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Glossary of **Repro Blueprints B USMLE 2

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"Double-bubble" on US indicates what problem?
Down's syndrome
what should the mother avoid during first trimester b/c it could lead to increased risk of neural tube defects?
Hyperthermia

(fevers and hot tubs)
what are the (2) possible initial tests for syphillis that become negative over time?
RPR,

VDRL
what are the (2) confirmatory tests for syphillis that are always reactive (positive) if you are exposed?
FTA-ABS,

TP-PA
what is the next step in management if a FNA is performed on a woman w/ a breast mass and clear fluid is withdrawn?
repeat the exam in 4 - 6 weeks

(clear fluid indicates Fibrocystic Dz)
what course of action is always contraindicated in placenta previas?
(2)
Vaginal exams

Labor Induction
if a placenta previa is diagnosed w/o bleeding, what is the course of management?
deliver by C-section at 36 - 37 weeks
if placenta previa is diagnosed w/ bleeding, what is the course of management?
Manage expectantly to increase gestational age, then C-section when necessary
if baby has decreased fetal movement, what is the first step?
order Non-Stress Test

(then BPP)
what are the (2) reasons for an Amnioinfusion?
Relieve cord compression,

Dilute meconium
what is next step in management of 26 week gestation PPROM in breech w/ oligohydramnios?
Admission and expectant management

(and test for Chorioamnionitis)
Define:

Fetal Demise
Intrauterine death > 20 weeks
what is the blood pressure difference b/t mild preeclampsia and severe preeclampsia?
Mild: > 140/90


Severe: > 160/110
what do the following Biophysical Profile scores mean:
1. 8 - 10
2. 6 - 7
3. less then 5
8 - 10: Normal

6 - 7: Deliver at term

less then 5: Deliver immediately
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?
Lochia

3 - 4 days: Red
10 days: Yellow-white

can last 4 - 8 weeks
Definition:
infection of placental implant site or hysterectomy scar upward thru venous or lymphatic routes

what is the classic initial sign?
Septic Pelvic Thrombophlebitis

sign:
continued temperature 5 days after Abx given postpartum
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?
Septic Pelvic Thrombophlebitis

Test:
MRI to see thrombosis or vascular edema

Tx: IV Heparin + IV broad Abx
what level is hCG, AFP and Estriol for:

Trisomy 21
hCG: Increased

AFP: Decreased

Estriol: Decreased
what level is hCG, AFP and Estriol for:

Trisomy 18
hCG: Decreased

AFP: Decreased

Estriol: Decreased
maternal infection that causes the following fetal problem:

skin scarring, abnormalities of the lens of the eye, abnormal motor movements and extremitiy hypoplasia
Varicella
maternal infection that causes the following fetal problem:

deafness, cerebral calcifications, microopthalmia
CMV
maternal infection that causes the following fetal problem:

pneumonia, meningoencephalopathy, petichae, mental retardation
HSV
maternal infection that causes the following fetal problem:

cataracts, congenital heart defects, deafness, possible "blueberry muffin" rash
Rubella
maternal infection that causes the following fetal problem:

IUGR, microencephalopathy, possible fetal hydrops, chorioretinitis
Toxoplasma gondii
pregnancy risk for mother w/ DM-1
Preeclampsia
what is the first line of Tx for DUB and dysmenorrhea?
NSAIDs
what is the first line of Tx for DUB and menorrhagia?
OCPs
Dx:
hirsutism, amenorrhea, overweight, infertile
PCOS
Tx of choice for PCOS?

what if the patient desires to be pregnant?
Tx: OCPs


if desires pregnancy:
Clomiphene
what is the first step in evaluating a couple for infertility?
Semen analysis
what medications can be used in female for infertility if she does not have adequate estrogen?
(2)
1. Human Menopausal Gonadotropins (hMG)

2. Clomiphene
what does Clomiphene citrate need to work?
adequate levels of Estrogen
(4)* causes of Secondary Amenorrhea
PACE:

PCOS,

Anorexia,

Chemotherapy Hx,

Endocrine disorders
a 21 yo girl comes to office for routine check. What test is most important?
Chlamydia culture
what is the first step in care for a suspicious breast lesion in woman under 35 yo?
FNA or Breast Bx

(mammography is not as efficient in this age group)
what is the first step of Tx in a woman over 50 yo who has a breast mass?
FNA or Breast Bx
Dx:
woman w/ mulitple deliveries has back pain,a heaviness in the pelvis, with sx that worsen w/ standing and get better lying down
Pelvic Relaxation

(Vaginal Prolapse)
what is the most non-obstetric cause for hospitalization during pregnancy?
Pyelonephritis
Definition:
puberty in girls less then 8 yo or boys less then 9 yo

Cause?
Tx? (2)
Precocious Puberty

cause:
Idiopathic
(but R/O hormone-secreting tumor or CNS disorder)

Tx:
Underlying cause,
GnRH analog to prevent premature closure of epiphyseal plates
Dx:
prepubescent girl w/ diabetes has vaginal itching
Candidiasis
what is the usual cause of vaginal bleeding in neonates?

Tx?
maternal estrogen withdrawl

Tx:
resolves on its own
(4) absolute contraindications to Estrogen therapy
Unexplained vaginal bleeding,

Liver Dz,

Hx of throbophlebitis or TE,

Hx of endometrial or breast CA
why is progesterone given w/ estrogen replacement therapy?

when dont they need it?
to counteract the unapposed estrogen that can lead to cancer in women w/ a uterus

women w/ hysterectomy don't need Progesterone therapy
MCC of secondary HTN in women
Oral Contraceptive Pills
why should OCPs be stopped 1 month before a major surgery and then restarted 1 month after?
risk of Thromboembolism
a woman is on OCP and has amenorrhea. What is the most likely cause?
Pregnancy

(no pill is 100% effective)
(2) main vitamins women should take during pregnancy
Folate

Iron
when are fetal heart tones heard w/ doppler and w/ normal stethoscope?
Doppler: 10 - 12 weeks


Stethoscope: 16 - 20 weeks
where is the fundus of the uterus at 12 weeks?

20 weeks?
12 weeks: Pubic bone


20 weeks: Umbilicus
when is US most accurate for fetal age?
16 - 20 weeks
when is the only time aspirin should be used during pregnancy?
antiphospholipid syndrome
what (2) rare disorders are assoc w/ prolonged gestation?
Anencephaly,

Placental Sulfatase deficiency
what are the steps if a person has an abnormal AFP?
(2)
1. Ultrasound

2. Amniocentesis
when is Chorionic Villus Sampling done instead of an Amniocentesis?
when is it done?
risk?
For women w/ previously affected offspring or known genetic Dz

Performed: at 9 - 12 weeks to offer the option of abortion in first trimester

Risk: higher risk of miscarriage then amniocentesis
what does CVS detect?

what can't it detect?
Detects:
genetic or chromosomal disorders

Not Detect:
Neural Tube Defects
Teratogen/drug that causes:

spina bifida; hydrospadius
Valproic Acid
Teratogen/drug that causes:

cleft lip/palate, limb, CV defects, mental retardation
Phenytoin
Teratogen/drug that causes:

cleft lip and/or palate
Diazepam

(Benzodiazepines)
Teratogen/drug that causes:

Cardiac (Ebstein's) anomalies
Lithium
Teratogen/drug that causes:

fingernail hypoplasia, craniofacial defects
Carbamazepine
Teratogen/drug that causes:

deafness
Aminoglycosides
Teratogen/drug that causes:

vertebral, anal, cardiac, tracheo-esophageal,renal and limb malformations
Oral Contraceptive Pills

(VACTERL syndrome)
Dx:

baby is born w/ cleft lip or palate; lower half of body incompletely formed; left colon hypoplasia, CV defects, microsomia or macrosomia
Mother w/ untreated DM
what was mother exposed to if baby has:

saber shins, interstitial keratitis, skin lesions, rhinitis, unusual teeth
Syphillis
in untreated HIV patients, what is the transmission rate to the fetus?
25%
when should Zidovudine be given to the HIV mother and baby?

what does this reduce the risk to?
mother: Prenatally (at 14 weeks)

baby: for 6 weeks after birth

reduces risk to 10% transmission
why might a non-infected baby of an HIV mother test positive at birth?

when does it revert to a negative test?
mother's antibodies can cross the placenta

reverts to negative:
6 months
what should you do for a newborn if the mother has chronic
Hep B?
give newborn first Hep-B vaccination and Hep-B immunoglobulin at birth
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?
give the child a VZV immunoglobulin shot
what is suspected if the lochia is foul-smelling?
Endometriitis
(4) common Infection-based contraindications to breast feeding
1. HIV

2. Hepatitis B

3. CMV

4. Active Herpes lesions on breast
what (2) ilicit drugs are not teratogens?
Weed,

LSD
what should you consider if preeclampsia develops before the third trimester?
(2)
Hydatiform mole,

Choriocarcinoma
what are the signs of Magnesium sulfate toxicity?
(3)
Hyporeflexia,

Respiratory depression,

CNS depression
(leading to coma and death)
when eclampsia occurs (seizure), when do you deliver the infant?
Only when the mother is stable...never do C-section during seizure
Dx:
recent postpartum mother w/ tachypnea, SOB, chest pain, hypotension, DIC
Amniotic fluid pulmonary embolism
Definition:

true labor has begun, but is progressing slower then normal time values
Protraction Disorder
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
Arrest Disorder
what is the first step in managing Protraction or Arrest disorder?
Rule-out:

Abnormal Lie

and

Cephalopelvic disproportion
MCC of Protraction or Arrest disorder?

Tx?
Cephalopelvic disproportion

(head wont fit)

Tx: C-section
what possible problems can be encountered when Oxytocin is used to induce labor
(4: 2 uterine, one fetal one electrolyte)

Tx?
Uterine hyperstimulation
(painful, irregular contractions),

Uterine rupture,

FHR decelerations,

Water intoxication/HypoN

Tx: stop the Pit (short T-1/2)
what are the contraindications to Labor induction and/or Vaginal delivery?
(7)*
Placenta or Vasa Previa,
Umbilical cord prolapse,
Prior classic C-section,
Cervical CA,
Cephalopelvic disproportion
Active genital Herpes,
Transverse Fetal Lie,
when is it detected on US:

1. Gestational sac

2. Fetal image

3. Beating heart
Gestational sac = 5 weeks

Fetal image = 6 - 7 weeks

Beating heart = 8 weeks
What is normal steps of management for mother when Variables are seen?
(3)

if bradycardia continues, what is next step?
1. place in Lateral decubitus position

2. give her oxygen

3. stop Pitocin

if continues: insert pH scalp monitor
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?
pH < 7.2 = Immediate C-section

pH > 7.2 = continued monitoring
if the child has a shoulder distocia during delivery, what is the first step?
what is done if this fails?
McRobert's maneuver

if it fails: C-section
what is always the initial step in management for Third Trimester bleeding?

Why?
Ultrasound

b/c it may be due to a placenta previa (CI to pelvic exam)
what can a placental abruption lead to if fetal products enter maternal circulation?
DIC
Biggest risk factor for fetal bleeding
(vasa previa or velamentous cord) in third trimester?
Multiple gestations
Definition:

blood-tinged mucous plug that is a normal cause of third trimester spotting
Bloody show
once a woman in preterm labor is stable, what is the next step in management?
manage as outpatient w/ oral tocolytics
assuming there are no prenatal procedures done, when is the normal time RhoGAM is given?
(2)
1. 28 weeks

2. w/i 72 hours after delivery
what are the (3) possible ways to treat Hemolytic Dz of the Newborn?
Delivery (if at term),

Intrauterine transfusion (risky),

Phenobarbitol
(helps liver breakdown bilirubin)
what is the blood type for the mother and infant that can also cause hemolytic dz?
Mother: Type O

Baby: Type A, B or AB
(3) possible reasons a postpartum patient will go into shock w/o evidence of bleeding
Amniotic fluid embolism,

Uterine Inversion,

Concealed hemorrhage
what strange lab tests are NORMAL in pregnancy?
(5)
ESR is high,

Total T4 and TBG inc, but free T4 is nml,

Dec Hct and Hb,

Alk Phos inc,

mild proteinuria and glycosuria,
Dx:
itching and abnormal LFT in any trimester, poss jaundice

Tx?
Cholestasis


Tx:
Delivery

(but cholestyramine helps w/ Sx)
Dx:
girl never had period w/ breast development, patent vagina, no uterus and 46, XY
Androgen Insensitivity

(Testicular Feminization)
Dx:
girl never had period, without breast development, normal uterus and vagina, 46,XX, FSH is low
Hypothalamic-Pituitary dysfunction
Dx:
girl never had period without breast development, normal uterus and vagina, 46,XX, FSH is high
Gonadal Dysgenesis

(Primary Ovarian failure)
Syndrome:

Hypothalamic-Pituitary dysfunction that results in a defect in GnRH production

what is unusual about patient presentation?

what are FSH and LH levels?
Kallman syndrome

(patient lost sense of smell)

LH and FSH are low
Definition:

defect in ovarian receptors for LH and FSH
Savage syndrome

(a Hypogonadotropic Hypogonaism defect)
what are (3) pathologic causes of Primary ovarian failure
(primary amenorrhea)?
Turner's syndrome,

Defects in Steroid synthesis,

Savage's syndrome
(no ovarian LH and FSH receptors)
what is the maternal MCC of IUGR?
Chronic maternal Hypertension
what is considered normal in the Hunter-Sims postcoital test for sperm?
(2)
1. 8 - 10 motile sperm in highpowered field

2. thin cervical mucous
Abortion type:

bleeding, cervical dilation, retained POC
Inevitable abortion
Dx:
woman at 18 week w/ 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
Missed abortion
what is the cause of Testicular femninization?

How do they present?
(5)
cause:
absence or dysfunction of testosterone receptors

Breasts, no pubic hair, amenorrhea, vagina that ends in blind pouch and w/o Hirsutism
what is the staging for ovarian cancer (Ia,b,c - IV)?
Ia: confined to one ovary
Ib: involves both ovaries
Ic: either a or b w/ rupture of ovary, dz outside capsule or positive washings

II: Extends into pelvis

III: Mets into abdomen

IV: Distant Mets
what gestational time does the formation for the (3) types of twins occur:
1. Di-Di
2. Mono-Di
3. Mono-Mono
Di-Di: zero - 3 days

Mono-Di: 3 - 8 days

Mono-Mono: 8 - 13 days
what ovarian tumor is most commonly assoc w/ increased AFP?
Endodermal Sinus Tumor

(Most Aggressive Germ Cell Tumor; Schiller-Duval Bodies; from extraembrionic tissue)
what ovarian tumor is most commonly assoc w/ increased hCG?
Choriocarcinoma
what are the steps and Dx in diagnosing a Secondary Amenorrhea?
(5)
1. R/O 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
what is the safe treatment for a pregnant woman who may get alcohol poisoning from bindge drinking?
Benzodiazepines
Of all the woman trying to get pregnant, how many will conceive in one year?
80 - 85%
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
Omphalocele
Dx:
anterior abdominal wall defect in the infant where the abdominal contents are herniated lateral to the normal insertion of the umbilical cord
Gastroschsis
MC female sexual disorder
Hypoactive sexual desire
what are the precursor cells to the placental membranes?
Trophoblasts
during a Threatened abortion, what lab is low?
Estradiol levels
what is the most common reason for an abnormal triple screen?

what is the first step for an abnormal triple screen?
incorrect gestational age

first step:
Ultrasound for accurate dating
what test determines the amount of fetal RBC in the maternal circulation?
Kleihaur-Bettke test
(5)* safe Vaccines during pregnancy
HOTY-D:

Hep B,
Oral Polio,
Tetanus,
Yellow fever,
Diphtheria
what (5)* exposures in pregnancy require Immune Globulin?
The Mom Can Really Hurt:

Tetanus,
Measles,
Chickenpox,
Rabies
Hep A and B,
Dx:
post-delivery in third stage there is a sudden gush of blood, umbilical cord lengthening and the uterus rises and firms
Placental separation
Definition:

the fatty substance consisting of desquamated epithelial cells and sebaceous matter that covers the skin of the fetus
Vernix
what is the main use of prostaglandins in delivery?
ripening of the cervix
which Leopold Maneuver:

What fetal part occupies the fundus?

What apect of fetal to mother relationship does it determine?
(2)
First maneuver

determines:

1. Fetal Lie

2. Fetal Presentation
which Leopold Maneuver:

On what side is the fetal back?
Second amneuver
which Leopold Maneuver:

What fetal part lies over the pelvic inlet?

What apect of fetal to mother relationship does it determine?
Third maneuver

determines:
Fetal Position
which Leopold Maneuver:

On which side is the cephalic prominence?
Fourth maneuver
Type of Breech:

thighs are flexed, legs extended over anterior surface of body, feet are in front of face
Frank breech
Type of Breech:

thighs are flexed on the abdomen and legs are flexed (folded)
Complete breech
Describe the 4 types of vaginal tears
First degree: skin and vaginal mucosa

Second degree: including underlying muscle

Third degree: including anal sphinctor

Fourth degree: including rectal mucosa
what causes fluid retention postpartum?
(2)
High Estrogen levels during Pregnancy

Increased Venous Pressure in lower body during pregnancy
what external stimulus provokes milk letdown?
cry of the infant
what are the diabetic classifications?
(8)
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
what is the CNS anomaly most specific to mother w/ DM?
Caudal regression
if a woman is taking anticonvulsants during pregnancy, what vitamin should be supplemented?
Folic Acid

(if not, risk of defects or Anemia related to folic acid deficiency)
since asthma can be exacerbated by respiratory tract infections in pregnant women, what specific vaccine should be given to all asthma patients for prophylaxis?
Killed Influenzae Vaccine
which anti-HTN medication in pregnancy can cause the AE of SLE-like syndrome?
Hydralazine
(5)* contraindications to giving Tocolytics
BAD CHad:

Bleeding (severe),
Abrupto placentae,
Death of fetus,
Chorioamnionitis,
HTN (severe)
first step in management for PROM
evaluate for Chorioamnionitis

(if so, deliver baby and Abx)
what is the Apt test and its results?
place vaginal blood in tube w/ KOH

turns Brown = Maternal

turns Pink = Fetal
Dx:

pregnant woman is rushed into ER from car accident and has back pain
Placental abruption
why is Estrogen a Pro-coagulant?
(2)
Increases Factors VII and X

Decreases Anti-Thrombin III
best method of hormonal birth control for woman w/ SLE?
Injectable Progesterone
what secretes Progesterone in the Luteal phase?

what does the secretion cause w/ respect to hormones?
Corpus luteum

causes:
decrease in LH and FSH
what hormone not related to menstrural cycle, inhibits GnRH pulsations and ovulation?
Prolactin
MC postoperative complication?
Pulmonary Atelectasis
MC cause of primary amenorrhea?
Gonadal dysgenesis
MC reason for neonatal sepsis?
Chorioamnionitis

(GBS or e.coli)
Dx:
a baby w/ ambiguous genitalia is born to a mother who complains of increased facial hair growth over the last few months
Luteoma of pregnancy

(Dx after birth...virilization in mother and fetus)
Diff Dx for Menorrhagia
(6)*
LACE-UP:

Leiomyoma,
Adenomyosis,
Coagulopathy,
Endometrial Hyperplasia,
Uterine (Endometrial) or Cervical CA,
Polyps of endometrium
Diff Dx for postcoital bleeding
(3)
Trauma,

Infection,

Cervical cancer
Definition:

pelvic pain assoc w/ ovulation
Mittelschmerz
MCC of acute pelvic pain
Ruptured ovarian cyst
Dx:
premenopausal patient complains of hemoptysis w/ each period
Endometriosis of nasopharynx or lung
what must be completely visualized for adequate colposcopic evaluation?
Transformation zone
what (4)* cancers metastasize to cervix by direct extension?
RIB-Eye steak:

Rectal,
Intra-abdominal,
Bladder,
Endometrial
which cervical cancer is susceptable to radiation therapy?

which is not?
Radiation: SCC of cervix


not: Adenocarcinoma of cervix
what are the 4 basic stages of endometrial CA?
I: only uterine involvement

II: includes cervical involvement

III: includes local spread

IV: includes distant spread
what is the most important prognostic indicator of endometrial CA?
Grade

G1 = Well differentiated; < 5% solid

G2 = Moderate differentiation; 5 - 50% solid

G3 = Poor differentiation; > 50% solid
Dx:

postmenopausal woman with a widening girth notices she can no longer button her pants
Ovarian cancer
Definition:

a fixed pelvic and upper abdominal mass w/ ascites

what is it a sign of?
Omental caking


sign:
Ovarian cancer
what GYN cancers are staged Surgically?

Clinically?
Surgically:
Ovarian,
Endometrial

Clinically:
Cervical
In addition to a TAH/BSO for epithelial cell ovarian cancer, what is the Tx in stages I-IV?
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
what is the tumor marker for a Granulosa-Theca cell tumor?
Inhibin

(and high estrogen)
what is the tumor marker for a Sertoli-Leydig ovarian tumor?
Testosterone
what class of female cancers secrete hCG, Lactogen and Thyrotropin?
Gestational Trophoblastic Neoplasias
(GTN)
what is the criteria for hospitalization for PID?
(5)*
GU PAP:

GI symptoms,
Unknown Dx,
Peritonitis,
Abscess,
Pregnancy
what is the diagnostic test for Gonorrhea?
culture on Thayer-Martin agar
what is the diagnostic test for chlamydia?
Microimmunofluorescence test
(MIF)
Dx:
painless papule on genitals, lymphadenitis, rectovaginal fistula
Lymphogranuloma Venereum
(LGV)


[serotype L1-L3 of chlamydia]
what is the level of Vaginal Prolapse w/ each Grade I-IV?
I: to level of Ischial spines

II: b/t Ischial spines and Introitus

III: within Introitus

IV: past Introitus
what type of incontinence does the Q-tip test measure?
Stress incontinence
Common COD for Ovarian CA patient?
Mets to bowel causing obstruction
if a female patient has HIV, what cancer will progress the Dx to AIDS?
Cervical CA
(HPV)
what is the next step if you cannot see the transformation zone on colposcopy?
LEEP procedure
what is the only cancer you can slice through w/o taking all of it out?
Ovarian CA
Definition:

Absence of spermatozoa
Azoospermia
Definition:

Low concentration of spermatozoa
Oligozoospermia
Definition:

Poor motility of sperm
Asthenozoospermia
Definition:

Poor morphology of sperm
Teratozoospermia
what is the difference in FSH levels of the Dx of Poor Oocyte Reserve versus Premature Ovarian Failure?

what are estrogen levels w/ each?
Poor Oocyte Reserve:
FSH > 10
Estrogen = normal

Premature Ovarian Failure:
FSH > 25
Estrogen is Low
(same as menopause)
Dx:

35yo female w/ secondary amenorrhea, low estrogen and very high FSH and LH
Premature Ovarian Failure

(menopause in female < 36 yo)
MCC of maternal death in the first trimester
Ectopic pregnancy
what is the cause of vaginal lubrication during sex?
Vaginal Transudation

(edema from engorged vaginal vessels)
Dx:

patient ovulates day 14 and starts bleeding day 22; low progesterone

Dx exam?
Luteal Phase Defect

(shortened luteal phase)

Dx exam:
Late Luteal Phase endometrial Bx
(3) reasons to use a Sterile vaginal Speculum on assessing the Laboring patient
1. Suspect Rupture of Membranes

2. Preterm Labor

3. signs of Placenta Previa
Dx:
PID with Perihepatic inflammation and adhesions from liver to diaphragm
Fitz-Hugh-Curtis syndrome
What is the next step in Tx for a patient with ASCUS?
Repeat Pap smear in 3 months
Patient comes in with a suspected Fibroadenoma.

Next step?
Ultrasound

(cannot send home without checking; this is sufficient to confirm Dx0
How long should HRT be used?
6 - 12 months

(then if Sx persist, switch to another method)
Most deaths from Cervical CA are due to what?
Uremia

(and pyelonephritis)
Most common form of contraception in USA?
Sterilization
Pregnant woman comes in with a gush of clear fluid from the vagina.

First step?
Sterile Vaginal Exam
Dx test for HSV
Viral Culture

(not Tzank smear)
Medicine to rapidly relax the Uterus if it is inverted?
(2)
1. Nitroglycerine


2. Terbutaline
Most sensitive test to distinguish types of Incontinence
Urethrocystometry
50-yo patient with Breast CA presents with Lytic lesions of the spine.

First step?
Radiation
Greatest risk factor for Endometrial Hyperplasia
Obesity

(50lbs overweight increases risks 10 times)
3-yo develops breasts without vaginal bleeding or pubic hair

First step?

Dx?
First:
obtain Serum Estradiol level

Dx:
Premature Thelarche

(MC before age 4 due to increase circulating E2; No Tx)
Ligament that contains the Ovarian artery and vein
Infundibulopelvic ligament
Ovarian tumor with Call-Exner bodies
Granulosa cell tumor

(increased serum E2)
Where is Hematopoiesis the most in development at age:
1. <12 weeks
2. 12 - 24 weeks
3. >24 weeks until birth
1. <12 weeks = Yolk Sac

2. 12 - 24 weeks = fetal Liver

3. >24 weeks until birth = fetal Bone Marrow
27-yo with secondary amenorrhea and 4 months of hirsutism; normal pelvic exam and US

First step?
Serum DHEAs

(to see if it is from ovary or adrenal gland)
At what age does a female have the most Oocytes?
20 weeks gestation

(at birth 1/2 are lost)
Dx:

Condyloma ACUMINATUM
HPV
woman being evaluated for infertility is found to have a double uterus

Next test?
IVP

(30% of women with uterine anomaly have urinary tract anomaly)
Patient has confirmed Chlamydia

Tx?
Tx Patient and Partner with Doxycycline ONLY
Patient has confirmed Gonorrhea

Tx?
Tx Patient and Partner with both Ceftriaxone and Doxycycline

(if it was Chlamydia, it would be Doxy only)
Dx test for Septic Pelvic thrombophlebitis

Tx?
Dx test:
MRI of pelvis

Tx:
Heparin and IV Abx
a 44-yo w/ normal pap smear 3 years ago has intermenstrual and post-coital spotting intermittently for 6 months.

First test?
Pap Smear

(cervical polyp is strong possibility of Dx0
Name of the surgery for Stress Incontinence
Retropubic Urethropexy
Best predictor of Breast CA that has spread outside of the breast?
Initial SIZE of the Tumor

(which is Stage in this case)
Dx:
Purulent vaginal discharge and pH of 4.2 - 5.0
Monilial Vaginitis
Dx:
Decreased ejaculate volume and azoospermia without fructose
Absent Seminal vesicles

(SV adds the fructose to ejaculate)
Total time for sperm to ejaculate
90 days
what type of immunity is a RhoGAM shot?
Passive Immunity

(b/c you give the Antibody)
after delivery, what should be suspected if placenta does not separate spontaneously after 30 minutes?
Placenta Accreta
What VD can affect the throat and present with exudative pharyngitis?
Herpes
(5) reasons to hospitalize for PID
1. Bad infection (>39C; N/V);

2. Adolescent

3. NULLIPAROUS

4. Low SES

5. Failure to respond to IV meds
In a woman with IDM, what should be done for fetal surveillance?
NST

(starting at 28 weeks; 2 times weekly to decrease risk of Sudden Intrauterine Death)
Which form of incontinence is associated with DM?

Tx?
Overflow Incontinence

(Detrusor instability from neuropathy; will present with increased post-void volume)

Tx:
Self-catheterization
which type of incontinence may be treated by alpha-adrenergic meds?
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)
How long must a diaphragm stay in after intercourse?
at least 6 hours
pregnant woman presents with tachycardia, increased breathing, and chest pain. CXR is negative

Next step?
V/Q exam
what is the follow-up post delivery if the patient has gestational diabetes?
2-hour GTT in 6 weeks post partum
14-yo presents with vaginal bleeding causing a Hct of 30%; no Hx of blood disorder; Beta-HCG and US are negative; normal vitals

First step?
give OCPs

(will stabilize bleed in initial menstrual cycles; no transfusion needed)

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