infection; active hepatitis; meds – tetracycline, chloramphenicol, warfarin
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Q250. Hyperemesis Gravidarum - What is it; Risk factors
|
A250. Persistent vomiting => wt. loss > 5% (or poor wt. gain); dev. of dehydration and ketoacidosis; persists past 16-18 weeks – rare, can damage liver risk factors; nulliparity; molar pregnancy (increased B-hCG); multiple gestations
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Q251. Hyperemesis Gravidarum - Dx
|
A251. Serum electrolytes; hypoK-hypoCl metab alkalosis; urine ketones; BUN/Cr
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Q252. Hyperemesis Gravidarum - Tx
|
A252. IV hydration; correct electrolyte def, Mg, P; antiemetics; fluids => freq. small meals as tolerated
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Q253. Gestational DM - What is it; Risk factors
|
A253. 3-5% of all pregnancies; usu due to of late pregnancy - usu Dx 24-28 weeks; hypergly in 1st trimester - usu means preexisting, may be due to insulin-antag hormones from placenta risk factors; > 25 y/o; obesity; personal or family History; prior macrosomia; congen deformed infants
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Q254. Gestational DM - History/PE
|
A254. Typically asymp; edema; polyhydramnios; LGA - warning sign
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Q255. Gestational DM - Dx
|
A255. UA tests done 24-28 weeks; 2 abnorm glu tests to include - fasting >= 126 mg/dL, random >= 200 or abnorm GTT; 1 hr (50g) GTT >140 suggestive, confirm with 3 hr (100g) GTT - any 2 of following:; fasting >= 95; 1 hr >= 180; 2 hr >= 155; 3 hr >= 140
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Q256. Gestational DM - Tx
|
A256. Tight maternal glu control - 90; ADA diet; regular exercise; add insulin if diet insuff. no oral hypogly; periodic US and NST; intrapartum insulin and dextrose during delivery; may need to induce labor at 38-40 weeks
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Q257. Gestational DM - Complications
|
A257. > 50% develop glu intolerance and/or DM Type 2
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Q258. Pregestational DM & Pregnancy- What is it
|
A258. HbA1C > 10% has ↑ risk of - congen malformations; ↑ mat./fetal morbidity during L&D
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Q259. Pregestational DM & Pregnancy- Management of Mom
|
A259. Prenatal care; nutrition counseling; Renal eval; ophthalmologic eval; CV eval; Strict glucose control - Type 1 get insulin to maintain; Fasting morning: ≤ 60-90 mg/dL; Prelunch: 60-105; Two-hour postprandial: < 120
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Q260. Pregestational DM & Pregnancy- Management of Fetus
|
A260. 16-20 weeks - US; AFP; 20-22 weeks - echo; 3rd trimester - close surveillance, NST, CST, BPP; admit at 32-36 weeks if DM poorly controlled, fetus is of concern
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Q261. Pregestational DM & Pregnancy- Management of Delivery and; Postpartum
|
A261. Maintain 80–100 during labor consider early delivery if:; poor maternal glu control; preeclampsia; macrosomia; fetal lung maturity; C-section if macrosomia; monitor glucose postpartum
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Q262. Pregestational DM & Pregnancy- Maternal Complications
|
A262. DKA; HHNK; preeclampsia/eclampsia; cephalopelvic disproportion (macrosomia) and need for C- section; preterm labor; infection; polyhydramnios; postpartum hemorrhage; maternal mortality
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Q263. Pregestational DM & Pregnancy- Fetal Complications
|
A263. Macrosomia; cardiac defects; renal defects; neural tube defects; hypocalcemia; polycythemia; hyperbilirubinemia; IUGR; hypoglycemia from hyperinsulinemia; RDS; birth injury; perinatal mortality
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Q264. Gestational & Chronic HTN - What is it
|
A264. Both increased risk of preeclampsia & eclampsia, M&M; Chronic - high before pregnant or before 20 weeks gestation; gestational - after 20 weeks, usually after 37 weeks remits by 6 weeks postpartum; MC in multifetal
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Q265. Gestational & Chronic HTN - Dx
|
A265. Monitor BP routinely; if severe for 1st time - check for other causes
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Q266. Gestational & Chronic HTN - Tx
|
A266. Methyldopa; B-blocker; hydralazine; no ACEI or diuretics
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Q267. Preeclampsia - What is it; Risk factors
|
A267. New-onset HTN; proteinuria; nondependent (hands & face) edema; > 20 weeks gestation Risk factors:; nulliparity; Black; extremes of age; multiple gestations; molar pregnancy; renal dis. (from SLE or DM1); family History; chronic HTN
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Q268. Mild Preeclampsia - History/PE
|
A268. Often asymp; BP > 140/90 on 2 occasions, > 6 hrs. apart; proteinuria; nondependent edema
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|
Q269. Mild Preeclampsia - Dx
|
A269. UA; 24-hour urine protein; CBC; electrolytes; BUN/Cr; uric acid; measure fetal age; amniocentesis - lung maturity; LFTs; PT/PTT; fibrinogen and FSP; urine tox screen; US; NST/CST/BPP - as needed
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Q270. Mild Preeclampsia - Tx
|
A270. Only cure - delivery; induce - IV oxytocin, prostaglandins or amniotomy based on mom and fetus; if far from term - bed rest, expectant management
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Q271. Severe Preeclampsia - History/PE
|
A271. Based on Sxs, organ damage, fetal growth restriction; BP > 160/110 on 2 occasions, > 6 hrs. apart; proteinuria; HELLP syndrome; RUQ/epigastric pain; oliguria; pulmonary edema/cyanosis; cerebral changes; visual changes; hyperactive reflexes; oligohydramnios or IUGR
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|
Q272. Severe Preeclampsia - Dx
|
A272. UA; 24-hour urine protein; CBC; electrolytes; BUN/Cr; uric acid; measure fetal age; amniocentesis - lung maturity; LFTs; PT/PTT; fibrinogen and FSP; urine tox screen; US; NST/CST/BPP - as needed
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Q273. Severe Preeclampsia - Tx
|
A273. Only cure - delivery; control BP – Hydralazine, labetalol, MgSO4 - prevent Seizures, postpartum - MGSO4 - 1st 24 hrs. monitor for Mg2+ toxicity: loss of DTRs, respiratory paralysis, coma, Tx with IV Ca2+ gluconate
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Q274. Preeclampsia - Complications
|
A274. Prematurity; fetal distress; stillbirth; placental abruption; seizure; DIC; cerebral hemorrhage; serous retinal detachment; fetal/maternal death
|
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Q275. Eclampsia - What is it
|
A275. Seizures in patients with preeclampsia; antepartum, intra or post; if post - MC within 48 hrs.
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Q276. Eclampsia - History/PE
|
A276. MC Sxs before attack - headache; visual changes; RUQ/epigastric pain; Seizures severe if not controlled; with anticonvulsant therapy
|
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Q277. Eclampsia - Dx
|
A277. UA; 24-hour urine protein; CBC; electrolytes; BUN/Cr; uric acid; measure fetal age; amniocentesis - lung maturity; LFTs; PT/PTT; fibrinogen and FSP; urine tox screen; US; NST/CST/BPP - as needed
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Q278. Eclampsia - Tx
|
A278. Monitor ABCs, O2; control seizures - MgSO4, consider IV diazepam; control BP – Hydralazine, labetalol; limit fluids: foley catheter- monitor I/Os; monitor Mg2+ level, Mg2+ toxicity; monitor fetal status; postpartum - MgSO4 - 1st 24 hrs; monitor for Mg2+ toxicity: loss of DTRs, respiratory paralysis, coma, Tx with IV Ca2+ gluconate
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Q279. Eclampsia - Complications
|
A279. Cerebral hemorrhage; aspiration pneumonia; hypoxic encephalopathy; thromboembolic events; fetal/maternal death
|
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Q280. Alcohol - Teratogenic Effect
|
A280. Fetal alcohol syndrome; microcephaly; midfacial hypoplasia; MR; IUGR; cardiac defects
|
|
Q281. Cocaine - Teratogenic Effect
|
A281. Bowel atresia; IUGR; microcephaly
|
|
Q282. Streptomycin - Teratogenic Effect
|
A282. CN8 damage; ototoxicity
|
|
Q283. Tetracycline - Teratogenic Effect
|
A283. Tooth discoloration; bone growth inhib; small limbs; syndactyly
|
|
Q284. Sulfonamides - Teratogenic Effect
|
A284. Kernicterus
|
|
Q285. Quinolones - Teratogenic Effect
|
A285. Cartilage damage
|
|
Q286. Isotretinoin - Teratogenic Effect
|
A286. Heart and great vessel defects; craniofacial dysmorphism; deafness
|
|
Q287. Iodide - Teratogenic Effect
|
A287. Congenital goiter; hypothyroidism; MR
|
|
Q288. Methotrexate - Teratogenic Effect
|
A288. CNS malformations; craniofacial dysmorphism; IUGR
|
|
Q289. DES (Diethylstilbestrol) - Teratogenic Effect
|
A289. Clear cell adenocarcinoma of vagina/cervix; genital tract abnorm; cervical incompetence
|
|
Q290. Thalidomide - Teratogenic Effect
|
A290. Limb reduction (phocomelia); ear and nasal anomalies; cardiac and lung defects; pyloric stenosis; duodenal stenosis; GI atresia
|
|
Q291. Coumadin - Teratogenic Effect
|
A291. Stippling of bone epiphyses; IUGR; nasal hypoplasia; MR
|
|
Q292. ACEIs - Teratogenic Effect
|
A292. Oligohydramnios; fetal renal damage
|
|
Q293. Lithium - Teratogenic Effect
|
A293. Ebstein's anomaly; other cardiac diseases
|
|
Q294. Carbamazepine - Teratogenic Effect
|
A294. Fingernail hypoplasia; IUGR; microcephaly; neural tube defects
|
|
Q295. Phenytoin - Teratogenic Effect
|
A295. Nail hypoplasia; IUGR; MR; craniofacial dysmorphism; microcephaly
|
|
Q296. Valproic Acid - Teratogenic Effect
|
A296. Neural tube defects; craniofacial defects; skeletal defects
|
|
Q297. HELLP Syndrome - What is it
|
A297. Variant of pre-eclampsia; Hemolytic anemia; Elevated Liver enzymes; Low Platelet count
|
|
Q298. Physio Changes in Pregnancy - CV
|
A298. Increased HR x increased SV = increased CO; CO lowest - supine; CO highest - lt. lateral position; sys vascular resistance - decreased; normal - systolic murmur, S3; abnorm - new diastolic murmur; CVP unchanged; FVP increases; BP - decreased in 1st trimester, diastolic more than systolic, nadir at 24 weeks, increased thereafter, but never to baseline; uterus displaces heart up & Left => looks like cardiomeg on CXR
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Q299. Physio Changes in Pregnancy - Cervix
|
A299. Softens and cyanosis ~ 4 weeks; "bloody show" - at or near labor; cervical mucus looks granular on slide
|
|
Q300. Physio Changes in Pregnancy - Endocrine
|
A300. Increased thyroid blood flow => thyroid increased in size; increased - TBG; increased bound T3 & T4, and total; unchanged - free T4; increased - total & free cortisol; adrenal gland unchanged in size; HPL - maintains fetal glucose levels => prolonged postprandial hyperglycemia, fasting hyperinsulinemia,; fasting Hypertriglyceridemia, exaggerated starvation ketosis
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|
Q301. Physio Changes in Pregnancy - GI
|
A301. N/V resolves by 14-16 weeks; increased acid reflux; aspiration; constipation; predisposed to gallstones
|
|
Q302. Physio Changes in Pregnancy - Hematology
|
A302. "physiologic anemia" - increased plasma vol (50%) & RBC mass (30%) => decreased H&H => normal pregnancy Hb is 10-12; WBC increased; ESR increased; platelets unchanged; hypercoagulable state; increased factors 7, 9, 10 & C; MC nonobstetric cause of postpartum death - thromboembolic disease
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Q303. Physio Changes in Pregnancy - Musculoskeletal
|
A303. Increased motility – sacroiliac, sacrococcygeal, pubic joints
|
|
Q304. Physio Changes in Pregnancy - Pulmonary
|
A304. TV - increased; RR unchanged; TV x RR = VE (min. ventilation) so, VE increased; decreased - RV (IRV, ERV, TLC); increased - alveolar & arterial PO2; decreased - alveolar & arterial PCO2; so, resp. alkalosis => increased renal loss of bicarb => alkaline urine; "dyspnea of pregnancy" - from increased VE and decreased PCO2
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Q305. Physio Changes in Pregnancy - Renal
|
A305. Increased renal blood flow => kidneys increased in size (until 3 mos. postpartum); ureters - diameter increased, right > left (due to progesterone); dilation of collecting system, can be mistaken for hydronephrosis; increased - GFR (by 50%), renal plasma flow, Cr clearance, aldosterone, all leads to - decreased BUN, Cr, uric acid; urine glucose increased because reabsorb threshhold decreased
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Q306. Physio Changes in Pregnancy - Skin
|
A306. striae – abdomen, breast, thighs; spider angiomas; palmar erythema; hyperpigmentation - linea nigra – midline, chloasma – face, perineum; diastasis recti
|
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Q307. Physio Changes in Pregnancy - Uterus
|
A307. 12 weeks, uterus - contracts anterior abdo wall, displaces intestines, felt above symphysis pubis; Braxton Hicks - irreg painless contractions throughout pregnancy => freq., rhythmic in 3rd trimester (false labor)
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|
Q308. Physio Changes in Pregnancy - Vagina
|
A308. Thick, acidic secretions; Chadwick's sign
|
|
Q309. Prenatal Care and Nutrition - Estimated Delivery Date; Gestational Age
|
A309. Nagele's rule - EDD; 1st day of LMP + 9 mos.+7 days; GA determined by - uterine size; heart tones (10 weeks); quickening (17-18 weeks); US - crown rump (5-12 weeks); biparietal diameter (20-30weeks)
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Q310. Prenatal Care and Nutrition - Weight Gain
|
A310. gain 25-35 lbs. obese to gain less; thin women to gain more; need 2,000-2,500 kcal/day; need additional - 300 kcal/day during pregnancy; 500 kcal/day in breastfeeding
|
|
Q311. Prenatal Care and Nutrition - Nutrition
|
A311. Prenatal vitamins; 1 mg/day of folate; 30-60 mg/day of elemental iron
|
|
Q312. Prenatal Labs - Initial Visit
|
A312. CBC; UA/UC; pap smear; blood type, Rh; Ab screen; rubella Ab titer; HBV surface Ag test; syphilis screen - RPR, VDRL; cervical gonorrhea and; chlamydia cultures; PPD; glucose testing; sickle prep; HIV
|
|
Q313. Prenatal Labs - 15-19 weeks
|
A313. Maternal serum AFP (MSAFP) or triple screen - MSAFP, estriol, B-hCG; offer amniocentesis if >35 y/o
|
|
Q314. Prenatal Labs - 18-20 weeks
|
A314. US - GA (if needed); fetal anatomy; amniotic fluid volume; placental location
|
|
Q315. Prenatal Labs - 26-28 weeks
|
A315. Glucose loading test (GLT); HCT
|
|
Q316. Prenatal Labs - 28 weeks
|
A316. Rhogam (if needed)
|
|
Q317. Prenatal Labs - 32-36 weeks
|
A317. HCT; screen for GBS - if positive - PCN during labor; cervical chlamydia and gonorrhea cultures if need
|
|
Q318. AFP - How to measure
|
A318. MSAFP at 15-20 weeks; results reported as - MoMs (multiples of the median)
|
|
Q319. AFP - What does elevated MSAFP mean
|
A319. > 2.5 MoMs: gastroschisis, omphalocele, multiple gestation, incorrect gestational dating, fetal death, placental abnorm – abruptio, open neural tube defects – anencephaly, spina bifida; MCC of high - date is wrong, if high - get US (check date); if true age more than thought - why "high" value, if still 15- 20 weeks, repeat MS-AFP; if date is right and no explanation on US - amnio for AF-AFP & acetylcholinesterase; high levels - open NTD; normal levels - still at risk for: IUGR, stillbirth, preeclampsia
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|
Q320. AFP - Abnormally low MSAFP means
|
A320. < 0.85 MoM; MCC of low - date is wrong, check date - get triple marker screen; if not available - then get US; if true age less than thought - why "low" value, if still 15-20 weeks, repeat MS-AFP; if date is right and no explanation on US - amnio for karyotype; sensitivity to detect chromosome abnorm increased by triple screen; trisomy 18 - all 3 are low; trisomy 21 - AFP and estriol low, B-hCG high
|
|
Q321. Amniocentesis - When done; Risks; Why done
|
A321. 15-17 weeks; US-guided needle; risks - fetal-maternal hemorrhage; fetal loss; why done - > 35 y/o at time of delivery; Rh-sensitized pregnancy; evaluate fetal lung maturity in conjunction with abnorm triple screen
|
|
Q322. Chorionic Villus Sampling - What is it; Advantages; Risks
|
A322. Transvaginal or transabdom aspiration; advantages - as accurate as amniocentesis; available 10-12 weeks (amniocentesis - 15-17 weeks) Risks; fetal loss 1%; can't Dx neural tube defects; if do < 9 weeks - association with limb defects
|
|
Q323. Percutaneous Umbilical; Blood Sampling (PUBS) - What is it
|
A323. Done in 2nd & 3rd trimesters; fetal karyotyping; fetal infection; evaluate genetic diseases; evaluate fetal acid-base status; assess & Tx Rh isoimmunization; erythroblastosis fetalis
|
|
Q324. Labor - First Stage
|
A324. Latent - from onset of labor to 3-4 cm dilation; active - from 4 cm to complete cervical dilation (10 cm); prolonged with cephalopelvic disproportion
|
|
Q325. Labor - Second Stage
|
A325. From complete cervical dilation to delivery
|
|
Q326. Labor - Third Stage
|
A326. From delivery of infant to delivery of placenta; uterus contracts to establish hemostasis
|
|
Q327. Nonstress Test (NST) - What is it
|
A327. Left lateral supine, FHR - monitored by Doppler, correlate with spontaneous fetal movement as reported by mom, unrelated to contractions; normal - accelerate 15 bpm above baseline for 15 seconds; reactive test - 2 accelerations in 20 mins. repeat weekly; nonreactive - 80% false positive, do vibroacoustic stimulation. if persistently nonreactive, do BPP; no accelerations can be due to: GA < 30 weeks, fetal sleeping, fetal CNS anomalies, moms' sedative admin, fetal hypoxia
|
|
Q328. Contraction Stress Test (CST)- What is it
|
A328. Used in high-risk pregnancies; assess uteroplacental dysfunction; monitor FHR during contraction; positive - repetitive late decelerations during at least 3 contractions in 10 mins. > 36 weeks - deliver; < 36 weeks - do BPP, negative - no late decelerations, fetus well, repeat weekly
|
|
Q329. Vasa Previa - What is it; Risk Factors
|
A329. Fetal vessels cross internal os; if they rupture - exsanguinate very fast => fetal death Risk factors:; accessory placental lobes; multiple gestation; velamentous insertion of umbilical cord
|
|
Q330. Vasa Previa - History/PE
|
A330. Classic triad - ROM; painless vaginal bleeding, then fetal bradycardia
|
|
Q331. Vasa Previa - Dx
|
A331. Antenatal US with color Doppler; confirm - after delivery; exam of placenta & fetal vessels; rarely confirm before delivery
|
|
Q332. Vasa Previa - Tx
|
A332. Immediate C-section
|
|
Q333. Uterine Rupture - What is it; Risk Factors
|
A333. Complete separation of wall of uterus with or without expulsion of fetus; complete or incomplete rupture before or during labor Risk factors:; previous classic uterine incision; myomectomy; excessive oxytocin stimulation; grand multiparity; marked uterine distention
|
|
Q334. Uterine Rupture - History/PE
|
A334. Nonreassuring fetal monitoring; vaginal bleeding; abdom pain; change in uterine contractility
|
|
Q335. Uterine Rupture - Dx
|
A335. Surgical exploration of uterus
|
|
Q336. Uterine Rupture - Tx
|
A336. Immediate C-section; uterine repair - stable, young; hysterectomy - unstable or no desire for more kids
|
|
Q337. Multiple Gestation - Complications
|
A337. Nutritional anemia; preeclampsia; preterm labor; malpresentation; C-section; postpartum hemorrhage
|
|
Q338. Multiple Gestation - History/PE
|
A338. Hyperemesis gravidarum - more common; from high levels of B-hCG; uterus larger than dates; MS-AFP very high
|
|
Q339. Multiple Gestation - Tx:; Antepartum; Intrapartum; Postpartum
|
A339. Antepartum - iron and folate, monitor BP, serial US; intrapartum - vaginal - if both cephalic, C-section - if 1st noncephalic, controversial - if 1st cephalic and 2nd not; postpartum - watch for postpartum hemorrhage from uterine atony (due to overextended uterus)
|
|
Q340. A pt on birth control has amenorrhea, what is the most common cause?
|
A340. Pregnancy, no contraception is 100%
|
|
Q341. Si/sx of pregnancy
|
A341. amenorrhea,; morning sickness,; weight gain,; linea nigra,; melasma,; fetal heart tones,
|
|
Q342. Hegar's sign
|
A342. softening and compressibility of the lower uterine segment
|
|
Q343. Chadwick's sign
|
A343. dark discoloration of the vulva and vaginal walls
|
|
Q344. Define macrosomia
|
A344. a newborn that weighs more than 4 kg (9 lbs), usually because of maternal diabetes
|
|
Q345. It's the first prenatal visit. What do you order?
|
A345. Pap smear,; UA,; CBC,; type and screen,; syphilis,; rubella,; glucose if risk factors present,; GC and chlamydia for every teenager and patient with risk factors
|
|
Q346. When do you screen for maternal diabetes?
|
A346. At the first visit if risk factors present. If not, screen at 24-28 weeks.
|
|
Q347. How do you screen for maternal diabetes?
|
A347. Get a fasting serum glucose and glucose levels 1-2 hours after an oral glucose load.
|
|
Q348. When do you do a triple screen?
|
A348. 16-20 weeks
|
|
Q349. How does Down Syndrome present on triple screen?
|
A349. low AFP,; low estriol,; high hCG
|
|
Q350. When can fetal heart tones be picked up by doppler?
|
A350. 10-12 weeks
|
|
Q351. When can fetal heart tones be picked up by stethescope?
|
A351. 16-20 weeks
|
|
Q352. When does the uterus reach the umbilicus?
|
A352. 20 weeks
|
|
Q353. When is ultrasound the most accurate in estimating the fetal age?
|
A353. At 16-20 weeks
|
|
Q354. What is a hydatiform mole?
|
A354. It's when the products of conception basically become a tumor.
|
|
Q355. Sx of a hydatiform mole?
|
A355. Preeclampsia before third trimester,; hCG that does not return to zero after delivery (or abortion or miscarriage) or one that rises rapidly during pregnancy,; 1st or 2nd trimester bleeding with possible expulsion of "grapes,"; excessive nausea/vomiting,; uterine size/date discrepancy,; "snow storm" appearance on ultrasound
|
|
Q356. Define complete mole
|
A356. comes "completely" from the father,; karyotype is 46XX, no fetal tissue
|
|
Q357. Define incomplete mole
|
A357. karyotype 69XXY,; fetal tissue present
|
|
Q358. Tx of hydatiform moles
|
A358. dilation and curettage,; hollow with serial measurements of hCG until they go to zero,
|
|
Q359. What if a pt is treated for hydatiform mole, and their hCG doesn't go to zero?
|
A359. They have an invasive mole or choriocarcinoma. They need chemotherapy.
|
|
Q360. What is a choriocarcinoma?
|
A360. An aggressive form of mole
|
|
Q361. What chemo agents are used for moles?
|
A361. Methotrexate and actinomycin D
|
|
Q362. Define IUGR
|
A362. fetal size below the tenth percentile for age.
|
|
Q363. Three type of causes of IUGR
|
A363. Maternal (smoking, alcohol, drugs, lupus),; Fetal (TORCH infections, congenital anomalies),; and Placental (HTN, preeclampsia)
|
|
Q364. When do you order a fetal ultrasound?
|
A364. size/date discrepancy,; risk factors for IUGR,; problems with previous pregnancies,; fetal death,; distress,; suspected abortion
|
|
Q365. What is a non-stress test?
|
A365. Done while mother is at rest, tracing of fetal heart tones is obtained for 20 minutes
|
|
Q366. What is a normal non-stress test?
|
A366. A normal strip has at least 2 accelerations of fetal heart rate,; each at 15 beats above baseline,; lasting at least 15 seconds.
|
|
Q367. How do you do a biophysical profile?
|
A367. it includes a non-stress test, and ultrasound measurement of amniotic fluid, fetal breathing movements, and general fetal movements
|
|
Q368. What do you do if a fetus scores poorly on BPP?
|
A368. The next test is the contraction stress test
|
|
Q369. What is a contraction stress test?
|
A369. It measures uteroplacental dysfunction. oxytocin is given and a fetal heart strip is monitored. If late decelerations are seen with each contraction, a c- section is usually performed
|
|
Q370. Would you do a BPP in a high risk pregnancy without obvious problems?
|
A370. yes, if worried, do a BPP once-twice a week at the start of the third trimester
|
|
Q371. Do you use aspirin in pregnancy?
|
A371. no, use tylenol, but there is an important exception-in patients with antiphospholipid syndrome, in whom aspirin may improve pregnancy outcome.
|
|
Q372. Define post-term pregnancy
|
A372. more than 42 weeks gestation
|
|
Q373. Why is morbidity and mortality increased in post-term pregnancies?
|
A373. Shoulder dystocia and difficult deliveries are increased
|
|
Q374. What do you do for post-term patients?
|
A374. Induce labor if cervix is favorable. If it's not favorable, do biweekly BPPs until 43 weeks, then induce.
|
|
Q375. What disorders are associated with prolonged gestation?
|
A375. anencephaly and placental sulfatase deficiency
|
|
Q376. Describe some normal changes in pregnant patients
|
A376. Nausea, vomiting,; heavy painful breasts,; increased pigment in nipples, backache, linea nigra, melasma,; striae gravidarum,; ankle edema,; heartburn,; increasing urination frequency
|
|
Q377. Causes of low AFP
|
A377. Down syndrome,; fetal demise,; inaccurate dates
|
|
Q378. Causes of high AFP
|
A378. neural tube defects,; ventral wall defects,; multiple gestation,; inaccurate dates
|
|
Q379. What do you do with an abnormal AFP or triple screen?
|
A379. First, do ultrasound, then amniocentesis is needed for definitive diagnosis.
|
|
Q380. When do you offer chorionic villous sampling?
|
A380. at 9-12 weeks
|
|
Q381. Why is chorionic villous sampling done?
|
A381. Because it offers the chance for first trimester abortion.
|
|
Q382. Can chorionic villous sampling detect neural tube defects?
|
A382. Nope, only genetic or chromosomal defects
|
|
Q383. What kind of birth defects are caused by thalidomide?
|
A383. Phocomelia--limbs are missing with hands and feet attached directly to torso
|
|
Q384. What kind of birth defects are caused by tetracycline?
|
A384. yellow or brown teeth
|
|
Q385. What kind of birth defects are caused by aminoglycosides?
|
A385. deafness
|
|
Q386. What kind of birth defects are caused by valproic acid?
|
A386. spina bifida,; hypospadias
|
|
Q387. What kind of birth defects are caused by progesterone?
|
A387. masculinization of female fetus
|
|
Q388. What kind of birth defects are caused by cigarettes?
|
A388. IUGR,; low birth weight,; prematurity
|
|
Q389. What kind of birth defects are caused by OCPs?
|
A389. VACTERL syndrome
|
|
Q390. What is VACTERL syndrome?
|
A390. Vertebral, Anal, Cardiac, TracheoEsophaeal, Renal, and Limb malformations
|
|
Q391. What kind of birth defects are caused by Lithium?
|
A391. Ebstein's cardiac anomaly
|
|
Q392. What kind of birth defects are caused by radiation?
|
A392. IUGR,; CNS defects,; eye defects,; leukemia
|
|
Q393. What kind of birth defects are caused by alcohol?
|
A393. Fetal alcohol syndrome
|
|
Q394. What kind of birth defects are caused by phenytoin?
|
A394. craniofacial, limb, and cerebrovascular defects,; mental retardation
|
|
Q395. What kind of birth defects are caused by warfarin?
|
A395. craniofacial defects,; IUGR,; CNS malformations,; stillbirth
|
|
Q396. What kind of birth defects are caused by carbamazepine?
|
A396. fingernail hypoplasia,; craniofacial defects
|
|
Q397. What kind of birth defects are caused by isotretinoin?
|
A397. CNS, craniofacial, ear, and cardiovascular defects
|
|
Q398. What kind of birth defects are caused by iodine?
|
A398. Goiter,; cretinism
|
|
Q399. What kind of birth defects are caused by cocaine?
|
A399. cerebral infarcts, mental retardation
|
|
Q400. What kind of birth defects are caused by diazepam?
|
A400. cleft lip and/or palate
|
|
Q401. What kind of birth defects are caused by diethylstilbestrol?
|
A401. clear cell vaginal cancer,; adenosis,; cervical incompetence
|
|
Q402. What kind of birth defects are caused by maternal diabetes?
|
A402. cardiovascular malformations,; cleft lip and/or palate,; caudal regression,; neural tube defects,; left colon hypoplasia/immaturity,; macrosomia,; microsomia (if mother has long-standing DM),
|
|
Q403. What kinds of problems do infants born to diabetic mothers have after birth?
|
A403. increased risk of respiratory distress syndrome,; postdelivery hypoglycemia,
|
|
Q404. How do you treat diabetes during pregnancy?
|
A404. insulin (after diet and exercise),; DON'T use oral hypoglycemics because they cross the placenta and cause fetal hypoglycemia
|
|
Q405. What drugs are safe during pregnancy?
|
A405. acetaminophen,; penicillin,; cephalosporins,; erythromycin,; nitrofurantoin,; H2 blockers,; antacids,; heparin,; hydralazine,; methyldopa,; labetolol,; insulin,; docusate
|
|
Q406. What does TORCH stand for?
|
A406. Toxoplasma,; Other,; Rubella,; Cytomegalovirus,; Herpes
|
|
Q407. risk factors for toxoplasma?
|
A407. exposure to cats
|
|
Q408. What kind of birth defects are caused by toxoplasma?
|
A408. intracranial calcifications,; chorioretinitis
|
|
Q409. What kind of birth defects are caused by varicella-zoster?
|
A409. limb hypoplasia,; scarring of the skin
|
|
Q410. What kind of birth defects are caused by syphilis?
|
A410. rhinitis,; saber shins,; Hutchinson's teeth,; interstitial keratitis,; skin lesions
|
|
Q411. What kind of birth defects are caused by rubella?
|
A411. effects are worse in the first trimester,; cardiovascular defects,; deafness,; cataracts,; microphthalmia
|
|
Q412. What kind of birth defects are caused by cytomegalovirus?
|
A412. deafness,; cerebral calcifications,; microphthalmia
|
|
Q413. What kind of birth defects are caused by herpes?
|
A413. vesicular lesions,; encephalitis,; early fusion of cranial bones,; seizures
|
|
Q414. What percent of fetuses are infected with HIV from their mothers if the mothers do not receive treatment?
|
A414. 0.25
|
|
Q415. How do you treat HIV in pregnant women?
|
A415. zidovudine (AZT) is given to the mother prenatally, and it's given to the infant for 6 weeks afer birth
|
|
Q416. What percent of fetuses are infected with HIV from their mothers if the mothers receive treatment?
|
A416. 0.08
|
|
Q417. When do you test an infant for HIV antibodies?
|
A417. between 6-18 months of age;; Abs tests will be positive at birth because maternal antibodies cross the placenta
|
|
Q418. How do you test newborns for HIV?
|
A418. HIV PCR, with follow up at 18 months with antibody test
|
|
Q419. can breastmilk transmit HIV?
|
A419. yes
|
|
Q420. What do you do if a woman has active visible genital herpes lesions during labor?
|
A420. do a c-section
|
|
Q421. What do you do if a woman has a history of genital herpes and goes into labor, and there's no visible lesions?
|
A421. proceed with vaginal birth
|
|
Q422. What do you do if a laboring mother has chronic hepatitis B?
|
A422. give infant the first hep B vaccine and hepB immunoglobulin at birth.
|
|
Q423. What do you do if a mother contracts chickenpox late in pregnancy?
|
A423. give the infant varicella-zoster immunoglobulin
|
|
Q424. How do you treat GC/chlamydia during pregnancy?
|
A424. ceftriaxone and erythromycin or azithromycin
|
|
Q425. How do you treat TB during pregnancy?
|
A425. same as in non-pregnant women. BUT don't use streptomycin (it's rarely use anyway). Make sure to give vitamin B6 with isoniazid.
|
|
Q426. How do you know if the placenta has separated during the third phase of delivery?
|
A426. there is a fresh gush of blood, lengthening of the umbilical cord, and a rising fundus that is firm and globular
|
|
Q427. If a pt has had a c-section, can they have a vaginal delivery during the next pregnancies?
|
A427. Maybe. If they have a vertical uterine incision, they have to have a repeat c-section. If they have a horizontal incision, they may deliver vaginally with only a slightly increased risk of uterine rupture.
|
|
Q428. 4 signs of placental separation
|
A428. 1. gush of blood - coincides with placenta separating from uterus; 2. cord lengthening - placenta has dropped to lower portion of the uterus; 3. globular uterus; 4. uterus ascends to anterior abdominal wall
|
|
Q429. what can cause uterine inversion; complication from inversion
|
A429. if cord doesn't separate from uterus and excessive force is used to cause the separation --> uterine inversion; massive hemorrhage
|
|
Q430. appearance of uterine inversion
|
A430. shaggy mass, red and bulging
|
|
Q431. definition of abnormally retained placenta; tx
|
A431. labor of placenta exceeds 30 mins; try manual extraction
|
|
Q432. risk factors for uterine inversion
|
A432. grand-multip; placental implantation in fundus
|
|
Q433. tx of uterine inversion
|
A433. halothane, terbutiline, and MgSO4 to cause uterine relaxation; emergent surgery
|
|
Q434. what is protective of uterine inversion
|
A434. attenuated umbilical cord: it will separate easily and cause cord severing
|
|
Q435. definition of premature ovarian failure
|
A435. cessation of ovulation younger than 40 yo
|
|
Q436. what causes ovarian failure in turner's syndrome
|
A436. ovarian failure
|
|
Q437. relationship between TSH and PRL and menstrual cycle
|
A437. low TSH and high PRL both inhibit GnRH pulsations --> FSH/LH inhibition
|
|
Q438. sx of TSS
|
A438. myalgias; n/v; hypotension; confusion; sunburn-like rash --> maculopapular rash --> desquamation with palm/sole involvement (by 10th day) --> increased serum bilirubin
|
|
Q439. what MAP is required to perfuse vital organs
|
A439. 65 mmhg
|
|
Q440. what is the organism in TSS; best way to culture it
|
A440. staph; exotoxin-1 enters body; vaginal culture
|
|
Q441. tx of TSS
|
A441. iv nafcillin or methicillin + amnioglycosides
|
|
Q442. definition of latent labor
|
A442. cervix mainly effaces and cervical dilation
|
|
Q443. time limit of latent labor
|
A443. <18-20 hrs in prime; <14 hrs in multip
|
|
Q444. arrest of active labor
|
A444. no cervical change during 2h of active labor
|
|
Q445. protracted active labor
|
A445. decreased cervical change over 2 hrs
|
|
Q446. causes of prolonged latent phase
|
A446. decreased power, pelvis, or passenger
|
|
Q447. definition of clinically adequate CTX
|
A447. q2-3 mins; firm abdomen 40-60 s; OR >200 montevideo units over 10 mins
|
|
Q448. bloody show
|
A448. loss of cervical mucous plug; sign of impending labor
|
|
Q449. 1st thing to consider in a woman with lower abdominal pain and vaginal spotting
|
A449. ectopic pregnancy, until proven otherwise
|
|
Q450. progesterone levels for nml uterine pregnancy; progesterone levels for nonviable pregnancy
|
A450. >25; <5
|
|
Q451. if non-viable pregnancy is dx, what is next step to determine etiology
|
A451. d&c to assess miscarriage (will see chorionic villi) or ectopic pregnancy (will see no villi)
|
|
Q452. when should MTX be given to tx miscarriage
|
A452. if patients are asymptomatic and fetus is <3.5 cm
|
|
Q453. what is cutoff in weeks for a pregnancy loss to be considered a spontaneous abortion
|
A453. 20w weeks
|
|
Q454. definition of PPROM
|
A454. rom prior to onset of labor <37 weeks; 50% will labor within 48 hrs and 90% w/i 1 week
|
|
Q455. sx of chorioamnionitis
|
A455. maternal fever, tachycardia, uterine tenderness, and malodorous d/c; fetal tachycardia >160 is also an early sign
|
|
Q456. tx of PPROM
|
A456. if <32 weeks, steroids and broad-spectrum antibiotics
|
|
Q457. dx of chorioamnionitis
|
A457. see gm stained bacteria on amniocentesis
|
|
Q458. time-frame of pre-term labor
|
A458. 20-37 weeks
|
|
Q459. complication of vbac
|
A459. uterine rupture
|
|
Q460. how to manage arrest of active phase of labor
|
A460. if CTX are not strong enough, give pit, then place IUCP if there is still no dilation
|
|
Q461. what things are included in the bishop score
|
A461. dilation; effacement; station; consistency; cervical position
|
|
Q462. what bishop score is favorable for induction
|
A462. >8
|
|
Q463. what are the cardinal movements of labor
|
A463. engagement (oociput transverse); internal rotation (to occiput anterior); complete rotation; extension of neck; external rotation; anterior shoulder; posterior shoulder
|
|
Q464. what is the most common type of breech presentation
|
A464. frank breech
|
|
Q465. what are the 3 types of breech and how do they differ
|
A465. frank: flexed hips with knees extended, feet are under fetal head; footling: one or both hips not flexed and foot or knee is in birth canal; complete: flexed hips and knees, with 1 foot near the breech
|
|
Q466. when can external version of breech be performed
|
A466. after 37 weeks b/c of risk of abruption or ROM secondary to external maneuvering
|
|
Q467. #1 cause of post-partum hemorrhage
|
A467. uterine atony
|
|
Q468. definition of post-partum hemorrhage
|
A468. >500 cc blood loss after vaginal birth; >1000 cc blood loss after c/s
|
|
Q469. orgs involved in endometritis
|
A469. anaerobes and aerobes
|
|
Q470. why is bromocriptine no longer given to prevent galactorrhea post-partum
|
A470. seizure and HTN can result (uncommonly)
|
|
Q471. what causes prolonged fetal tachycardia
|
A471. maternal fever; chorioamnionitis
|
|
Q472. cause of early decelerations; morphology
|
A472. head compression during CTX; mirror images of CTX tracing
|
|
Q473. cause of late decelerations
|
A473. placental insufficiency; chronic HTN; post-date pregnancy
|
|
Q474. causes of variable decelerations
|
A474. cord compression; cord around fetal parts; fetal anomalies; oligohydramnios
|
|
Q475. causes of sinusoidal FHT
|
A475. severe fetal anemia; maternal drugs
|
|
Q476. causes of prolonged bradycardia in FHT
|
A476. uterine hyperstimulation
|
|
Q477. when is an amnioinfusion performed
|
A477. to tx variable decelerations or meconium stained amniotic fluid
|
|
Q478. which PG is contraindicated in asthma
|
A478. PGF2
|
|
Q479. what is used to decrease uterine bleeding post-partum
|
A479. ergots; oxytocin; PGs
|
|
Q480. which 2 placental problems often go together
|
A480. accreta and previa
|
|
Q481. what effect does pregnancy have on peptid ulcer disease; on ms
|
A481. makes both of them better
|
|
Q482. dx of endometriosis
|
A482. laparoscopy
|
|
Q483. management of placental abruption in setting of painful bleeding in 3rd trimester
|
A483. can progress rapidly so pt should be carefully monitored; ensure rapid vaginal delivery; c/s only if there is rapid deterioration in early stages of labor
|
|
Q484. when is rhogam given
|
A484. at 28 weeks
|
|
Q485. after 1h gtt, what is the threshold for gdm
|
A485. >140
|
|
Q486. after the 3hr gtt what is the threshold for gdm
|
A486. at 1h >180; at 2h >155; at 3h >140
|
|
Q487. what can be done to decrease utis in sexually active women
|
A487. void after sex
|
|
Q488. what is the most common genetic mutation associated with ovarian ca
|
A488. p53 (much more common than brca)
|
|
Q489. consistency of granulosa theca cells
|
A489. solid
|
|
Q490. appearance of a serous cystadenoma
|
A490. larger than a functional cyst; pt has increased abdominal girth
|
|
Q491. what determines prognosis in ca
|
A491. tumor stage
|
|
Q492. standard of care for advanced ovarian ca in a pt s/p oopherectomy and surgical staging
|
A492. post-op chemo
|
|
Q493. definition of anemia in pregnancy; most common cause
|
A493. hb <10.5; Fe deficiency
|
|
Q494. tx of hellp
|
A494. delivery
|
|
Q495. what happens to haptoglobin lvls in hemolysis
|
A495. they decrease b/c they are bound by hb
|
|
Q496. side effects of MgSO4
|
A496. decreased DTR; pulmonary edema; respiratory depression
|
|
Q497. when should antenatal steroids be given in ptl
|
A497. between 24-34 weeks, after that not needed
|
|
Q498. should tocolysis be given to patients with suspected abruption
|
A498. no they should be delivered, b/c if tocolysis is used the abruption can continue
|
|
Q499. what effect do b-agonists have on K
|
A499. hypokalemia
|
|
Q500. complication of pyelonephritis in pregnancy
|
A500. 2-5% --> ARDs (usually endotoxin related)
|
|
Q501. what is the most common reason for septic shock in pregnancy
|
A501. pyelo
|
|
Q502. how is incidence of pyelo reduced
|
A502. at 1st pnv urine culture is done to id asx bacteriuria
|
|
Q503. tx of dvt in pregnancy
|
A503. heparin x 5-7 days then subq heparin to keep ptt 1.5-2.5 x nml limit x 3 mo
|
|
Q504. stages of pelvic relaxation
|
A504. first degree:structure has descended into the upper 2/3 of the vagina; 2nd degree: structure descends into the introitus; 3rd degree: structure protrudes outside the vagina
|
|
Q505. stress incontinence
|
A505. urine loss with exertion ro straining; caused by pelvic relzxation and displacement of urethrovesical junction
|
|
Q506. urge incontinence
|
A506. detrusor instability; urine leakage is 2ndary to involuntary and uninhibited bladder contractions
|
|
Q507. total incontinence
|
A507. continuous urine leakage secondary to urinary fistulas (usually 2ndary to pelvic surgery or pelvic radiation)
|
|
Q508. overflow incontinence
|
A508. incomplete voiding; urinary retention and overdistension of the bladder
|
|
Q509. treatment of bv
|
A509. metronidazole
|
|
Q510. primary causes of third-trimester bleeding
|
A510. placental abruption and placenta previa
|
|
Q511. classic ultrasound and gross appearance of complete hydatiform mole
|
A511. snowstorm appearance on ultrasound;; cluster of grapes on physical exam
|
|
Q512. chromosomal pattern of a complete mole
|
A512. 46, XX
|
|
Q513. molar pregnancy containing fetal tissue
|
A513. partial mole
|
|
Q514. symptoms of placental abruption
|
A514. continuous, painful vaginal bleeding
|
|
Q515. symptoms of placental previa
|
A515. self-limited, painless vaginal bleeding
|
|
Q516. when should a vaginal exam be performed with a suspected placenta previa?
|
A516. never
|
|
Q517. antibiotics with teratogenic effects
|
A517. tetracycline,; fluoroquinolones,; aminoglycosides,; sulfonamides
|
|
Q518. shortest AP diameter of the pelvis
|
A518. obstetric conjugate: between the sacral promonotory and the midpoint of the line of the symphysis pubis
|
|
Q519. medication given to accelerate fetal lung maturity
|
A519. betamethasone or dexamethasone x 48 hours
|
|
Q520. the most common cause of postpartum hemorrhage
|
A520. uterine atony
|
|
Q521. treatment for postpartum hemorrhage
|
A521. uterine massage;; if that fails, give oxytocin
|
|
Q522. typical antibiotics for group B strep (GBS) prophylaxis
|
A522. IV penicillin or ampicillin
|
|
Q523. a patient fails to lactate after an emergency C-section with marked blood loss
|
A523. Sheehans syndrome; (postpartum pituitary necrosis)
|
|
Q524. uterine bleeding at 18 weeks gestation; no products expelled; membranes ruptured; cervical os open
|
A524. inevitable abortion
|
|
Q525. uterine bleeding at 18 weeks gestation; no products expelled; cervical os closed
|
A525. threatened abortion
|
|
Q526. what is the definition of pre-term labor?
|
A526. regular uterine contractions + concurrent cervical changes at <37 weeks gestation
|
|
Q527. Group-B strep prophylaxix
|
A527. penicillin or ampicillin
|
|
Q528. what defines a post-partum hemorrhage?
|
A528. >500mL with vaginal delivery or >1000mL with c-section
|
|
Q529. most common cause of post-partum hemorrhage
|
A529. uterine atony
|
|
Q530. treatment for uterine atony protocol
|
A530. 1. uterine massage; 2. oxytocin; 3. methergine; 4. prostin PGF2-alpha
|
|
Q531. when should the uterus be palpable above the pubic symphysis?
|
A531. 12 weeks
|
|
Q532. what does human placental lactogen do?
|
A532. insulin-antagonist to maintain fetal glucose levels
|
|
Q533. what is the cut-off for anemia in pregnancy?
|
A533. Hgb below 11.0mg/dL
|
|
Q534. what is the average WBC count during pregnancy? what about during labor?
|
A534. 10.5 during pregnancy, 20+ during labor
|
|
Q535. Definition:; child at fertilization to 8 weeks
|
A535. Embryo
|
|
Q536. Definition:; child at 8 weeks to delivery
|
A536. Fetus
|
|
Q537. Definition:; Softening and cyanosis of the cervix at or after 4 weeks
|
A537. Goodell's sign
|
|
Q538. Definition:; softening of the uterus (after 6 weeks)
|
A538. Ladin's sign
|
|
Q539. Definition:; first trimester
|
A539. fertilization to 12 weeks
|
|
Q540. Definition:; second trimester
|
A540. 12 weeks to 24 weeks
|
|
Q541. Definition:; third trimester
|
A541. 24 weeks to delivery
|
|
Q542. Definition:; child delivery less then 24 weeks
|
A542. Priviable
|
|
Q543. Definition:; Quickening
|
A543. Patient's initial presentation of fetal movement
|
|
Q544. what are the changes in CO, HR, SV, TPR and BP during pregnancy?
|
A544. Increased CO, HR, SV; Decreased TPR,; Decreased BP (returns to nml >24 weeks)
|
|
Q545. (4) Respiratory changes during pregnancy
|
A545. Increased Tidal volume,; Increased PaO2 and PAO2,; Decreased lung capacity,; Mild Respiratory Alkalosis
|
|
Q546. (3) GI changes during pregnancy
|
A546. Increased vomiting,; Decreased motility (constipation),; Prolonged gastric emptying (GERD)
|
|
Q547. (4) Renal changes during pregnancy
|
A547. Increased kidney size,; Increased GFR (by 50%) leading to... Decreased BUN and Creatinine by 25%,; Increased Renin, Aldosterone and Na absorption (balanced by Inc GFR)
|
|
Q548. (4) Blood changes during pregnancy
|
A548. Increased plasma volume (50%),; Increased RBC (20%),; both percents lead to Decreased Hct,; possibly causing Iron deficiency anemia,; Increased Fibrinogen and factors VII - X leading to... Increased Thromboembolism
|
|
Q549. what hormones are maintained by the placenta in pregnancy?; (4)
|
A549. Estrogen,; hCG,; hPL,; Progesterone (after initial maintenance from corpus luteum)
|
|
Q550. what causes increased Thyroid Binding Globulin?; how does this affect T3 and T4?
|
A550. Inc estrogen; T3 and T4 inc binding to TBG leading to low serum levels of free T3 and T4
|
|
Q551. what is the cause of gestational diabetes?; how?
|
A551. hPL; it is an insulin antagoinist (inc diabetic effect and leading to inc insulin and protein synthesis)
|
|
Q552. what is the adequate amount of nutrition needed in pregnancy?; breast feeding?
|
A552. Pregnancy: 300 kcal/day; Breast feeding: 500 kcal/day
|
|
Q553. how often should prenatal visits be?
|
A553. every 4 weeks until week 28; week 28 - 36: every 2 weeks,; 36 to term: every week
|
|
Q554. when is genetic screening done?; what are the (3) main tests?
|
A554. during second trimester (usu 15 - 20 weeks); MSAFP,; b-hCG,; Estriol
|
|
Q555. which germ cell ovarian tumor has a different treatment method then the others?; what is the Tx?
|
A555. Dysgerminoma; Tx: Radiation
|
|
Q556. what is tested in pregnancy b/t 27 and 29 weeks?; (3)
|
A556. Glucose Loading Test (for gestational diabetes),; Hematocrit (for iron levels),; Glucose Tolerance Test if GLT is positive
|
|
Q557. how is the Glucose Loading Test performed?; (2)
|
A557. give 50g oral glucose and check in one hour if > 140 mg/dL, then do GTT
|
|
Q558. How is a Glucose Tolerance Test performed?; What are the blood glucose values for fasting, one, two and three hour intervals?
|
A558. Fasting glucose: give 100 g oral glucose and test at 1, 2 and 3 hours; Gestational Diabetes = Fasting glucose > 105 mg/dL; or any two values over 180, 155 or 140 respectively
|
|
Q559. what can dehydration lead to later in pregnancy?
|
A559. Braxton-Hicks contractions
|
|
Q560. what causes edema of lower extremities, feet and ankles, and hemorrhoids in pregnancy?; Tx?
|
A560. Compression of IVC and pelvic veins; Tx: elevating feet
|
|
Q561. what is the best test for fetal lung maturity?; normal levels?
|
A561. Lecithin/Sphingomyelin ratio; normal > 2
|
|
Q562. describe a positive Non-Stress Test
|
A562. 2 increases in FHR in 20 min that are >15 beats above nml and for >15 seconds
|
|
Q563. describe a positive Oxytocin Challenge Test
|
A563. 3 contractions in 10 minutes
|
|
Q564. (5)* categories of the Biophysical Profiles
|
A564. Test the Baby MAN!:; Fetal Tone,; Fetal Breathing,; Fetal Movement,; Amniotic Fluid volume,; NST (zero or 2 points each; nml is 8 - 10)
|
|
Q565. Definition:; multiple gestation with at least one IUP and at least one ectopic
|
A565. Heterotrophic Pregnancy
|
|
Q566. at what b-hCG levels should you detect an IUP on vaginal US?
|
A566. IUP should be seen on US with b-hCG of 1500 – 2000 mIU/mL
|
|
Q567. at what b-hCG levels should you detect a fetal heartbeat with trans-abdominal US?
|
A567. Fetal heartbeat should be seen with b-hCG > 5000 mIU/mL
|
|
Q568. Tx for Ruptured Ectopic
|
A568. Exploratory Lap (and maintain fluid levels)
|
|
Q569. what hormone best resembles b-hCG?; how?
|
A569. LH; they also have similar beta units (in addition to similar alpha)
|
|
Q570. what is the criteria to use Methotrexate for an ectopic?; (2)
|
A570. ectopic must be < 3.5 cm,; without heartbeat
|
|
Q571. what is the progesterone level in a nonviable intra- or extra- uterine pregnency?
|
A571. < 5 ng/mL
|
|
Q572. what is the progesterone level in 98% of intrauterine pregnancies?
|
A572. > 25 ng/mL
|
|
Q573. what does G5P2124 indicate?
|
A573. Twins
|
|
Q574. Definition:; Spontaneous abortion time
|
A574. pregnancy ending < 20 weeks
|
|
Q575. Type of Abortion:; any IU bleeding < 20 weeks without dilation or expulsion of POC
|
A575. Threatened abortion
|
|
Q576. Type of Abortion:; death of embryo of fetus < 20 weeks with complete retention of POC (usu leads to complete SAB)
|
A576. Missed abortion
|
|
Q577. Type of Abortion:; no expulsion of POC, but bleeding and dilation of cervix such that viability is unlikely
|
A577. Inevitable abortion
|
|
Q578. (2) ways an incomplete abortion can be taken to completion in first trimester
|
A578. D&C; Prostaglandins (Misoprotol)
|
|
Q579. causes of abortion in second trimester; (4)
|
A579. Congenital abnormalities; cervical / uterine abnormalities,; trauma,; systemic Disease or infection
|
|
Q580. (3) ways an incomplete abortion can be taken to completion in second trimester
|
A580. D&E,; Prostaglandins (Misoprostol),; Oxytocin at high doses
|
|
Q581. Definition:; Painless dilation leading to infection, Preterm Premature Rupture of Membranes (PPROM) or PTL
|
A581. Incomplete cervix
|
|
Q582. what should be done if patient is in first trimester and has a history of incomplete cervix?; when?
|
A582. Cerclage; 12 - 14 weeks
|
|
Q583. (3) tests to verify if patient has ruptured membranes
|
A583. Pool - collection of fluid in vagina; Nitrazine - turns blue (alkaline); Ferning
|
|
Q584. Definition:; Rupture of membranes > 1 hour before onset of labor
|
A584. Premature Rupture of Membranes; (PROM)
|
|
Q585. (5) parts of a Bishop score
|
A585. Dilation,; Effacement,; Station,; Cervical consistency,; Cervical position
|
|
Q586. Bishop score points zero - 3 for:; Dilation
|
A586. zero: Closed; 1 point: 1 - 2; 2 points: 3 - 4; 3 points: > 5
|
|
Q587. Bishop score points zero - 3 for:; Effacement
|
A587. zero: 0 - 30%; 1 point: 40 - 50%; 2 points: 60 - 70%; 3 points: > 80%
|
|
Q588. Bishop score points zero - 3 for:; Station
|
A588. zero: -3; 1 point: -2; 2 points: -1 to zero; 3 points: +1 - +3
|
|
Q589. Bishop score points zero - 3 for:; Cervical consistency
|
A589. zero: Firm; 1 point: Medium; 2 points: Soft; 3 points: (none)
|
|
Q590. Bishop score points zero - 3 for:; Cervical position
|
A590. zero: Posterior; 1 point: Mid; 2 points: Anterior; 3 points: (none)
|
|
Q591. Definition:; Lengthening (thinning) of the cervix
|
A591. Effacement
|
|
Q592. Definition:; relationship of fetal occiput to maternal pelvis
|
A592. Fetal Position
|
|
Q593. (4) ways to Induce labor
|
A593. Pitocin,; Prostaglandins (Cervadil or Misoprostol),; Mechanical dilation of cervix,; Rupture of membranes (Amniotomy)
|
|
Q594. MC 4 steps to Augment and monitor labor progress
|
A594. water broke? if not -> Amniotomy; change? if not -> IUPC; change? if not -> Pitocin; change? if not -> C-section
|
|
Q595. what does an IUPC measure with respect to contractions?; (2)
|
A595. 1. Time of contraction; 2. Strength of contractions
|
|
Q596. Name the (6)* movements of labor in order and what each means
|
A596. Engagement - biparietal diameter (largest) part of head enters pelvis,; Flexion - smallest diameter of head enters,; Descent - head completely into pelvis,; Internal rotation - from OT to OA or OP,; Extension - vertex passes beyond pubic synthesis; crowning occurs; External rotation - after delivery of the head as the head rotates to face forward
|
|
Q597. (3) P's of the Active Phase that may cause problems in delivery
|
A597. Power (strength of contractions),; Passenger (size and position of infant),; Pelvis (shape)
|
|
Q598. (5) steps of Tx in patient with Non-reassuring fetal status
|
A598. 1. Give mother oxygen mask; 2. turn her to Left side to decrease IVC compression; 3. D/C Pitocin; 4. if due to Hypertonus (long contraction) or Tachysystole (>5 contractions in 10 min), give Terbutaline to relax uterus; 5. If 1 – 4 does not work, C-section patient
|
|
Q599. Dx:; Painless vaginal bleeding in the third trimester; Tx for perterm patient (<36 weeks)?; (3); Tx for term patient?
|
A599. Placenta previa; Tx for Preterm:; 1. Monitor in hospital; 2. Transfusion PRN; 3. Tocolytic to prolong until 36 weeks; Tx for Term: C-section
|
|
Q600. Dx:; Vaginal bleeding, painful contractions, firm and tender uterus; Tx?
|
A600. Placental Abruption; Tx – Delivery (by C-section if mother or baby is unstable)
|
|
Q601. Dx:; sudden onset of intense abdominal pain assoc with pregnancy; Tx?
|
A601. Uterine rupture; Tx - immediate laparotomy
|
|
Q602. Dx:; Vaginal bleeding and sinusoidal FHR pattern; MCC?; Tx?
|
A602. Fetal Vessel Rupture; MCC - Velamentous cord insertion; Tx - emergency C-section
|
|
Q603. Dx:; contractions and changes in cervix at < 37 weeks gestation
|
A603. Preterm Labor
|
|
Q604. The only Tocolytic approved by the FDA; MOA?
|
A604. Ritrodrine; MOA: Beta-agonist
|
|
Q605. Tocolytic that acts as a calcium antagonist
|
A605. Magnesium sulfate
|
|
Q606. what is the test to determine if patient is near a Magnesium sulfate toxicity?
|
A606. check DTRs continuously. they are depressed less then the toxic level of 10 mg/dL
|
|
Q607. what Calcium channel blocker is used as a Tocolytic?
|
A607. Nifedipine
|
|
Q608. what NSAID is used as a Tocolytic?
|
A608. Indomethacin
|
|
Q609. MC concern with PROM?
|
A609. Chorioamnionitis
|
|
Q610. when is it common to see maternal hypotension?; what can it cause in child?; what is Tx for maternal hypotension?
|
A610. After epidural; causes - Fetal bradycardia; Tx - IV hydration and Ephedrine
|
|
Q611. Tx for fetal bradycardia lasting for longer then 4 - 5 minutes?
|
A611. C-section
|
|
Q612. Monozygotic Twins:; separation before the differentiation of trophoblasts
|
A612. Dichorionic-Diamnionic
|
|
Q613. Monozygotic Twins:; separation after trophoblast differentiation and before amnion formation
|
A613. Monochorionic-Diamnionic
|
|
Q614. what type of twins can develop Twin-to-Twin Transfusion Syndrome?
|
A614. Mono-Di (one big baby and one small)
|
|
Q615. Twin type:; division of fertilized ovum
|
A615. Monozygotic
|
|
Q616. Twin type:; fertilization of two ova by two sperm
|
A616. Dizygotic
|
|
Q617. Monozygotic Twins:; separation after amnion formation
|
A617. Monochorionic-Monoamnionic (highest mortality rate)
|
|
Q618. Dx:; pregnant woman with HTN, edema, proteinuria
|
A618. Preeclampsia
|
|
Q619. (3) risk factors for onset of Preeclampsia
|
A619. Nulliparity,; Multiple gestation,; Chronic HTN
|
|
Q620. Tx for Preeclampsia near term and preterm
|
A620. Near term: Delivery; Preterm (and Eclampsia Tx): Mag sulfate - against seizures, Hydralazine - HTN
|
|
Q621. with Eclampsia, what percentage of patients have seizures before labor, during labor and after labor?
|
A621. Before: 25%; During: 50%; After: 25%
|
|
Q622. what anti-hypertensives are given to mothers with chronic HTN during birth?; (2)
|
A622. Nifedipine; Labetolol
|
|
Q623. what tests should be performed if patient has chronic HTN with pregnancy?; (2); why?
|
A623. Baseline ECG,; 24-hr urine collection; helps differentiate superimposed preeclampsia
|
|
Q624. How common is gestational diabetes?
|
A624. approx 15% of pregnancies
|
|
Q625. (3) fetal complications of Gestational Diabetes
|
A625. Macrosomia,; Shoulder dystocia,; neonatal Hypoglycemia
|
|
Q626. when is a C-section indicated in gestational diabetes?
|
A626. if fetal weight > 4500g
|
|
Q627. How is the DM-1 patient managed during pregnancy?; Delivery?
|
A627. Pregnancy - insulin pump; Delivery - insulin drip
|
|
Q628. What gestational age of onset would you stop considering using a tocolytic agent?; A steroid agent?; What is done after that?
|
A628. Tocolytic: >34 weeks; Steroid: >36 weeks; then: Expectant management
|
|
Q629. how are lower UTIs treated versus pyelonephritis in pregnancy?
|
A629. Lower UTI - oral Antibiotics; Pyelonephritis - IV Antibiotics
|
|
Q630. (2) complications of pyelonephritis during pregnancy for mother
|
A630. Septic shock; ARDS
|
|
Q631. what can Bacterial Vaginosis cause during pregnancy?
|
A631. Preterm delivery
|
|
Q632. Leading cause of Neonatal sepsis; Tx?
|
A632. Group B strep; Tx: Ampicillin
|
|
Q633. Dx:; maternal fever, uterine tenderness, high WBC, fetal tachycardia; Tx? (2)
|
A633. Chorioamnionitis; Tx: Delivery, IV Antibiotics
|
|
Q634. Dx:; nausea and vomiting in pregnancy to the extent where the patient cannot maintain adequate hydration and nutrition; (3) Tx?
|
A634. Hyperemesis Gravidarum; Tx: IV hydration, Electrolyte repletion, Antiemetics
|
|
Q635. Management of women with Epilepsy during pregnancy; (3)
|
A635. check antiepileptic drug levels monthly,; Level 2 Ultrasound at 19 - 20 weeks,; supplement with Vitamin K from 37 weeks to delivery
|
|
Q636. what do women with mild renal disease have a risk of getting during pregnancy?; (2 pregnancy problems)
|
A636. Preeclampsia,; IUGR
|
|
Q637. Leading cause of maternal death
|
A637. Pulmonary emboli
|
|
Q638. Tx for pregnancy-related DVT and PE
|
A638. Heparin
|
|
Q639. Management for Hyperthyroidism in pregnant woman; (3)
|
A639. Thyroid-stimulating immunoglobulins (TSI) should be screened. if elevated, screen for fetal goiter and IUGR; continue with PTU medication
|
|
Q640. Management for Hypothyroidism in pregnant woman
|
A640. Synthroid (Increased Synthroid requirements during preg for somone already on meds)
|
|
Q641. (3) common problems that can occur in the pregnant SLE patient. what (3) meds can be used in these patients as prophylaxis?
|
A641. Risk for: Pregnancy loss, IUGR, Preeclampsia; Meds: Low-dose aspirin, Heparin, Corticosteroids
|
|
Q642. how are Lupus flares and Preeclampsia differentiated in pregnancy?
|
A642. Complement levels
|
|
Q643. SLE and Sjogren mothers with anti-Ro and Anti-La antibodies have risk of developing what fetal problem?
|
A643. Fetus with Congenital Heart Block
|
|
Q644. Dx:; infant is delivered and has growth restriction, CNS problems, cardiac defects and abnormal facies
|
A644. Alcohol abuse during pregnancy; (FAS)
|
|
Q645. Pregnancy Risk:; Caffeine > 150 mg/day
|
A645. Spontaneous abortions
|
|
Q646. Pregnancy Risk:; Cigarette smoking; (4)
|
A646. Growth restriction,; Abruptions,; Preterm delivery,; Fetal death
|
|
Q647. Pregnancy Risk:; Cocaine; (2)
|
A647. Placental Abruption,; CNS defects in children
|
|
Q648. what is best for the pregnant woman on Heroin during pregnancy?
|
A648. Quitting outright will endanger fetus--need to be enrolled in a methadone clinic, then quit after delivery
|
|
Q649. (2) central issues in the immediate postpartum period for the patient
|
A649. Pain management,; Wound care
|
|
Q650. when do diaphragms and cervical caps need to be refitted postpartum?
|
A650. 6 weeks
|
|
Q651. what are the (3) hormonal contraceptives of choice postaprtum?; Why?
|
A651. Depo-provera,; Norplant,; Progesterone-only minipill b/c they are less likely to decrease milk production in breast-feeding patients
|
|
Q652. What are the causes of postpartum hemorrhage?; (6)*
|
A652. Coagulation Defect;; Atony;; Rupture;; Placenta (POC) retained;; Implantation site bleed;; Trauma
|
|
Q653. what are the steps in managing a postpartum hemorrhage?; (4 steps)
|
A653. 1. RULE OUT cervical/vaginal lacerations; 2. if still bleeding: give Uterotonic agents (Oxytocin); 3. if still bleeding: D&C; 4. if still bleeding: Laparotomy with bilateral O'Leary sutures to tie off uterine arteries
|
|
Q654. Dx:; fever, high WBC, uterine tenderness 5 - 10 days post C- section; Tx?; (2)
|
A654. Endomyometritis; Tx: D&C, broad-spectrum Antibiotics until afibrile for 48 hrs
|
|
Q655. what is the underlying cause of labial fusion?
|
A655. excess Androgens
|
|
Q656. MC form of enzymatic deficiency assoc with ambiguous genitalia; what is deficient?
|
A656. Congenital Adrenal hyperplasia; (21-hydroxylase deficiency)
|
|
Q657. Dx:; hyperandrogenism, salt wasting, hypotension, hyperkalemia, hypoglycemia, ambiguous genitalia
|
A657. Congenital Adrenal Hyperplasia; (21-hydroxylase deficiency)
|
|
Q658. what main lab is elevated in Congenital Adrenal Hyperplasia?; what is Tx?
|
A658. 17-alpha-hydroxyprogesterone; Tx: Cortisol (and a mineralcorticoid if pt is salt-wasting)
|
|
Q659. what is the name of the fertilized oocyte 2 - 4 days after fertilization?; what is it called in the next stage?
|
A659. Blastomere / Morula; next: Blastocyst
|
|
Q660. Dx:; patient at puberty with primary amenorrhea and cyclic pelvic pain, lower abdominal girth
|
A660. Imperforate hymen
|
|
Q661. Definition:; build-up of blood behind the hymen in person with imperforate hymen; Tx?
|
A661. Hematocolpos; Tx: surgery
|
|
Q662. (2) causes of Vaginal Agenesis
|
A662. Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH); Androgen Insensitivity
|
|
Q663. Dx:; normal female karyotype with ovaries and secondary sexual characteristics, but congenital absence or hypoplasia of vagina, cervix, uterus and fallopian tubes
|
A663. Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH)
|
|
Q664. what is the Tx for Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH)?
|
A664. Create vagina: with dilators; or McIndoe procedure (surgically creating vagina with skin grafts)
|
|
Q665. Dx:; woman with scant pubic hair and small breasts with vaginal agenesis or absence and absence of uterus; cause?
|
A665. Androgen Insensitivity; cause: nonfunctioning androgen receptors (normal levels of Testosterone)
|
|
Q666. Dx:; symmetric white, thinned skin on labia, perineum and perianal region. Shrinkage and agglutination of labia with occasional pruritis or dysparunia; Tx?
|
A666. Lichen Sclerosis; Tx: Topical steroids (Clobetasol)
|
|
Q667. Dx:; localized thickening of the vuvlar skin from edema with chronic pruritis, possible raised white lesion on labia majora or clitoris
|
A667. Squamous cell hyperplasia
|
|
Q668. Dx:; multiple shiny, flat, purple papules usu on the inner aspects of the labia minora, vagina and vestibule. Often erosive and causing pruritis and mild inflammation
|
A668. Lichen Planus
|
|
Q669. Dx:; Thickened white epithelium, slight scaling, usually unilateral and circumscribed on vulva, with pruritis; (2) Tx?
|
A669. Lichen Simplex Chronicus; Tx: Ultraviolet light, Topical steroids
|
|
Q670. Dx:; Red, moist and sometimes scaly lesions on vulva, which may also be found on scalp, axilla, groin and trunk
|
A670. Vulvar Psoriasis
|
|
Q671. Dx:; palpable red granular spots and patches in the upper third of the vagina on the anterior wall
|
A671. Vaginal Adenosis
|
|
Q672. how are vulvar lesions Dx?
|
A672. Biopsied
|
|
Q673. MC benign tumor on the vulva
|
A673. Epidermal Inclusion cysts
|
|
Q674. Definition:; Disease that causes occlusion of the sweat glands on mons pubis and labia majora, causing cyst formations; Tx?
|
A674. Fox-Fordyce Disease; Tx: I&D
|
|
Q675. how do you differentiate an epidermal cyst from a sebaceous cyst?
|
A675. Epidermal - solitary cyst; Sebaceous - collection of cysts
|
|
Q676. where are the Skene glands located?
|
A676. Paraurethral
|
|
Q677. where are the Bartholian glands located?
|
A677. Bilaterally at 4 and 8 o'clock on labia majora
|
|
Q678. what is first step in Tx if a Bartholian cyst first appears in woman over 40yo?
|
A678. Biopsy to RULE OUT Bartholian gland carcinoma
|
|
Q679. Tx of a Bartholian Abscess; what is Tx for recurrent Bartholian Abscesses?
|
A679. Tx: I&D with placement of Word catheter; Recurrent: Marsupialization
|
|
Q680. Definition:; Cervical dilated retention cysts
|
A680. Nabothian cysts
|
|
Q681. Definition:; Cervical cysts that lie deep in the stroma and are from remnants of Wolffian ducts
|
A681. Mesonephric cysts
|
|
Q682. even though cervical polyps are not premalignant, why are they removed?
|
A682. to avoid masking bleeding from other sources and to avoid misidentification for an endometrial polyp
|
|
Q683. MC Uterine formation anomaly; cause?
|
A683. Septate uterus; cause: Problems with fusion of Paramesonepheric ducts
|
|
Q684. what are anomalies of the uterus assoc with (non-gyn medical)?; (2)
|
A684. Urinary tract anomalies; Inguinal hernias
|
|
Q685. Dx:; amenorrhea or dysmenorrhea, dyspareunia, cyclic pelvic pain, infertility or recurrent pregnancy loss or premature labor
|
A685. Uterine anatomic anomalies; (Septate uterus)
|
|
Q686. Dx:; small uterine cavity, second-trimester pregnancy loss, malpresentation and possible premature labor
|
A686. Bicornuate uterus
|
|
Q687. Tx of Septate and Bicornuate uteri
|
A687. Surgical removal of septum
|
|
Q688. Definition:; Benign, estrogen-sensitive smooth muscle tumors of the uterus; found in what percentage of reproductive-age women?
|
A688. Fibroids (Uterine Leiomyomas); in 20 - 30% of reproductive-age women
|
|
Q689. Incidence of Fibroids in Black women; (3) causes to increase risk of developing fibroids
|
A689. 3 - 9 x higher in Black Risks:; Non-smoking,; Obese,; PeriMenopausal
|
|
Q690. what distinguishes a Fibroid from adenomyosis?
|
A690. Fibroid has a Pseudocapsule
|
|
Q691. Top (2) MC Sx in patient with Fibroids
|
A691. Asymptomatic (50 - 65%) (MC otherwise is Prolonged bleeding)
|
|
Q692. Drug Tx for Fibroids; (3); MOA of these drugs collectively
|
A692. Provera,; Danzol,; GnRH agonists (Lupron) MOA - shrink fibroids by reducing circulating Estrogen
|
|
Q693. If drugs dont work, what is the name of the surgical Tx for Fibroids?; Only Difinitive Tx?
|
A693. Myomectomy (removal of one or more Fibroid surgically); Only Difinitive Tx: Hysterectomy
|
|
Q694. what causes Endometrial Hyperplasia?
|
A694. continuous endogenous or exogenous Estrogen in absence of Progesterone
|
|
Q695. In endometrial hyperplasia, what proliferates in endometrium?; (2)
|
A695. Glandular and Stromal elements of endometrium
|
|
Q696. Risk factors for getting Endometrial Hyperplasia; (9)
|
A696. CLONED PHD:; Chronic Anovulation,; Late Menopause (> age 55),; Obesity,; Nulliparity,; Estrogen-producing tumors (granulosa-theca cell tumor),; Diabetes,; PCOS,; Hypertension,; Drugs - Tamoxifen
|
|
Q697. Dx:; long periods of Oligomenorrhea or amenorrhea followed by irregular or excessive uterine bleeding
|
A697. Endometrial Hyperplasia
|
|
Q698. main Dx evaluation used to Dx Endometrial Hyperplasia; what is second choice?
|
A698. Endometrial biopsy (or D&C...second choice)
|
|
Q699. Risk of malignant transformation from Endometrial Hyperplasia in:; 1. Simple Hyperplasia; 2. Complex Hyperplasia; 3. Atypical Simple Hyperplasia; 4. Atypical Complex Hyperplasia
|
A699. Simple = 1%; Complex = 3%; Atypical Simple = 8%; Atypical Complex = 29%
|
|
Q700. what is the initial Tx for all types of endometrial hyperplasia in child-bearing patient?; Non-child bearing patient?
|
A700. Child bearing:; Progestin therapy for 3 months; (followed by resampling of Endometrium); Non-child bearing:; Hysterectomy
|
|
Q701. MC functional Ovarian cyst; usu unilateral; what can they lead to?; Tx?
|
A701. Follicular cyst; leads to: Ovarian torsion; Tx: resolve spontaneously
|
|
Q702. MCC of infertility in USA
|
A702. PID
|
|
Q703. Dx:; patient with abdominal pain, adnexal tenderness and cervical motion tenderness, possible ESR, Inc WBC, fever, or purulent cervical discharge
|
A703. PID
|
|
Q704. how is the tuboovarian abscess rupture treated in PID?
|
A704. Removal of infected tube
|
|
Q705. Antibiotic Tx for outpatient versus inpatient with PID
|
A705. Outpatient: Ceftriaxone + Doxycycline; Inpatient: Clindamycin + Gentamycin
|
|
Q706. Bug that causes PID in pt with intrauterine device
|
A706. Actinomyces Israelii
|
|
Q707. Dx:; nodularities on Broad ligament and a retroverted uterus with abdominal pain; Tx?
|
A707. Endometriosis; Tx: birth control pills
|
|
Q708. MCC of infertility in menstruating woman over age of 30 without PID?
|
A708. Endometriosis
|
|
Q709. How is chlamydia Tx in pregnant patient?
|
A709. Erythromycin
|
|
Q710. Dx:; ovarian cyst that can cause a missed period or dull lower; Quadrant pain; can rupture to cause acute abdominal pain and intraabdominal hemorrhage; Tx?
|
A710. Corpus Luteum cyst; Tx: resolve spontaneously (or oral contraceptives if recurrent)
|
|
Q711. Dx:; large, bilateral ovarian cysts filled with clear, straw-colored fluid;; high b-hCG
|
A711. Theca-Lutein cyst
|
|
Q712. First step in management for a cystic adnexal mass in premenarchal and postmenopausal patients
|
A712. Exploratory Lap (due to high risk on cancer in those age groups)
|
|
Q713. what percent of ovarian masses in women of reproductive age are functional cysts?; non-functional neoplasms?
|
A713. functional cysts = 75%; non-functional neoplasms = 25%
|
|
Q714. First Dx evaluation for Ovarian cysts
|
A714. Pelvic Ultrasound...wait 6 - 8 weeks then repeat
|
|
Q715. in reproductive-aged woman who has an ovarian cyst seen on ultrasound, what management steps are taken if the cyst size is:; 1. < 6 cm; 2. 6 - 8 cm; 3. > 8 cm
|
A715. 1. observe for 6 - 8 weeks -> start on oral contraceptives -> repeat US; 2. if Unilocular = repeat steps above; if multilocular or solid on US = Exploratory Laparoscopy; 3. Exploratory Laparoscopy for cystectomy
|
|
Q716. if ovarian cysts do not resolve with oral contraceptives in 60; 90 days, what is next step?
|
A716. Cystectomy via Laparoscopy
|
|
Q717. Definition:; Endometriosis in the ovary
|
A717. Endometrioma
|
|
Q718. Risk factors for endometriosis; (2)
|
A718. First-degree relatives (mothers AND Sisters); autoimmune disorders
|
|
Q719. how is endometriosis detected on rectovaginal exam?
|
A719. Uterosacral nodularity
|
|
Q720. Instead of using oral contraceptives for endometriosis, what else can be used?; (2); what do they do?
|
A720. GnRH agonists in steady state (Leuprolide); or Danazol (inhibits gonadal steroid synthesis); they supress FSH and LH
|
|
Q721. what are the drawbacks to Danazol therapy for Endometriosis?
|
A721. Androgen-related anabolic side effects:; Acne, Oily skin, weight gain, deep voice, Hirsutism
|
|
Q722. AE of GnRH agonists
|
A722. Estrogen deficiency; Menopausal symptoms: hot flashes, loss of bone density, HA, vaginal atrophy and dryness
|
|
Q723. what intraabdominal problem can endometriosis lead to?
|
A723. Adhesion formation -> bowel obstructions
|
|
Q724. what is the drug management of Endometriosis in the woman wanting to conceive?
|
A724. None; Only Tx in these patients is Conservative surgical therapy by removal of lesions laparoscopically
|
|
Q725. what percent of women with Adenomyosis also have Endometriosis?; Fibroids?
|
A725. Endometriosis - 15%; Fibroids - 50%
|
|
Q726. Incidence of Adenomyosis?
|
A726. 15% of women in late 30s - early 40s
|
|
Q727. Dx:; pelvic exam reveals a diffusely enlarged globular uterus and secondary dysmenorrhea
|
A727. Adenomyosis
|
|
Q728. What is the first Dx test for Adenomyosis?; What is the only definitive Dx test?; What is the Tx?
|
A728. Ultrasound (if suggestive, then MRI to distingiush b/t it and Fibroids); Definitive means of Dx and Tx: Hysterectomy
|
|
Q729. Tx for Adenomyosis; (3 meds or one procedure)
|
A729. NSAIDs and analgesics,; Oral Contraceptives,; Progestins; Definitive Tx: Hysterectomy
|
|
Q730. Dx:; fever, rash and desquamataion of palms and soles of feet, hypotension
|
A730. Toxic Shock Syndrome (s.aureus)
|
|
Q731. how is HIV screened and confirmed?
|
A731. screened with ELISA; confirmed with Western blot
|
|
Q732. Dx:; Cottage cheese-like discharge, pruritis, burning, dysuria, vulvar edema; what is Dx test and result?; Tx?
|
A732. Candida Albicans; Test: branching hyphae and spores on KOH prep; Tx: Topical OTC Azole cream
|
|
Q733. Dx:; diffuse, malodorous, gray-green, frothy discharge from vagina; what is Dx test and result?; Tx?
|
A733. Trichomonas Vaginalis; Test: Bugs swimming under microscope; Wet prep; Tx: Metronidazole (Flagyl) 2g orally in single dose
|
|
Q734. Dx:; vaginal discharge that is thin, yellow and has a "fishy" amine odor; what is Dx test and results?; Tx?
|
A734. Bacterial Vaginosis (Gardnerella); Test: Clue cells on Wet prep, Whiff test exaggerates the odor with KOH; Tx: Metronidazole (Flagl) 500mg orally BID for 7 days
|
|
Q735. Dx:; Painless cancre; what is the Hystological Dx test and results?; Tx?
|
A735. Syphilis (stage 1); Test: Spirochetes on Dark-field Microscopy; Tx: Penicillin
|
|
Q736. Dx:; maculopapular rash extending to the palms and soles and/or moist papules on the skin or mucous membranes
|
A736. Syphilis (stage 2)
|
|
Q737. Dx test for HSV; Tx?
|
A737. Tzanck smear; Tx: Acyclovir
|
|
Q738. Dx:; painful, demarcated, non-indurated ulcer located anywhere in the anogenital region; painful inguinal lymphadenopathy
|
A738. Chancroid (Haemophilus Ducreyi)
|
|
Q739. Dx:; STD that causes LGV; (2) possible Tx?
|
A739. Chlamydia (MC STD); Tx: Doxycycline 100mg orally BID for 7 days, 1-time dose of Azithromycin
|
|
Q740. Dx:; mucopurulent cervicitis; gram-negative bug; Tx?
|
A740. N. Gonorrhea; Tx: Ceftriaxone 250mg IM
|
|
Q741. Dx:; small, 1 - 5mm domed papule with umbilicated center, can occur all over body; what is Dx test and results?; Tx?
|
A741. Molluscum contaginosum; Tests: waxy material and intracytoplasmic inclusions on Wright stain or Giemsa stain; Tx: Cryotherapy
|
|
Q742. Dx:; Pruritis, iritated skin, vesicles and burrows confined to pubic area; Tx?
|
A742. P. Pubis (Pediculosis) ["Crabs"]; Tx: Lindane (Kwell) shampoo to pubic hair
|
|
Q743. what is the protrusion of the vaginal vault secondary to the loss of support structures post hysterectomy?
|
A743. Vaginal Vault Prolapse
|
|
Q744. Initial Tx for pelvic relaxation or Stress Incontinence?; If that doesn't work, what is the Tx?
|
A744. Kegel exercises; if not: Vaginal Pessaries (and/or Estrogen replacement)
|
|
Q745. Dx:; Urine loss with exertion or straining (coughing, exercise, etc); cause?
|
A745. Stress incontinence; cause: Pelvic relaxation and displacement of the Urethrovesical junction
|
|
Q746. Dx:; urine leakage due to involuntary and uninhibited bladder contractions; cause?
|
A746. Urge Incontinence; cause: Detrusor instability
|
|
Q747. Dx:; continuous urine leakage; cause?
|
A747. Total Incontinence; cause: Urinary fistulas from birth trauma or pelvic surgery / radiation
|
|
Q748. Dx:; incomplete voiding, urinary retention and overdistention of the bladder; cause?
|
A748. Overflow Incontinence; cause: poor or absent Bladder Contractions due to meds or neurological dysfunction
|
|
Q749. what are (2) easy office Dx evaluations for incontinence?
|
A749. Standing stress test; Cotton swab test
|
|
Q750. what class of meds are used to help Tx Stress Incontinence?
|
A750. Alpha Adrenergic agents
|
|
Q751. what class of meds are used to Tx Urge Incontinence?
|
A751. Anticholinergics (help with detrusor stability)
|
|
Q752. how is Total Incontinence treated?
|
A752. Surgical repair of the fistula
|
|
Q753. what drug class increases bladder contractility?
|
A753. cholinergics
|
|
Q754. what drug class lowers urethral resistance?
|
A754. alpha-adrenergic agents
|
|
Q755. what is the Tx for Overflow Incontinence?; (1 procedure or 2 possible meds)
|
A755. Self catheterization; or Meds: Cholinergics, Alpha-adrenergic agents
|
|
Q756. what is the order of the (5) stages of Puberty in females?
|
A756. All Girls Think Puberty's Messy:; Adrenarche (Androgen production),; Gonadarche (GnRH production),; Thelarche (Breast production),; Pubarche (pubic hair),; Menarche
|
|
Q757. what is stage 4 of Thelarche?
|
A757. Areolar mound (in stage 5, mound disappears again)
|
|
Q758. what is the first phenotypic sign of puberty?
|
A758. Thelarche (breast production)
|
|
Q759. when does menarche occur in relation to thelarche?
|
A759. about 2.5 years after the development of breast buds
|
|
Q760. what (2) phases of the menstrual cycle describe the ovary?; the endometrium?
|
A760. Ovary: Follicular phase, Luteal phase; Endometrium: Proliferative phase, Secretory phase
|
|
Q761. when does the placenta begin to develop its own estrogen and progesterone?
|
A761. at 8 - 10 weeks gestation
|
|
Q762. Definition:; the termination of the reproductive phase in a woman's life
|
A762. Climacteric (menopause, the final menstruation, marks the cornerstone event of the climacteric)
|
|
Q763. what during menopause leads to the hot flashes, mood changes, insomnia and depression?
|
A763. fall in Estrogen production
|
|
Q764. what is the average age of menopause?
|
A764. 48 - 52
|
|
Q765. what occurs with respect to the CV system during menopause?
|
A765. Affects lipid profiles, leading to atherosclerosis and increased risk of CAD
|
|
Q766. Dx:; severe pain with menses that cannot be attributed to an organic cause, is usually dx before 20 yo
|
A766. Primary Dysmenorrhea
|
|
Q767. what is believed to be the reason of Primary Dysmenorrhea?; Tx? (3)
|
A767. Increased levels of Prostaglandins Tx:; NSAIDs,; OCPs,; and/or TENS (Transcutaneous Electrical Nerve Stimulation)
|
|
Q768. Dx:; HA, weight gain, bloating, breast tenderness, mood fluctuation, anxiety, irritability in the second half of the menstrual cycle
|
A768. Premenstrual Syndrome (PMS)
|
|
Q769. what is the Dx criteria for PMS?; (2)
|
A769. symptoms of PMS in the second half of the menstrual cycle with at least 7-day symptom-free interval during the first half;; symptoms must occur in two consecutive cycles
|
|
Q770. Dx:; regularly timed menses, but an unusually heavy or prolonged flow
|
A770. Menorrhagia
|
|
Q771. How many days is the flow suppose to last in the normal menstrual cycle?; how much blood loss?
|
A771. days: 3 - 5; blood loss: 30 - 50mL
|
|
Q772. Definition:; idiopathic heavy and/or irregular bleeding that cannot be attributed to another cause
|
A772. Dysfunctional Uterine Bleeding (DUB)
|
|
Q773. Dx:; regularly timed menses but unusually light amount of flow
|
A773. Hypomenorrhea
|
|
Q774. Dx:; bleeding that occurs b/t regular menstrual periods
|
A774. Metrorrhagia
|
|
Q775. Dx:; excessive (greater then 80mL) or prolonged bleeding at irregular intervals
|
A775. Menometrorrhagia
|
|
Q776. Dx:; irregular periods greater then 35 days
|
A776. Oligomenorrhea
|
|
Q777. Dx:; frequent periods that occur less then 21 days apart
|
A777. Polymenorrhea
|
|
Q778. (3) of the MCC of Oligomenorrhea
|
A778. PCOS,; Chronic Anovulation,; Pregnancy
|
|
Q779. when is DUB most common?; (in General and list 4 times)
|
A779. when she is "Anovulatory":; Adolescence,; Perimenopause,; Lactation,; Pregnancy
|
|
Q780. When does pathologic Anovulation related to hormones occur?; (3)
|
A780. Hypothyroidism,; Hyperprolactinemia,; Hyperandrogenism
|
|
Q781. if a woman > 35 yo has abnormal uterine bleeding, what is the next step?
|
A781. Endometrial biopsy to rule out cancer
|
|
Q782. Drug Tx for DUB (Anovulatory vs. Ovulatory)?; Tx for Acute Hemorrhage / Heavy bleed from uterus?
|
A782. Anovulatory DUB: Progestins to stimulate withdrawal bleeding; Ovulatory DUB: NSAIDs; Acute hemorrhage/heavy bleed: IV Estrogens to stop bleeding
|
|
Q783. what is the metabolic goal of pregnancy?
|
A783. Increase availability of Glucose for the fetus, while mother utilizes lipids
|
|
Q784. MCC of postmenopausal bleeding
|
A784. Endometrial and/or Vaginal Atrophy
|
|
Q785. what is responsible for the conversion of vellus hair to terminal hair at puberty?
|
A785. Androgens (DHT)
|
|
Q786. what converts testosterone to DHT?
|
A786. 5-alpha-reductase
|
|
Q787. what precursor to cancer does a woman with PCOS have an increased risk for?
|
A787. Endometrial Hyperplasia (moreso then ovarian cancar)
|
|
Q788. what are the (2) most common adrenal androgens?; what is the immediate precursor to them?
|
A788. DHEA and DHEAS; precursor: 17-alpha-hydroxypregnenolone
|
|
Q789. what stimulates the Theca cells?; what is produced?; (2)
|
A789. LH; makes: Androstenedione, Testosterone
|
|
Q790. what stimulates the Granulosa cells?; what is produced?; (2)
|
A790. FSH; makes: Estrone (from Androsterone), Estradiol (from Testosterone)
|
|
Q791. what lab elevation is the marker for adrenal androgen excess production?
|
A791. Increased DHEAS
|
|
Q792. Dx:; Inc cortisol, androgens, hirsutism, acne, menstrual irregularities
|
A792. Cushing's syndrome
|
|
Q793. how can you tell if Cushing's syndrome is from an adrenal tumor?
|
A793. ACTH is low; if from Pituitary or paraneoplastic, ACTH would be high
|
|
Q794. what is the diagnostic test for Cushing's syndrome?
|
A794. Dexametasone suppression test
|
|
Q795. MC Congenital Adrenal Hyperplasia disorder; what is in excess?
|
A795. 21-alpha-hydroxylase deficiency; in excess: 7-alpha-hydroxyprogesterone
|
|
Q796. Dx:; mild virilization, menstrual irregularities, low cortisol and salt wasting
|
A796. Congenital Adrenal Hyperplasia
|
|
Q797. what is the first step in Dx Congenital Adrenal Hyperplasia?; how do you confirm this?
|
A797. see if 17-OHP is > 200ng/dL; confirm: ACTH stimulation test
|
|
Q798. Dx:; enlarged ovaries, hirsutism and possible virilization; how is Dx made?
|
A798. Theca Lutein cysts; Dx by Ovarian biopsy
|
|
Q799. what drug inhibits 5-alpha-reductase?
|
A799. Finesteride
|
|
Q800. what can occur if a contraception diaphragm is left in for too long?
|
A800. Toxic Shock Syndrome (s.aureus)
|
|
Q801. what (2) things must be done if a woman wants to use the cervical cap contraception device?
|
A801. 1. Must be fitted by a doctor; 2. Must be used with spermicidal jelly
|
|
Q802. what are the (2) most widely used spermicides?
|
A802. Nonoxynol-9; Octoxynol-9
|
|
Q803. what is the efficacy rate of condoms, diaphragms and cervical caps?
|
A803. 75 - 85%
|
|
Q804. what is the efficacy rate of spermicides alone?
|
A804. 70 - 80%
|
|
Q805. what is the most widely used method of reversible contraception in the world?
|
A805. IUDs
|
|
Q806. how do IUDs work?
|
A806. elicit a sterile inflammatory response -> sperm destruction
|
|
Q807. what is the advantage to the Mirena (levonorgestrel) IUD?; (3)
|
A807. Progesterone addition acts to:; thicken the cervical mucous,; atrophy the endometrium (dec bleeding),; decreases dysmenorrhea
|
|
Q808. (4) serious side-effects of IUDs
|
A808. Insertion-related salpingitis,; Spontaneous abortion,; Uterine perforation,; Ectopic pregnancies
|
|
Q809. what is the single most important characteristic of the baseline FHR?
|
A809. Beat-to-beat variability
|
|
Q810. what are the (2) main IUDs and the amount of years each is good for?
|
A810. Copper (ParaGard) = 10 years; Mirena (with Progesterone) = 5 years
|
|
Q811. how do OCPs work?; (specifically)
|
A811. place body in "pseudo-pregnancy" state by supressing hormones at Anterior Pituitary (supressing ovulation); Estrogen supresses FSH - no follicles made; Progesterone supresses LH surge
|
|
Q812. (5) CV and (2) non-CV complications assoc with OCPs
|
A812. CV: DVT, PE, CVA, MI, HTN; other: cholelithiasis, cholecystitis
|
|
Q813. Benefits from combined OCPs:; what (2) cancers does it protect women from?; what can it help reduce the incidence of?; (3)
|
A813. protection from: Ovarian CA, Endometrial CA,; reduction in: Osteoporosis, Ectopic pregnancies, PID
|
|
Q814. (3) MOA of Progesterone-only contraception
|
A814. Supress ovulation,; thicken cervical mucous,; make endometrium unsuitable for implantation
|
|
Q815. (3) AE of Depo-provera
|
A815. Irregular bleeding,; Bone demineralization,; Long time to return to fertile after discontinuation
|
|
Q816. how does Emergency contraception work?; what is the only stipulation?
|
A816. Inhibits ovulation, fertilization or implantation; Must take w/i 72 hours of intercourse
|
|
Q817. what are (2) common misconceptions of Emergency contraception?
|
A817. They Do NOT: cause Abortions,; Protect against STDs
|
|
Q818. what is the hysteroscopic transcervical approach to tubal ligations called?; How is it confirmed?; what is patient required to do post-operation?
|
A818. "Essure"; Confirmed: Hysterosalpingogram; patient must: Use backup contraception for 3 months
|
|
Q819. what type of anesthesia is used in a D&C?
|
A819. Paracervical block
|
|
Q820. when is the most effective time to have a D&C in the first trimester?
|
A820. 6 - 12 weeks
|
|
Q821. what abortifacient blocks progesterone stimulation causing detatchment of the embryo?; when can it be used?
|
A821. Mifepristone; can be used: up to 7 weeks from the LMP
|
|
Q822. what is the test performed 2 weeks after medical abortion to confirm?; (2)
|
A822. Ultrasound; and serum b-hCG level
|
|
Q823. what abortifacient interrupts placental villi proliferation?
|
A823. Methotrexate
|
|
Q824. what can both Methotrexate and Mifepristone be used with to increase efficacy rates of medical abortion?
|
A824. Misoprostol; (prostaglandin analogue)
|
|
Q825. what is the primary reason for second trimester abortions?
|
A825. congenital abnormalities
|
|
Q826. how is induction of labor for second-trimester pregnancy termination accomplished?; (3 steps)
|
A826. Cervical ripening agents,; Amniotomy,; high-dose IV Oxytocin
|
|
Q827. Definition:; likelihood of achieving pregnancy in a given month; what is the percentage?
|
A827. Fecundity; 20 - 25%
|
|
Q828. what is tested in a male sperm count?; (6); [give norms]
|
A828. Volume (> 2 mL),; Sperm count (> 20k),; Motility (> 50%),; Morphology (> 30% nml),; pH,; WBC count
|
|
Q829. what is the first way to help patients increase the probability of conception?; (3 ways to Improve coital practices)
|
A829. 1. Timing: Intercourse every other day near ovulation; 2. Position: Woman on Bottom; 3. Post-coital: woman lies on back with knees to chest for 15 min
|
|
Q830. how is low semen volume most commonly treated?
|
A830. Wash sperm for Intrauterine insemination
|
|
Q831. what is the option for infertility if male problem is low sperm density or impaired motility?
|
A831. Intracytoplasmic Sperm Injection (ICSI)
|
|
Q832. (2) main causes of peritoneal/tubal factors of female infertility
|
A832. Endometriosis,; Pelvic adhesions
|
|
Q833. what is the drug treatment for infertility caused my endometriosis?; surgical?
|
A833. Drug: No Tx increased fertility rates; Surgical: laparoscopic excision or vaporization of implants
|
|
Q834. (2) risk factors for intrauterine adhesions
|
A834. multiple D&Cs,; PID
|
|
Q835. how can uterine synechiae and septae be treated for infertility?
|
A835. Ligation via Hysteroscopy
|
|
Q836. what is the MCC of ovulatory-related infertility?
|
A836. PCOS
|
|
Q837. what is the next step if a pruritic area of the vulva does not respond to antifungals?
|
A837. Vulvar biopsy
|
|
Q838. Dx:; velvety red lesions on the vulva that become eczematous and scar as white plaques, pruritis, patient is > 60yo, possible coexistent adenocarcinoma
|
A838. Padget's Disease of the Vulva
|
|
Q839. (2) possible Tx for Vulvar intraepithelial neoplasia?
|
A839. Wide Local Excision; or Laser vaporization (if not extensive and no tissue sample needed)
|
|
Q840. what is the follow-up for a VIN patient?
|
A840. colposcopies every 3 months until Disease-free for 2 years, then every 6 months
|
|
Q841. Dx:; vulvar pruritis, pain and bleeding
|
A841. Vulvar cancer
|
|
Q842. what in surgery must also be done when Dx a vulvar SCC?
|
A842. Inguinal LN dissection (for staging)
|
|
Q843. what is the Tx for stages I - IV in Vulvar SCC?
|
A843. I: Wide local excision (< 1cm) and LN removal; II: Radical Vulvectomy and LN removal; III and IV: Radical Vulvectomy, removal of affected organs and Radiation
|
|
Q844. what is the most important prognostic factor of vulvar SCC?; what is the 5-year survival rate?
|
A844. the number of positive inguinal LN; 5-year Survival rates; 1 positive LN: 90 - 95%; 2 positive LN: 50 - 80%; 3 or more: 15%
|
|
Q845. what vulvar cancer has a 100% mortality rate if it metastasizes?
|
A845. Melanoma
|
|
Q846. Dx:; asymptomatic, multifocal lesions in the vaginal apex, History of HPV
|
A846. Vaginal Intraepithelial Neoplasia (VAIN)
|
|
Q847. what is seen in 50% of patients with VAIN?
|
A847. coexistant Neoplasia (usu of lower genital tract)
|
|
Q848. Dx:; patient has regular abnormal pap smears but no cervical neoplasia on cervical biopsy
|
A848. Vaginal Intraepithelial Neoplasia (VAIN)
|
|
Q849. (3) possible Tx for Vaginal Intraepithelial Neoplasia; (VAIN); (2 possible procedures and 1 drug)
|
A849. Surgical excision; or Laser vaporization, topical 5-FU
|
|
Q850. MC cancer of the vagina
|
A850. SCC: 85% (Clear cell is with DES exposure: 5%)
|
|
Q851. How is Vaginal SCC Tx with each stage (I-IV)?
|
A851. Stage I and II: Surgical excision; Stage III and IV: Radiation therapy
|
|
Q852. where does CIN usually begin and where is it most likely to be growing?
|
A852. starts: Transformation zone of cervix; MC place: Anterior lip of cervix
|
|
Q853. what are the (4) HPV types that are high-risk types for CIN and CA?
|
A853. 16, 18, 31, 45
|
|
Q854. at what age is CIN most commonly Dx?; by what percent can Pap smears reduce the incidence?
|
A854. women in their 20's; Paps reduce incidence by 90%
|
|
Q855. if woman has a hysterectomy for a benign condition like fibroids, how often should they have a pap smear?
|
A855. they do not need to continue regular paps; (they do if their cervix is intact)
|
|
Q856. current recommendations of time to begin Pap smears
|
A856. within 3 years of becoming sexually active or by age 21
|
|
Q857. what percent of women have Atypical Squamous Cell Pap smears that harbor severe dysplasia histology?
|
A857. 10 - 15%
|
|
Q858. what is the next step in Tx for pap smears that come back as:; ASC-US (unknown significance); ASC-H (cannot rule-out High grade)
|
A858. ASC-US: HPV testing (HPV negative: regular Paps) (HPV positive: Colposcopy with biopsy); ASC-H: Colposcopy with biopsy
|
|
Q859. what is the management of Tx if patient has ASC-US, High risk HPV negative?
|
A859. repeat Pap smear and HPV testing in one year
|
|
Q860. what is the management of Tx if patient has CIN-I versus CIN-II and CIN-III?
|
A860. CIN-I: repeat Pap every 6 mo for 1 year; if still has CIN-I, do LEEP; CIN-II and CIN-III: LEEP
|
|
Q861. Complications of LEEP; (4)
|
A861. Cervical Stenosis,; Cervical Incompetence,; Infection,; Bleeding
|
|
Q862. what is management if patient has CIN that is a large lesion, in a teenage patient or involves the vagina?
|
A862. Laser Ablation
|
|
Q863. what is the Tx for Preinvasive (stage 0) or microinvasive; (stage Ia-1) cervical cancer?; (2 possible)
|
A863. Cone biopsy,; Simple Hysterectomy
|
|
Q864. what is the Tx for Stage IIb - IV cervical CA?; (2)
|
A864. Chemotherapy (Cisplatin); and Radiation (ONLY)
|
|
Q865. what is the Tx for Stage Ia-2 to IIa cervical CA?; (2 possibilities)
|
A865. Radical Hysterectomy; or External Radiation
|
|
Q866. what is the difference b/t the presentation of:; Mastitis,; Blocked duct,; Mammary Ectasia,; Engorgement
|
A866. Mastitis: Unilateral and fever; Blocked duct: Unilateral, no fever; Mammary Ectasia: Bilateral, green discharge; Engorgement: Bilateral during preg
|
|
Q867. what is the 5-year survival rate for cervical CA stage I?; stage IV?
|
A867. Stage I: 85 - 90%; Stage IV: 15 - 20%
|
|
Q868. MC GYN cancer in USA
|
A868. Endometrial CA
|
|
Q869. MC type of endometrial CA; what is the average age to Dx endometrial CA?
|
A869. Endometrioid AdenoCA; Ave age: 61
|
|
Q870. what is the Tx for endometrial CA for stages:; 1. I and II; 2. III and IV
|
A870. I and II: TAHBSO, then radiation; III and IV: TAHBSO and Para-aortic LN removal, then radiation
|
|
Q871. what is the Tx for recurrent endometrial CA?; when does recurrence usually occur?
|
A871. High-dose Progestins; recurrence: 85% occur w/i 3 years
|
|
Q872. how common is Ovarian CA compared to all GYN cancers?; what percent of deaths from cancer of the female gential tract?
|
A872. 25% of all GYN cancers; responsible for 50% of GYN deaths; (b/c of lack of screening tools)
|
|
Q873. MC place on ovary where cancers form
|
A873. Epithelium on ovary capsule; (Coelomic epithelium)
|
|
Q874. what is a common familial cancer syndrome that also is seen to include ovarian cancer?
|
A874. Lynch II syndrome; (Hereditary nonpolyposis Colorectal CA)
|
|
Q875. what is the chance a woman will get ovarian cancer?
|
A875. 1 in 60
|
|
Q876. Dx:; ovarian cancer that mets to umbilicus
|
A876. Sister Mary Joseph nodule
|
|
Q877. what is the tumor marker in 80% of epithelial ovarian tumors?; at what stage are most diagnosed?
|
A877. CA-125; most Dx at Stage III
|
|
Q878. Ovarian tumor type:; asymptomatic, with possible low abdominal discomfort and early satiety
|
A878. Ovarian Epithelial tumor
|
|
Q879. what is the 5-year survival rate for Epithelial Ovarian CA?
|
A879. 0.2
|
|
Q880. Tx for Epithelial Ovarian CA; (procedure and 2 drugs)
|
A880. TAHBSO,; followed by: Taxol and Carboplatin chemo
|
|
Q881. (2) of the MC types of Germ cell tumors
|
A881. Dysgerminomas; Immature Teratomas
|
|
Q882. Dx:; ovarian tumor with cancer markers of CA-125 and LDH
|
A882. Dysgerminoma
|
|
Q883. what is the only thyroid or parathyroid hormone that crosses the placenta?
|
A883. TSH
|
|
Q884. germ cell ovarian tumors are most commonly seen in what population?
|
A884. women < 20 yo
|
|
Q885. Tx for Germ cell tumors; (procedure and 3 drugs)
|
A885. Unilateral Saplingo-oophorectomy; drugs (BEP): Bleomycin, Etoposide, CisPlatin [med for GERM: BE Penicillin]
|
|
Q886. MC age for all Sex-cord tumors except Sertoli-Leygig. what is age for Sertoli-Leydig?
|
A886. 40 - 70 yo; S-L: < 40 yo
|
|
Q887. MC type of Sex-cord tumor
|
A887. Granulosa cell tumor (70%)
|
|
Q888. Dx:; ovarian tumor that secretes Inhibin and Estrogen; (causing feminization)
|
A888. Granulosa-Theca cell tumor
|
|
Q889. Dx:; ovarian tumor that secretes Androgens (causing virilization)
|
A889. Sertoli-Leydig cell tumors
|
|
Q890. what causes the nonfunctioning tumor: Ovarian Fibroma?
|
A890. mature fibroblasts
|
|
Q891. Dx:; Ovarian tumor, ascites, right hydrothorax
|
A891. Meig's syndrome
|
|
Q892. what sex cord-stromal ovarian tumor can recur 15 to 20 years later?
|
A892. Granulosa cell tumors
|
|
Q893. Tx for sex cord-stromal tumors in young patients?; old patients?
|
A893. young: Unilateral Salpingo-Oophorectomy; older: TAHBSO; (never chemo or radiation)
|
|
Q894. MC type of fallopian tube cancers
|
A894. Adenocarcinoma (from mucosa)
|
|
Q895. Dx:; abdominal pain, profuse watery discharge from vagina, pelvic mass
|
A895. Fallopian tube CA
|
|
Q896. Tx for fallopian tube CA; (procedure and 2 drugs)
|
A896. TAHBSO,; drugs: Taxol, Carboplatin
|
|
Q897. Definition:; intermittent hydrosalpinx; what is it seen in?
|
A897. Hydrops tubae profluens; (seen in fallopian tube CA)
|
|
Q898. Definition:; fertilization of an egg without a nucleus by one sperm
|
A898. Complete Mole
|
|
Q899. who do the chromosomes come from in a Complete mole?; what is most common karyotype?
|
A899. Paternal; 46,XX
|
|
Q900. Dx:; irregular or heavy bleeding during early pregnancy, hyperemesis gravidarum, preeclampsia, hyperthyroidism, large uterine size, b-hCG > 50,000
|
A900. Complete mole
|
|
Q901. what is the lab sign of a Complete mole?; Dx test sign on US?
|
A901. b-hCG > 50,000; US: "snowstorm" pattern
|
|
Q902. Tx for Complete and Incomplete moles; (2 steps)
|
A902. 1. Immediate D&E; 2. IV Pitocin (post D&E)
|
|
Q903. what is the average time to normalize the hCG levels for molar pregnancies?; what percent results in malignancy?
|
A903. 8 - 14 weeks; to CA: 15 - 25%
|
|
Q904. Definition:; pregnancy caused by simultaneous fertilization of a normal ovum by two sperm; Karyotype?
|
A904. Incomplete mole; (69,XXY)
|
|
Q905. GYN bug:; Giant multinucleated cells with intracellular inclusions on Wright stain
|
A905. HSV
|
|
Q906. GYN bug:; Granular-appearing epithelial cells that are coated with coccobacillary organisms on saline
|
A906. Baterial Vaginosis; (Gardinella)
|
|
Q907. GYN bug:; Motile, flagellated organisms on saline
|
A907. Trichomonas
|
|
Q908. GYN bug:; Squamous cells with perinuclear halos on Pap
|
A908. HPV
|
|
Q909. (3) types of Malignant Gestational Trophoblastic Disease
|
A909. Persistant/Invasive moles; Choriocarcinoma,; Placental Site trophoblastic Tumors
|
|
Q910. Tx for all types of Malignant Gestational Trophoblastic Disease if it is confined to the uterus; (2 possible)
|
A910. Single-agent therapy: Methotrexate or Actinomycin-D
|
|
Q911. Tx for the (3) types of Malignant Gestational Trophoblastic Disease if it has mets to outside the uterus; (5)
|
A911. Multi-agent therapy: [EMA/CO]; Etoposide,; Methotrexate,; Actinomycin-D,; Cytoxan,; Oncovin (Vincristine)
|
|
Q912. Dx:; plateauing or rising b-hCG after molar evacuation; Chemotherapy Tx?; (inside vs outside)
|
A912. Persistent/Invasive moles; Tx: Inside uterus only: M or A, Outside: EMA/CO
|
|
Q913. Definition:; malignant necrotizing tumor that can arise from trophoblastic tissue weeks to years after any type of gestation; (molar, live birth, etc)
|
A913. Choriocarcinoma
|
|
Q914. Histology:; sheets of anaplastic cytotrophoblasts and synctiotrophoblasts in the absence of chorionic villi
|
A914. Choriocarcinoma
|
|
Q915. Histology:; tumors with absence of villi and proliferation of intermediate cytotrophoblasts
|
A915. Placental Site Trophoblastic Tumors
|
|
Q916. what is the only Gestational Trophoblastic Disease that presents with low b-hCG?
|
A916. Placental Site Trophoblastic Tumors
|
|
Q917. what is the only Gestational Trophoblastic Disease that does not respond to chemotherapy?; what is the Tx of choice?
|
A917. Placental Site Trophoblastic Tumors; Tx: Hysterectomy (with multi-agent chemo [EMA/CO] one week after surgery to prevent recurrence)
|
|
Q918. chance of a woman having breast cancer in her lifetime?
|
A918. 1 in 8
|
|
Q919. what is the major blood supply to the breasts?; (2)
|
A919. Internal Mammary; and Lateral thoracic artery
|
|
Q920. what does estrogen do for breast development?; (2)
|
A920. Ductal development,; Fat deposition
|
|
Q921. what does Progesterone do for breast development?
|
A921. Lobular-alveolar development (makes lactation possible)
|
|
Q922. what is responsible for milk letdown?
|
A922. Oxytocin
|
|
Q923. when should self breast exams be performed?
|
A923. monthy about 5 days after menses
|
|
Q924. what are the mammography screening guidelines?
|
A924. start every other year at 40yo then every year at age 50yo;; women with history of breast CA in family should start 5 years before youngest Dx of breast CA
|
|
Q925. what percent of breast cancers are not detected by mammography?
|
A925. up to 20%
|
|
Q926. why is US useful in breast masses?
|
A926. detects if cystic or solid
|
|
Q927. what is the first step in Dx a breast mass?; what if this doesn't work?
|
A927. Needle aspiration (if not working -> excisional biopsy)
|
|
Q928. Dx Nipple discharge:; Bloody; (2)
|
A928. Invasive Papillary CA,; Intraductal CA
|
|
Q929. Dx Nipple discharge:; Serous; (4)
|
A929. normal Menses,; OCPs,; Fibrocystic Disease,; early pregnancy
|
|
Q930. Dx Nipple discharge:; Yellow-tinged; (2)
|
A930. Fibrocystic Disease,; Galactocele
|
|
Q931. Dx Nipple discharge:; Green, sticky
|
A931. Mammary Duct Ectasia
|
|
Q932. Dx Nipple discharge:; Purulent
|
A932. Breast abscess
|
|
Q933. Dx:; cyclic breast pain with multiple, bilateral masses
|
A933. Fibrocystic Disease
|
|
Q934. reducing what should help with ameliorating fibrocystic disease?
|
A934. Caffeine (coffee, tea, chocolate)
|
|
Q935. what drugs are used to help Sx of Fibrocystic Disease?; (4)*
|
A935. TPD Bro:; Tamoxifen,; Progestins,; Danazol,; BROmocriptine
|
|
Q936. Dx:; rubbery, non-tender breast mass in patient younger then 25yo
|
A936. Fibroadenoma
|
|
Q937. Dx:; large, bulky mobile breast mass with overlying skin being warm, erythematous, shiny and engorged; Tx?
|
A937. Cystosarcoma Phyllodes; Tx: wide local excision (b/c 10% go to CA)
|
|
Q938. what (4) breast problems require only "Local excision" as the Tx of choice?
|
A938. Phyllodes,; Papilloma,; Ectasia,; LCIS
|
|
Q939. Dx:; inflammation of the ductal system at or after menopause causing nipple retraction, discharge and pain, usu bilateral; Tx?
|
A939. Mammary Duct Ectasia (Plasma cell Mastitis); Tx: Local excision of inflammed area
|
|
Q940. what are the top three risk factors for Malignant Breast cancer?
|
A940. 1. First-degree relative with bilateral premenopausal onset; 2. Previous breast cancer; 3. first birth after age 34
|
|
Q941. Dx:; bilateral malignant breast cells, non-palpable, not seen on mammography; Tx?
|
A941. Lobular Carcinoma In Situ (LCIS); Tx: Local excision
|
|
Q942. Dx:; malignant epithelial cells in mid-50's woman, microcalcifications on mammography, unilateral; Tx?
|
A942. Ductal Carcinoma In Situ (DCIS); Tx: Simple Mastectomy (additional Radiation if margins < 10mm)
|
|
Q943. what is the most reliable predictor for survival in breast cancer?
|
A943. the stage of breast cancer at the time of diagnosis
|
|
Q944. what is the recommended follow-up for breast cancer patients?
|
A944. Exam every 3 months for first year,; every 4 months in second year,; every 6 months thereafter (mammogram, LFTs and Alk-phos is done 6 months after Tx)
|
|
Q945. what percent of breast cancer is related to genetic predisposition?
|
A945. 5 - 10%
|
|
Q946. what is the criteria in treating a Breast cancer patient if she has negative or positive lymph nodes versus her ER/PR (receptor) status?
|
A946. Neg LN + ER/PR Neg - Chemo ONLY (Cyclophosphamide, Methotrexate, 5-FU); Neg LN + ER/PR Pos - Tamoxifen or Anastrozole ONLY; Pos LN: Always Chemo (CMF),; Pos LN + ER/PR Pos - Chemo plus Tamoxifen or Anastrozole
|
|
Q947. "Double-bubble" on US indicates what problem?
|
A947. Down's syndrome
|
|
Q948. what should the mother avoid during first trimester b/c it could lead to increased risk of neural tube defects?
|
A948. Hyperthermia (fevers and hot tubs)
|
|
Q949. what are the (2) possible initial tests for syphillis that become negative over time?
|
A949. RPR,; VDRL
|
|
Q950. what are the (2) confirmatory tests for syphillis that are always reactive (positive) if you are exposed?
|
A950. FTA-ABS,; TP-PA
|
|
Q951. what is the next step in management if a FNA is performed on a woman with a breast mass and clear fluid is withdrawn?
|
A951. repeat the exam in 4 - 6 weeks (clear fluid indicates Fibrocystic Disease)
|
|
Q952. what course of action is always contraindicated in placenta previas?; (2)
|
A952. Vaginal exams; Labor Induction
|
|
Q953. if a placenta previa is diagnosed without bleeding, what is the course of management?
|
A953. deliver by C-section at 36 - 37 weeks
|
|
Q954. if placenta previa is diagnosed with bleeding, what is the course of management?
|
A954. Manage expectantly to increase gestational age, then C- section when necessary
|
|
Q955. if baby has decreased fetal movement, what is the first step?
|
A955. order Non-Stress Test (then BPP)
|
|
Q956. what are the (2) reasons for an Amnioinfusion?
|
A956. Relieve cord compression,; Dilute meconium
|
|
Q957. what is next step in management of 26 week gestation PPROM in breech with oligohydramnios?
|
A957. Admission and expectant management (and test for Chorioamnionitis)
|
|
Q958. Define:; Fetal Demise
|
A958. Intrauterine death > 20 weeks
|
|
Q959. what is the blood pressure difference b/t mild preeclampsia and severe preeclampsia?
|
A959. Mild: > 140/90; Severe: > 160/110
|
|
Q960. what do the following Biophysical Profile scores mean:; 1. 8 - 10; 2. 6 - 7; 3. less then 5
|
A960. 8 - 10: Normal; 6 - 7: Deliver at term; less then 5: Deliver immediately
|
|
Q961. what is the name of Postpartum vaginal discharge?; what color is normal at 3 - 4 days PP?; at 10 days PP?; how long can it continue?
|
A961. Lochia; 3 - 4 days: Red; 10 days: Yellow-white; can last 4 - 8 weeks
|
|
Q962. Definition:; infection of placental implant site or hysterectomy scar upward thru venous or lymphatic routes; what is the classic initial sign?
|
A962. Septic Pelvic Thrombophlebitis; sign:; continued temperature 5 days after Antibiotics given postpartum
|
|
Q963. Dx:; patient has delivery and begins to run fever, so antibiotics are given, but the fever does not go down. what is the first step in management?; what is the Tx?
|
A963. Septic Pelvic Thrombophlebitis; Test: MRI to see thrombosis or vascular edema; Tx: IV Heparin + IV broad Antibiotics
|
|
Q964. what level is hCG, AFP and Estriol for:; Trisomy 21
|
A964. hCG: Increased; AFP: Decreased; Estriol: Decreased
|
|
Q965. what level is hCG, AFP and Estriol for:; Trisomy 18
|
A965. hCG: Decreased; AFP: Decreased; Estriol: Decreased
|
|
Q966. maternal infection that causes the following fetal problem:; skin scarring, abnormalities of the lens of the eye, abnormal motor movements and extremitiy hypoplasia
|
A966. Varicella
|
|
Q967. maternal infection that causes the following fetal problem:; deafness, cerebral calcifications, microopthalmia
|
A967. CMV
|
|
Q968. maternal infection that causes the following fetal problem:; pneumonia, meningoencephalopathy, petichae, mental retardation
|
A968. HSV
|
|
Q969. maternal infection that causes the following fetal problem:; cataracts, congenital heart defects, deafness, possible "blueberry muffin" rash
|
A969. Rubella
|
|
Q970. maternal infection that causes the following fetal problem:; IUGR, microencephalopathy, possible fetal hydrops, chorioretinitis
|
A970. Toxoplasma gondii
|
|
Q971. pregnancy risk for mother with DM-1
|
A971. Preeclampsia
|
|
Q972. what is the first line of Tx for DUB and dysmenorrhea?
|
A972. NSAIDs
|
|
Q973. what is the first line of Tx for DUB and menorrhagia?
|
A973. OCPs
|
|
Q974. Dx:; hirsutism, amenorrhea, overweight, infertile
|
A974. PCOS
|
|
Q975. Tx of choice for PCOS?; what if the patient desires to be pregnant?
|
A975. Tx: OCPs; if desires pregnancy: Clomiphene
|
|
Q976. what is the first step in evaluating a couple for infertility?
|
A976. Semen analysis
|
|
Q977. what medications can be used in female for infertility if she does not have adequate estrogen?; (2)
|
A977. 1. Human Menopausal Gonadotropins (hMG); 2. Clomiphene
|
|
Q978. what does Clomiphene citrate need to work?
|
A978. adequate levels of Estrogen
|
|
Q979. (4)* causes of Secondary Amenorrhea
|
A979. PACE:; PCOS,; Anorexia,; Chemotherapy History,; Endocrine disorders
|
|
Q980. a 21 yo girl comes to office for routine check. What test is most important?
|
A980. Chlamydia culture
|
|
Q981. what is the first step in care for a suspicious breast lesion in woman under 35 yo?
|
A981. FNA or Breast biopsy (mammography is not as efficient in this age group)
|
|
Q982. what is the first step of Tx in a woman over 50 yo who has a breast mass?
|
A982. FNA or Breast biopsy
|
|
Q983. Dx:; woman with mulitple deliveries has back pain,a heaviness in the pelvis, with sx that worsen with standing and get better lying down
|
A983. Pelvic Relaxation (Vaginal Prolapse)
|
|
Q984. what is the most non-obstetric cause for hospitalization during pregnancy?
|
A984. Pyelonephritis
|
|
Q985. Definition:; puberty in girls less then 8 yo or boys less then 9 yo; Cause?; Tx? (2)
|
A985. Precocious Puberty; cause: Idiopathic (but RULE OUT hormone-secreting tumor or CNS disorder); Tx: Underlying cause, GnRH analog to prevent premature closure of epiphyseal plates
|
|
Q986. Dx:; prepubescent girl with diabetes has vaginal itching
|
A986. Candidiasis
|
|
Q987. what is the usual cause of vaginal bleeding in neonates?; Tx?
|
A987. maternal estrogen withdrawl; Tx: resolves on its own
|
|
Q988. (4) absolute contraindications to Estrogen therapy
|
A988. Unexplained vaginal bleeding,; Liver Disease,; History of throbophlebitis or TE,; History of endometrial or breast CA
|
|
Q989. why is progesterone given with estrogen replacement therapy?; when dont they need it?
|
A989. to counteract the unapposed estrogen that can lead to cancer in women with a uterus; women with hysterectomy don't need Progesterone therapy
|
|
Q990. MCC of secondary HTN in women
|
A990. Oral Contraceptive Pills
|
|
Q991. why should OCPs be stopped 1 month before a major surgery and then restarted 1 month after?
|
A991. risk of Thromboembolism
|
|
Q992. a woman is on OCP and has amenorrhea. What is the most likely cause?
|
A992. Pregnancy (no pill is 100% effective)
|
|
Q993. (2) main vitamins women should take during pregnancy
|
A993. Folate; Iron
|
|
Q994. when are fetal heart tones heard with doppler and with normal stethoscope?
|
A994. Doppler: 10 - 12 weeks; Stethoscope: 16 - 20 weeks
|
|
Q995. where is the fundus of the uterus at 12 weeks?; 20 weeks?
|
A995. 12 weeks: Pubic bone; 20 weeks: Umbilicus
|
|
Q996. when is US most accurate for fetal age?
|
A996. 16 - 20 weeks
|
|
Q997. when is the only time aspirin should be used during pregnancy?
|
A997. antiphospholipid syndrome
|
|
Q998. what (2) rare disorders are assoc with prolonged gestation?
|
A998. Anencephaly,; Placental Sulfatase deficiency
|
|
Q999. what are the steps if a person has an abnormal AFP?; (2)
|
A999. 1. Ultrasound; 2. Amniocentesis
|
|
Q1000. when is Chorionic Villus Sampling done instead of an Amniocentesis?; when is it done?; risk?
|
A1000. For women with previously affected offspring or known genetic Disease; Performed: at 9 - 12 weeks to offer the option of abortion in first trimester; Risk: higher risk of miscarriage then amniocentesis
|
|
Q1001. what does CVS detect?; what can't it detect?
|
A1001. Detects: genetic or chromosomal disorders; Not Detect: Neural Tube Defects
|
|
Q1002. Teratogen/drug that causes:; spina bifida; hydrospadius
|
A1002. Valproic Acid
|
|
Q1003. Teratogen/drug that causes:; cleft lip/palate, limb, CV defects, mental retardation
|
A1003. Phenytoin
|
|
Q1004. Teratogen/drug that causes:; cleft lip and/or palate
|
A1004. Diazepam; (Benzodiazepines)
|
|
Q1005. Teratogen/drug that causes:; Cardiac (Ebstein's) anomalies
|
A1005. Lithium
|
|
Q1006. Teratogen/drug that causes:; fingernail hypoplasia, craniofacial defects
|
A1006. Carbamazepine
|
|
Q1007. Teratogen/drug that causes:; deafness
|
A1007. Aminoglycosides
|
|
Q1008. Teratogen/drug that causes:; vertebral, anal, cardiac, tracheo-esophageal,renal and limb malformations
|
A1008. Oral Contraceptive Pills; (VACTERL syndrome)
|
|
Q1009. Dx:; baby is born with cleft lip or palate; lower half of body incompletely formed; left colon hypoplasia, CV defects, microsomia or macrosomia
|
A1009. Mother with untreated DM
|
|
Q1010. what was mother exposed to if baby has:; saber shins, interstitial keratitis, skin lesions, rhinitis, unusual teeth
|
A1010. Syphillis
|
|
Q1011. in untreated HIV patients, what is the transmission rate to the fetus?
|
A1011. 0.25
|
|
Q1012. when should Zidovudine be given to the HIV mother and baby?; what does this reduce the risk to?
|
A1012. mother: Prenatally (at 14 weeks); baby: for 6 weeks after birth; reduces risk to 10% transmission
|
|
Q1013. why might a non-infected baby of an HIV mother test positive at birth?; when does it revert to a negative test?
|
A1013. mother's antibodies can cross the placenta; reverts to negative:; 6 months
|
|
Q1014. what should you do for a newborn if the mother has chronic; Hep B?
|
A1014. give newborn first Hep-B vaccination and Hep-B immunoglobulin at birth
|
|
Q1015. what should be done for baby if the mother contracts chicken pox w/i the last 5 days of pregnancy or the first 2 days post-delivery?
|
A1015. give the child a VZV immunoglobulin shot
|
|
Q1016. what is suspected if the lochia is foul-smelling?
|
A1016. Endometriitis
|
|
Q1017. (4) common Infection-based contraindications to breast feeding
|
A1017. 1. HIV; 2. Hepatitis B; 3. CMV; 4. Active Herpes lesions on breast
|
|
Q1018. what (2) ilicit drugs are not teratogens?
|
A1018. Weed,; LSD
|
|
Q1019. what should you consider if preeclampsia develops before the third trimester?; (2)
|
A1019. Hydatiform mole,; Choriocarcinoma
|
|
Q1020. what are the signs of Magnesium sulfate toxicity?; (3)
|
A1020. Hyporeflexia,; Respiratory depression,; CNS depression; (leading to coma and death)
|
|
Q1021. when eclampsia occurs (seizure), when do you deliver the infant?
|
A1021. Only when the mother is stable...never do C-section during seizure
|
|
Q1022. Dx:; recent postpartum mother with tachypnea, SOB, chest pain, hypotension, DIC
|
A1022. Amniotic fluid pulmonary embolism
|
|
Q1023. Definition:; true labor has begun, but is progressing slower then normal time values
|
A1023. Protraction Disorder
|
|
Q1024. Definition:; true labor has begun, but there has been no change in dilation in over 2 hours or no change in desent in 1 hour
|
A1024. Arrest Disorder
|
|
Q1025. what is the first step in managing Protraction or Arrest disorder?
|
A1025. Rule-out: Abnormal Lie and Cephalopelvic disproportion
|
|
Q1026. MCC of Protraction or Arrest disorder?; Tx?
|
A1026. Cephalopelvic disproportion (head wont fit); Tx: C-section
|
|
Q1027. what possible problems can be encountered when Oxytocin is used to induce labor; (4: 2 uterine, one fetal one electrolyte); Tx?
|
A1027. Uterine hyperstimulation (painful, irregular contractions),; Uterine rupture,; FHR decelerations,; Water intoxication/HypoN; Tx: stop the Pit (short T-1/2)
|
|
Q1028. what are the contraindications to Labor induction and/or Vaginal delivery?; (7)*
|
A1028. Placenta or Vasa Previa,; Umbilical cord prolapse,; Prior classic C-section,; Cervical CA,; Cephalopelvic disproportion; Active genital Herpes,; Transverse Fetal Lie,
|
|
Q1029. when is it detected on US:; 1. Gestational sac; 2. Fetal image; 3. Beating heart
|
A1029. Gestational sac = 5 weeks; Fetal image = 6 - 7 weeks; Beating heart = 8 weeks
|
|
Q1030. What is normal steps of management for mother when Variables are seen?; (3); if bradycardia continues, what is next step?
|
A1030. 1. place in Lateral decubitus position; 2. give her oxygen; 3. stop Pitocin if continues: insert pH scalp monitor
|
|
Q1031. if the mother had Variables or Lates and you went thru the steps to the insertion of the fetal scalp pH monitor. what is the next step if the pH is below 7.2?; Above 7.2?
|
A1031. pH < 7.2 = Immediate C-section; pH > 7.2 = continued monitoring
|
|
Q1032. if the child has a shoulder distocia during delivery, what is the first step?; what is done if this fails?
|
A1032. McRobert's maneuver; if it fails: C-section
|
|
Q1033. what is always the initial step in management for Third Trimester bleeding?; Why?
|
A1033. Ultrasound; b/c it may be due to a placenta previa (CI to pelvic exam)
|
|
Q1034. what can a placental abruption lead to if fetal products enter maternal circulation?
|
A1034. DIC
|
|
Q1035. Biggest risk factor for fetal bleeding; (vasa previa or velamentous cord) in third trimester?
|
A1035. Multiple gestations
|
|
Q1036. Definition:; blood-tinged mucous plug that is a normal cause of third trimester spotting
|
A1036. Bloody show
|
|
Q1037. once a woman in preterm labor is stable, what is the next step in management?
|
A1037. manage as outpatient with oral tocolytics
|
|
Q1038. assuming there are no prenatal procedures done, when is the normal time RhoGAM is given?; (2)
|
A1038. 1. 28 weeks; 2. w/i 72 hours after delivery
|
|
Q1039. what are the (3) possible ways to treat Hemolytic Disease of the Newborn?
|
A1039. Delivery (if at term),; Intrauterine transfusion (risky),; Phenobarbitol (helps liver breakdown bilirubin)
|
|
Q1040. what is the blood type for the mother and infant that can also cause hemolytic disease?
|
A1040. Mother: Type O; Baby: Type A, B or AB
|
|
Q1041. (3) possible reasons a postpartum patient will go into shock without evidence of bleeding
|
A1041. Amniotic fluid embolism,; Uterine Inversion,; Concealed hemorrhage
|
|
Q1042. what strange lab tests are NORMAL in pregnancy?; (5)
|
A1042. ESR is high,; Total T4 and TBG inc, but free T4 is nml,; Dec Hct and Hb,; Alk Phos inc,; mild proteinuria and glycosuria,
|
|
Q1043. Dx:; itching and abnormal LFT in any trimester, poss jaundice; Tx?
|
A1043. Cholestasis; Tx: Delivery (but cholestyramine helps with Sx)
|
|
Q1044. Dx:; girl never had period with breast development, patent vagina, no uterus and 46, XY
|
A1044. Androgen Insensitivity; (Testicular Feminization)
|
|
Q1045. Dx:; girl never had period, without breast development, normal uterus and vagina, 46,XX, FSH is low
|
A1045. Hypothalamic-Pituitary dysfunction
|
|
Q1046. Dx:; girl never had period without breast development, normal uterus and vagina, 46,XX, FSH is high
|
A1046. Gonadal Dysgenesis; (Primary Ovarian failure)
|
|
Q1047. Syndrome:; Hypothalamic-Pituitary dysfunction that results in a defect in GnRH production; what is unusual about patient presentation?; what are FSH and LH levels?
|
A1047. Kallman syndrome (patient lost sense of smell); LH and FSH are low
|
|
Q1048. Definition:; defect in ovarian receptors for LH and FSH
|
A1048. Savage syndrome (a Hypogonadotropic Hypogonaism defect)
|
|
Q1049. what are (3) pathologic causes of Primary ovarian failure; (primary amenorrhea)?
|
A1049. Turner's syndrome,; Defects in Steroid synthesis,; Savage's syndrome (no ovarian LH and FSH receptors)
|
|
Q1050. what is the maternal MCC of IUGR?
|
A1050. Chronic maternal Hypertension
|
|
Q1051. what is considered normal in the Hunter-Sims postcoital test for sperm?; (2)
|
A1051. 1. 8 - 10 motile sperm in highpowered field; 2. thin cervical mucous
|
|
Q1052. Abortion type:; bleeding, cervical dilation, retained POC
|
A1052. Inevitable abortion
|
|
Q1053. Dx:; woman at 18 week with decrease in uterine size, loss of pregnancy symptoms (no Fetal Heart Beat) and brownish vaginal discharge. The cervix is closed and no intrauterine contents have passed
|
A1053. Missed abortion
|
|
Q1054. what is the cause of Testicular femninization?; How do they present?; (5)
|
A1054. cause: absence or dysfunction of testosterone receptors; Breasts, no pubic hair, amenorrhea, vagina that ends in blind pouch and without Hirsutism
|
|
Q1055. what is the staging for ovarian cancer (Ia,b,c - IV)?
|
A1055. Ia: confined to one ovary; Ib: involves both ovaries; Ic: either a or b with rupture of ovary, disease outside capsule or positive washings; II: Extends into pelvis; III: Mets into abdomen; IV: Distant Mets
|
|
Q1056. what gestational time does the formation for the (3) types of twins occur:; 1. Di-Di; 2. Mono-Di; 3. Mono-Mono
|
A1056. Di-Di: zero - 3 days; Mono-Di: 3 - 8 days; Mono-Mono: 8 - 13 days
|
|
Q1057. what ovarian tumor is most commonly assoc with increased AFP?
|
A1057. Endodermal Sinus Tumor; (Most Aggressive Germ Cell Tumor; Schiller-Duval Bodies; from extraembrionic tissue)
|
|
Q1058. what ovarian tumor is most commonly assoc with increased hCG?
|
A1058. Choriocarcinoma
|
|
Q1059. what are the steps and Dx in diagnosing a Secondary Amenorrhea?; (5)
|
A1059. 1. RULE OUT Pregnancy; 2. If Galactorrhea present: High TSH = Hypothyroidism, Nml TSH and High Prolactin = Pituitary tumor or drug; 3. Galactorrhea not present: Progesterone challenge, (+) Bleeding = good estrogen -> Anovulation; 4. (-) Bleeding -> Hysteroscopy for Ashermans; 5. Neg Ashermans -> test LH/FSH: Low LH/FHS = Hypothalamic-Pituitary, High LH/FSH = Ovary problem
|
|
Q1060. what is the safe treatment for a pregnant woman who may get alcohol poisoning from bindge drinking?
|
A1060. Benzodiazepines
|
|
Q1061. Of all the woman trying to get pregnant, how many will conceive in one year?
|
A1061. 80 - 85%
|
|
Q1062. Dx:; anterior abdominal wall defect in the infant where the skin, muscles and fascia are missing and the cord inserts into a created amniotic membrane that covers the abdominal organs
|
A1062. Omphalocele
|
|
Q1063. Dx:; anterior abdominal wall defect in the infant where the abdominal contents are herniated lateral to the normal insertion of the umbilical cord
|
A1063. Gastroschsis
|
|
Q1064. MC female sexual disorder
|
A1064. Hypoactive sexual desire
|
|
Q1065. what are the precursor cells to the placental membranes?
|
A1065. Trophoblasts
|
|
Q1066. during a Threatened abortion, what lab is low?
|
A1066. Estradiol levels
|
|
Q1067. what is the most common reason for an abnormal triple screen?; what is the first step for an abnormal triple screen?
|
A1067. incorrect gestational age; first step: Ultrasound for accurate dating
|
|
Q1068. what test determines the amount of fetal RBC in the maternal circulation?
|
A1068. Kleihaur-Bettke test
|
|
Q1069. (5)* safe Vaccines during pregnancy
|
A1069. HOTY-D:; Hep B,; Oral Polio,; Tetanus,; Yellow fever,; Diphtheria
|
|
Q1070. what (5)* exposures in pregnancy require Immune Globulin?
|
A1070. The Mom Can Really Hurt:; Tetanus,; Measles,; Chickenpox,; Rabies; Hep A and B,
|
|
Q1071. Dx:; post-delivery in third stage there is a sudden gush of blood, umbilical cord lengthening and the uterus rises and firms
|
A1071. Placental separation
|
|
Q1072. Definition:; the fatty substance consisting of desquamated epithelial cells and sebaceous matter that covers the skin of the fetus
|
A1072. Vernix
|
|
Q1073. what is the main use of prostaglandins in delivery?
|
A1073. ripening of the cervix
|
|
Q1074. which Leopold Maneuver:; What fetal part occupies the fundus?; What apect of fetal to mother relationship does it determine?; (2)
|
A1074. First maneuver determines:; 1. Fetal Lie; 2. Fetal Presentation
|
|
Q1075. which Leopold Maneuver:; On what side is the fetal back?
|
A1075. Second amneuver
|
|
Q1076. which Leopold Maneuver:; What fetal part lies over the pelvic inlet?; What apect of fetal to mother relationship does it determine?
|
A1076. Third maneuver; determines: Fetal Position
|
|
Q1077. which Leopold Maneuver:; On which side is the cephalic prominence?
|
A1077. Fourth maneuver
|
|
Q1078. Type of Breech:; thighs are flexed, legs extended over anterior surface of body, feet are in front of face
|
A1078. Frank breech
|
|
Q1079. Type of Breech:; thighs are flexed on the abdomen and legs are flexed (folded)
|
A1079. Complete breech
|
|
Q1080. Describe the 4 types of vaginal tears
|
A1080. First degree: skin and vaginal mucosa; Second degree: including underlying muscle; Third degree: including anal sphinctor; Fourth degree: including rectal mucosa
|
|
Q1081. what causes fluid retention postpartum?; (2)
|
A1081. High Estrogen levels during Pregnancy; Increased Venous Pressure in lower body during pregnancy
|
|
Q1082. what external stimulus provokes milk letdown?
|
A1082. cry of the infant
|
|
Q1083. what are the diabetic classifications?; (8)
|
A1083. Gestational:; A1: < 120 two-hr PP glucose; A2: > 120 Non-Gestational (normal DM):; B: onset > 20 yo; C: onset 10 - 19 yo; D: onset < 10 yo; F: any onset age including neFropathy; H: any onset age including Heart prob; R: any onset age including Retinopathy
|
|
Q1084. what is the CNS anomaly most specific to mother with DM?
|
A1084. Caudal regression
|
|
Q1085. if a woman is taking anticonvulsants during pregnancy, what vitamin should be supplemented?
|
A1085. Folic Acid (if not, risk of defects or Anemia related to folic acid deficiency)
|
|
Q1086. since asthma can be exacerbated by respiratory tract infections in pregnant women, what specific vaccine should be given to all asthma patients for prophylaxis?
|
A1086. Killed Influenzae Vaccine
|
|
Q1087. which anti-HTN medication in pregnancy can cause the AE of SLE-like syndrome?
|
A1087. Hydralazine
|
|
Q1088. (5)* contraindications to giving Tocolytics
|
A1088. BAD CHad:; Bleeding (severe),; Abrupto placentae,; Death of fetus,; Chorioamnionitis,; HTN (severe)
|
|
Q1089. first step in management for PROM
|
A1089. evaluate for Chorioamnionitis; (if so, deliver baby and Antibiotics)
|
|
Q1090. what is the Apt test and its results?
|
A1090. place vaginal blood in tube with KOH; turns Brown = Maternal; turns Pink = Fetal
|
|
Q1091. Dx:; pregnant woman is rushed into ER from car accident and has back pain
|
A1091. Placental abruption
|
|
Q1092. why is Estrogen a Pro-coagulant?; (2)
|
A1092. Increases Factors VII and X; Decreases Anti-Thrombin III
|
|
Q1093. best method of hormonal birth control for woman with SLE?
|
A1093. Injectable Progesterone
|
|
Q1094. what secretes Progesterone in the Luteal phase?; what does the secretion cause with respect to hormones?
|
A1094. Corpus luteum; causes: decrease in LH and FSH
|
|
Q1095. what hormone not related to menstrural cycle, inhibits GnRH pulsations and ovulation?
|
A1095. Prolactin
|
|
Q1096. MC postoperative complication?
|
A1096. Pulmonary Atelectasis
|
|
Q1097. MC cause of primary amenorrhea?
|
A1097. Gonadal dysgenesis
|
|
Q1098. MC reason for neonatal sepsis?
|
A1098. Chorioamnionitis (GBS or e.coli)
|
|
Q1099. Dx:; a baby with ambiguous genitalia is born to a mother who complains of increased facial hair growth over the last few months
|
A1099. Luteoma of pregnancy (Dx after birth...virilization in mother and fetus)
|
|
Q1100. Diff Dx for Menorrhagia; (6)*
|
A1100. LACE-UP:; Leiomyoma,; Adenomyosis,; Coagulopathy,; Endometrial Hyperplasia,; Uterine (Endometrial) or Cervical CA,; Polyps of endometrium
|
|
Q1101. Diff Dx for postcoital bleeding; (3)
|
A1101. Trauma,; Infection,; Cervical cancer
|
|
Q1102. Definition:; pelvic pain assoc with ovulation
|
A1102. Mittelschmerz
|
|
Q1103. MCC of acute pelvic pain
|
A1103. Ruptured ovarian cyst
|
|
Q1104. Dx:; premenopausal patient complains of hemoptysis with each period
|
A1104. Endometriosis of nasopharynx or lung
|
|
Q1105. what must be completely visualized for adequate colposcopic evaluation?
|
A1105. Transformation zone
|
|
Q1106. what (4)* cancers metastasize to cervix by direct extension?
|
A1106. RIB-Eye steak:; Rectal,; Intra-abdominal,; Bladder,; Endometrial
|
|
Q1107. which cervical cancer is susceptable to radiation therapy?; which is not?
|
A1107. Radiation: SCC of cervix; not: Adenocarcinoma of cervix
|
|
Q1108. what are the 4 basic stages of endometrial CA?
|
A1108. I: only uterine involvement; II: includes cervical involvement; III: includes local spread; IV: includes distant spread
|
|
Q1109. what is the most important prognostic indicator of endometrial CA?
|
A1109. Grade; G1 = Well differentiated; < 5% solid; G2 = Moderate differentiation; 5 - 50% solid; G3 = Poor differentiation; > 50% solid
|
|
Q1110. Dx:; postmenopausal woman with a widening girth notices she can no longer button her pants
|
A1110. Ovarian cancer
|
|
Q1111. Definition:; a fixed pelvic and upper abdominal mass with ascites; what is it a sign of?
|
A1111. Omental caking; sign: Ovarian cancer
|
|
Q1112. what GYN cancers are staged Surgically?; Clinically?
|
A1112. Surgically:; Ovarian,; Endometrial; Clinically:; Cervical
|
|
Q1113. In addition to a TAH/BSO for epithelial cell ovarian cancer, what is the Tx in stages I-IV?
|
A1113. Stage I and II: Only chemotherapy (Taxol and Cisplatin); Stage III and IV: Chemotherapy plus... 1. Radiation if tumor < 2 cm; 2. Interval Debulking (more surgery) if > 2 cm
|
|
Q1114. what is the tumor marker for a Granulosa-Theca cell tumor?
|
A1114. Inhibin (and high estrogen)
|
|
Q1115. what is the tumor marker for a Sertoli-Leydig ovarian tumor?
|
A1115. Testosterone
|
|
Q1116. what class of female cancers secrete hCG, Lactogen and Thyrotropin?
|
A1116. Gestational Trophoblastic Neoplasias (GTN)
|
|
Q1117. what is the criteria for hospitalization for PID?; (5)*
|
A1117. GU PAP:; GI symptoms,; Unknown Dx,; Peritonitis,; Abscess,; Pregnancy
|
|
Q1118. what is the diagnostic test for Gonorrhea?
|
A1118. culture on Thayer-Martin agar
|
|
Q1119. what is the diagnostic test for chlamydia?
|
A1119. Microimmunofluorescence test (MIF)
|
|
Q1120. Dx:; painless papule on genitals, lymphadenitis, rectovaginal fistula
|
A1120. Lymphogranuloma Venereum (LGV); [serotype L1-L3 of chlamydia]
|
|
Q1121. what is the level of Vaginal Prolapse with each Grade I-IV?
|
A1121. I: to level of Ischial spines; II: b/t Ischial spines and Introitus; III: within Introitus; IV: past Introitus
|
|
Q1122. what type of incontinence does the Q-tip test measure?
|
A1122. Stress incontinence
|
|
Q1123. Common COD for Ovarian CA patient?
|
A1123. Mets to bowel causing obstruction
|
|
Q1124. if a female patient has HIV, what cancer will progress the Dx to AIDS?
|
A1124. Cervical CA; (HPV)
|
|
Q1125. what is the next step if you cannot see the transformation zone on colposcopy?
|
A1125. LEEP procedure
|
|
Q1126. what is the only cancer you can slice through without taking all of it out?
|
A1126. Ovarian CA
|
|
Q1127. Definition:; Absence of spermatozoa
|
A1127. Azoospermia
|
|
Q1128. Definition:; Low concentration of spermatozoa
|
A1128. Oligozoospermia
|
|
Q1129. Definition:; Poor motility of sperm
|
A1129. Asthenozoospermia
|
|
Q1130. Definition:; Poor morphology of sperm
|
A1130. Teratozoospermia
|
|
Q1131. what is the difference in FSH levels of the Dx of Poor Oocyte Reserve versus Premature Ovarian Failure?; what are estrogen levels with each?
|
A1131. Poor Oocyte Reserve:; FSH > 10; Estrogen = normal; Premature Ovarian Failure:; FSH > 25; Estrogen is Low (same as menopause)
|
|
Q1132. Dx:; 35yo female with secondary amenorrhea, low estrogen and very high FSH and LH
|
A1132. Premature Ovarian Failure; (menopause in female < 36 yo)
|
|
Q1133. MCC of maternal death in the first trimester
|
A1133. Ectopic pregnancy
|
|
Q1134. what is the cause of vaginal lubrication during sex?
|
A1134. Vaginal Transudation; (edema from engorged vaginal vessels)
|
|
Q1135. Dx:; patient ovulates day 14 and starts bleeding day 22; low progesterone; Dx exam?
|
A1135. Luteal Phase Defect (shortened luteal phase); Dx exam: Late Luteal Phase endometrial biopsy
|
|
Q1136. (3) reasons to use a Sterile vaginal Speculum on assessing the Laboring patient
|
A1136. 1. Suspect Rupture of Membranes; 2. Preterm Labor; 3. signs of Placenta Previa
|
|
Q1137. Dx:; PID with Perihepatic inflammation and adhesions from liver to diaphragm
|
A1137. Fitz-Hugh-Curtis syndrome
|
|
Q1138. What is the next step in Tx for a patient with ASCUS?
|
A1138. Repeat Pap smear in 3 months
|
|
Q1139. Patient comes in with a suspected Fibroadenoma. Next step?
|
A1139. Ultrasound (cannot send home without checking; this is sufficient to confirm Dx0
|
|
Q1140. How long should HRT be used?
|
A1140. 6 - 12 months; (then if Sx persist, switch to another method)
|
|
Q1141. Most deaths from Cervical CA are due to what?
|
A1141. Uremia; (and pyelonephritis)
|
|
Q1142. Most common form of contraception in USA?
|
A1142. Sterilization
|
|
Q1143. Pregnant woman comes in with a gush of clear fluid from the vagina. First step?
|
A1143. Sterile Vaginal Exam
|
|
Q1144. Dx test for HSV
|
A1144. Viral Culture (not Tzank smear)
|
|
Q1145. Medicine to rapidly relax the Uterus if it is inverted?; (2)
|
A1145. 1. Nitroglycerine; 2. Terbutaline
|
|
Q1146. Most sensitive test to distinguish types of Incontinence
|
A1146. Urethrocystometry
|
|
Q1147. 50-yo patient with Breast CA presents with Lytic lesions of the spine. First step?
|
A1147. Radiation
|
|
Q1148. Greatest risk factor for Endometrial Hyperplasia
|
A1148. Obesity; (50lbs overweight increases risks 10 times)
|
|
Q1149. 3-yo develops breasts without vaginal bleeding or pubic hair; First step?; Dx?
|
A1149. First: obtain Serum Estradiol level; Dx: Premature Thelarche; (MC before age 4 due to increase circulating E2; No Tx)
|
|
Q1150. Ligament that contains the Ovarian artery and vein
|
A1150. Infundibulopelvic ligament
|
|
Q1151. Ovarian tumor with Call-Exner bodies
|
A1151. Granulosa cell tumor; (increased serum E2)
|
|
Q1152. Where is Hematopoiesis the most in development at age:; 1. <12 weeks; 2. 12 - 24 weeks; 3. >24 weeks until birth
|
A1152. 1. <12 weeks = Yolk Sac; 2. 12 - 24 weeks = fetal Liver; 3. >24 weeks until birth = fetal Bone Marrow
|
|
Q1153. 27-yo with secondary amenorrhea and 4 months of hirsutism; normal pelvic exam and US; First step?
|
A1153. Serum DHEAs; (to see if it is from ovary or adrenal gland)
|
|
Q1154. At what age does a female have the most Oocytes?
|
A1154. 20 weeks gestation; (at birth 1/2 are lost)
|
|
Q1155. Dx:; Condyloma ACUMINATUM
|
A1155. HPV
|
|
Q1156. woman being evaluated for infertility is found to have a double uterus; Next test?
|
A1156. IVP; (30% of women with uterine anomaly have urinary tract anomaly)
|
|
Q1157. Patient has confirmed Chlamydia; Tx?
|
A1157. Tx Patient and Partner with Doxycycline ONLY
|
|
Q1158. Patient has confirmed Gonorrhea; Tx?
|
A1158. Tx Patient and Partner with both Ceftriaxone and Doxycycline; (if it was Chlamydia, it would be Doxy only)
|
|
Q1159. Dx test for Septic Pelvic thrombophlebitis; Tx?
|
A1159. Dx test: MRI of pelvis; Tx: Heparin and IV Antibiotics
|
|
Q1160. a 44-yo with normal pap smear 3 years ago has intermenstrual and post-coital spotting intermittently for 6 months. First test?
|
A1160. Pap Smear; (cervical polyp is strong possibility of Dx0
|
|
Q1161. Name of the surgery for Stress Incontinence
|
A1161. Retropubic Urethropexy
|
|
Q1162. Best predictor of Breast CA that has spread outside of the breast?
|
A1162. Initial SIZE of the Tumor; (which is Stage in this case)
|
|
Q1163. Dx:; Purulent vaginal discharge and pH of 4.2 - 5.0
|
A1163. Monilial Vaginitis
|
|
Q1164. Dx:; Decreased ejaculate volume and azoospermia without fructose
|
A1164. Absent Seminal vesicles; (SV adds the fructose to ejaculate)
|
|
Q1165. Total time for sperm to ejaculate
|
A1165. 90 days
|
|
Q1166. what type of immunity is a RhoGAM shot?
|
A1166. Passive Immunity; (b/c you give the Antibody)
|
|
Q1167. after delivery, what should be suspected if placenta does not separate spontaneously after 30 minutes?
|
A1167. Placenta Accreta
|
|
Q1168. What VD can affect the throat and present with exudative pharyngitis?
|
A1168. Herpes
|
|
Q1169. (5) reasons to hospitalize for PID
|
A1169. 1. Bad infection (>39C; N/V);; 2. Adolescent; 3. NULLIPAROUS; 4. Low SES; 5. Failure to respond to IV meds
|
|
Q1170. In a woman with IDM, what should be done for fetal surveillance?
|
A1170. NST; (starting at 28 weeks; 2 times weekly to decrease risk of Sudden Intrauterine Death)
|
|
Q1171. Which form of incontinence is associated with DM?; Tx?
|
A1171. Overflow Incontinence (Detrusor instability from neuropathy; will present with increased post-void volume); Tx: Self-catheterization
|
|
Q1172. which type of incontinence may be treated by alpha- adrenergic meds?
|
A1172. Stress Incontinence; (after Kegel exercises are attempted; also E2 therapy works; if all else fails, then this is the only one that can be cured by surgery)
|
|
Q1173. How long must a diaphragm stay in after intercourse?
|
A1173. at least 6 hours
|
|
Q1174. pregnant woman presents with tachycardia, increased breathing, and chest pain. CXR is negative; Next step?
|
A1174. V/Q exam
|
|
Q1175. what is the follow-up post delivery if the patient has gestational diabetes?
|
A1175. 2-hour GTT in 6 weeks post partum
|
|
Q1176. 14-yo presents with vaginal bleeding causing a Hct of 30%; no History of blood disorder; Beta-HCG and US are negative; normal vitals; First step?
|
A1176. give OCPs; (will stabilize bleed in initial menstrual cycles; no transfusion needed)
|
|
Q1177. Uterine Leiomyoma (Fibroids) - What is it
|
A1177. MC benign gyn lesion; MC in Blacks and patients > 35; smooth muscle cell tumors; responds to hormones; increased during pregnancy; usu regresses after menopause; transform to leiomyosarcoma is rare
|
|
Q1178. Uterine Leiomyoma (Fibroids) - History/PE
|
A1178. Usu asymp; may have - abnorm uterine bleeding; pelvic pressure; dysmenorrhea; urinary freq. pain; NT; irreg enlarged uterus; "lumpy bumpy"
|
|
Q1179. Uterine Leiomyoma (Fibroids) - Dx
|
A1179. US
|
|
Q1180. Uterine Leiomyoma (Fibroids) - Tx
|
A1180. If asymp - manage expectantly; monitor growth; serial exams; US; if severe Sxs or postmenopausal growth - myomectomy or hysterectomy; med therapies - shrink tumors; tumors grow when meds stopped; use in perimenopausal
|
|
Q1181. Infertility - What is it
|
A1181. Inability after 1 year; female dysfunction (no. 1); male dysfunction; female - no. 1 = endometriosis, PID, cervix, uterine-tubal, ovulation prob, peritoneum, multiple factors, UNK
|
|
Q1182. Infertility - Dx
|
A1182. FSH; LH; TSH; prolactin; hysterosalpingography; semen analysis
|
|
Q1183. Infertility - Tx
|
A1183. Tx underlying cause; endometriosis - lap removal of implants; clomiphene citrate; Pergonal - purified human FSH & LH; GIFT, IVF
|
|
Q1184. Menopause - What is it
|
A1184. Due to end-organ ovarian resistance to gonadotropins; median age 50-52; premature - < 40: idiopathic premature ovarian failure, assoc. with cigarettes, artificial - after removal of ovaries, after irradiation of ovaries; postmenopausal - lose protection from estrogen, increased risk for osteoporosis and heart dis.
|
|
Q1185. Menopause - History/PE
|
A1185. Menstrual irreg; sweating; sleep disturb; mood changes; decreased libido; dyspareunia; dysuria; vaginal dryness; decreased breast size; genital tract atrophy
|
|
Q1186. Menopause - Dx
|
A1186. Increased serum FSH - suggestive; 1 yr without menses
|
|
Q1187. Menopause - Tx
|
A1187. HRT - can relieve Sxs, help prevent osteoporosis; contraindications - unDx vag bleeding, liver disease, acute vas thrombosis, history of endometrial cancer, history of breast cancer; progesterone/estrogen - if still have uterus; estrogen alone - if had TAHBSO; clonidine; topical estrogens; calcium, vit D; calcitonin; bisphosphonates
|
|
Q1188. Contraception - Rhythm Method; What is it
|
A1188. Use body temp and cervical mucus consistency to predict time of fertility
|
|
Q1189. Contraception - Rhythm Method; Side Effect
|
A1189. Unreliable
|
|
Q1190. Contraception - Coitus Interruptus; What is it
|
A1190. Withdraw before ejaculation
|
|
Q1191. Contraception - Coitus Interruptus; Side Effect
|
A1191. High failure rate
|
|
Q1192. Contraception - Diaphragm and Cervical Caps; What is it
|
A1192. Domed sheet of rubber or latex placed over cervix; must be fitted by physician; must remain in vagina 6-8 hrs after intercourse
|
|
Q1193. Contraception - Diaphragm and Cervical Caps; Side Effects
|
A1193. Possible allergy to latex or spermicides; risk of UTI, TSS
|
|
Q1194. Contraception - Condoms; What is it
|
A1194. Latex sheath
|
|
Q1195. Contraception - Condoms; Side Effects
|
A1195. Possible allergy to latex or spermicides
|
|
Q1196. Contraception - IUD; What is it
|
A1196. Plastic and/or metal device placed in uterus; causes local sterile inflammatory reaction in uterine wall so that sperm engulfed and destroyed
|
|
Q1197. Contraception - IUD; Side Effects
|
A1197. Increased vag bleeding - copper IUD; uterine perforation; IUD migration; infection; increased risk of PID; increased risk of ectopic preg
|
|
Q1198. Contraception - OCPs; What is it
|
A1198. Suppress ovulation by inhibiting FSH/LH; change consistency of cervical mucus; make endometrium unsuitable for implantation
|
|
Q1199. Contraception - OCPs; Side Effects
|
A1199. HTN; hepatic adenoma; weight gain; increased risk of thromboembolism; nausea; acne; breast tenderness; mood changes
|
|
Q1200. Contraception - Levonorgestrel (Norplant) - What is it
|
A1200. Taken off market 2002; progestin subdermal implant; suppresses ovulation; thickens cervical mucus; makes endometrium unsuitable for implantation; effect lasts 5 yrs.
|
|
Q1201. Contraception - Levonorgestrel (Norplant) - Side Effects
|
A1201. Irreg vag bleeding; weight gain; galactorrhea; acne; breast tenderness; headache; hard to remove
|
|
Q1202. Contraception - Postcoital morning-after pill; What is it
|
A1202. Progesterone +/- estrogen; take within 72 hrs of unprotected sex; suppresses ovulation; discourages implantation
|
|
Q1203. Contraception - Postcoital morning-after pill; Side Effects
|
A1203. N/V; fatigue; breast tenderness; headache; dizziness
|
|
Q1204. Contraception - Medroxyprogesterone; (Depo-Provera); What is it
|
A1204. IM injection given every 3 mos; suppresses ovulation; thickens cervical mucus; makes endometrium unsuitable for implantation
|
|
Q1205. Contraception - Medroxyprogesterone; (Depo-Provera); Side Effects
|
A1205. Irreg vag bleeding; depression; weight gain; breast tenderness; delayed restoration of ovulation after discontinue
|
|
Q1206. Contraception - Surgical Sterilization; (Tubal Ligation, Vasectomy); What is it
|
A1206. Tubes ligated, cauterized or mechanically occluded
|
|
Q1207. Contraception - Surgical Sterilization; (Tubal Ligation, Vasectomy); Side Effects
|
A1207. Essentially irreversible; bleeding; infection; failure; ectopic pregnancy
|
|
Q1208. Intraductal Papilloma - What is it
|
A1208. Common cause of bloody nipple discharge
|
|
Q1209. Fibrocystic Change - What is it
|
A1209. Catchall term; spectrum of clinical findings; mastalgia; breast cysts; fibroadenoma; mastitis; hyperplasia; nodularity; commonly seen in premenopause; from exaggerated response of stroma to hormones & growth factors; increased cancer risk only if cellular atypia
|
|
Q1210. Fibrocystic Change - History/PE
|
A1210. Cyclic,; premenstrual,; b/l breast pain,; tenderness, swelling; excessive tissue nodularity
|
|
Q1211. Fibrocystic Change - Dx
|
A1211. Fine-needle aspiration; cytologic exam
|
|
Q1212. Fibrocystic Change - Tx
|
A1212. Decreased caffeine and nicotine; vit E; progestins; danazol; tamoxifen; diuretics
|
|
Q1213. Fibroadenoma - What is it
|
A1213. MC breast lesion < 30; benign, slow-growing tumor; epithelial & stroma components; recurrence common; phyllodes tumor - (cystosarcoma phylloides); grows fast; large type of fibroadenoma; rarely malignant
|
|
Q1214. Fibroadenoma - History/PE
|
A1214. Round; firm, NT; mobile; solitary mass, discrete
|
|
Q1215. Fibroadenoma - Dx
|
A1215. Surgical excision - tissue for Dx
|
|
Q1216. Fibroadenoma - Tx
|
A1216. Surgical excision
|
|
Q1217. Breast Cancer - What is it
|
A1217. MC cancer (incidence); no. 2 in cancer death; risk factors – gender, age, breast Ca 1st degree relatives, history of breast cancer, 1st fullterm preg after 35 y/o, history of fibrocystic change with cellular atypia, increased exposure to estrogen – nullparity, early menarche, late menopause, late menarche - decreased risk, BRCA-1 & BRCA-2 mutations - early-onset familial breast, and ovarian cancers
|
|
Q1218. Breast Cancer - History/PE
|
A1218. Lump – hard, irreg, not mobile, painless; possible nipple discharge; can be asymp and nonpalpable; MC location - upper outer quad; mets to - lymph nodes, bones, brain, lung, liver; advanced disease - skin changes: dimpling, redness, ulceration, edema, axillary adenopathy
|
|
Q1219. Breast Cancer - Dx
|
A1219. Mammography - ↑ density, microcalcifications, irregular borders; US - solid mass vs. benign cyst; tumor markers for recurrent- CEA, CA 15-3, CA 27-29, estrogen receptor (ER), progesterone receptor (PR), HER2/neu status; metastatic disease - ↑ ESR, ↑ alk phos, ↑ calcium; CXR - pulmonary metas; CT - chest, abdomen, pelvis, brain; bone scan
|
|
Q1220. Breast Cancer - Tx
|
A1220. All hormone receptor pos. - tamoxifen; estrogen rec. neg - chemo; trastuzumab - HER2/neu-expressive cancers; partial mastectomy and axillary dissection followed by radiation; modified radical mastectomy (total mastectomy plus axillary dissection); contraindications to breast-conserving therapy - large tumor, multifocal tumors, subareolar location, fixation to chest wall, nipple involved, overlying skin involved; Invasive cancer requires axillary dissection; stage IV - radiation and hormones, mastectomy may required; ER- and PR+ - favorable
|
|
Q1221. Ectopic Pregnancy - What is it
|
A1221. Implants outside uterus cavity; MC site - ampulla; risk - history of PID (most common), prior ectopic pregnancy, tubal/pelvic surgery, DES exposure in utero, IUD
|
|
Q1222. Ectopic Pregnancy - History/PE
|
A1222. Classic triad – amenorrhea, light vag bleeding, lower abdom or pelvic pain/tender pelvic or adnexal mass; ruptured ectopic - surgical emergency; sudden, sharp abdom pain, shock, orthostatic hypotension, tachycardia; shoulder pain; generalized abdominal and adnexal tenderness with rebound tenderness
|
|
Q1223. Ectopic Pregnancy - Dx
|
A1223. B-hCG - levels lower than normal preg, level takes > 2D to double; serum progesterone < normal; transabdom or transvag US; Dx - empty uterine cavity and B-hCG of 6,500; culdocentesis - > 5cc of nonclotting blood, identifies hemoperitoneum, not sensitive nor specific
|
|
Q1224. Ectopic Pregnancy - Tx
|
A1224. Serial B-hCG and US; expectant management if - asymp; decreased B-hCG; small mass; no US evidence of bleeding; methotrexate - stable, unruptured; all others, surgery – salpingostomy, salpingectomy, salpingo-oophorectomy; RhoGAM if appropriate
|
|
Q1225. Ectopic Pregnancy - Complications
|
A1225. Inevitable loss of fetus; hemorrhagic shock; future ectopic pregnancy; infertility; maternal death; Rh sensitization
|
|
Q1226. Vaginitis - What Causes it
|
A1226. Vagina normally - mixed bacterial flora; acidic envi (pH 3.5-4.5); maintained by lactic acid- producing lactobacilli; change in environment => overgrowth of other bacteria, can be bact., fungi, protozoa
|
|
Q1227. Bacterial Vaginosis - History/PE
|
A1227. Gray, fishy-smelling discharge; often pruritus and irritation
|
|
Q1228. Bacterial Vaginosis - Dx
|
A1228. pH > 4.5; saline smear - clue cells; KOH prep - positive whiff test
|
|
Q1229. Bacterial Vaginosis - Tx
|
A1229. PO metronidazole
|
|
Q1230. Trichomonas - History/PE
|
A1230. Profuse, malodorous, yellow-green discharge; dysuria; dyspareunia; erythema; strawberry petechiae in upper vagina/cervix
|
|
Q1231. Trichomonas - Dx
|
A1231. pH > 4.5; saline smear - motile trichomonads; KOH prep - nothing
|
|
Q1232. Trichomonas - Tx
|
A1232. PO metronidazole; Tx partner; test for other STDs
|
|
Q1233. Candidal Vaginitis - History/PE
|
A1233. Thick, white discharge - cottage-cheese texture; pruritus with or without burning; erythematous, excoriated vulva/vagina
|
|
Q1234. Candidal Vaginitis - Dx
|
A1234. pH - normal; saline smear - nothing; KOH prep - pseudohyphae
|
|
Q1235. Candidal Vaginitis - Tx
|
A1235. Topical antifungals (miconazole); po fluconazole
|
|
Q1236. Vaginitis - Dx
|
A1236. Detect vag pH with nitrazine paper; micro exam of discharge - saline (wet prep), KOH; rule out STDs - gram stain of discharge; Chlamydia Ag test; rule out UTI - clean-catch UC and UA
|
|
Q1237. Vaginitis - Complications
|
A1237. Increased risk of PID - with bacterial vaginosis; preterm labor; ROM
|
|
Q1238. Cervicitis - What is it
|
A1238. N. gonorrhea; Chlamydia; co-infection common; infect cervical glandular epithelium; cervix - red & bleeds easily; yellowish-green mucopurulent discharge; discharge can be seen exuding from endocervical canal
|
|
Q1239. Cervicitis - Dx
|
A1239. Cervical motion tenderness (CMT); no other signs of PID
|
|
Q1240. Pelvic Inflammatory Disease - What is it; Risk Factors
|
A1240. Microorg. ascend into:; endometrium - endometritis; uterine wall - myometritis; fallopian tubes - salpingitis; ovaries - oophoritis; parietal perit. - peritonitis; most causes - gonorrhea & chlamydia; risk factors - multiple sexual partners, unprotected or freq. sex, young age at 1st intercourse, mucopurulent cervicitis, prior PID, IUD; incidence decreases with – OCPs, barrier contraception
|
|
Q1241. Pelvic Inflammatory Disease - History/PE
|
A1241. Lower abdominal pain; fever, chills; menstrual disturbances; purulent cervical discharge; cervical motion tenderness; adnexal tenderness; RUQ pain may indicate perihepatitis (Fitz-Hugh–Curtis syndrome)
|
|
Q1242. Pelvic Inflammatory Disease - Dx
|
A1242. Lower abdom, adnexal and cervical motion tenderness; fever; increased ESR; increased CRP; WBC > 10,000; cervical swab pos. for chlamydia or gonorrhea; US - pelvic abscess; Def. Dx - laparoscopy; consider - B-hCG, RPR/VDRL, HIV, LFTs
|
|
Q1243. Pelvic Inflammatory Disease - Tx
|
A1243. Don't wait on culture results; treat partner; outpatient (3 options) - cefoxitin + probenecid × 1dose; ceftriaxone IM × 1 dose and doxycycline × 14 days; ofloxacin × 14 days and metronidazole × 14 days; admit - if surgical emergency can't be ruled out, tubo- ovarian abscess - admit for at least 24 hours, pregnant, don't improve after 48-72 hrs. of outpatient Tx, severe illness, n/v, high fever, immunodeficient, noncompliant; cefoxitin or cefotetan and doxycycline × 14 days.
|
|
Q1244. Pelvic Inflammatory Disease - Complications
|
A1244. Ectopic pregnancy; chronic pelvic pain; infertility; repeated infections; Fitz-Hugh-Curtis syndrome; pelvic/tubo-ovarian abscess - severe pain, high fever, n/v, signs of sepsis, peritoneal signs, adnexal mass; admit - IV Antibiotics, hydration, drainage or TAHBSO
|
|
Q1245. Toxic Shock Syndrome - What is it
|
A1245. Acute illness; caused by preformed S. aureus toxin (TSST-1); 90% women of childbearing age in 5 days of onset of menses, tampon use; nonmenstrual almost as common- organisms from: nasopharynx, bones, vagina, rectum, wounds
|
|
Q1246. Toxic Shock Syndrome - History/PE
|
A1246. Abrupt onset - fever, vomiting, diarrhea; can => hypotensive shock, diffuse macular erythematous rash (sunburn-like); nonpurulent conjunctivitis; desquamation of palms and soles within 1–2 weeks
|
|
Q1247. Toxic Shock Syndrome - Dx
|
A1247. BC - neg
|
|
Q1248. Toxic Shock Syndrome - Tx
|
A1248. Admit; rehydration; remove source of toxin; antistaph Antibiotics - nafcillin, oxacillin; manage renal or cardiac failure
|
|
Q1249. Menorrhagia - What is it; Cause
|
A1249. ↑ amount of flow > 80 mL per cycle or prolonged bleeding, flow lasts > 8 days causes; leiomyoma; endometrial hyperplasia; endometrial polyps; endometrial cancer; cervical cancer; pregnancy complications
|
|
Q1250. Oligomenorrhea - What is it; MCC
|
A1250. ↑ length of time between menses; 35–90 days between cycles; MCC - pregnancy
|
|
Q1251. Polymenorrhea - What is it; Cause
|
A1251. Frequent menstruation; < 21-day cycle; cause - anovulation
|
|
Q1252. Metrorrhagia - What is it; Causes
|
A1252. Bleeding between periods Causes:; endometrial polyps; endometrial cancer; cervical cancer; pregnancy complications; exogenous estrogen
|
|
Q1253. Menometrorrhagia - What is it; Causes
|
A1253. Excessive and irregular bleeding causes:; endometrial polyps; endometrial cancer; cervical cancer; pregnancy complications; exogenous estrogen
|
|
Q1254. Postmenopausal Bleeding - What is it; Causes
|
A1254. Uterine bleeding > 1 year after menopause Causes:; vaginal atrophy; exogenous hormones; cancer
|
|
Q1255. Abnormal Uterine Bleeding - Dx
|
A1255. Distinguish ovulatory from anovulatory disorders; thorough menstrual History - bleeding freq., vol, duration, bimanual exam, pap smear; ovulatory - transvag US, sonohysterogram, D&C with hysteroscopy; anovulatory - B-hCG, CBC, coag profile, FSH, LH, TSH, prolactin, endometrial biopsy; any postmenopausal woman with uterine bleeding - endometrial biopsy to rule out endometrial cancer
|
|
Q1256. Abnormal Uterine Bleeding - Tx
|
A1256. Treat underlying disorder; ovulatory - NSAIDs +/- OCPs; anovulatory – OCPs, cyclic progestin (medroxyprogesterone); high-dose IV estrogen; D&C; endometrial ablation; hysterectomy - last resort
|
|
Q1257. Amenorrhea - What is Primary Amenorrhea
|
A1257. No menses by 16 y/o; no secondary sexual characteristics by 14 y/o
|
|
Q1258. Primary Amenorrhea - Causes
|
A1258. Mullerian anomalies; vaginal agenesis; imperforate hymen; testicular feminization; ovarian failure; Turner's; Kallmann's; anorexia; excess exercise; weight loss; stress; tumor; infection
|
|
Q1259. Amenorrhea - What is Secondary Amenorrhea
|
A1259. No menses for 3 cycles if history of irreg cycles - no menses for 6 mos.
|
|
Q1260. Secondary Amenorrhea - Causes
|
A1260. Asherman's syndrome; cervical stenosis; pregnancy; polycystic ovarian syndrome; anorexia; excess exercise; weight loss; stress
|
|
Q1261. Amenorrhea - Tx
|
A1261. Tx underlying cause; if low estrogen – HRT, Ca2+ supplements
|
|
Q1262. Dysmenorrhea - What is it
|
A1262. Pain during menses that - requires meds; prevents normal activity; primary - no structural gyn disorder, start < 20 y/o, tends to decreased with age, due to uterine contractions, probably mediated by PGE, Tx - NSAIDs and OCPs; secondary - pelvic pathology, MC – endometriosis, adenomyosis, myomas, pelvic congestion, PID, ovarian cysts, cervical stenosis, pelvic adhesions
|
|
Q1263. Endometriosis- What is it
|
A1263. Functional endometrial tissue (glands and stroma) implanted outside uterus; women of reproductive age; common sites – ovaries, cul-de-sac, uterosacral ligament; due to - implant via retrograde menses; vascular and lymph dissem, metaplasia; risk factors - family History, nulliparity, infertility
|
|
Q1264. Endometriosis- History/PE
|
A1264. History - premenstrual pain; dyschezia; chronic pelvic pain; dyspareunia; abnorm bleeding; infertility; PE - tender, nodularity along uterosacral ligament, fixed, retroverted uterus, tender, fixed adnexal masses
|
|
Q1265. Endometriosis- Dx
|
A1265. Definitive Dx - direct visualization via laparoscopy or laparotomy; implants - rust-colored, dark brown "powder burns", raised blue raspberry lesions"; severe - adhesions surround implants; ovary may have - endometrioma (chocolate cysts); pain severity - doesn't always correlate with extent of disease
|
|
Q1266. Endometriosis- Tx
|
A1266. OCPs or progestin; danazol or GnRH agonists; lap ablation; TAH-BSO; lysis of adhesions
|
|
Q1267. Vulvar Cancer - What is it; Risk Factors
|
A1267. 4th MC gyn malignancy; usu occurs after menopause - (peaks in 60s); squamous cell ca (90%); risk factors – diabetes, obesity, HTN, vulvar dystrophy, HPV- 16, HPV-18
|
|
Q1268. Vulvar Cancer - History/PE
|
A1268. Asymp in early stages; vulvar pruritis (MC); erythematous or ulcerated vulvar lesion; palpable vulvar mass
|
|
Q1269. Vulvar Cancer - Dx
|
A1269. Definitive Dx - Biopsy
|
|
Q1270. Vulvar Cancer - Tx
|
A1270. Wide local excision; regional lymph node dissection; radiation - decreased tumor metas, recurrence
|
|
Q1271. Cervical Cancer - What is it; Risk Factors
|
A1271. 3rd MC gyn malignancy; squamous cell ca (most); adenoca (most of remaining); results from cervical intraepithlial neoplasia (CIN), if untreated => invasive ca; spreads – directly, blood, lymphatics to - pelvic lymph nodes, para-aortic lymph nodes; Risk factors - HPV 16, 18 and 31, early onset of sex, multiple sex partners, immune compromised, tobacco, STDs
|
|
Q1272. Cervical Cancer - History/PE
|
A1272. History - usu asymp; if asymp, usu Dx by - Pap smear, colposcopy and biopsy; if symp - postcoital bleeding is usu 1st Sx, menorrhagia, metrorrhagia, pelvic pain, vag discharge; PE - cervical discharge, cervical ulceration, pelvic mass, fistulas
|
|
Q1273. Cervical Cancer - Dx
|
A1273. Bx all lesions; colposcopy and endocervical curettage if - dysplasia (on Pap smear),; squamous intraepithelial neoplasia (on Pap smear); or 2 consec findings of atyp squamous cells of undet signif (ASCUS); pelvic exam under anesthesia; CXR; IVP; staging – clinical based on invasion into adjacent structures and metastases; CT/MRI can't be used to stage
|
|
Q1274. Cervical Cancer - Tx
|
A1274. Carcinoma in situ - finished childbearing – TAH; wish to keep uterus - cervical conization; ablation of lesion: cryotherapy / laser; invasive: all stages - radiation & chemo; less radical surgeries: early stages - radical hysterectomy, lymph node dissection; advanced disease or bulky tumors - radiation +/- chemo
|
|
Q1275. Cervical Cancer- Staging of CIN
|
A1275. CIN I - mild dysplasia, low-grade squamous intraepithelial lesion (LSIL); CIN II - moderate dysplasia, high-grade squamous intraepithelial lesion (HSIL); CIN III - severe dysplasia or carcinoma in situ, high-grade squamous intraepithelial lesion (HSIL)
|
|
Q1276. Endometrial Cancer - What is it; Risk Factors
|
A1276. MC gyn malignancy; strong association with high levels of unopposed estrogen; ages 50-70; usu adenoca; mets to: direct – cervix; intraperitoneal seeding; blood - lungs, vagina; lymphatics - aortic node, pelvic node; risk factors - unopposed estrogen, diabetes, HTN, nulliparity, family History
|
|
Q1277. Endometrial Cancer - Examples of Unopposed Estrogen
|
A1277. Estrogen replacement therapy; chronic anovulation; early menarche; late menopause; ovarian granulosa cell tumors; polycystic ovarian syndrome; obesity; tamoxifen
|
|
Q1278. Endometrial Cancer - History/PE
|
A1278. postmenopausal bleeding; menorrhagia; metrorrhagia; lower abdom pain; cramping; uterus - fixed, immobile if spread to adnexa & peritoneum; signs of mets – hepatosplenomegaly, lymphadenopathy, abdom masses
|
|
Q1279. Endometrial Cancer - Dx
|
A1279. Pap smear - not very sensitive; ECC; EMB; D&C - if sample inadeq; US to rule out - fibroids; polyps; endometrial hyperplasia; grade - key prognostic factor; staging - surgical; peritoneal fluid cytology; abdom exploration; TAH-BSO; pelvic & para-aortic nodes
|
|
Q1280. Endometrial Cancer - Tx
|
A1280. High dose progestins - stage I; chemo – doxorubicin, cisplatin; advanced & recurrent dis. adjuvant radiation - cervical & extrauterine spread
|
|
Q1281. Ovarian Cancer - What is it; Risk Factors
|
A1281. 2nd MC gyn malignancy; leading cause of U.S. gyn ca deaths; MC - postmenopausal; OCPs - protective effect; risk factors - fam history of breast or ovarian ca, chronic uninterrupted ovulate- nulliparity, delayed childbearing, infertility, late menopause; categorize by site of origin - epithelial cell – MC; serous cystadenoca; germ cell – dysgerminoma; sex cord-stromal tumors
|
|
Q1282. Ovarian Cancer - History/PE
|
A1282. History - Usu asymp until advanced - abdom pain; bloating; pelvic pressure; urinary freq. early satiety; constipation; vag bleeding; systemic Sxs; PE - solid, fixed nodular pelvic mass, ascites, pleural effusion
|
|
Q1283. Ovarian Cancer - Dx
|
A1283. Pelvic US; CT or MRI; surgical staging - TAH-BSO; omentectomy; tumor debulking; monitor - CA-125, aFP, LDH, hCG
|
|
Q1284. Ovarian Cancer - Tx
|
A1284. Radiation - dysgerminomas; postsurgical chemo – carboplatin, paclitaxel; epithelial cell tumors
|
|
Q1285. Ovarian Cancer - Prevention
|
A1285. 2 first degree relatives - annual screening CA-125; transvag US after childbearng - prophylactic oophorectomy; OCPs may help decreased risk
|
|
Q1286. Polycystic Ovarian Syndrome - What is it
|
A1286. Oligomenorrhea; cause unknown; Sxs of - androgen overproduction; increased circulating androgens, excess LH; b/l polycystic ovaries; chronic anovulation; infertility; obese; hirsute; ages 15-30; association - insulin resistance, DM; increased risk of endometrial ca
|
|
Q1287. Polycystic Ovarian Syndrome - History/PE
|
A1287. History - hirsutism; obesity; amenorrhea; infertility; May have – virilization, acne, DM, HTN, acanthosis nigricans; PE - enlarged cystic ovaries
|
|
Q1288. Polycystic Ovarian Syndrome - Dx
|
A1288. Serum LH/FSH ratio > 3; increased serum androstenedione; increased DHEA; US
|
|
Q1289. Polycystic Ovarian Syndrome - Tx
|
A1289. weight reduction; clomiphene citrate; metformin; OCPs
|
|
Q1290. Spontaneous Abortion (SAB) - What is it; Risk Factors
|
A1290. Nonelective termination at < 20 weeks GA; most 1st tri - fetal factors; most 2nd tri - mat. factors; risk factors - advanced mat. Age, advanced pat. Age, increased gravidity, prior SAB, minority status
|
|
Q1291. Spontaneous Abortion (SAB) - History/PE
|
A1291. History - ask history of: abortions, infections, familial genetic abnorm; PE - vaginal bleeding, passage of tissue, open or closed cervical os
|
|
Q1292. Spontaneous Abortion (SAB) - Dx
|
A1292. B-hCG; establish GA; transvag US - assess viability; CBC; blood type
|
|
Q1293. Spontaneous Abortion (SAB) - Tx
|
A1293. Ensure hemodynamically stable; give Rhogam (if appropriate); uterine evacuation
|
|
Q1294. Threatened Abortion - Sxs
|
A1294. Minimal bleeding; possible abdom pain; no POC expelled; (POC= products of contraception)
|
|
Q1295. Threatened Abortion - PE/US
|
A1295. Closed internal cervical os; normal US
|
|
Q1296. Threatened Abortion - Tx
|
A1296. Avoid heavy activity; pelvic and bed rest
|
|
Q1297. Inevitable Abortion - Sxs
|
A1297. Profuse bleeding; severe cramping
|
|
Q1298. Inevitable Abortion - PE/US
|
A1298. Open internal cervical os
|
|
Q1299. Inevitable Abortion - Tx
|
A1299. Emergent D&C
|
|
Q1300. Incomplete Abortion - Sxs
|
A1300. Some POC expelled
|
|
Q1301. Incomplete Abortion - PE/US
|
A1301. Open internal cervical os; retained fetal tissue on US
|
|
Q1302. Incomplete Abortion - Tx
|
A1302. Emergent D&C
|
|
Q1303. Complete Abortion - Sxs
|
A1303. Minimal bleeding; minimal cramping; all POC expelled
|
|
Q1304. Complete Abortion - PE/US
|
A1304. Closed internal cervical os; empty uterus on US
|
|
Q1305. Missed Abortion - Sxs
|
A1305. No uterine bleeding; no POC expelled
|
|
Q1306. Missed Abortion - PE/US
|
A1306. Closed internal cervical os; no fetal cardiac activity; retained fetal tissue on US
|
|
Q1307. Missed Abortion - Tx
|
A1307. Evacuate uterus; D&C
|
|
Q1308. Septic abortion - Sxs
|
A1308. Fever; chills; peritoneal signs; often recent history of therapeutic abortion
|
|
Q1309. Septic abortion - PE/US
|
A1309. Hypotension; hypothermia; oliguria; resp distress if in shock; increased WBC
|
|
Q1310. Septic abortion - Tx
|
A1310. Evacuate uterus; D&C; IV Antibiotics
|
|
Q1311. Intrauterine fetal demise - Sxs
|
A1311. Mom may report absence of fetal movements
|
|
Q1312. Intrauterine fetal demise - PE/US
|
A1312. Uterus small for GA; no fetal heart tones or movement on US
|
|
Q1313. Intrauterine fetal demise - Tx
|
A1313. Induce labor; evacuate uterus to avoid DIC
|
|
Q1314. Urinary Incontinence - Risk Factors
|
A1314. Older age; pelvic relaxation; obstructed labor; traumatic delivery; menopause; chronic cough; straining; ascites; large pelvic tumors
|
|
Q1315. Urinary Incontinence - Causes
|
A1315. DIAPPERS; Delirium; Infection (UTI); Atrophic urethritis/vaginitis; Pharmaceutical; Psych causes (esp. depression); Excess urine output (hyperglycemia, hypercalcemia, CHF); Restricted mobility; Stool impaction
|
|
Q1316. Urinary Incontinence - Dx
|
A1316. UA and UC - to exclude UTI; Serum Cr - to exclude renal dysfunction; Cystogram - fistulas; bladder neck abnorm
|
|
Q1317. Stress Incontinence - What is it
|
A1317. Sphincter insufficiency; laxity of pelvic floor muscles; common in multiparous women or after pelvic surgery
|
|
Q1318. Stress Incontinence - History
|
A1318. Activities that ↑ intra-abdominal pressure; coughing,; sneezing,; lifting; not common in supine position
|
|
Q1319. Stress Incontinence - Tx
|
A1319. Kegel exercises; surgery - place bladder neck in correct anatomical position
|
|
Q1320. Urge Incontinence - What is it
|
A1320. Detrusor hyperreflexia or sphincter dysfunction; due to bladder - inflammatory conditions, neurogenic disorders
|
|
Q1321. Urge Incontinence - History
|
A1321. Preceded by strong, unexpected urge to void; unrelated to position or activity
|
|
Q1322. Urge Incontinence - Tx
|
A1322. Anticholinergics; TCAs
|
|
Q1323. Overflow Incontinence - What is it
|
A1323. Dribbling of urine from overly full bladder; Volume is usually small
|
|
Q1324. Overflow Incontinence - History
|
A1324. Chronic urinary retention
|
|
Q1325. Overflow Incontinence - Tx
|
A1325. Catheter - if acute; Tx underlying disease; timed voiding
|
|
Q1326. pt presentation of genuine stress incontinence
|
A1326. losing urine with coughing, sneezing, laughing, etc
|
|
Q1327. pt presentation of overflow incontinence
|
A1327. constant urinary dribbling + sx of stress or urge incontinence
|
|
Q1328. pt presentation of urge incontinence
|
A1328. urge to go, but can't make it to the bathroom in time; strong urge to void
|
|
Q1329. pt presentation of total incontinence
|
A1329. painless, continuous loss of urine
|
|
Q1330. dx of stress incontinence
|
A1330. q tip test: if it moves more than 30 degrees, then urethra is hypermobile
|
|
Q1331. dx of overflow incontinence
|
A1331. residual volumes >300 cc
|
|
Q1332. dx of total incontinence
|
A1332. inject dye to see if there is a fistula, if there is then do a cystourethroscopy to determine # and location
|
|
Q1333. tx of stress incontinence
|
A1333. non surgical: reduce fluid intake, alpha-adrenergics and estrogens; surgical: if there is intrinsic sphincter deficiency, then urethral bulking; otherwise, retropubic urethropexy
|
|
Q1334. tx of urge incontinence
|
A1334. bladder retraining; anticholinergics
|
|
Q1335. tx of overflow incontinence
|
A1335. alpha-1 inhibitors (to reduce urterhal closing pressure); cholinergics; intermittent self-cath
|
|
Q1336. tx of total incontinence
|
A1336. if ob fistula, repair immediately; if 2/2 surgery, wait 3-6 months, then repair
|
|
Q1337. MCC preventable infertility in the US?
|
A1337. PID
|
|
Q1338. Most likely cause of infertility in a normally menstruating woman below the age of 30? Above the age of 30, if it is not the answer to the previous question?
|
A1338. 1. PID; 2. Endometriosis
|
|
Q1339. What symptoms are necessary to diagnose PID?
|
A1339. 1. Abdominal Pain; 2. Adnexal Tenderness; 3. Cervical motion tenderness; 4. One of the following: Elevated ESR/CRP, Leukocytosis, fever, purulent cervical discharge
|
|
Q1340. How do you treat PID?
|
A1340. 1. Outpatient: Cefoxitin/Ceftriaxone + Doxycycline; 2. Inpatient: Clindamycin + Gentamycin
|
|
Q1341. What are the most common organisms you have to cover for when treating PID?
|
A1341. Gonorrhea, Chlamydia
|
|
Q1342. What causal organism do you have to consider in PID when a patient has a history of an IUD?
|
A1342. Actinomyces israelii
|
|
Q1343. What are the signs and symptoms of endometriosis?
|
A1343. 1. Dysmenorrhea (painful menstruation); 2. Dyspareunia (painful intercourse); 3. Dyschezia (painful defecation); 4. Perimenstrual spotting
|
|
Q1344. How do you treat endometriosis?
|
A1344. 1. Birth control pills; 2. Danazol and GnRH agonists; 3. Surgery & Cautery; 4. In older patients: Hysterectomy & Bilateral salpingoopherectomy
|
|
Q1345. Candida: Findings and treatment
|
A1345. 1. Findings: ""cottage cheese," pseudohyphae on KOH prep, History diabetes, antibiotic treatment, pregnancy. 2. Treatment: Topical or oral antifungal
|
|
Q1346. Trichomonas vaginalis: Findings and treatment
|
A1346. 1. Findings: Bugs swimming under microscope, pale green, frothy, watery, discharge, "Strawberry cervix"; 2. Treatment: Metronidazole
|
|
Q1347. Gardnerella vaginalis: Findings and treatment
|
A1347. 1. Findings: Malodorous discharge, fishy smell on KOH prep, clue cells; 2. Treatment: Metronidazole
|
|
Q1348. HPV: Findings and treatment
|
A1348. 1. Findings: Venereal warts, koilocytosis in PAP smear; 2. Treatment: Acid therapy, cryotherapy, laser therapy, podophyllin
|
|
Q1349. Herpes virus: Findings and treatment
|
A1349. 1. Findings: Multiple shallowl, painful ulcers, recurrence and resolution; 2. Treatment: Acyclovir
|
|
Q1350. Syphilis (stage 1): Findings and treatment
|
A1350. 1. Findings: Painless chancre, spirochete on dark-field microscopy; 2. Treatment: Penicillin
|
|
Q1351. Syphilis (stage 2): Findings and treatment
|
A1351. 1. Findings: Condyloma lata, maculopapular rash on palms, serology is positive at this point. 2. Treatment: Penicillin
|
|
Q1352. Chlamydia trachomatis: Findings and treatment
|
A1352. 1. Findings: Most common STD, dysuria, positive culture and antibody tests; 2. Treatment: Doxycycline or azithromycin
|
|
Q1353. Neiserria gonorrhea: Findings and treatment
|
A1353. 1. Findings: Muculopurulent cervicitis; gram negative bug on Gram-stain; 2. Treatment: Ceftriaxone or fluoroquinolone
|
|
Q1354. Molluscum contagiosum: Findings and treatment
|
A1354. 1. Findings: Characteristic appearance of lesions, intracellular inclusions; 2. Treatment: Curette, cryotherapy, electrocauterization/coagulation
|
|
Q1355. Pediculosis: Findings and treatment
|
A1355. 1. Findings: "Crabs," look for itching, lice can be seen on pubic hairs; 2. Treatment: Permethrin cream (or lindane)
|
|
Q1356. What do you need to treat for if you suspect a patient has gonorrhea?
|
A1356. You need to treat for gonorrhea, with Ceftriaxone or fluoroquinolone. You also need to treat for presumed chlamydial infection, with doxycycline or azithromycin.
|
|
Q1357. What do you need to treat for if you suspect a patient has chlamydia?
|
A1357. You need to treat for chlamydia, with doxycycline or azithromycin.
|
|
Q1358. How do you treat chlamydia in pregnancy?
|
A1358. Instead of doxycycline or azithromycin, use erythromycin.
|
|
Q1359. In a patient over 40, with dysmehorrhea, metrorrhagia, and a large, boggy uterus on physical exam: 1. What do you suspect? 2. How do you diagnose? 3. How do you treat?
|
A1359. 1. You suspect Adenomyosis; 2. Diagnose with dilation and curettage to rule out endometrial cancer; 3. Treat with hysterectomy, or GnRH agonists to relieve symptoms
|
|
Q1360. What is the relationship between leiomyomas and hormones?
|
A1360. Leiomyomas are estrogen-dependent. Rapid growth occurs during pregnancy or use of oral contraceptive pills, while regression occurs after menopause.
|
|
Q1361. What is the management of dysfunctional uterine bleeding after the age of 35?
|
A1361. 1. D&C to rule out endometrial cancer; 2. Hemoglobin & Hematocrit (or CBC) to make sure that the patient is not anemic from excessive blood loss.
|
|
Q1362. What is the most common nonphysiologic cause of dysfunctional uterine bleeding?
|
A1362. Polycystic ovarian syndrome
|
|
Q1363. How do you treat polycystic ovarian syndrome?
|
A1363. Oral contraceptive pills or cyclic progesterone
|
|
Q1364. What is the sequence of steps in evaluating infertility?
|
A1364. 1. History and physical exam; 2. Semen analysis: (>1ml, >20million/ml, >50% moving forwards, >60% normal morphology); 3. Documentation of ovulation (check basal body temperature, luteal phase progesterone levels, endometrial biopsy); 4. Hysterosalpingogram; 5. Laparoscopy (last resort)
|
|
Q1365. What medications are used to restore female fertility?
|
A1365. 1. Clomiphene citrate (ovulation induction in a woman with adequate estrogen); 2. Human menopausal gonadotropin (combination of FSH and LH to induce ovulation in a woman who is hypoestrogenic); 3. If medications fail: use IVF
|
|
Q1366. What are the causes of secondary amenorrhea?
|
A1366. PCOS, anorexia, endocrine disorder (think of a pituitary tumor in a woman with headaches, galactorrhea, and visual field defects),; antipsychotics (due to increased prolactin),; previous chemotherapy (which causes premature ovarian failure and menopause),; and menopause.
|
|
Q1367. What is the pathophysiology of exercise-induced amenorrhea?
|
A1367. Exercise-induced depression of GnRH.
|
|
Q1368. What is required to make a diagnosis of anorexia?
|
A1368. Amenorrhea
|
|
Q1369. How do you evaluate the cause of secondary amenorrhea? (If SUFFicient estrogen)
|
A1369. 1. Rule out pregnancy (check hCG); 2. Do H & P to look for obvious causes; 3. Administer progesterone to assess the patient's estrogen status. If vaginal bleeding develops within 2 weeks, the patient has sufficient estrogen. Check LH. If high, consider PCOS. If low or normal, check prolactin and TSH levels. High TSH levels in hypothyroidism cause high prolactin levels. If the prolactin is high with a normal TSH level, order an MR scan of the brain to rule out pituitary prolactinoma. If prolactin is normal, then look for low levels of GnRH, which may be induced by drugs, stress, or exercise. In these patients, clomiphene may be used to facilitate pregnancy.
|
|
Q1370. How do you evaluate the cause of secondary amenorrhea? (If INSUFFicient estrogen)
|
A1370. 1. Rule out pregnancy (check hCG); 2. Do H & P; 3. Administer progesterone. If no bleeding: estrogen levels are inadequate. 4. Check FSH. If elevated, premature ovarian failure is the problem, check for autoimmune disorders, karyotype abnormalities, history of chemotherapy. If FSH is low or normal, problem may be a brain tumor (craniopharyngioma). Order an MR of the brain.
|
|
Q1371. When do you suspect primary amenorrhea?
|
A1371. If no menstruation by the age of 16, no secondary sexual characteristics by age 14, or no menstruation within 2 years of secondary sex characteristics.
|
|
Q1372. What is the algorhythm for diagnosing the cause of amenorrhea?
|
A1372. 1. Pregnancy test; 2. If negative, administer progesterone; 3. Evaluate if bleeding or no bleeding; 4. With symptoms of hypothyroidism or pituitary tumor, order TSH and/or prolactin
|
|
Q1373. What medications can cause nipple discharge?
|
A1373. OCPs,; hormone therapies,; antipsychotics,; hypothyroidism symptoms.
|
|
Q1374. How do you evaluate bilateral, non-bloody nipple discharge?
|
A1374. 1. Check prolactin level to evaluate prolactinoma; 2. Check TSH to evaluate for endocrine disorder
|
|
Q1375. How do you evaluate unilateral, bloody nipple discharge?
|
A1375. 1. Biopsy if any mass is present.
|
|
Q1376. What are the characteristics of fibrocystic disease? What is the management?
|
A1376. 1. Bilateral, multiple, cystic lesions tender to the touch. 2. OCPs, progesterone or danazol to relieve symptoms.
|
|
Q1377. What are the characteristics of a fibroadenoma? What is the management?
|
A1377. 1. Painless, discrete, sharply circumscribed, unilateral, rubbery, mobile mass. 2. Observe, pregnancy and OCPs may stimulate growth, since these are hormone-dependent. Excision for cosmetic reasons.
|
|
Q1378. What are the characteristics of mastitis/abscess? What is the management?
|
A1378. 1. Swollen, erythematous breasts postpartum. 2. Treat with analgesics, continue to breastfeed, if severe symptoms, give antistaphylococcal antibiotics (Cephalexin, dicloxacillin). If fluctuant mass develops, or no response to antibiotics, mass is likely present and must be drained.
|
|
Q1379. What is the main sign of fat necrosis in the breast?
|
A1379. History of trauma in the area of the mass.
|
|
Q1380. How do you diagnose a breast lesion in women <30?
|
A1380. Ultrasound or biopsy. Do not to mammography, because breast tissue is too dense to discern a mass.
|
|
Q1381. Causes and symptoms of a cystocele
|
A1381. Bladder bulges into upper anterior vaginal wall. Symptoms include urinary urgency, frequency, and/or incontinence.
|
|
Q1382. Causes and symptoms of a rectocele
|
A1382. Rectum bulges into the lower posterior vaginal wall. Watch for difficulty with defecation.
|
|
Q1383. Causes of an enterocele
|
A1383. Loops of bowel bulge into the upper posterior vaginal wall.
|
|
Q1384. Causes and symptoms of a urethrocele.
|
A1384. Urethra bulges into the lower anterior vaginal wall. Common symptoms include urinary urgency, frequency and/or incontinence.
|
|
Q1385. What are the risks of an IUD?
|
A1385. Increased risk of ectopic pregnancy and PID (Actinomyces!)
|
|
Q1386. What is the classic cause of ambiguous genitalia on step 2?
|
A1386. Adrenogenital syndrome (congenital adrenal hyperplasia). 90% caused by 21-hydroxylase deficiency.
|
|
Q1387. What are the symptoms of 21-hydroxylase deficiency? Treatment?
|
A1387. Females: ambiguous genitalia; Males: Precocious sexual development, salt-wasting, hyperkalemia, hypotension, elevated 17- hydroxyprogesterone. Treatment: Treat with steroids, IV fluids to prevent death.
|
|
Q1388. MCC ""bunch of grapes" protruding from a pediatric vagina?
|
A1388. Sarcoma botryoides, a malignant tumor
|
|
Q1389. How do you diagnose precocious puberty in males and females, and how do you treat and why?
|
A1389. 1. Girls <8 years old, Boys <9 years old. 2. If idiopathic, treat with GnRH analog until age is appropriate. 3. Prevent premature epiphysial closure.
|
|
Q1390. What causes vaginitis or discharge in prepubescent girls?
|
A1390. Vaginal foreign body,; sexual abuse,; candida; (RULE OUT diabetes!)
|
|
Q1391. What is the cause of vaginal bleeding in neonates?
|
A1391. Physiologic, due to maternal estrogen withdrawal. No treatment required.
|
|
Q1392. What are the benefits of estrogen therapy?
|
A1392. 1. Decreased osteoporosis and fractures (hip!); 2. Decreased coronary heard disease, because estrogen increases HDL; 3. Reduced hot flashes, genitourinary symptoms of menopause (dryness, urgency, atrophy-induced incontinence, frequency)
|
|
Q1393. What are the risks of estrogen therapy?
|
A1393. 1. Increased risk of endometrial cancer; 2. Increased risk of venous thromboembolism; 3. Possible increased risk of breast cancer; 4. Increased risk of gallbladder disease
|
|
Q1394. What are the side effects of estrogen therapy?
|
A1394. 1. Endometrial bleeding; 2. Breast tenderness; 3. Nausea; 4. Bloating; 5. Headaches
|
|
Q1395. What are the absolute contraindications to estrogen therapy?
|
A1395. 1. Unexplained vaginal bleeding; 2. Active liver disease; 3. History of thrombophlebitis or thromboembolism; 4. History of endometrial or breast cancer
|
|
Q1396. What are the relative contraindications to estrogen therapy?
|
A1396. 1. Known seizure disorder; 2. HTN; 3. Uterine leiomyomas; 4. Familial hyperlipidemia; 5. Migraines; 6. Thrombophlebitis; 7. Endometriosis; 8. Gallbladder disease
|
|
Q1397. What are the absolute contraindications to OCP use?
|
A1397. 1. Smoking after age 35; 2. Pregnancy; 3. Breast feeding; 4. Active liver disease; 5. Hyperlipidemia; 6. Uncontrolled HTN; 7. DM with vascular changes; 8. Prolonged immobilization of an extremity; 9. History of thromboembolism or thrombophlebitis; 10. CAD; 11. History of stroke, sickle cell, estrogen dependent neoplasm (breast, endometrial,), liver adenoma, cholestatic jaundice of pregnancy
|
|
Q1398. OCPs and surgery
|
A1398. Need to stop OCPs one month before elective surgery, restart 1 month after.
|
|
Q1399. Side effects of OCPs
|
A1399. Glucose intolerance,; depression,; edema,; weight gain,; cholelithiasis,; benign liver adenomas,; melasma,; nausea, vomiting,; headache,; hypertension,; drug interactions.
|
|
Q1400. Relationship between OCPs and ovarian and endometrial cancer?
|
A1400. OCPs reduce the incidence of ovarian cancer by 50%, also decrease incidence of endometrial cancer.
|
|
Q1401. 32 y/o w/R complex adnexal mass; What is the next best step?
|
A1401. 1. Exploratory laparotomy; 2. R salpingo-oophorectomy; 3. Send for frozen section; (if borderline ovarian CA, then resection is curative)
|
|
Q1402. 42 y/o w/history menometrorrhagia; 1. Next step?; 2. Possible diagnoses and management
|
A1402. 1. Endometrial sampling; 2. If hyperplasia (cystic, adenomatous, adenocarcinoma), treat with oral progesterone (Provera). If atypical hyperplasia, do hysterectomy.
|
|
Q1403. 62 y/o w/vulvar pruritus, white lesion in L labia minora. 1. Next step and likely result?; 2. Treatment?
|
A1403. 1. biopsy, vulvar carcinoma in situ; 2. Treat with wide excision, laser therapy, cryotherapy.
|
|
Q1404. 62 y/o w/2cm white lesion in L vaginal wall. 1. Next step?; 2. Treatment based on likely cause?
|
A1404. 1. Biopsy. Result is severe dysplasia of vaginal. 2. This is a precancerous lesion, perform laser removal or cryotherapy.
|
|
Q1405. What do you do for the following PAP smear results:; 1. ASCUS; 2. HPV; 3. Precancerous lesion
|
A1405. 1. Repeat PAP in 3-6 months; 2. Repeat PAP in 3-6 months; 3. Colposcopy w/bx.
|
|
Q1406. What is Meigs syndrome?
|
A1406. 1. Benign ovarian tumor (adnexal mass/benign fibroma); 2. Ascites; 3. R pleural effusion
|
|
Q1407. What is the most common cancer in women?
|
A1407. Breast cancer
|
|
Q1408. What is the cancer in women with the highest mortality?
|
A1408. Lung Ca
|
|
Q1409. What is the gynecologic cancer with the highest mortality? Why?
|
A1409. Ovarian cancer. It is silent.
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Q1410. What is the most common gynecologic cancer in women?
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A1410. Endometrial carcinoma.
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Q1411. What is the most common cause of mortality in patients with ovarian carcinoma?
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A1411. Bowel obstruction.
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Q1412. What is the most common cause of mortality in women?
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A1412. Heart disease
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Q1413. What are the three most common cancers in females, and what cancers have the highest mortality in women?
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A1413. Most common cancers:; 1. Breast; 2. Lung; 3. Colon. Highest mortality:; 1. Lung; 2. Breast; 3. Colon.
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Q1414. Cervical cancer:; 1. Etiology; 2. MC symptom; 3. Histology; 4. Mortality
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A1414. 1. HPV; 2. Post-coital bleeding; 3. Squamous cell carcinoma (ectocervix), 15% adenocarcinoma (endocervix); 4. Renal failure
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Q1415. Endometrial cancer:; 1. Etiology; 2. MC symptom; 3. Histology
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A1415. 1. Estrogen; 2. Post-menstrual bleeding; 3. Adenocarcinoma
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Q1416. Ovarian cancer:; 1. Etiology; 2. MC symptom; 3. Histology; 4. Treatment; 5. Mortality
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A1416. 1. Ovulation; 2. Ascites (be suspicious in a postmenopausal patient w/ascites); 3. #1 Epithelial #2 Germ cell #3 Stromal; 4. Debulking surgery (TAH-BSO, Omentectomy), cytoreductive surgery, Carboplatin and Taxol. 5. Bowel obstruction, secondary to seeding.
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Q1417. What are the types of epithelial ovarian cancer, the symptoms, and the tumor marker?
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A1417. #1: Serous; Then: Mucinous, Endometrioid, Brenner. Symptom: No pain, picked up in stage 3 due to slow growth. Tumor marker: CA-125.
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Q1418. Ovarian germ cell cancer:; 1. Types; 2. Symptoms; 3. Tumor markers
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A1418. 1. Dysgerminoma, endodermal sinus tumor, teratoma, choriocarcinoma; 2. Pain due to rapid growth. Picked up in stage 1. Teenagers. 3. Dysgerminoma: LDH, Endodermal sinus tumor: alpha fetoprotein, Teratoma, Choriocarcinoma: hCG.
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Q1419. Ovarian stromal cancer; 1. Types; 2. Tumor markers
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A1419. 1. Sertoli-Leydig cell tumors, or granulosa thecal cell tumor; 2. Hormones. Sertoli-Leydig: Testosterone. Granulosa- theca: Estrogen.
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Q1420. Vulvar cancer:; 1. Etiology; 2. MC symptom; 3. Histology
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A1420. 1. HPV; 2. Pruritus; 3. #1: Squamous cell carcinoma #2: Melanoma (black lesion) #3: Paget's disease (Red lesion)
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Q1421. Vaginal cancer:; 1. Etiology; 2. MC symptom; 3. Causes
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A1421. 1. HPV; 2. Bloody vaginal discharge; 3. #1: Squamous cell carcinoma #2: Adenocarcinoma (DES exposure causing clear cell carcinoma, or metastasis from cervical carcinoma.
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Q1422. Fallopian tube cancer:; 1. Etiology; 2. MC symptom
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A1422. 1. Unknown; 2. Clear, serous vaginal discharge.
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Q1423. When does PAP screening begin?
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A1423. at 21 years old.
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Q1424. At which point can PAP smears be done every 2 years?
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A1424. If PAP smears are negative for 3 years in a row.
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Q1425. What are the effects of DES?
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A1425. 1. Clear cell carcinoma; 2. Structural abnormalities (hypoplastic cervix, t-shaped uterus (increased incidence of miscarriage/ectopics); 3. Adenosis of vagina (columnar cells)
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Q1426. What do the L and R ovarian veins drain into?
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A1426. L ovarian vein: L renal vein; R ovarian vein: IVC
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