WHAT IS CONSIDERED LATE PPH?
>24 HOURS
WHAT ARE THE 2 CAUSES OF LATE PPH
1) SUBINVOLUTION OF PLACENTAL SITE
-10-14 DAYS, TX: ERGOT
2) RETAINED POC
-CRAMPING, BLEEDING, FEVER, FOUL COCHIA
-TX: IV ABX, D&C
WHAT IS DELAYED PUBERTY?
NO SECONDARY SEX CHARACERISTICS BY 14
NO MENSES BY 16 REGARDLESS OF SECONDARY SEX CHARACTERISTICS
WHAT IS THE CLASSIC DISEASE ASS WITH HYPERGONADITROPIC HYPOGONADISM?
TURNERS (45 X0)
INCREASED FSH, DECREASED ESTROGEN
NO OVARIES, + GONADAL STREAKS
WHAT ARE THE PHYSICAL CHARACTERISTICS OF TURNURS?
SHORT, WEBBED NECK, SHIELD CHEST, WIDE SPACED NIPPLE, PRIMARY AMENORRHEA, SEXUALLY INFANTILE GENITALIA
WHAT IS THE TX FOR TURNERS?
OCP
HYPOGONADATROPHIC HYPOGONADISM IS DUE TO WHAT?
CNS DEFECT --> HYPOTHALMIC DYSFNX, ANOREXIA, HYPOTHRYOID, CUSHING, PROLACTINOMA, CRANIOPHARYNGIOMA (MC NEOPLASM)
LOW FSH, LOW ESTROGEN
TX: OCP/UNDERLYING CAUSE
TRUE/FALSE. OPTHALMIC ABX GIVENT TO A NEONATE PREVENT CHLAYMDIA CONJUNCTIVITIES.
FALSE
WHAT IS THE LEADING CAUSES OF BLINDNESS WORLDWIDE?
CHLYMDIA CONJUNCTIVITIS
WHAT IS THE TX FOR CHLYMIDIA CONJUNCTIVITIS?
PO ERYTHROMYCIN
IF + CX IN T1 RECHECK IN T3
WHAT IS THE WORST TIME FOR A MOTHER TO GET PARVOB19?
FIRST TRIMESTER (<20 WEEKS)
WHAT ARE THE SX FOR PARVOB19/FIFTHS/ERYTHEMA INFECTIOSUM IN AN ADULT?
MALAISE, ARTHRALGIA, MYALGIA, RETICULAR LACY RASH
IF A PREGNANT MOM GETS INFECTED WITH PARVO IN THE FIRST TRIMESTER WHAT ARE THE EFFECTS ON THE FETUS?
SUPRESSION OF BONE MARROW WITH DECREASE IN ERYTHROCYTE PROUCTION --> FETAL ANEMIA --> HYDROPS
EARLIST SIGN : POLYHYDRAMINOS
HOW CAN YOU DX PARVO?
IGM/IGG SEROLOGY
WHAT IS THE GOLD STANDARD FOR HSV2 DX
VIRAL CULTURE
WHAT IS THE MCC OF ENDROMETRITIS?
BACTEROIDES
WHAT IS THE MCC OF FEVER POST C-SECTION?
ENDOMYOMETRITIS
WHAT IS THE TX FOR ENDOMYRITIS?
CLINDA + GENT
WHAT IS THE PATHOGRAN THAT CAUSES A CHANCROID?
H. DUCREYI (GRAM - ROD)
WHAT IS THE PE FOR A CHANDROID?
TENDER ULCER WITH RAGGED EDGES ON A NECROTIC BASE
(compared to syphillis - nontender on clean edges/clean base)
WHAT IS THE CLASSIC APPEARANCE OF CHANCROID ON GRAM STAIN?
SCHOOL OF FISH
WHAT IS THE TX FOR A CHANCROID?
AZITHRO/IM ROCEPHIN
A G2P1001 PRESNTS WITH PPROM AND PROLONGED ROM, WHAT IS SHE AT RISK FOR?
CHORIOAMNIOITIS
WHAT IS THE SX FOR CHORIOAMNIOITIS?
FEVER, MATERNAL TACHY, UTERINE TENDERNESS, MALODOROUS D/C
EARLY: FETAL TACHY
WHAT IS THE TX FOR CHRIOAMNIOITIS?
DELIVERY + AMPICILLIN + GENT
WHAT IS A CAUSE OF CHORIOAMNIOITIS IN A WOMEN W/O ROM AND WITH A HX OF EARING GOATS CHZ/MILK?
LISTERIA
IS BV AN STD?
NO
WHAT ARE THE CHARACTERISTICS OF BV?
MC VAGINAL INFECTION
HOMOGENOUS SPILLED MILK
FISHY ODOR, + KOH WHIFF TEST
ODOR WORSENS POST INERCOURSE
PH: > 4.5
MICROPSCOPY: CLUE CELLS (SALT AND PEPPER)
TX: FLAGYL
NAGELES RULE
LMP + 7 DAYS - 3 MONTH + 1 YEAR
NORMAL MENSES
MENARCHE: 9-16 Y/O
CYCLE: 28 DAYS +/- 7 DAYS
MENSES: < 7 DAYS, < 80 ML
WHAT MURMUR IS COMMON IN PREGNANCY?
SYSTOLIC FLOW MURMUR
WHERE ARE BARATHOLIN GLANDS LOCATED?
5'0 CLOCK AND 7'0 CLOCK POSITION
WHAT BACTERIA IS ASSOCIATED WITH BARATHOLIN GLAND CYSTS?
GONORRHEA
WHEN DOING A VAGINAL EXAM YOU ARE EXAMINING THE ANTIOR OR POSTERIOR PELVIS? WHAT ABOUT DURING A RECTAL EXAM?
VAGINAL --> ANTERIOR
RECTAL --> POSTERIOR
RH (-) MOM AND RH (+) FETUS, WHAT MUST BE ADMINISTERED AND WHEN?
RHOGAM AT 28 WEEKS
RHOGRAM WITHIN 72 HOURS OF DELIVERY
WHEN IS THE TRIPLE SCREEN PERFORMED?
16-20 WEEKS
WHEN DO YOU CHECK WITH GDM?
26-28 WEEKS
WHEN DO YOU CHECK FOR GBS?
35-37 WEEKS
WHAT PRENATAL TESTS MUST BE DONE ACCORDING TO THE STATE?
CBC, BLOOD TYPE, RH, HEPB, RUBELLA, HIV, UA, PAP, SYPHILLIS, G/C
WHAT ARE THE MARKERS FOR OVARIAN CANCER?
CA-125
WHAT TEST IS USED TO DIFFERENTIATE BTWN STRESS AND URGE INCONTINENCE?
CYSTOMETRIC EVALUATION
ARE STRESS AND URGE INCONTINECE TREATED THE SAME?
NO!
STRESS = SURGICAL (BURCH URETHROPLEXY)
URGE = MEDICAL (ANTISPASMODICS/ANTICHOLINERGICS)
WHAT IS THE CAUSES OF STRESS INCONTINENCE?
WEAK PELVIC DIAPHRAGM
NO DELAY IN PRESSURE --> URINATION
WHAT IS THE TX FOR STRESS INCONTINENCE?
KEGAL, BIOFEEDBACK
BURCH URETHROPLEXY
WHAT IS THE CAUSE OF URGE INCONTINCE?
DETRUSOR SPASM/OVERACTIVITY
WHAT ARE THE SX OF URGE INCONTINENCE?
URGE TO GO AND DYSURIA
DELAY IN URINATION
WHAT IS THE TX OR URGE INCONTINECE?
MEDICAL
OXYBUTYLIN, BENTYL, LEVSIN, DITROPAN
WHAT DISEASES ARE ASS W/ OVERFLOW INCONTINENCE?
DM/SPINAL CORD INJURY
**PT DRIBBLIGN URINE AND HAVE POST VOID RESIDUAL (>200)
WHAT IS THE TX FOR OVERFLOW INCONTINENCE?
CATH
WHEN SHOULD YOU START SCREENING FOR DYSLIPIDEMIA AND HOW OFTEN SHOULD YOU SCREEN?
AGE 45 EVERY 5 YEARS
WHEN SHOUL DYOU START SCREENING FOR DM AND HOW OFTEN SHOULD YOU SCREEN?
45 AND EVERY 3 YEARS
WHEN SHOULD YOU START SCREENING FOR COLORECTAL CA?
50 Y/O WITH COLONSCOPY Q 10 YEARS
WHEN DO YOU START MAMMOGRAPHY?
40-49 EVERY 2 YEARS
50+ EVERY YEAR
WHEN IS A BMD SCREENING INDICATED?
DEXA @ 65 EVERY 2-3 YEARS
WHAT IS THE THIRD STAGE OF LABOR?
PLACENTAL SEPERATION
WHAT ARE THE STAGES OF PLACENTAL SEPERATION?
GUSH OF BLOOD
LENGTHENING OF CORD
GLOBULAR AND FIRM UTERUS
UTERUS RISES UP INTO ANTERIOR ABD WALL
HOW LONG DOES TO THE THIRD STAGE OF LABOR GENERALLY LAST?
< 30 MIN
WHAT IS THE MCC OF UTERINE INVERSION?
TOO MUCH TRACTION ON THE CORD
WHAT ARE THE SX OF UTERINE INVERSION?
SHAGGY, REDDISH BULGING MASS AT INTROITUS NEXT TO PLACENTA
HOW DO YOU PREVENT URTERINE INVERSION?
ALWAYS WAIT FOR PLACENTA TO SPONTANEOUSLY SEPERATE TO APPLY TRACTION TO THE CORD
WHAT IS A COMPLICATION OF UTERINE INVERSION?
HEMORRAGE AND SHOCK
WHAT ARE THE RISK FACTORS FOR UTERINE INVERSION?
PLACENTA ACCRETA/PREVIA
MULTIPAROUS
WHAT IS THE TX FOR UTERINE INVERSION?
STEP 1. RELAX UTERUS WITH HALOTHANE/MGSO4/TERBULATINE
STEP 2. REPOSITION UTERUS
STEP 3. OXYTOCIN
WHAT IS THE MOST COMON CAUSE OF TOXIC SHOCK SYNDROME?
STAPH AUREA (FROM VAGINA)
WHAT IS THE CLASSIC PRESENTAITON OF TSS?
SUNBURN LIKE RASH --> MACRULOPAPULAR --> DESQUAMINATION (10 DAYS)
WHAT IS THE TX FOR TSS?
NAFICILLIN, METHICILLIN, VANCO
WHAT IS THE DEFINITION OF LABOR?
DILATATION + CONTRACTION
WHAT IS THE "LATENT" PHASE OF LABOR DEFINED AS?
< 4 CM DILATED WITH CONTRACTIONS
HOW LONG DOES THE "LATENT PHASE" OF LABOR LAST IN A NULLIPAROUS AND MULTIPAROUS WOMEN?
(N) = 18-24 HOURS
(M) = <14 HOURS
WHAT IS THE "ACTIVE" PHASE OF LABOR DEFINED AS?
> 4 CM DILATED TO 10 CM DILATED WITH CONTRACTION
IN A NULLIPAROUS FEMALE, HOW MANY CM/HOUR SHOULD SHE PROGRESS IN ACTIVE LABOR?
1.2 CM/HOUR
IN A MULTIPAROUS FEMALE, HOW MANY CM/HOUR SHOULD SHE PROGRES IN ACTIVE LABOR?
1.5 CM/HOUR
WHAT IS CONSIDERED "ARREST OF ACTIVE LABOR"?
NO MOVEMENT FOR 2 HOURS
WHAT IS THE SECOND STAGE OF LABOR?
COMPLETE DILITATION TO DELIVERY OF FETUS
HOW LONG IS THE 2ND STAGE OF LABOR W/O AN EPIDURAL? W/ AN EPIDURAL?
W/O: 2 HOURS
W/: 3 HOURS
IF LABOR IS ABNORMAL WHAT ARE THE "3Ps" YOU MUST ACCESS?
PASSENGER, PELVIX, POWER
WHAT IS CONSIDERED ADEQUATE UTERINE CONTRACTIONS?
CONTRACTION EVERY 2-3 MIN, UTERUS FIRM ON PALPATION, LASTING 45-60 SEC
IF A PATIENT IS HAVING FEVER AND FLANK PAIN POST ABDOMINAL HYSTERECTOMY, WHAT SHOULD YOU EXPECT?
URETHRAL INJURY - MC LIGATION OF THE URETER AT LEVEL OF CARDINAL LIGAMENT
NAME THE TERM TO THE DEFINITION:
"ABNORMAL ADHERENCE OF PLACENTAL TO UTERINE WALL, ABNORMAL DECIDUA BASALIS LAYER OF UTERUS. ATTACHED TO MYOMETRIUM
PLACENTA ACCRETA
NAME THE TERM TO THE DEFINITION:
"ABNORMAL IMPLANTED PLACENTA, PENTRATED INTO MYOMETRIUM
PLACENTA INCRETA
NAME THE TERM TO THE DEFINITION:
"ABNORMAL IMPLANTED PLACENTA, PENTRATES THROUGH MYOMETRIUM
PLACENTA PERCRETA
WHAT ARE THE RF FOR PLACENTA ACCRETA/INCRETA/PERCRETA?
LOW LYING PRESENTATION, PLACENTA PREVIA, C-SECTION/D&C/MYOMECTOMY/ABLATION
WHAT IS THE TX FOR ACRETA/INCRETA/PERCRETA?
HYSTERECTOMY
WHAT IS THE MCC OF FETAL MISCARRIAGE?
FETAL KAROTYPE ABNORMALITY
HOW DO YOU DIFFERENIATE INCOMPETANT CERVIX FROM INEVITABLE ABORTION?
INCOMPETANT CERVIX: CERVIX OPENS SPONTANEOUSLY
WITHOUT
UTERINE CONTRACTION AND IT IS
PAINLESS
WHAT IS A RISK FRACTORS FOR INCOMPETANT CERVIX?
CONE BX/LEEP
WHAT IS THE TX FOR INCOMPETANT CERVIX?
SURGICAL LIGATURE/CERVICAL CERCLAGE
NAME THE MATERAL & FETAL RISKS FOR SHOULDER DYSTOCIA?
MATERNAL: HEMORRAGE
FETAL: BRACHIAL PLEXUS INJURY, HYPOXIA, DEATH
IS SHOULDER DYSTOCIA AN OBSTETRICAL EMERGENCY?
YES
WHAT ARE THE S&S OF SHOULDER DYSTOCIA?
TURTLE SIGN": FETAL HEAD RETRACTED BACK TOWARD MATERNAL INTROITUS
PROLONGED 2ND STAGE OF LABOR
WHAT IS THE MC ISSUE WITH SHOULDER DYSTOCIA?
ANTERIOR SHOULD IMPACTED BEHIND MATERNAL PUBLIC SYMPHYSIS
WHAT BRACHIAL PLEXUS PALSY IS MC ASSOCIATED WITH SHOULDER DYSTOCIA?
ERBS PLASY (C5-C6) = WAITER TIP DEFORMITY, ARM EXT, IR
NAME THAT MANUEVAR FOR SHOULDER DYSTOCIA:
"FLEX MATERNAL THIGHS AGAINST ABDOMEN, ANTERIOR ROTATES PELVIX
MCROBERTS
NAME THAT MANUEVAR FOR SHOULDER DYSTOCIA:
"PUSHES SHOULDER INTO OBLIQUE PLANE
SUPRAPUBIC PRESSURE
NAME THAT MANUEVAR FOR SHOULDER DYSTOCIA:
"ROTATING SHOULDER IN 180 DEGRESS CORKSCREW FASHION
WOODS CORKSKREW
NAME THAT MANEUVAR FOR SHOUDLER DYSTOCIA:
"CEPHALIC REPLACEMENT AND IMMEDIATE C-SECTION
ZAVENELLI
NAME THAT MANEUVAR FOR SHOULDER DYSTOCIA:
"SHOULDER GIRTH DECREASED FROM SHLD-SHLD TO SHLD-AXILLA
DELIVERY OF POSTERIOR ARM
WHAT IS C/I IN SHOULDER DYSTOCIA?
FUNDAL PRESSURE
WHAT IS THE NORMAL ENDOMETRIAL STRIPE?
< 5 MM
WHAT IS THE MCC OF POST MENOPAUSAL BLEEDING?
ATROPIC ENDOMETRITIS/VAGINITIS
WHAT IS THE MOST WORRISOME CAUSE OF POSTMENO BLEEDING?
ENDOMETRIAL CANCER
IS ENDOMETRIAL CANCER STAGED SURGICALLY/CLINICALLY?
SURGICALLY - 4 STEPS
(1) TAH +BSO
(2) OMENTECTOMY
(3) LYMPH NODE SAMPLING
(4) PERITONEAL WASHING
WHAT IS THE #1 RISK FACTOR FOR ENDOMETRIAL CANCER?
UNOPPOSED ESTROGEN
WHAT ARE THE RISK FACTORS FOR PLACENTA PREVIA?
GRAND MULTIPARITY
PRIOR C-SECTION
PRIOR D&C
PREVIOUS PREVIA
MULTIPLE GESTATIONS
WHAT IS THE PROCESS OF EVALUATION OF PLACENTA PREVIA WHEN PRESENTS WITH PAINLESS BLEEDING?
U/S --> SPECULUM --> DIGITAL
*
US IS SOC
*
PATIENT WITH PLACENTA PREVIA PRESENTS WITH A FIRST EPISODE OF PAINLESS BLEEDING, WHAT IS THE MANAMEGENT?
1ST TIME BLEEDING DOES NOT WARRENT DELIVERY
OBESERV AND BEDREST
WHAT MANAGEMENT SHOULD BE TAKEN FOR A TERM BABY WITH PLACENTA PREVIA? (significant bleeding)
C-SECTION
WHAT ARE THE RF FOR PLACENTA ABRUPTO?
COCAINE, HTN, TRAUMA
IS PLACENTA ABRUPTO DIAGNOSED VIA U/S?
NO U/S IS
NOT
DEFINITIVE, RELY ON CLINICAL DIAGNOSIS
WHAT ARE THE SX OF PLACENTA ABRUPTO?
PAINFUL BLEEDING IN 3RD TRIMETEST
WHAT IS THE MGMT FOR PLACENTA ABRUPTO?
DELIVERY - IVF/BLOOD PRODUCTS/MGSO4
WHAT IS THE MC LOCATION AND TYPE OF CERVICAL CA?
LOCATION: SQUAMOCOLUMNAR JNX OR TRANSFORMATION ZONE
TYPE: SCC
WHAT IS THE MC SX OF CERVICAL CA?
ABNORMAL VAGINAL BLEEDING OR POSTCOITAL SPOTTING
IF A PT COMES BACK IS AGUS ON A PAP WHAT ARE SUSPECIOUS OF?
ENDOMETRIAL CANCER
IS CERVICAL CANCER A CLINICAL/SURGICAL DX?
CLINICAL
(1) EXAM UNDER ANESTHESIA
(2) IVP
(3) CXR
(4) BARIUM ENDEMA/PROCTOSCOPY
(5) CYSTOSCOPY
WHAT IS THE TX FOR EARLY CERVICAL CA?
RADICAL HYSTERECTOMY +/- RT
WHAT IS THE TX FOR ADVANCED CERVICAL CANCER?
RT AND CHEMO
WHAT IS THE MCC OF DEATH IN CERVICAL CANCER?
BILATERAL URETHRAL INJURY --> OBST --> UREMIA
WHAT LABS SHOULD BE ORDERED IN PCOS?
DHEA, TESTOSTERONE, FHS, LH
IN PCOS WHAT IS THE LH:FSH RATIO?
2:1
WHAT IS THE SYNDROME THAT OCCURS IN DURING POSTPARTUM HERMORRHAGE WHERE THE ANT PIT UNDERGOES HEMORRAGIC NECROSIS CAUSED BY HYPERTROPHY OF PROLACTIN SECRETING CELLS IN CONJ WITH A HYPOTENSIVE EPISODE?
SHEEHAN'S SYNDROME
WHAT ARE THE SX OF SHEEHAN'S SYNDROME?
AMENORRHEA, INABILITY TO BREASTFEED
HOW DO YOU DIFFERENTIATE ASHERMANNS SYNDROME FROM SHEEHANS SYNDROME?
SHEEHANS SYNDROME HAS THE FOLLOWING CHARACTERISTICS:
-LOW TO NO ANT PIT FUNCTION
-LOW TO NO TSH/T4/FSH/CORTISOL/ PROLACTIN/LH SURGE/ESTRADIOL
-MONOPHASIC BODY TEMP
WHAT IS CONSIDERED POSTPARTUM HEMORRHAGE IN A VAGINAL DELIVERY?C-SECTION?
VAG: 500 ML
C-SECTION: 1000 ML
WHAT IS ASHERMANN'S SYNDROME?
INTRAUTERINE ADHESIONS
SCAR TISSUE IN THE ENDOMETRIUM LEADS TO AMENORRHEA AND UNRESPONSIVENESS TO ENDOMETRIAL TISSUE
WHAT ARE THE RF FOR ASHERMANN'S SYNDROME?
PREVIOUS C-SECTION
D&C
WHAT ARE THE KEY DIFFERENTIATING FACTS FOR ASHERMANNS IN COMPARISON TO SHEEHANS?
MAINTAINS ABILITY TO BREASTFEED
BIPHASIC BODY TEMP
NL HORMONE LEVELS
WHEN IS IS MOST COMMON TO HAVE UMBILICAL CORD ACCIDENTS/PRLOLAPSE?
WHEN FETUS IS UNENGAGED, AVOID ARTIFICIAL ROM WHEN FETUS IS NOT ENGAGED
WHAT IS THE MC POSITION FOR CORD PROLPASE?
TRANSVERSE/FOOTLING
WHAT IS THE LEAST COMMON FOR CORD PROLAPSE?
FRANK/VERTEX
YOU ARE DELIVERING AN INFANT AND NOTE THAT THERE IS FETAL BRADY, WHAT IS YOUR NEXT STEPS?
(1) CONFIRM FETAL HR
(2) VAGINAL EXAM TO ACCESS PROLAPSE
(3) POSITIONAL CHANGE (LLD)
(4) O2
(5) IVF BOLUS
(6) D/C OXYTOCIN
IF FETAL BRADY IS DUE TO CORD PROLAPSE, WHAT IS YOUR NEXT STEP?
ELEVATE PRESENTING PART AND EMERGENT C-SECTION
WHAT IS THE MC SYMPTOMS OF FIBROIDS?
MENORRHAGIA
WHAT IS THE PHYSICAL EXAM FOR FIBROIDS?
MASS THAT MOVES
WITH
CERVIX, IRRIGULAR, MIDLINE, FIRM, NONTENDE
WHAT IS ANOTHER NAME FOR FIBROIDS?
LEIOMYOMATA
WHAT ARE 4 TYPES OF FIBROIDS?
PEDUNCULATED: ON A STALK
SUBMUCOSAL: IMPINGE ON UTERINE CAVITY
INTRAMURAL: IN UTERINE MM
SUBSEROSAL: OUTSIDE UTERINE CAVITY
WHICH TYPE OF UTERINE FIBROID IS MOST SYMPTOMATIC?
SUBMUCOSAL - CAN INTERFERE WITH PREGNANCY
WHAT DO SUBSEROSAL FIBROID FEEL LIKE ON EXAM?
KNOBBY SENSATION
WHAT ARE THE TX OPTIONS FOR FIBROIDS?
NSAIDS/PROVERA/OCP
GNRH X 3 MONTHS PRIOR TO SURGERY (NOT LONG TERM)
HYSTERECTOMY
MYOMECTOMY
WHAT IS THE MC BREAST MASS IN AN ADOLESCENT/YOUNG ADULT?
FIBROADENOMA
DESCRIBE A FIBROADENOMA?
PT < 35 Y/O
FIRM, RUBBERY, MONILE, SOLID
NONCYCLIC
FIBROCYSTIC BREASTS
CYCLICAL BREAST "PEBBLY" TEXTURE AND MASTODYNIA
WHAT IS THE MCC OF SEROSANGINOUS NIPPLE D/C FROM ONE DUCT IN THE ABENSE OF A BREAST MASS?
INTRADUCTAL PAPILLOMA/DUCT ECTASIA
WHAT ARE THE 3 Ds OF ENDOMETRIOSIS?
DYSMENORRHEA
DYSPAREUNIA
DYSCHEZIA
WHAT IS THE GLD STD FOR DX ENDOMETRIOSIS?
LAPROSCOPY
WHAT DAY OF THE MENSTRUAL CYCLE DOES THE LG SURGE OCCUR?
DAY 21
HOW MANY DAYS AFTER THE LH SURGE DOES A WOMEN OVULATE?
2-3 DAYS
WHAT IS THE TX FOR OVULATORY INFERTILITY?
COMPHINE CITRATE
IF A PT HAS INFERTILITY DUE TO TUBAL ISSUES, WHAT IS THE TX?
INVITRO
WHAT IS THE NORMAL SEMEN ANALYSIS? WHAT IS THE MOST IMPORTANT PREDICTING FEATURE?
NORMAL:
VOLUME: >2.0 ML
CONCENTRATION: > 20 MILLION/ML
MOTILITY: >50%
MORPHOLOGY: >40%
MOST IMPORTANT
RULE OF THUMB...
REGULAR MENSES = REGULAR OVULATION
IRREGULAR MENSES = IRREGULAR OVULATION
WHEN DOES OVARIAN TORSION IN PREGNANCY GENERALLY OCCUR?
14 WEEKS OR POSTPARTUM
WHAT IS THE S&S OF OVARIAN TORSION?
UNILATERAL
COLICKY
ADOMINAL/PELVIC PAIN ASS WITH N/V (ACUTE ONSET)
IS APPENDICITIS A SURGICAL EMERGENCY IN PREGNANCY?
YES!
WHERE IS MCBURNEY'S POINT LOCATED IN PREGNANCY?
SUPERIOR AND LATERAL
IS CHOLYSTASIS IN PREGNANCY A SURGICAL TX?
NO, WATCH IN WAIT
DO PREGNANT WOMEN PRESENT WITH THE TYPICAL SYMPTOMS OF CHOLESTASIS IN PREGNANCY?
NO.
THEY HAVE PRURITIS DUE TO SEQUESTION OF BILE ACIDS
TX: BAS, ANTIHISTAMINES
WHAT IS THE LEADING CAUSE OF DEATH IN PREGNANCY IN 1ST/2ND TRIMESTER?
ECTOPIC
WHAT IS THE ECTOPIC TRIAD?
ABDOMINAL PAIN
HX OF AMENORRHEA
VAGINAL BLEEDING
IF PT HAS A RUPTURED ECTOPIC WHAT SX COULD SHE EXPERIENCE?
SHOULDER PAIN
SYNCOPE
WHAT IS THE SOC FOR ECTOPIC?
TVUS
*
BEST THING IS DETERMINE IF THERE IS AN IUP
*
IF A PATIENT HAS A TVUS AND THERE IS NO ADENXAL MASS AND A NEGATIVE IUP CAN YOU RULE OUT ECTOPIC?
NO
WHAT IS A CHARACTERTIC FINIDNG ON TVUS FOR ECTOPIC?
EMBRYO OUTSIDE UTERUS OR LARGE AMOUNT OF INTRAABDOMINAL FLUID
AT WHAT LEVEL OF BHCG SHOULD YOU VISUALIZE AN IUP?
1500-2000
WHAT PROGESTERONE VALUE INDICATED A NORMAL OR ABNORMAL PREG?
NORMAL: >25
ABNROMAL: <5
WHAT IS THE TX FOR ECTOPIC?
MTX (<4 CM AND STABLE)
SALPINGECTOMY
SALPINOSTOMY
MUST FOLLOW HCG TO ZERO
WHAT IS A ABNORMAL HGB IN PREGNANCY?
< 10
8-10 MILD
<8 SEVERE
28 WK PREGNNAT FEMALE PRESENTS TO THE ED FOR EVALUATION OF DARK URINE AND FATIGUE. ON HX YOU FIND THAT SHE HAD A UTI 5 DAYS AGO AND HAS BEEN ON NITROFURANTOIN X 3 DAYS. ON EXAM THE PATIENT APPEARS JAUNDICE. WHAT SHOULD DX SHOULD YOU EXPECT?
G6PD DEFICIENCY
TRIGGERS: SULFA, ANTI-MALARIAL, NITROFURANTION
SX: JAUNDICE, FATIGUE, DARK URINE
WHAT IS THE DEFINITION OF PRETERM LABOR?
< 37 WKS, > 2 CM DILATED, > 80% EFFACEMENT, REG UTERINE CONTRACTIONS
WHAT PHARMOCOLOGIC DRUGS CAN BE USED IN PRETERM LABOR?
TOCOLYSIS - TERBULATILNE, MGS04, INDOMETHICIN, RITODRINE
WHAT IS A COMPLICATION OF INDOMETHICIN?
PDA CLOSURE AND PULM HTN IN NEWBORN
WHAT IS SE OF MGSO4?
PULM EDEMA
WHAT IS SE OF TERBULATINE?
TACHY, HYPERGLY, HYPOKALEMIA, WIDE PULSE PRESSURE
WHAT IS THE
MCC
OF SEPSIS IN PREGNANCY?
PYLONEPHRITIS
WHAT IS THE MOST WORRISOME COMPLICATION FROM PYELONEPHRITIS?
ARDS CAUSED BY ENDOTOXIN RELEASE FROM E.COLI
SX: DYSPNEA
CXR: DIFFUSE BILAT OR INTERSTITIAL INFILTRATES, SPARES COSTOPHRENIC ANGLES
WHILE DOING A CBE YOU FIND A SMALL 1 CM MASS IN LOQ, YOU REFER THE PT FOR MAMMO AND IT COMES BACK NORMAL, WHAT IS YOUR NEXT STEP?
<35: FNA
>35: EXCISIONAL BX
IF AN OVARIAN CYST IS <5 CM IS IS MOST LIKELEY?
FUNCTIONAL CYST
IF AN OVARIAN CYST IS > 8 CM IT IS MOST LIKELY?
OVARIAN CA
WHAT DO YOU DO IS A CYST IS BTWN 5-8 CM?
LOOK AT US
CANCER: SEPTATE, SOLID, EXCRESENCES
WHAT TYPE OF OVARIAN MASS CONTAINS TYHROID TISSUE?
STRUMA OVARII,
MC ON RIGHT
MC PRESENTS WITH HYPOTHROIDISM
NEED MRI: LOBULATED MASS WITH THICK SEPTA
IF A PT IS POSTMENO WITH AN OVARIAN CYSTS > 4-5 CM, WHAT IS YOUR NEXT STEP?
OPERATE
WHAT IS THE MC OVARIAN TUMOR IS WOMEN > 30?
SEROUS CYSTOADENOMA
IF THERE IS AN OVARIAN MASS MEASURING 2-3 CM IN A PREPUBITAL WOMEN, WHAT IS YOUR NEXT STEP?
SURGERY
IS OVARIAN CANCER STAGED SURGICALLY OR CLINICALLY?
SURGICALLY
(1) TAH + BSO
(2) OMENECTOMY
(3) PERITONEAL WASHING
(4) PERITONEAL BX
(5) SAMPLING ASCITIC FLUID AND KAD
WHAT ARE THE SX OF ASHERMANN'S SYNDROME?
SECONDARY AMENORRHEA
NEG PREG TEST
NEG PROGESTERONE WITHDRAWAL
WHAT IS FIRST LINE FOR ASHERMANN'S SYNDROME?
HYSTEROSALPINGOGRAM
WHAT IS GOLD STANDARD FOR ASHERMANN'S SYNDROME?
HYSTEROSCOPY
WHAT IS THE TX FOR ASHERMANNS SYNDROME?
OPERATIVE HYSTEROSCOPY
DESCRIBE MULLARIAN AGENESIS:
NL PUBARCHE, ADRENARCHE, THELARCHE
ABSENT UTERUS, BLIND VAGINA, ABSENT MENSES
NL TESTOSTERONE, 46 XX
WHAT IS A COMPLICATION OF MULLARIAN AGENESIS
RENAL ANOMALIES
DESCBRIBE ANDROGEN INSENSITIVITY:
NL THELARCHE, ABSENT PUBARCHE/ADRENARCHE
ABSENT UTERUS, BLIND VAGINA, NO MENSES
INCREASED TESTOSTERONE, 46 XY
NEEDS GONADECTOMY
WHAT ARE THE MOST COMMON BACTERIA IN SEPTIC ABORTIONS?
BACTEROIDES, E.COLI, GRAM (-) RODS, GBS
WHAT IS THE MCC OF POSTPARTUM HEMORRAGE?
UTERINE ATONY
HOW DO YOU MANAGE UTERINE ATONY?
(1) UTERINE MASSAGE
(2) DILUTE OXYTOCIN
(3) METHERGINE (C/I: HTN) OR PROSTAGLANDIN (C/I: ASTHMA)
(4) LAPAROTOMY & POSSIBLE TAH
PATIENT IS POST SVD AND EST BLOOD LOSS IS > 500 ML. PT HAS A FIRM UTERUS AND NO SIGNS OF ATONY, WHAT IS THE MOST LIKELY CAUSE OF BLEEDING?
GENITAL LACERATIONS
WHAT ARE THE COMPLICATIONS OF BV?
PID, PROM, ENDOMETRITIS POSTPARTUM
WHAT ARE THE CHARACTERISTICS OF TRICH?
+ INFLAMMATORY, + STD
FROTHY YELLOW, GREEN D/C
STRABERRY CERVIX
+MILD WHIFF TESTS
PH > 4.5
MICROPSCY: FLAGELLA
TX: FLAGYL (TX PARTNER)
WHAT IS THE CHARACTERISTIC PRESENTATION OF CANDIDIA?
CURDY, LUMPY D/C
VAGINAL BURNING, IRRIATION, SWELLING, NO ODOR
PH < 4.5
MICRSCOPCY: PSEUDOHYPAE
TX: MICOAZOLE TOPICAL, FLUCONAZOLE 1 PO
WHAT IS SEEN ON MICROSCOPY WITH ATROPHIC VAGINITIS?
PARABASALAR CELLS
WHAT IS AN ABNORMAL MSAFP (maternal serum alpha fetoprotein)?
2-2.5 TIMES NORM
SIGNIFYS ANENCAPHLY OR SPINA BIFIDA
WHAT IS SEEN IN DOWNS FOR MSAFP, HCG, ESTRADIOL?
MSAFP: DECREASED
HCG: INCREASED
ESTRADIOL: DECREASED
WHAT IS SEEN IN TRISOMY 18 FOR MSAFT, HCG, ESTRADIOL?
ALL DECREASED
WHAT IS THE MCC OF ABNORMAL SERUM MARKERS IN PREGNANCY?
ABNORMAL DATING
WHEN IS GENETIC SCREENING DONE?
15-20 WEEKS
IF A PATIENT HAS AN ABNORMAL TRIPLE SCREEN WHAT IS THE NEXT STEP?
U/S
EMBRYO
0-8 WKS
FETUS
9WKS - TERM
PRETERM
< 37 WKS
IMMATURE
20-28 WKS
PREMATURE
28-37
LBW
<2500 GRAMS
CHADWICKS SIGNS
BLUE DISCOLORATION OF CERVIX
LEUKORRHEA
INCREASED VAGINAL D/C IN PREGNANCY (NORMAL)
HEGARS SIGNS
SOFTENING OF THE LOWER UTERINE SEGMENT
GODDELLS SIGNS
CYANOSIS AND SOFTENING OF CERVIX
LADINS SIGNS
UTERINE SOFTENING IN ANTERIOR MIDLINE ALONG UTEROCERVICAL JNX
VON FERNWALDS SIGN
IRREGULAR SOFTENING OF FUNDUS OVER SITE OF IMPLANTATION
HOW WOULD YOU ACCESS LUNG MATURITY AND WHEN?
< 34 WKS
AMNIOCENTESIS
LECITHIN:SPINGOPMYLIN RATIO 2:1
+ PHOSPHATIDYGLYCEROL
WHAT IS TX FOR SYPHILLIS IN PREG?
IF ALLERGIC?
PCN
DESENTATIZE AND GIVE PCN
WHAT IS THE TX FOR GONORRHEA?
ROCEPHIN
WHAT IS THE TX FOR CHALYMIDA IN PREG?
AZITHRO
WHAT IS THE TX FOR HSV IN PREG?
acyclovir STARTING AT 35 WEEKS
TX FOR TRICH IN PREG?
FLAGYL
TX FOR CANDIDA IN PREG?
MICONAZLE CREAM
MCC FOR MENINGITIS IN A NEWBORN?
GBS, LISTERIA, ECOLI
EXPLAIN WHEN YOU DO OB EXAMS BASED ON WEEKS PREGNANT
0-32: EVERY 4 WEEKS
32-36: EVERY 2 WEEKS
36+: WEEKLY
WITH TWINS START WEEKLY EXAMS AT 24 WEEKS AND REGULAR US
INTEGRATED SCREEN DOES WHAT?
1ST AND 2ND TRIMETEST BLOOD WORK + U/S TO LOOK FOR DOWNS AND TRISOMY 18
WHAT IS AN ABNORMAL 1 HOURS GTT?
140
WHEN IS NST BEST?
28-32 WKS
WHAT IS A NORMAL NST?
2 ACCELERATIONS WITH AN INCREASE IN 15 BPM ABOVE BASELINE FOR 15 SEC in a 20min period
HOW MANY ARTERIES AND VEINS ARE IN THE PLACENTA?
2 ARTERIES (UNOXY)
1 VEIN (OXY)
WHAT IS A BISCHOPS SCORE?
USED TO DETERMINE INDUCTION
YES: >5
NO: <5
WHAT DOES THE BISHOPS SCORE LOOK AT/
POSITION, CONSISTENCY, EFFACEMENT, DILITATION, STATION ON A SCALE OF 0-3
POSITION: (0) POSTERIOR, (1) MIDLINE, (2) ANTERIOR
CONSISTENCY: (0) FIRM, (1) MIDDLE (2) SOFT
EFFACEMENT: (0) 0-30, (1) 30-50, (2) 60-70, (3) > 80
DILITATION: (0) CLOSED, (1) 1-2, (2
WHAT ARE THE MOVEMENTS OF LABOR?
DESCENT, FLEX, IR, EXT, ER, EXPLUSION
WHAT NARCOTIC IS USED IN LABOR?
STADOL (Butorphanol)
WHAT IS A FIRST DEGREE PERINEAL LAC?
SKIN/MUCOSA
WHAT IS A SECOND DEGREE PERINEAL LAC?
SUBMUCOSA
WHAT IS A THIRD DEGREE PERINEAL LAC?
ANAL SPHINCTER INVOLVEMENT
WHAT IS A FOURTH DEGREE PERINEAL LAC?
INVOLVED RECAL MUCOSA
WHAT CAUSES CLOSURE OF PDA?
CORD CLAMPING
APGAR SCORE
0-2 (>7 = GOOD) ASSESSED AT 1,5 MIN
ACTIVITY: NONE, FLEXED, ACTIVE
PULSE: NONE, <100, >100
GRIMACE: FLACCID, SOME FLEX, ACTIVE (COUGH, CRYING, ETC)
APPEARANCE: BLUE, ACRO, PINK
RESP: NONE, IRREG, REG
WHAT 2 THINGS MUST YOU CHECK IN A NEWBORN?
PKU, HYPOTHROIDISM
WHAT IS THE TX FOR CONJUNCTIVITIS IN THE NEWBORN?
SILVER NITRATES, ERYTHROMYCIN, TCN
WHAT IS USED TO PREVENT HEMORRAGIC DISEASE OF THE NEWBORN?
VITAMIN K
WHEN ARE THE STAPLES REMOVED POST C-SECTION?
3-5 DAYS
WHEN DOES A PT VIIST THE OFFICE POST C-SECTION, V-DELIVERY?
C-SECTION: 2 AND 6 WEEKS
VAG: 6 WEEKS
WHAT IS THE MC LOCATION FOR AN ECTOPIC PREGNANCY?
AMPULLA
WHAT SITE OF ECTOPIC HAS THE LEAST AMOUNT OF COMPLICATIONS?
ISTHMIC
WHAT SIDE OF ECTOPIC HAS THE MOST SERIOUS COMPLICATIONS?
INTERESTITIAL (LARGER/RUPTURE LATER)
COMPLICATION: HEMORRHAGE
IN UMBILICAL CORD PROLAPSE, WHEN THE CORD IS ADJACENT TO THE PRESENTING PART IS IT CALLED?
OCCULT
IN UMBILICAL CORD PROLAPSE WHEN THE CORD IS BENEATH THE PRESENTING PART IS CALLED?
OVERT
TX FOR OVERT AND OCCULT PROLAPSE
OVERT: RAISE PRESENTING PART OFF CORD AND IMMEDIATE C-SECTION
OVERT: LLD
IN PLACENTA APRUPTO DO YOU PERFORM A VAGINAL OR C-SECTION?
VAGINAL
WHAT ARE THE DIFFERENT TYPES OF PLACENTA PREVIA?
COMPLETE: COVERS OS
PARTIAL: PARTIALLY COVERING OS
MARGINAL: PLACENTA AT THE MARGIN OF THE OS
HALLMARKS OF GESTATIONAL TROPHOBLASTIC DISEASE:
UTERINE BLEEDING IN T1 (MC)
ABSENSE OF HEART TONES
UTERINE SIZE GREATER THAN FOR EST DATE
BHCG GREATER THAN EXPECTED GA
HYPERMESIS GRAVIDUM
COMPLETE MOLE:
MORE COMMON
HAPLOID SPERM 46 XX
NO FETUS FORMED AND FETAL MEMBRANES ABSENT
PARTIAL MOLE
MOST COMMON 46 XXY
CHROMOSOMALLY ABNORMAL FETUS
WHAT IS THE U/S FINDING FOR A HYDRATIFORM MOLE?
SNOWSTORM APPEARANCE
WHAT ARE THE TYPICAL VESICLES FOUND IN HYDRATIFORM MOLE?
GRAPE LIKE VESICLES
WHAT IS THE TX FOR HYDRATIFORM MOLES WITH MALIGNANT POTENTIAL (MOST COMMONLY COMPLETE)
CHEMO
WHAT IS FRANK BREECH?
HIPS FLEXED WITH EXTENDED KNEE BILATERALLY
WHAT IS COMPLETE BREECH?
BOTH HIPS AND KNEES FLEXED
WHAT IS FOOTLING BREECH?
ONE OR BOTH LEGS EXTENDED BELOW BUTTOX
PREECLAMPTIC TRIAD?
HYPTERTENSION, PROTIENURIA, EDEMA
WHAT TYPE OF SIEZURES ARE SEEN IN ECLAMPSIA?
TONIC-CLONIC
WHAT IS HELLP SYNDROME
HEMOLYSIS
ELEVATED LIVER ENZYMES
LOW PLATELETS
WHAT DRUGS CAN BE USED FOR HTN IN PREGNANCY?
METHYDOPA, LABATEOLOL, NIFIDIPINE
MC breast cancer?
IDC
BIRADS SYSTEM
I: NORMAL
II: BENIGN APPEARING
III:POSSIBLE BENIGN/MALIGNANT
IV: SUSPICOUS MALIGNANT
V: MALIGNANT UNTIL PROVEN OTHERWISE
WHAT IS THE PHYLLODES TUMOR?
MC NONEPITHELIAL NEOPLASM OF BREAST
LARGE 5-30 CM
LEAF LIKE PATTERN
SURGERICAL REMOVAL
WHAT IS THE MC LOCATION OF BREAST CANCER?
UOQ
DESCRIBE THE STAGING OF PELVIC ORGAN PROLAPSE
0-4
0: NO PROLAPSE
1: WITHIN 1-2 CM PROX OF OF HYMEN
2: WITHIN 1 CM PROX/DISTAL OF HYMEN
3. WITHIN 1-2 CM DISTAL OF HYMEN
4. 2 CM DISTAL TO HYMEN
WHAT TYPE OF PROLAPSE IS ASS W/ SPLINTING?
RECTAL PROLAPSE
WHAT IS THE TX FOR CYSTOCELE/RECTOCELE?
COLPORRHAPHY + MESH
WHAT IS THE TX FOR ENTEROCELE?
PURSE STRING CLOSURE
WHAT IS THE FIRST THING IN THE W/U FOR INCONTINENCE?
UA AND CULTURE (R/O UTI)
WHAT IS A NORMAL PVR?
<50
> 200 = URINARY RETENTION
WHAT IS SHOWN ON CYSTOSCOPY FOR INTERSITITAL CYSTITIS?
GLOMERULATIONS/HUNNER ULCER
WHAT IS THE TX FOR INTERSTITIAL CYSTITIS?
PENTOSAN POLYSULFATE SODIUM
WHAT CANCER IS ASS WITH DES?
CLEAR CELL CARCINOMA
BLIGHTED OVUM
ANEMBRYONIC PREG, FAILE DEVELOPMENT OF AN EMBYRO SO THAT THE GESTATIONAL SAC W/ OR W/O A YOLK SAC
HALLMARKS OF ROM
+ NITRALIZINE TEST (ALKALINE)
FERNING
POOLING OF FLUID
DONE WITH A STERILE SPECULUM EXAM
MOST RELIABLE SIGNS OF CHIOAMNIONITIS:
FEVER
MATERNAL LEUKOCYTOSIS
UTERINE TENDERNESS
TACHY (MATERNAL & FETAL)
FOUL SMELLING AMNIOTIC FLUID
OVERT CORD PROLAPSE:
IMMEDIATE ACTION --> IMMEDIATE PELVIC EXAM
VIABLE FETUS: MOM KNEE TO CHEST AND UPWARD PRESSURE AGAINST PRESENTING PART, UNTIL C-SECTION PREP, DO NOT REPLACE CORD
WHAT IS THE #1 RF FOR SHOULDER DYSTOCIA?
FETAL MACROSOMIA/GDM
WHAT HTN DRUGS ARE TERATOGENIC?
ACEI/ARB --> FETAL NEONATAL DEATH AND RENAL FAILURE
DIURETICS
DIVISION OF TWINS
DIDI: 3 DAYS
DI MONO: 3-8 DAYS
MONO-MONO: 8 - 11
CONJOINED 11-12
WHEN IS RHOGAM GIVEN?
28 WEEKS AND WITHIN 72 HRS OF DELIVERY
WHAT IS THE #1 RF FOR CHROMOSOMAL ABNORMALITIES?
INCREASED MATERNAL AGE
WHAT IS THE MC ANEULOPLOIDY IN MISCARRIAGES?
TURNERS 45 XO
WHO DOES INFERTILITY AFFECT MORE MALES/FEMALES?
EQUALLY
ON A CYCLE DAY 3 FSH LEVEL IS > 10, IS THIS NORMAL OR ABNORMAL?
ABNORMAL --> DIMINISHED OVARIAN RESERVE
IF A PATIENT IS ON CLOMPHINE CITRATE AND EXPERIENCES VISUAL DISTURBANCES, CAN SHE CONTINUES?
NO
TRUE/FALE. DOMESTIC VIOLENCE IS A LEARNED BEHAVIO IN WHICH THEY WERE OFTEN ABUSED OR BATTERED THEMSELVES,
TRUE
WHAT ARE SITUATIONS IN WHICH THERAPEUTIC ABORTIONS ARE USED?
1. MALIGNANCIES
2. MEDICAL ILLNESS IN WHICH PREGNANCY CAN THREATENED THE LIFE OF MOM
3. RAPE/INSEST
4. FETAL ABNORMALITIES
5. FETAL DEMISE