Term
| What are the stages of the normal menstrual cycle? |
|
Definition
1) Menstruation/follicular phase (days 1-13)
- Begins with menstruation and ends at LH surge/ovulation
- Increased GnRH pulse leads to increased FSH leading leading to follicular growth and increased estrogen production
- By late follicular, endometrium thickens and mucus is stringy
2) Ovulation (day 14)
- Estradiol peaks, positive feedback and pituitary leads to LH surge and follicle rupture with release of ovum
- Ruptured follicular cells become corpus luteum
3) Luteal phase (day 15-28)
- Estrogen dominance shifts to Progesterone from CL, which maintains endometrial lining and thickens secretions (secretory phase)
- If no fertilization takes place, LH drops and progesterone/estradiol from CL drops, leading to sloughing of lining.
- Lack of estrogen/progesterone stops feedback inhibition of FSH, and rise in FSH begins follicular phase |
|
|
Term
| What changes in FSH, LH and lipids are expected in a patient who underwent Menopause? |
|
Definition
- FSH rises first, followed by LH
- Total cholesterol increases and HDL decreases |
|
|
Term
What are the major risks of HRT for menopausal vasomotor symptoms?
What are the contraindications? |
|
Definition
1) Increased risk of breast cancer and CV morbidity
2) Vaginal bleeding, breast cancer, endometrial cancer, history of TE, liver disease, hypertriglyceridemia |
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Term
| What non-HRT methods are available to reduce frequency of hot flashes in menopausal women? |
|
Definition
1) SSRI/SNRI
2) Clonidine
3) Gabapentin |
|
|
Term
What are the disadvantages of each of the following types of birth control?
1) Implanon (progestin-only implant)
2) IUD with progestin (Mirena)
3) Copper T IUD
4) Depo-P
5) OCP
6) Progestin-only pills |
|
Definition
1) Irregular periods
2) Spotting, acne
3) Cramping and bleeding (5-10%)
4) Weight gain, irregular periods, decrease in fertility 10 months after discontinuation
5) TE risk (smokers > 35)
6) Strick compliance and daily timing |
|
|
Term
| Which types of contraception are protective against endometrial and ovarian cancer? |
|
Definition
1) OCPs
- Inhibit FSH/LH, suppressing ovulation and leading to thickening of cervical mucous
2) No use in smokers > 35 |
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|
Term
| How is primary amenorrhea defined? What is the differential diagnosis? |
|
Definition
1) Absence of menses by 16 with secondary sexual development present, or absence at age 14 without secondary sexual development
2) Differential
- Primary ovarian insufficiency- no sexual characteristics
- Central hypogonadism: no sexual characteristics
- Mullerian agenesis- present sexual characteristics
- Imperforate hymen- present SC
- Complete androgen insensitivity- present SC
- CAH: Virilization with amenorrhea or oligomenorrhea |
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Term
| What is the most common cause of primary Amenorrhea. What are the likely etiologies? |
|
Definition
1) Primary ovarian insufficiency: absent sexual characteristics
2) Etiologies
- Turner syndrome (45 XO): streak gonads, webbed neck, coarctation, bicuspid AV
- Radiation therapy or chemotherapy |
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|
Term
| What are the 4 causes of primary Amenorrhea in women WITHOUT secondary sexual characteristics? |
|
Definition
1) Ovarian failure (think Turner's)
2) Central Hypogonadism (prolactinoma?)
3) Kallman's syndrome (anosmia and isolated gonadotropin loss)
4) Constitutional growth delay |
|
|
Term
| What are the 4 causes of primary Amenorrhea in women WITH secondary sexual characteristics? |
|
Definition
1) Mullerian agenesis: absence of two-thirds of vagina with uterine abnormalities
2) Imperforate hymen: blood in vagina that cannot escape
3) Complete androgen insensitivity: breast development present (aromatiziation of testosterone to estrogen), but amenorheic and lack of pubic hair
4) CAH: Virilization with amenorrhea or oligomenorrhea |
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Term
| What are the contraindications to estrogen-containing hormonal methods? |
|
Definition
1) Pregnancy
2) History of CVA, DVT/PE
3) Breast cancer
4) Abnormal vaginal bleeding
5) Smoking > 35
6) Liver neoplasm |
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Term
| What are the available emergency contraceptive methods and how do they work? |
|
Definition
1) Morning-after pill (estrogen/progestin)
- OTC option used as bridge to contraception
2) Progestin only pill
- Fewer N/V SE than combined
3) Copper IUD (99% effective vs. 80% above) |
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|
Term
| Describe the first steps in a workup for primary amenorrhea |
|
Definition
1) Pregnancy test
2a) Secondary Sex characteristics Present
- If Uterus absent, get Karyotype and serum testosterone (Abnormal mullerian development, 46 XX; Androgen insensitivity, 46 XY)
- If Uterus present, consider outflow obstruction (imperforate hymen)
2b) Absent Secondary Sexual Characteristics
- Get FSH and LH
- FSH increased, get Karyotype 46XY (Swyer), 46XX (Ovarian failure), 45 XO (Turner)
- Normal/low FSH: Central, constitutional delay, measure prolactin
3) Hypertensive? Consider CAH, get 17 hydroxyls and 11 hydroxylase.
4) Hyperandrogenism? Consider androngen-secretion neoplasms. Check testosterone and DHEAS |
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|
Term
| What should you think of in a patient with hypertension and primary amenorrhea? |
|
Definition
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|
Term
| What is the treatment for a patient with primary amenorrhea related to hypogonadism? |
|
Definition
Could be hypogonadotropic (Low FSH/LH) or hypergonadotropic (High FSH)
1) Start HRT with low-dose estrogen
2)Begin cclic estrogen/progesterone 12-18m later |
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|
Term
What are the major causes of secondary amenorrhea?
What are the first steps in workup? |
|
Definition
- Get pregnancy test, if (-) get TSH and prolactin
1) Pregnancy
2) Ovary: PCOS, premature failure
3) Hypothalamus
4) Pituitary: Adenoma, Sheehan syndrome
5) Thyroid
6) Uterine: Asherman |
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|
Term
| 18 year old woman present for amenorrhea. Initial workup reveals negative pregnancy test and normal TSH/prolactin. What is the next step? |
|
Definition
Progestin challenge (10d)
- If (+) withdrawal bleed, think an ovulation due to noncyclic gonadotropic (PCOS, premature menopause, or idiopathic)
- If (-), get FSH. High FSH indicates hypergonadotropic hypogonadism/ovarian failure
- Low FSH indicates Uterine abnormality or estrogen deficiency |
|
|
Term
18 year old woman present for amenorrhea. Initial workup reveals negative pregnancy test and normal TSH/prolactin. Progestin challenge is normal and there are clinical signs of Virilization.
What is the next step? |
|
Definition
- Measure testosterone, DHEAS and 17-hydroxyprogesterone
- Could be PCOS, CAH, Cushing, ovarian/adrenal tumor |
|
|
Term
| Describe the workup and differential for secondary/organic dysmenorrhea |
|
Definition
Endometriosis and adenomyosis, fibroids, adhesions and PID
Workup
- Order B-hcG (ro Ectopic)
- Order CBC (infection, neoplasm), UA (UTI), STD swab (STD/PID) |
|
|
Term
| How do you distinguish between Endometriosis and Adenomyosis? |
|
Definition
1) Endometriosis
- Functional tissue outside of uterus
- Uterus normal size and restricted range of motion
- Diagnose with Laparoscopy
2) Adenomyosis
- tissue IN myometrium
- menorrhagia, enlarged boggy and symmetric uterus
- Diagnose with MRI and pathological evaluation |
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|
Term
| How are Endometriosis and Adenomyosis treated? |
|
Definition
1) Endometriosis: complication is infertility
- Inhibit ovulation with OCPs (first line), GnRH analogues (leuprolide), Danazol
- Conservative or definitive surgical treatment options
2) Adenomyosis
- NSAIDS (first line) + OCPs
- Surgery also option
- Rare chance of becoming endometrial carcinoma |
|
|
Term
| What is the differential for Abnormal Uterine Bleeding? |
|
Definition
PALM-COEIN
1) PALM is structural
- Polyps
- Adnomyosis
- Leiomyoma
- Malignancy
2) COEIN is non-structural
- Coagulopathy
- Ovulatory dysfunction
- Endometrial
- Iatrogenic
- Not yet classified |
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|
Term
| Describe the workup for abnormal uterine bleeding |
|
Definition
Remember, if post-menopausal it is CA until proven otherwise
**First line treatment is NSAIDS to reduce blood loss
1) Pregnancy Test
2) CBC (anemia)
3) Pap (cervical cancer)
4) STD probe
5) TFTs and prolactin
6) Platelets, PT/PTT
7) Ultrasound |
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|
Term
| Who needs an endometrial biopsy for evaluation of abnormal uterine bleeding? |
|
Definition
1) > 4mm endometrium in post-menopausal
2) Patient > 35 with risk factors (obesity, diabetes) |
|
|
Term
How is uterine bleeding handled in the following situations?
1) Acute heavy loss
2) Ovulatory
3) Anovulatory |
|
Definition
1) High-dose IV estrogen to stabilize lining and then transition to oral
- If uncontrolled after 12-24h, perform D & C
2) NSAIDs to reduce blood loss
- Can give tranexamic acid for 5d during meshes
- If HDS, give OCPs
3) Progestins X 10 days to stimulate withdrawal bleeding
- OCPs, Mirena IUD
- Worry is endometrial hyperplasia/cancer |
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|
Term
What are the defining features of the following forms of CAH?
1) 17a-hydroxylase deficiency
2) 21-hydroxylase deficiency
3) 11b- hydroxylase deficiency |
|
Definition
Separate 11 from 17 but sex hormone level
1) Increased aldosterone (HTN and low K+), low cortisol, low sex hormones
- XY- pseudohermaphorditism
- XX- lack of secondary sexual development
- Look for low androstenedione
2) Low aldosterone (Hypotension and high K+), high cortisol, high sex hormones
- Look for increased renin and increase 17 hydroxyprogesterone
3) Low aldosterone, but high 11-deoxycorticosterone (HTN, low cortisol, increased sex hormones
- Look for low renin |
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|
Term
What kind of CAH is described in each of the following.
1) High 17-OH progesterone levels in virilized patient with hypotension
2) Increased 11-deoxycortisol and 11-deoxycorticosterone in virilized patient with hypertension and hypokalemia
3) Low androstenedione in hypertensive patient with ambiguous genitalia |
|
Definition
Remember, Cosyntropin stimulation test is gold standard
1) 21 hydroxylase deficiency
2) 11b-hydroxylase deficiency
3) 17a-hydroxylase deficiency |
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|
Term
| What is the treatment for CAH? |
|
Definition
| Steroids + Mineralocorticoid (Fludrocortisone) if salt wasting (21 hydroxlase) |
|
|
Term
| What are the diagnostic criteria for PCOS? |
|
Definition
HAIR-AN syndrome
- HyperAndrogenism, Insulin Resistance, Acanthosis Nigricans
- Risk of DM2 and Metabolic syndrome
Rotterdamn (2 of 3)
- Polycystic ovaries on US
- Physical signs of hyperandrogenism
- Oligo- and/or an ovulation |
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|
Term
45 year old obese female with an ovulation and signs of hirsutism presents to your office. You find elevated testosterone, normal DHEA-S, 17-OH progesterone.
You order FSH/LH levels and 24h free cortisol levels. What do you expect to see and how might you treat? |
|
Definition
Sounds like PCOS. DHEA-S ro adrenal tumor and 17-OH ro CAH
1) Tests)
- FSH/LH should be elevated (hypergonadotropic hypergonadism)
- 24h free cortisol should be normal (ro Cushing's or adult-onset CAH)
2) Treatment
- No need for conception: OCPs, progestin + Metformin
- If attempting to conceive: Clompiphene (SERM) +/- metformin
- Hirsutism: OCPs, antiandrogens, metformin |
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|
Term
| What is the common etiology of a mass at eh medial labia major or lower vestibular area? |
|
Definition
Bartholin Duct Cysts vs. Abscess
- No treatment for cysts, I/D abscess (no need to antibiotics) |
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|
Term
| What is the differential and defining features of Vaginitis? |
|
Definition
1) BV
- Clue cells (>20% on wet mount)
- No infection, but shift in vaginal flora (anaerobic)
- Fishy odor with gray-white discharge. + Whiff on KOH
- Treat with MTZ
2) Trichomonas
- STD protozoal infection
- green discharge with foul odor and "strawberry petechiae" in upper vagina
- Motil trihcomonads on wet mount
- Single dose MTZ and treat partners
3) Candida
- Risk involves DM, antibiotics, pregnancy and steroid use
- Cottage-cheese discharge without odor
- Look for Pseudoyphae on KOH
- Treat with topical Azole or PO fluconazole |
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|
Term
| What is the differential for genital ulcers? |
|
Definition
1) Syphillus: painless chancre
2) H. ducrei: painful and deep
3) HSV: shallow and painful multiple |
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|
Term
| What are the 2 antibiotic regimens for outpatient PID? What about inpatient? |
|
Definition
1) Ceftriaxone 1 dose IM + Doxy for 14d +/- MTZ for 14d
2) Ofloxacin or Levofloxacin x 14d +/- MTZ for 14d
3) Inpatient: Defoxitin/Cefotetan + Doxy for 14d, or Clinda + Gentamicin X 14d |
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|
Term
| What is Fitz-Hugh-Curtis Syndrome? |
|
Definition
| Patient with PID who develops perihepatitis with RUQ pain, elevated LFTs and referred right shoulder pain. |
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Term
Young woman presents with acute onset fever, vomiting and water diarrhea, as well as diffuse macular erythematous rash and non-purulent conjunctivitis.
You also notice desquamation of palms and soles 2 weeks after treating her.
What was going on and how was it diagnosed/treated? |
|
Definition
TSS related to Staph toxin. Blood cultures are negative given pre-formed toxin
Treated with rapid rehydration, examination for foreign objects and Empiric Antibiotics (Vancomycin + Clindamycin)
**Mortality is 3-6%** |
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|
Term
32 year old pregnant female presents with complaints of heavy periods, dysmenorrhea and pelvic pressure.
On pelvic exam you observe a firm, irregular "lumpy bumpy" uterus with normal mobility.
What is your first diagnostic step and what is the common treatment once confirmed? |
|
Definition
Sounds like Uterine Leiomyoma (Fibroid)
- These are hormone sensitive and usually increase in size during pregnancy
- They are benign but can cause infertility and menorrhagia
- If this were a postmenopausal female, malignancy would be greater worry
1) Transvaginal US. Also get CBC (anemia) and consider MRI if considering surgery
2) Pharmacological first line is Hormonal contraception. Can give medryxoyprogesterone or danazol for bleeding.
Surgery type depends on condition
- childbearing age: hysteroscopic myomectomy
- completed childbearing: hysterectomy
- uterine artery embolization can also be tried |
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|
Term
| What are the differentiating features between Type 1 and Type 2 Endometrial cancer? |
|
Definition
Type 1: Endometroid (most common)
- Related to unopposed estrogen stimulation
- Younger women with favorable prognosis
Type 2: Serous
- Unrelated to estrogen, but instead related to p53 mutation
- 67 is mean age with poor prognosis |
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|
Term
| What are the common treatment options for endometrial cancer? |
|
Definition
1) Childbearing age: first try high-dose progestins
2) Post-menopausal: TAH/BSO +/- radiation
3) TAH/BSO + chemo for advanced-stage |
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|
Term
| Describe the appropriate screening protocol for cervical cancer |
|
Definition
21-29: every 3 years pap
30-65: every 3 years or every 5 years + HPV test |
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|
Term
What is the next step in management in the following cases of suspected cervical abnormalities?
1) 22 year old with LSIL on pap
2) 27 year old with ASCUS
3) 25 year old with ASC-H
4) 22 year old AGC
5) 27 year old with HSIL |
|
Definition
1) 21-24 with ASCUS or LSIL
- repeat cytology at 12 months
- If ASC-H or HSIL, colposcopy is indicated
2) >24 with ASCUS
- Get reflex HPV test, and if + get colposcopy
3) Colposcopy regardless of HPV
4) Colposcopy regardless of age with endometrial sampling
5) Immediate loop electrosurgical excision or colposcopy |
|
|
Term
| What are the primary risk factors for vulvar SCC? |
|
Definition
1) HPV 16, 18, 31
2) Lichen sclerosis |
|
|
Term
| What are the primary risk factors for Ovarian cancer? What decreases the risk? |
|
Definition
greatest cause of cancer deaths from female reproductive tract
**>5 years of OCPs decreases risk by 29%**
- Age
- Nulliparity
- Low fertility
- Delayed childbearing
- Family history |
|
|
Term
What is the appropriate treatment of ovarian masses in the following conditions?
Premenopausal woman with 11cm with complex features |
|
Definition
| Surgical treatment for premenopausal masses > 10cm and postpenopausal masses > 5cm |
|
|
Term
What type of ovarian malignancy is associated with each of the following markers?
1) CA-125
2) AFP
3) AFP + BhCG
4) BhCG only
5) LDH
6) Inhibin |
|
Definition
1) Epithelial
2) Endodermal sinus
3) Embryonal
4) Choriocarcinoma
5) Dysgerminoma
6) Granulosa cell tumor |
|
|
Term
| What are the common causes of pediatric infectious vulvovaginitis? |
|
Definition
1) GAS (most common)
2) Candida
3) STD (sexual abuse) |
|
|
Term
| Why is a lesion with the appearance of a "bunch of grapes" in a pediatric vagina so worrisome? |
|
Definition
| Sarcoma botryoides (Rhabdomyosarcoma) |
|
|
Term
| How can you diagnostically distinguish between Central and Peripheral causes of Precocious Puberty? |
|
Definition
Signs of estrogen excess? Think ovarian cyst/tumor
Signs of androgen excess? Think CAH or adrenal tumor
- Start by determining bone age and conducting GnRH stimulation test
1) Bone age within 1 year of chronological age
- Puberty has not started yet
2) Bone age > 2 years chronological age
- If GnRH stimulation test (Leuprolide) is (+) and leads to LH response, it is CENTRAL (Tumor or Constitutional)
- If GnRH stimulation test is (-), and LH is normal, it is PERIPHERAL (get US to look for cysts, tumors, and if none are present think about CAH or exogenous estrogen) |
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|
Term
Patient with suspected precocious puberty has bone age 3 years older than chronological age.
You order Leuprolide stimulation test and observe increase in LH.
What is your next step and what is the first-line treatment? |
|
Definition
Sounds like + GnRH test, indicating central precocious puberty.
First line treatment is Leuprolide. Look for CNS tumor |
|
|
Term
| What are the commence causes of peripheral precocious puberty and what are the treatments? |
|
Definition
- GnRH stim test with advanced bone age is diagnostic
1) Ovarian cyst (diagnosed by US)
- No intervention needed
2) CAH (negative US)
- Steroids.
3) Adrenal or ovarian tumor
- Surgery
4) McCune-Albright (cafe au lait spots and bony abnormalities)
- Antiestrogens (tamoxifen) or estrogen synthesis blockers (Ketooconazole or Testolactone) |
|
|
Term
| What is the basic differential for breast mass and what are the defining features of each? |
|
Definition
1) Fibrocystic disease
- Cyclic bilateral mastalgia with swelling (most prominent before menstruation)
- Rapid fluctuation in size
- No risk of cancer
2) Fibroadenoma
- Proliferative lesion without atypic
- Round, rubbery discrete mass without cycle fluctuation, but can increase in size during pregnancy
3) Mastitis/abscess
- Fever, constitutional symptoms
4) Fat necrosis
5) Cancer |
|
|
Term
27 year old female with no family history of breast cancer presents with complaints of breast mass. The mass is mobile and changes size with menstrual cycle
Describe you workup |
|
Definition
Likely Fibrocystic disease
1) Get US followed by FNA
2a) If Cystic and fluid is non-bloody just follow it
2b) If Cystic and fluid is bloody or if there is residual mass, excision biopsy
2c) If solid, perform cytology, and if benign, repeat FNA or open surgical biopsy |
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|
Term
38 year old female with family history of breast cancer presents with complaints of breast mass. The mass is firm and rigid and you notice some overlying skin changes
Describe you workup |
|
Definition
This is a concerning finding.
Go straight to Mammography with Core or Excisional biopsy (skip US and FNA)
- If DCIS/cancer, treat as indicated
- If negative, reassure and follow |
|
|
Term
| What is the indication for breast cancer screening? |
|
Definition
| > 50 and < 74, mammogram every 2 years |
|
|
Term
| What is the first step in the workup of a suspicious breast mass in women >30 and women < 30 |
|
Definition
> 30 mammorgram
< 30 ultrasound |
|
|
Term
Why is ER/PR status important in breast cancer management?
What about HER2/neu status? |
|
Definition
1) PR/ER + patients gets Tamoxifen (competitive antagonist of ER) OR an aromatase inhibitor for postmenopausal women
2) HER2/neu + gets Trastuzumab antibody
3) Triple negative patients get Chemotherapy if tumor > 0.5cm |
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|
Term
| What is the next step in the management of a pregnant woman with an abnormal bHcG doubling time (should be every 48h) |
|
Definition
| Screen for ectopic with US |
|
|
Term
Which of the following is NOT a normal physiological change of pregnancy?
1) Increase in GFR
2) Decrease in HR
3) Decrease in BP
4) Increase in Tv
5) Increase in blood volume
6) Increase in gastric emptying time |
|
Definition
2: HR actually increases
1) Renal: Flow and GFR increase early on
2) CV: BP decreases, SV, CO and HR increase
3) Pulmonary: RR and VC unchanged, but Tv increases leading to increased minute ventilation
4) Blood: volume increases and hematocrit decreases
5) GI: Sphincter tone decreases and emptying time increases |
|
|
Term
| What are the major nutrition recommendations for standard prenatal care |
|
Definition
1) Folic acid: 0.4 mg or 4 mg if history of NT defects
2) Iron: 30 mg/day starting at first visit
3) Calcium: 1300 <19 years, 1000 for > 19 years
4) Vitamin D and B12 for vegetarians |
|
|
Term
| What tests should be ordered at first prenatal visit? |
|
Definition
1) CBC, Rh, type and screen
2) UA, rubella, HBsAg, RPR/VDRL, cervical STD, PPD, HIV, Pap |
|
|
Term
What specific tests should be offered during prenatal visits at each of the following times?
1) 9-14 weeks
2) 15-22 weeks
3) 18-20 weeks
4) 24-28 weeks
5) 28-30 weeks
6) 35-37 weeks
7) 34-40 weeks |
|
Definition
1) PAPP-A + nuchal translucency + free beta-hCG +/- CVS
2) AFP, Inhibin A, b-hCG, Estriol +/- Amnio
3) US for anatomic screen
4) One-hour glucose test
5) RHOGAM for RH-(-) women
6) GBS culture and repeat CBC
7) In high-risk, chlamydia and gonorrhea, with HIV and RPR |
|
|
Term
| What is on the differential for an elevated AFP level? What about decreased? |
|
Definition
1) Elevated
- NT defect
- Multiple gestation
- Abdominal wall defect
- Placental abnormalities
2) Decreased
- Trisomy 21/18
- Fetal demise
- Incorrect dating |
|
|
Term
| What are the quad screen findings for Trisomy 18 vs. 21? |
|
Definition
21: AFP down, estriol down, Inhibin up, b-HCG up
18: All down |
|
|
Term
| What are the risks of using CVS and Amniocentesis for prenatal screening? |
|
Definition
1) CVS (10-12 weeks)
- Fetal loss (15)
- Misses NT defects
2) Amnio (15-17 weeks)
- PROM
- Chorioamnionitis
- F/M hemorrhage |
|
|
Term
| What are the major risk factors for spontaneous abortion? |
|
Definition
Loss prior to 20th week
Big 3
1) Chromosome abnormalities
2) Thrombophilias
3) Uterine abnormalities |
|
|
Term
What are the key diagnostic findings for the following types of spontaneous abortions?
1) Complete
2) Threatened
3) Incomplete
4) Inevitable
5) Misses
6) Septic |
|
Definition
1) Bleeding and cramping with POC expelled and CLOSED os
2) Uterine bleeding and/or abdominal pain with no POC expelled and closed os with fetal cardiac activity
3) Partial POC expelled, OS OPEN
4) Uterine bleeding and cramps without expulsion of POC but with OPEN OS and ROM
5) Cramping without bleeding and closed os with no fetal cardiac activity
6) Fowl smelling discharge, sepsis signs |
|
|
Term
19 week pregnant woman presents with uterine bleeding and abdominal pain. On exam, cervical os is closed and there has been no POC expelled.
What is your next step? |
|
Definition
This is a threatened abortion
Pelvic rest for 24-48 hours is indicated and follow-up US to assess viability |
|
|
Term
What are the major teratogenic affects of the following agents?
1) ACE-I
2) Alcohol
3) Androgen
4) Carbamazepine
5) Valproic acid
6) Phenytoin |
|
Definition
1) Renal tubular dysplasia, IUGR, oligohydramnios
2) FAS
3) Virilization of females
4) NT defects, fingernail hypoplasia, microcephaly
5) NT defects, minor craniofacial defects
6) IUGR, MR, cardiac, fingernail hypoplasia |
|
|
Term
What are the major teratogenic affects of the following agents?
1) DES
2) Lead
3) Lithium
4) MTX
5) Tetracycline |
|
Definition
1) Clear cell adenocarcinoma of vagina or cervix
2) SAB and still birth
3) Ebstein anomaly
4) SAB
5) Teeth discolaation and hypoplasia of enamel |
|
|
Term
What are the major teratogenic affects of the following agents?
1) Streptomycin/kanamycin
2) Thalidomide
3) Vitamin A
4) Warfarin |
|
Definition
1) Hearing loss, CN VIII damage
2) Bialteral limb defects, cardiac/GI abnormalities
3) SAB, microtia, thymic agenesis, lceft lip, MR
4) Nasal hypoplasia, stippled bone epiphyses, IUGR, opthalmic |
|
|
Term
| Which congenital infections are passed trans-placentally and how are they prevented/treated? |
|
Definition
Of TORCHES, Toxo, Rubella, CMV and Syphillis are commonly transmitted transplacentally
1) Toxoplasmosis:
- Prevent by avoiding cat feces and Spiramycin ppx can be used in 3rd trimester
- Treat with Piramethamine + Sulfadiazine
2) Rubella:
- Prevent with immunization before pregnancy, and vaccination of mother after delivery if titers are (-)
- Treatment is symptomatic
3) CMV:
- Prevention is not possible
- Treat with postpartum Ganciclovir
4) Syphillis
- Prevent with PCN in pregnant women with positive test
- Treat with PCN |
|
|
Term
Which congenital infection is described by each of the following? What do you do?
1) Hydrocephalus, Chorioretintis and Intracranial calcifications
2) Petechial rash with Periventricular calcifications
3) Maculopapular skin rash with LNA, hepatomegaly, and Osteitis
4) "Blueberry muffin" rash with cataracts, MR and hearing loss, as well as PDA
5) Skin, eye and mouth infections |
|
Definition
1) Toxoplasmosis: confirm with serology
- Pyrimethamine + Sulfadiazine
2) CMV: confirm with urine culture or PCR of amniotic fluid
- post-partum ganciclovir
3) Syphillis: Get DF microscopy, VDRL/RPR, FTA-ABS
- Treat with PCN
4) Rubella: confirm with serology
- Treatment is symptomatic
5) HSV
- Treat with acyclovir |
|
|
Term
| What is the management of a women in labor who exhibits vaginal lesions suggestive of HSV infection? |
|
Definition
|
|
Term
| What are the particular management requirements for a pregnant woman with HIV? |
|
Definition
1) Treat in pregnancy with AZT or Nevirapine
2) C section if viral load > 1000
3) Infant gets AZT and avoid breast feeding |
|
|
Term
| What are the options for elective abortion in first and second trimester pregnancies? |
|
Definition
1) First (90% of ABs)
Medical:
- Oral mifepristone + misprostol (up to 49 days GA)
- IM MTX with misoprostol (up to 49 days)
- Vaginal or buccal misoprostol x 3 (59 days)
Surgical
- Manual or D & C up to 13 weeks
2) Second trimester (13-24 weeks)
- Obstetric induction with PGE, amniotomy and oxytocin
- Surgical with D & E |
|
|
Term
| What are the major stages of labor and their defining features? |
|
Definition
1a) First Latent: Onset of labor until 3-4 cm dilation
- Lasts 4-11 hours
1b) First Active: 4 cm to complete (10cm) dilation
- 4-6 hours
- Prolonged with cephalopelvic disproportion
2) Second: complete dilation until delivery
- 0.5-3h
- Cardinal movements of delivery take place
3) Third
- 0-0.5h
- Uterus contracts and |
|
|
Term
| What are the normal ranges for FHR in terms of rate, variability, accelerations and decelerations? |
|
Definition
1) Rate 110-160
- bradycardia: CHD or hypoxia
- tachycardia: hypoxia, maternal fever, fetal anemia
2) Variability: 6-25 bpm
- Minimal: hypoxia or opioids, magnesium or sleep cycle
- Marked: hypoxia
3) Accelerations: Increase in FHR of > 15 bpm above baseline to peak in < 30s
4) Decelerations
- Early: head compression from contraction
- Late: UP insufficiency or hypoxemia
- Variable: Chord compression |
|
|
Term
| Why are late and variable decelerations in FHR concerning? |
|
Definition
Late: UP insufficiency
Variable: Chord compression |
|
|
Term
| What are absolute contraindications for regional anesthesia (epidural, spinal or combination) during delivery? |
|
Definition
1) Refractory maternal hypotension
2) Maternal coagulopathy
3) Maternal use of LMWH in last 12h
4) Untreated bacteremia
4) Skin infection offer site of needle
6) Increased ICP caused by mass lesion |
|
|
Term
G1P0 female 27 weeks along complains of persistent vomiting and weight loss.
What is your next step and how is this condition managed? |
|
Definition
Sounds like Hyperemesis Gravidarum
1) Order B-hCG and perform US (ro Molar pregnancy)
- Evaluate for electrolyte/metabolic abnormalities
2) Treatment
- B6
- PO Doxylamine (antihistamine)
- Promethazine or dimenhydrinate PO
- for SEVERE cases: Metaclopramide or SGAs |
|
|
Term
27 year old G1P1 undergoes 1h glucose challenge test at 25 weeks, which reveals glucose of 155.
What is the next step? How is this condition treated? |
|
Definition
Gestational Diabetes
1) Confirm with 3h GTT (100g)
2) Treatment
- Mother: ADA diet, insulin if needed
- Fetus: Ultrasound and NSTs starting at 34 weeks if mother requires insulin or oral agent. |
|
|
Term
| How is gestational HTN distinguished from chronic HTN? |
|
Definition
<20w is chronic, > 20w GA is gestational
Treat with methyldopa, labetalol or nefedipine, NOT with ACE-i or diuretics |
|
|
Term
How is Preeclampsia defined?
How is it treated? |
|
Definition
new-onset HTN (140/90) with proteinuria > 300 in 24h occurring at > 20w GA.
Treatment
- Far from term: treat with bed rest and expectant management
- Close to term or worsening: induce delivery with IV oxytocin, PGE or amniotomy
- Give continuous MgSO4 drip, and if Mg toxic, give Ca gluconate
- If BP is severe, give IV hydrazine or labetolol |
|
|
Term
28 year old G1P1 at 37 weeks presents with new onset HTN of 150/90 and 24h urine protein of 350.
You induce labor with oxytocin and begin IV MgSO4. The patient develops diminished DTRs and SOB. What is the next step? |
|
Definition
Mg toxicity in treatment of pre-ecclampsia.
Give calcium gluconate |
|
|
Term
| How is HELLP syndrome differentiated from pre-ecclampsia? |
|
Definition
| HELLP syndrome involves hemolytic anemia, elevated LFts and low platelets |
|
|
Term
| How are ecclamptic seizures managed? What other treatment is indicated in this case? |
|
Definition
IV diazepam (PPX was with Mg)
Control BP and limit fluids
like with pre-ecclampsia, continue seizure ppx 24h after delivery |
|
|
Term
| What are the most common causes of bleeding during pregnancy after 20w GA? |
|
Definition
1) Placental abruption: premature separation of normally implanted placenta
- Painful, dark vaginal bleeding with abdominal pain and uterine hypertonicity
2) Placenta previa: Abnormal placental implantation
- Painless, bright red blood that stops after 1-2h
- Order TA/TV Ultrasound, do NOT perform exam
- Deliver by C section
3) Vasa previa: Umbilical cord insertion causing vessels to pass over internal os
- Painless bleeding at rupture of membranes with fetal bradycardia
- TV US with dopplers |
|
|
Term
A 29 year old G1P1 is at her 30 week visit and ultrasound reveals placental vessels crossing over internal cervical os.
What is your next step? |
|
Definition
Vasa Previa: Risk of fetal exsanguination!
1) 28-32w: give steroids for fetal lung maturity
2) 30-32 weeks: admit to hospital for close monitoring
3) Schedule C section at 35 weeks. |
|
|
Term
| How are ectopic pregnancies managed? |
|
Definition
1) Small, un-ruptured? Give MTX
2) Otherwise surgery |
|
|
Term
| What are the major RF for IUGR? What can be done medically? |
|
Definition
Perform US for EFW (< 10% percentile for GA)
If near due date, give steroids (at least 48h before delivery)
1) Maternal systemic disease leading to UP insufficiency (late decelerations)
2) Maternal substance abuse
3) Placenta previa
4) Multiple gestations |
|
|
Term
What does it mean if AFI is measured at > 25 on ultrasound?
What are the common etiologies? |
|
Definition
Polyhydramnios
1) Chromosomal developmental abnormalities
2) Maternal DM
3) Multiple gestation
4) Pulmonary abnormalities
5) Fetal anomalies
6) Twin-twin transfusion syndrome |
|
|
Term
What does it mean if AFI is measured at <5 on ultrasound?
What are the common etiologies? |
|
Definition
Oligohydramnios. Usually asymptomatic, but IUGR or fetal distress is possible. In particular, pulmonary hypoplasia and MSK abnormalities are common.
1) Fetal urinary tract abnormalities (renal agenesis, GU obstruction)
2) Chronic UP insufficiency
3) ROM |
|
|
Term
| Under what circumstances does a pregnant mother need to receive RhoGAM? |
|
Definition
1) Rh (-) at 28w if father is + or unknown
2) If baby is Rh +, give mother postpartum
3) Rh (-) mother who undergoes abortion or who has ectopic pregnancy, amniocentesis, vaginal bleeding or placenta pre via |
|
|
Term
Pregnant woman 8w along presents with uterine bleeding, hyperemesis gravidarum and new onset HTN with uterine size greater than dates.
What are you worried about and what do you do next? |
|
Definition
Concerning of gestational trophoblastic disease and molar pregnancy.
Complete mole: 46XX and no fetal tissue
Incomplete mole: 69XXY
1) Get FHR: should be no fetal heart beat
2) Perform pelvic exam: expulsion of grapelike molar clusters into vagina
3) Labs show > 100k b-hCG
4) Get CXR for lung mets |
|
|
Term
| What are the important complications of malignant gestational trophoblastic disease? |
|
Definition
1) Pulmonary or CNS metastasis
- sensitive to chemo and radiation
2) Trophoblastic PE |
|
|
Term
| How can shoulder dystocia during labor be managed? |
|
Definition
HELPER
1) Help reposition
2) Episiotomy
3) Leg elevation
4) Pressure (suprapubic)
5) Enter vagina and attempt rotation
6) Reach for fetal arm |
|
|
Term
How is PROM managed at each of the following time points?
1) Term
2) 34-36w
3) < 32w |
|
Definition
**give antibiotics to prevent infection and steroids for fetal lung maturity**
1) Check GBS status and fetal presentation, then induce or observe
2) Labor induction can be considered
3) Expectant management with bed rest and pelvic rest |
|
|
Term
| What are the important risk factors of premature labor? |
|
Definition
20-37w GA
1) Multiple gestation
2) Infection
3) PROM
4) Uterine anomaly
5) Previous pre-term birth |
|
|
Term
| What are the important complications of pre-term birth? |
|
Definition
1) RDS
2) IVH
3) PDA
4) Nec enterocolitis
5) Retinopathy of prematurity
6) BP dysplasia |
|
|
Term
27 year old woman gave birth 24h ago now presents with fever of 39, uterine tenderness and malodorous lochia
What is your next step? |
|
Definition
Fever, uterine tenderness and malodorous lochia within 36h of delivery sounds like Postpartum Endometritis
Give broad-spectrum empiric ABx (clindamycin and gentamycin) until febrile for 47h (or 24h for chorioamnionitis). |
|
|
Term
| What are the 3 major causes of postpartum hemorrhage? |
|
Definition
1) Uterine Atony
- Sof "enlarged "boggy" uterus
- Perform bimanuel massage and Oxytocin infusion. Give Methergine if NOT hypertensive
2) Genital tract trauma
- Surgical repair may be needed
3) Retained placental tissue
- D and C to remove tissue |
|
|
Term
| What is the "scary" complication of postpartum endometritis? What do you do about it? |
|
Definition
Septic Pelvic Thrombophlebitis
- High fevers, bdominal fever and back pain.
- Diagnose with blood cultures and CT for pelvic abscess
- Give IV antibiotics and ANTIcoagulation with heparin 7-10d |
|
|
Term
|
Definition
| HIV, active HBV/HCV, or use of tetracyclines or chloramphenicol |
|
|
Term
| What should you suggest for a patient who recently gave birth and now has developed mastitis? |
|
Definition
1) Continue to breastfeed
2) PO antibiotics
3) If no improvement in 48-72h, get US for abscess (treat with I/D) |
|
|
Term
| What are the STI screening recommendations for pregnant women? |
|
Definition
- Syphilis, HIV and HBV is ALL
- HCV in HIV patients and women at high risk
- Chlamydia and Gonorrhea if < 25 or at high risk |
|
|
Term
| What should be done if a pregnant patient presents with signs of hyper-androgenism? |
|
Definition
Think about ovarian mass
1) Get US
- Leutoma: unilateral, solid yellow mass of lutein cells, spontaneous regression after delivery, but can lead to fetal virilization
- Theca luteum cyst: bilateral ovarian cysts with association with molar pregnancy and multiple gestation. Low risk to fetus
- Krukenberg tumor: bilateral solid ovarian mass. Mets from primary GI tumor. High risk of fetal virilzaiton |
|
|
Term
| What are the principles of UTI management in pregnancy? |
|
Definition
1) Asymptomatic or Cystitis:
- Nitrofurantoin for 5-7d
- Amoxicillin, Augmentin or Cephalexin
- AVOID Quinolones (fetal cartilage abnormalities) and Bactrim (1st and 3rd trimesters- folic acid effects)
2) Pyelonephritis: hospitalize and IV antibiotics (not aminoglycosides). After afebrile for >24h, switch to 10-14d course of PO |
|
|
Term
| What kind of screening is appropriate in a patient with PID? |
|
Definition
| HIV, syphilis, HBV, cervical cancer and hepatitis C if IV drug user, in addition to gonorrhea and chlamydia |
|
|
Term
| How should symptomatic neonatal polycythemia be managed? |
|
Definition
| Exchange transfusion with saline if symptomatic. Otherwise hydration is sufficient |
|
|
Term
| What is the next step once HSIL has been identified? |
|
Definition
1) Get colposcopy (if >25 can do loop except in pregnancy or post-menopausal)
2) CIN 2-3 manage per guidelines
3) No CIN age 21-24 repeat colposcopy and cytology at 6m intervals up to 2 years
4) If pregnant and colposcopy is negative, repeat after delivery |
|
|
Term
| What is the management of neonatal sepsis? What are the common organisms? |
|
Definition
1) GBS and E. coli
2) Treated with IV amplicillin + gentamicin |
|
|
Term
| 67 year old female presents with ascites and pelvic mass. What is your next step and what is the definitive management? |
|
Definition
Epithelial ovarian cancer is likely
Get US followed by CA-125. After, CT or Ex-Lap. DO NOT BIOPSY
Ex-Lap + chemo is definitive |
|
|
Term
| What is the underlying cause of massive bleeding during manual extraction of neonate? |
|
Definition
| Accreta: villa attach directly to myometrium |
|
|
Term
| How can Placenta prevue and Vasa previa be distinguished? |
|
Definition
Both will present with painless vaginal bleeding
1) Placenta previa will not affect FHR
2) Vasa previa will cause FHR abnormalities |
|
|
Term
| What are the 3 kinds of urinary incontinence and appropriate management? |
|
Definition
1) Stress: coughing, sneezing, laughing- pelvic floor exercise, pessary, surgery. Associated with fibroids (Leiomyomata Uteri)
2) Urge: sudden overwhelming need- lifestyle, bladder training (first-line), anti-muscarinic drugs (Oxybutynin). Detrussor overactivity.
3) Overflow: Constant dribbling- Cholinergic agonists (bethanechol), alpha blockers (tamsulosin), intermittent catheterization |
|
|
Term
| What are the major causes of Hyperandrogenism in females? |
|
Definition
1) PCOS: oligo-ovulation, polycystic ovaries on imaging
2) Nonclassic CAH: oligo-ovulation, increased 17-OH-progesterone
3) Ovarian/Adrenal Tumor
4) Hyperprolactinemia: Amenorrhea, galactorrhea, high prolactin
5) Cushing’s’: Nonsuppressible dexamethasone suppression test |
|
|
Term
Pregnant woman presents with fever + uterine tenderness. There is malodorous AF and purulent vaginal discharge.
What is going on. What is your next step? |
|
Definition
Chorioamnionitis: RF is prolonged ROM >18h
IV antibiotics and give Oxytocin to promote delivery. Not indicator for Cessarian! |
|
|
Term
| Why do obese women have fewer menopausal symptoms? |
|
Definition
| Aromatase activity in peripheral adipose (no longer in granulosa cells of ovary) |
|
|
Term
| What are the absolute maternal contraindications and infant contraindications to breast feeding? |
|
Definition
1) Maternal
- Active substance abuse, active untreated TB, HIV.
- HBV and HCV are NOT.
2) Infant
- Galactosemia |
|
|
Term
42 yo G5P5 woman presents shortly after giving birth in respiratory failure and has a seizure.
What do you suspect and what are the risks? |
|
Definition
AF embolism: RF are advanced maternal age and high gravies
Neurological damage is high risk.
Give respiratory and HD support +/- transfusion |
|
|
Term
| What are the functions of bHCG, Progesterone and Estrogen in pregnancy? |
|
Definition
1) bHCG:
- secreted by syncitiotrophoblast to preserve corpus luteum during early pregnancy to maintain progesterone secretion until placenta is able to produce progesterone alone.
2) Progesterone:
- Prepares endometrium for implantation of fertilized ovum
i- Inhibits uterine contractions.
3) Estrogen:
- Induction of prolactin production |
|
|
Term
| What changes to thyroid function occur normally during pregnancy? |
|
Definition
1) Increased Total T4, Increased Free T4
- b-hCG stimulates T hormone production and increased TBG binds extra T4 (only slight increase in free T4)
2) Decreased TSH
**sometimes have to increase levo dose in pregnancy** |
|
|
Term
| What is the major risk of untreated Endometriosis? How is it diagnosed and treated? |
|
Definition
1) Infertility from adhesions and scarring
2) NSIADs +/- OCPs. Laparoscopy is diagnostic and therapeutic. |
|
|
Term
| What do you suspect in a child with asthma, chronic rhinosinusitis and nasal polyposis? |
|
Definition
| Could be CF, but most likely AERD, which is pseudo allergic reaction to NSAIDs |
|
|
Term
| How can you assess fertility? |
|
Definition
1) Early follicular phase FSH, Clomiphene challenge, Inhibin A level
2) Anatomic with hysterosalpingogram |
|
|
Term
| How is endometrial hyperplasia managed and how does the presence of cellular atypia modulate this treatment? |
|
Definition
Get a biopsy
1) If hyperplasia without atypia, give Progestin
2) If hyperplasia with atypia and considering pregnancy, give Progestin
3) If hyperplasia with atypia and no plans for pregnancy, give Hysterectomy. |
|
|
Term
| What is the most accurate method for determining current gestational age early in pregnancy? |
|
Definition
| First trimester US with crow-rump length |
|
|
Term
| How is lyme disease treated in pregnancy? |
|
Definition
Don’t give Doxycycline to children <8 yo or pregnant women with Lyme
Give Oral Amoxicillin instead. |
|
|
Term
13 year old female presents with irregular menstrual cycles. She recently started getting periods.
What is the most likely explanation? What hormone levels do you expect to find (FSH, LH, Progesterone) |
|
Definition
| HPO axis immaturity. FSH/LH production is low and progesterone is low. |
|
|
Term
| What are the renal changes in normal pregnancy? |
|
Definition
1) Increased RBF, GFR, BM permeability
2) Decreased BUN/Cr, increased renal protein excretion
3) Changes in volume produce dilutional anemia
4) Hypercoagulable state prevents bleeding in pregnancy. |
|
|
Term
| What are the different types of postpartum mood changes and how are they managed? |
|
Definition
1) Blues: 40-80% of women, lasting 2-3d, mild depression, tearfulness: Reassurance
2) Depression: 8-15%, resolves within 4w, Antidepressents and psychotherapy
3) Psychosis: 0.1%-0.2%, delusions, hallucinations, thought disorganization. Antipsychotics and anti-depressants but do not leave alone with child. |
|
|
Term
| What are the risks and benefits of low-dose OCPs? |
|
Definition
1) Benefits: RR of endometrial and ovarian cancer. Reduced risk of benign breast disease.
2) Risks: Venous TE, hypertension, hepatic adenoma, stroke (rare!) |
|
|
Term
| You detect variable deceleration on fetal heart tracing. What is this and how can you manage it? |
|
Definition
variable: chord compression vs. late: UP insufficiency
1) 1st line Tx for persistent decellerations (>50% of time) is Maternal repositioning
2) 2nd line is amnioinfusion |
|
|
Term
| What is the appropriate management of inevitable abortion in hemodynamically stable and unstable patients? |
|
Definition
1) HDS: expectant management, PGE
2) HD unstable: Manage with suction curettage |
|
|
Term
| What normal physiological effects of estrogen should women expect to experience shortly after giving birth? |
|
Definition
1) Breast hypertrophy
2) Swollen Labia
3) Leucorrhea (whitish vag discharge)
4) Uterine withdrawal bleeding |
|
|
Term
| What is the underlying pathophysiology of PCOS? How is it managed? |
|
Definition
1) Abnormal GnRH secretion stimulates pituitary to secrete excess LH (androgen production in theca cells) and insufficient FSH
2) weight loss, OCPs, clomiphene (ovulation induction), met forming |
|
|
Term
| What are the adverse effects possible when using Oxytocin to augment labor or prevent postpartum hemorrhage? |
|
Definition
| Hyponatremia, Hypotension, Tachysystole |
|
|
Term
| What is the appropriate management of apparent uterine inversion? |
|
Definition
1) Aggressive fluid replacement
2) Manual replacement of uterus
3) Placental removal with uterotonic drugs after replacement |
|
|
Term
| What are the indications for using SERMS like tamoxifen and raloxifine? What are the common SE of these agents? |
|
Definition
Prevent breast cancer in high-risk patients
1) Tamoxifen: Adjuvent treatment of breast cancer
- endometrial hyperplasia and carcinoma, VTE, hot flashes
2) Raloxifene: Postmenopausal osteoporosis
- hot flashes, VTE |
|
|
Term
| Describe the appropriate workup for decreased fetal movement in pregnancy? |
|
Definition
1) Get non-stress test
2) If non-reactive, get biophysical profile or contraction stress test (if no placenta previa or prior myomectomy)
3) Low BP score: hypoxia due to placental dysfunction: prompt delivery would be required |
|
|
Term
| Why do you need to increase levothyroxine dose in pregnancy? |
|
Definition
| Estrogen increases TBG, decreasing free T4 |
|
|
Term
| What is the appropriate management of a 31 year old G1P0 who enters labor at 33 weeks GA? |
|
Definition
Patients in preterm labor at <34 weeks should receive
1) Tocolytics (beta agonist, CCB) to delay labor.
2) MgSo4 for neuroprotection against CP
3) Steroids for fetal lung maturity |
|
|
Term
| What is the best way to manage HIV in pregnancy? When is a C section indicated? |
|
Definition
1) Maternal combination HAART during pregnancy
2) Neonatal Zidovudine therapy
3) C section is viral load is > 1000 along with Zidovudine |
|
|
Term
| What type of OCP should be used in breastfeeding mothers and why? |
|
Definition
| Use progestin-only OCP for breastfeeding mothers because combined OCPs can decrease milk production and pass to fetus |
|
|
Term
| What are the options for emergency contraception? |
|
Definition
1) Levonorgestrel and Ulipristal are medical options.
2) Copper IUD is most effective, but requires experienced provider |
|
|
Term
| How is ASCUS managed in young women? |
|
Definition
Age is important here
1) 21-24: repeat PAP in 1 year. Only Colposcopy if 3 consecutive paps as long as ASC-US or L-SIL.
- If H-SIL, get colsposcopy
2) >25: test for HPV, if HPV positive then precede wiwth colposcopy. If negative, repeat pap and HPV in 3 years |
|
|
Term
| What is the appropriate first test in the case of rapid development of hyper-androgenism with virilization |
|
Definition
Virilizing Neoplasm is a concern (Ovarian or Adrenal)
1st test is testosterone and DHEAS level
- High testosterone with normal DHEAS (Ovarian)
- Elevated DHEAS with normal testosterone (Adrenal) |
|
|
Term
| What are appropriate anti hypertensive medications for use in pregnancy? |
|
Definition
- Labetalol and Methyldopa
- Hydralazine and CCB are acceptable alternatives
- ACE-I and ARBs are contraindicated. |
|
|
Term
| Describe the initial steps of a primary amenorrhea workup. |
|
Definition
1) Get pelvic exam and US
2) If Uterus present, get FSH (If elevated get karyotype) if decreased get Cranial MRI
3) If Uterus absent, get karyotype + testosterone.
If normal karyotype (abnormal mullerian development), if male karyotype (Androgen insensitivity syndrome) |
|
|
Term
| How should Lichen Sclerosis be evaluated? |
|
Definition
get punch biopsy to confirm and because it is premalignant for SCC.
Treat with topical steroids. |
|
|
Term
| How is preterm labor managed and how does it vary by GA? |
|
Definition
1) 34-36: betamethasone and PCN if GBS unknown
2) 32-34: betamethasone and tocolytics (indomethacin and nifedipine) and PCN if GBS unknown
3) < 32: betamethasone, tocolytics, MgSO4 and PCN if GBS unknown |
|
|
Term
| What are the 3 liver disease concerns in pregnancy? |
|
Definition
1) Acute fatty liver of pregnancy (AFLP)
- 3rd trimester, serious liver failure
2) HELLP: Hemolysis, elevated liver enzymes and low platelets.
3) Intrahepatic cholestasis of pregnancy (ICP)
- Generalized pruritis and high bile acids
- Can give Ursodeoxycholic acid |
|
|
