Term
|
Definition
| when the umbilical cord is wrapped around the baby's neck |
|
|
Term
| What could happen if a mother becomes infected with rubella in her first trimester? |
|
Definition
| spontaneous abortion or congenital rubella syndrome |
|
|
Term
| How is a baby affected by congenital rubella syndrome? |
|
Definition
congenital heart defects
mental retardation
deafness
cataracts |
|
|
Term
During what trimester is the fetus most at risk for developing congenital rubella syndrome?
What tests do you do? What do you look for? |
|
Definition
higher risk during the first month of pregnancy and decreases with increasing gestational age
Primary infection can be diagnosed by serologic testing for IgM and IgG antibodies |
|
|
Term
| Should a prego woman be vaccinated for rubella? |
|
Definition
NO
it is recommended that pregnancy be delayed 1 month following immunizations |
|
|
Term
| What is hemolytic disease of the newborn? |
|
Definition
| Alloimmune hemolytic disease of the newborn (HDN) is a condition in which the red cells of the fetus or newborn are destroyed by maternally-derived alloantibodies. These antibodies arise in the mother as the direct result of a blood group incompatibility between the mother and fetus, as when an Rh(D) negative mother carries an Rh(D) positive fetus |
|
|
Term
| How do you treat prego lady with either PE or DVT? |
|
Definition
Once it is determined that anticoagulation is indicated, it should be initiated using subcutaneous low molecular weight heparin (SC LMWH), intravenous unfractionated heparin (IV UFH), or subcutaneous unfractionated heparin.
nticoagulant therapy generally continues for at least six weeks postpartum |
|
|
Term
| Why ar prego womens more susceptible to UTIs? |
|
Definition
| smooth muscle relaxation and subsequent ureteral dilatation that accompany pregnancy are thought to facilitate the ascent of bacteria from the bladder to the kidney |
|
|
Term
| What two abx classes are generally safe in pregnancies? |
|
Definition
| It is generally accepted that penicillins and cephalosporins (FDA category B) are safe in pregnancy |
|
|
Term
| What are tx chocies for UTI in prego lady? |
|
Definition
Amoxicillin (500 mg orally every 12 hours for three to seven days)
Amoxicillin-clavulanate (500 mg orally every 12 hours for three to seven days)
Cephalexin (500 mg orally every 12 hours for three to seven days)
Fosfomycin (3 g orally as a single dose)
Sulfonamides can be used in pregnancy, but resistance among uropathogens is high and they offer no advantage over the other agents listed above. |
|
|
Term
| What is tx of choice for pyelonephritis in prego lady? |
|
Definition
| intravenous cefazolin or intramuscular ceftriaxone had equivalent efficac |
|
|
Term
| What's the tx for Group B Strep causing asymptomatic bacteruria? |
|
Definition
| Treatment consists of antibiotic therapy with amoxicillin, penicillin, or cephalexin. |
|
|
Term
| Pt has group B strep pyelonephritis...she is prego. what is her tx plan? |
|
Definition
| Treatment includes intravenous hydration and intravenous antibiotics (ampicillin plus gentamicin or a cephalosporin). If GBS is identified as the cause of pyelonephritis, treatment can be changed to penicillin G, and therapy continued for a total duration of 10 days |
|
|
Term
| What is affect on mom or newborn with group b strep? |
|
Definition
Pregnant women who are infected with GBS are at increased risk of preterm delivery, infection of the amniotic fluid (bag of water), and infection of the uterus after delivery.
Newborns who are infected with GBS can develop pneumonia (lung infection), septicemia (blood infection), or meningitis (infection of the lining of the brain and spinal cord). |
|
|
Term
| What is the patho behind bacterial vaginosis? |
|
Definition
| polymicrobial infection characterized by lack of hydrogen peroxide producing lactobacilli and an overgrowth of facultative anaerobic organisms |
|
|
Term
Pt complains of "musty" or "fishy" odor with an increased thin gray-white to yellow discharge.
You notice on physical exam that the vaginal discharge is mildly adherent to the vaginal wall and has a pH greater than 4.5.
What could it be? how do you treat? |
|
Definition
bacterial vaginosis
metronidazole |
|
|
Term
| "Clue cells" are associated with... |
|
Definition
|
|
Term
| What is the criteria to diagnose BV? |
|
Definition
three of the follwoign criteria:
1. abnormal gray discharge
2. pH greater than 4.5
3. positive whiff test
4. presence of clue cells |
|
|
Term
|
Definition
| Failure of a couple to conceive after 12 months of frequent, unprotected intercourse. |
|
|
Term
| What is part of the infertility work up? |
|
Definition
ovulation: tested by basal body temp charting and ovulation predictor kits
Uterus: US
Fallopian tubes and perioneum: hysterosalpingography
Male: semen analysis, repeat semen analysis if indicated and post coital test (not routine) |
|
|
Term
| What is the precursor to endometrioid adenocarcinoma? |
|
Definition
|
|
Term
| What are the four types of endometrial hyperplasia? |
|
Definition
simple and complex hyperlasia
with or without atypia |
|
|
Term
Name the endometrial hyperplasia:
least significant form of endometrial hyperplasia and is not commonly associated with progression to endometrial carcinoma. Both glandular elements and stromal cell elements proliferate excessively |
|
Definition
|
|
Term
name the endometrial hyperplasia:
represents an abnormal proliferation of primarily glandular elements without concomittant proliferation of stromal elements |
|
Definition
|
|
Term
| What causes endometrial hyperplasia? |
|
Definition
| overgrowth of the endometrium in response to excess unopposed estrogen |
|
|
Term
what are sources of endogenous estrogen?
Sources of exogenous? |
|
Definition
endogenous: ovarian, peripheral conversion of androgen precursors
Exogenous: vaginal creams, cutaneous pathces, lyophilized estradiol, conjugated estrogen |
|
|
Term
| What is the hallmark sign of endometrial hyperplasia and cancer? |
|
Definition
|
|
Term
| How do you diagnose endometrial hyperplasia? |
|
Definition
|
|
Term
| What are other studies that can be done for endometrial hyperplasia? |
|
Definition
D&C or hysteroscopy
transvaginal US |
|
|
Term
What is tx for endometrial hyperplasia?
how does it work? |
|
Definition
synthetic progesterones or other progestins are central in the medical tx.
How it works:
1. alter enzymatic pathways, which eventually convert endogenous estradiol to weaker estrogens
2. decrease the number of estrogen receptors in the endometrial glandular cells, rendering them less susceptible to exogenous stimulation
3. stimulation fo progesterone receptors results in thinning of the endometrium and stromal decidualization |
|
|
Term
|
Definition
| excess terminal hair in a male pattern of distributio |
|
|
Term
|
Definition
| masculinization of a woman and is assoicated with a marked increase in circulating testosterone |
|
|
Term
| A woman who is becoming virilized will start to complain about what? |
|
Definition
| she first notices enlargement of the clitoris, followed by temporal balding, deepening of the voice, involution of the breasts and a remodeling of the limb shoulder girdle AS WELL AS hirsituism |
|
|
Term
| What is the most common cause of androgen excess and hirsituism? |
|
Definition
| polycystic ovarian syndrome |
|
|
Term
| Pt presents with oligomenorrhea or amenorrhea, acne, hirsituism and infertility. What could it be? |
|
Definition
| polycystic ovarian syndrome |
|
|
Term
| What are other disorders that need to be r/o for excess androgen production? |
|
Definition
PCOS
congenital adrenal hyperplasia
Cushing syndrome
hyperprolactinemia |
|
|
Term
| What is the patho behind PCOS? |
|
Definition
| LH stimulates theca lutein cells to increase androstendione production. Androstendione converst to estone within adipocytes. The increased estrone (weak estrogen) has a positive feedback on pituitary so it secretes more LH. WHen you have increased estrone production, you have increased testosterone production. |
|
|
Term
| What would labs show in pt with PCOS? |
|
Definition
increased LH:FSH ratio
Estrone in greater concentration than estradiol
androstendione at the upper limites of normal or increased
testosterone at the upper limites of normal or increased |
|
|
Term
| What is the most common therapy for PCOS? Why? |
|
Definition
oral contraceptives
suppresses pituitary LH production |
|
|
Term
| Name the different pelvic outlets. |
|
Definition
"Round" is gynecoid
"oval" is platypelloid
"Wedge" is android
"oval long" is anthropoid |
|
|
Term
| What is the most common type of pelvis? |
|
Definition
|
|
Term
What is an ectropion?
What type of female anatomy is it associated with?
What population gets them? |
|
Definition
affects pregnant woman
assoc with cervix
ectropion is an area on the ectocervix where columnar epithelium has been exposed to vaginal acidity due to eversion of the endocervix |
|
|
Term
What is the causative agent for chancroids?
What test helps diagnose? |
|
Definition
haemophilus ducreyi--difficult to culture
PCR confirms diagnosis |
|
|
Term
| 10% of individuals diagnosed with chancroid will also have what? |
|
Definition
|
|
Term
| How do you treat chancroids? |
|
Definition
1. azithromycin, (Zithromax) 1 g orally in single dose (safety and efficacy not established in pregnant and lactating patients)
2. ceftriaxone, (Rocephin) 250 mg intramuscularly in single dose
3. ciprofloxacin, (Cipro) 500 mg orally twice daily for 3 days (contraindicated during pregnancy and lactation)
4. erythromycin base 500 mg orally 3 times daily for 7 days |
|
|
Term
An infected abortion, either complete or incomplete is called ______
How do pts present? |
|
Definition
septic abortion
pts present with sepsis, shock, hemorrhage and possibly renal failure |
|
|
Term
| What can lead to post partum hemorrhage? |
|
Definition
| uterine atony: ordinarily the uterine corporus contracts promptly fter delivery of the placenta, constricting the spiral arteries in the newly created placental bed, and preventing excessive bleeding. The muscular contraction, rather than coagulation, prevents excessive bleeding from the placental implantation site. When contraction does not occur as expected, the resulting uterine atony caused PPH |
|
|
Term
| What are risk factors for post partum hemorrhage? |
|
Definition
prolonged labor
augmented labor
rapid labor
hx of post partum hemorrhage
episiotomy, esp mediolateral
preeclampsia
overdistended uterus
operative delivery
asian or hispanic ethnicity
chorioamnioitis |
|
|
Term
|
Definition
|
|
Term
How does lymphogranuloma venereum present if transmitted vaginally vs anally??
|
|
Definition
vaginal: inguinal or femoral lymphadenopathy in women
anal: anal bleeding, purulent anal discharge, constipation and anal spasms |
|
|
Term
What is the tx for lymphogranuloma venereum?
|
|
Definition
Doxycycline, 100 mg twice daily orally for 21 days
Erythromycin, 500 mg four times daily orally for 21 days
Trimethoprim-sulfamethoxazole, 160/800 mg twice daily orally for 21 days |
|
|
Term
| What bacteria causes lymphogranuloma venereum? |
|
Definition
| Caused by Chlamydia trachomatis types L1–L3 |
|
|
Term
| How do you diagnose chlamydial infectections? |
|
Definition
culture
direct immunofluorescence
enzyme immunoassay
NAATS: MOST SENSITIVE |
|
|
Term
| What are sxs of chamydial infections? |
|
Definition
| abnormal vaginal discharge and vaginal bleeding |
|
|
Term
| What is tx for chlamydia? |
|
Definition
| azithromycin or doxycylcline |
|
|
Term
|
Definition
| withdrawal of 20 to 40 mL of amniotic fluid transabdominally, under concurrent US guidant with a 20 gauge to 22 gauge needle |
|
|
Term
| When is amniocentesis typically performed? |
|
Definition
|
|
Term
| What is chorionic villus sampling? |
|
Definition
| developed to provide prenatal diagnosis in the first trimester. Performed after 10 week of gestation by trasnvervical or transabdominal aspiration of chorionic villi (immature placenta) under concurrent US guidance |
|
|
Term
|
Definition
| atrophy of the vaginal epithelium due to diminished estrogen levels. |
|
|
Term
Pt presents with the following:
menopausal woman...
abnormal vaginal discharge, dryness, ithcing, b urning or dyspareunia.
Urinary sxs include: urgency, frequency, recurrent UTI and incontinence.
What is it? How do you treat? |
|
Definition
atrophic vaginitis
tx: estrogen therapy |
|
|
Term
| What is a molar pregnancy? How are they classified? |
|
Definition
rare variation of pregnancy of unknown etiology and usually presents as a benign disease
complete: no fetus
incomplete: fetal parts in addition to molar degeneration |
|
|
Term
What population is most susceptible to molar pregnancies?
What is it associated with?
|
|
Definition
Asian women
assoc with low carotene consumption and vit A deficiency |
|
|
Term
Pt presents after pos pregnancy test.
You can't hear fetal tones.
Mom has been saying she has painless second trimester bleeding.
There is a "snowstorm" appearance on US. What is it? |
|
Definition
|
|
Term
| In any women that presents with severe HTN prior to 20 weeks of pregnancy, what should you think? |
|
Definition
|
|
Term
| What are some indications for a c-section? |
|
Definition
hemorrhage from placenta
abruptio placentae
prolapse of umbilical cprd
uterine rupture |
|
|
Term
| What are the classifications of obstetric lacerations? |
|
Definition
first degree: involves the vaginal mucosa or perineal skin, but not the underlying tissue
Second: involves the underlying subcutaneous tissue, but not the rectal sphincter or rectal mucosa
Third degree: extends through the rectal sphincter, but not into the rectal mucosa
Fourth : extends into the rectal mucosa |
|
|
Term
Anovulatory uterine bleeding is associated with what?
What is tx? |
|
Definition
polycystic ovarian disease
exogenous obesity
adrenal hyperplasia
Tx: medroxyprogesterone acetate for 10 days. Whenyou stop the progesterone agent, uterine withdrawal causes cleeding |
|
|
Term
| What type of therapy should be started for woman with osteoporosis? |
|
Definition
hormone therapy
calcium supplementation
weight bearing exercise (walking for 30 min a day) |
|
|
Term
| how much calcium is recommended for menopausal women? |
|
Definition
|
|
Term
| What type of medication reduce bone resorption though inhibiting osteoclastic activity? |
|
Definition
bisphosphonates: alendronate, ibandronate
risedronate |
|
|
Term
| When do mammographies start? |
|
Definition
| after age 40, you should have every 1-2 years |
|
|
Term
| When do clinical breast exams start? |
|
Definition
| every 3 years btw ages of 20 and 39 y.o. |
|
|
Term
| What four characteristics define a newborn who requires no additional resuscitation? |
|
Definition
1. full term infant
2. clear amniotic fluid with no evidence of meconium an dinfection
3. spontanenous breathing and crying
4. good muscle tone |
|
|
Term
| What does a Ballard score evaluate? |
|
Definition
| neuromuscular and physical maturity |
|
|
Term
| What is assessed in the APGAR score? |
|
Definition
color
heart rate
reflex activity response to stimulation
muscle tone
respirations |
|
|
Term
| What defines a post term pregnancy? |
|
Definition
|
|
Term
| What is the most common cause of post term labor? |
|
Definition
| inaccurate estimation of gestational age |
|
|
Term
| What establishes the diagnosis of gestational DM? |
|
Definition
pts who glucose values exceeds 140 require a standard 3 hour glucose tolerance test using 100 g glucose
two or more abnormal results in the 3 hour test establish the diagnosis |
|
|
Term
| Pt who has gestational DM. How do you treat? |
|
Definition
#1 control diet
#2 if diet control doesnt work then exogenous insulin; intermediate acting NPH and fast acting insulin |
|
|
Term
True or false:
insulin crosses the placenta and affects the fetus. |
|
Definition
|
|
Term
| What type of glucose level do you want to miantain in pt with gestational DM? |
|
Definition
| 100 mg/dL...so once glucose lvels decrease to 70 then start 5% dextrose solution |
|
|
Term
| Where do the majority of normal vaginal secretions come from? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are risk factors for placenta previa? |
|
Definition
| Grand multiparity, maternal age over 35, hypertension, previous c-section and smoking are the most common risk factors for placenta previa |
|
|
Term
| While performing a routine speculum exam, you notice, smooth clear or yellow glandular elevations on the cervix. What could it be? What further work up do you need? |
|
Definition
| nabothian cyst; no further w/u |
|
|
Term
|
Definition
cephalexin
amoxicillin
tylenol |
|
|
Term
| bloody unilateral nipple discharge |
|
Definition
| may be caused by invasvie ductal carcinoma |
|
|
Term
| green, yellow, or brown sticky discharge can be due to what? |
|
Definition
| ductal ectasia or fibrocystic changes of the breast |
|
|
