**Repro Blueprints B USMLE 2
Terms
undefined, object
copy deck
- "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TP-PA - what is the next step in management if a FNA is performed on a woman w/ a breast mass and clear fluid is withdrawn?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)