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115 Cards in this Set

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how to manage postpartum hemorrhage
fundal or bimanual massage, IV access, infusion to keep SBP above 90, notify blood bank for pRBCs, give oxytocin
when to do uterine artery embolization with hemorrhage
stable vital signs and persistent bleeding if rate of loss is not excessive
risks for uterine atony
overdistention, uterine fatigue (prolonged labor)
hyperemesis gravidarum
usually 4-10wks, usually managed with supportive care, ketonuria
gesterational trophoblastic disease
enlarged uterus, hyperemesis, markedly elevated bHCG
ddx of hyperemesis gravidarum
pyleo, gestational trophoblastic disease, gastroenteritis, heptatobiliary disease
presenation of trichomonas vaginalis
pruritic, green frothy, foul smelling, pear shaped motile organisms, tx is oral metronidazole
decels- early, late, variable
early- fetal head compression, late uteroplacental insufficiency/ acidosis, variable- fetal cord compression
inhibin b checks for?
ovulatory reserve, older women have less
when/what to test for ovulation
mid luteal serum progesterone level (should be >10ng/mL)
tx of DUB
mild: iron, mod: progestin, mod w/ bleeding or severe: estrogen
PCOS
androgen and LH excess
contra to breast feeding
HIV, tb, HSV on breasts, malaria, sepsis, typhoid, eclampsia, nephritis, substance abuse, breast ca
tx of preg pt with RMSF
chloramphenicol, not preg- doxy
aromatase def
poor funct or absent conversion of androgens to estrogens, maculinization of mother during pregnancy, nomral internal b/ ambiguous external genetalia, clitoromegaly, delayed puberty, osteoporosis, undetectable estrogen, high LH FSH, PCOS,
mccune albright
cafe au lait, polyostotic fibrous dysplasia and autonomous endocrine hyperfunction, precocious puberty
htn meds during pregnancy
NO ACE, ARB, give labetalol and methyldopa, only start if BP> 150/95
epidural effects on bp
10% hypotension from sympathetic fiber block that results in vasodilation of lower extremities
pathophys of preeclampsia
vasospasm
metformin and PCOS
helps prevent type 2 DM, helps lose weight, helps with fertility, helps with hirsutism
clomiphene citrate
used to induce ovulation in PCOS
NSAIDs and pregnancy
can increase risk of miscarriage, promote premature closure of fetal ductus arteriosus
tx of UTI during pregnancy
ampicillin, amox, nitrofurantoin, cephalexin
causes of chorioamnionitis
PROM, intrauterine instrumentation, STD, prolonged labor
pt with multiple sex partners, mucopurulent urethral d/x
chlamydia (gonorrhea is more purulent and will see organisms on gram stain)
amenorrhea... approach?
preg test --> TSH--> prolactin
tx of gonorrhea, chlamydia
ceftriaxone, azithromycin OR doxycycline, if stain shows gonorhea- tx for both
pt with placental abruption, but stable pt and baby
vaginal delivery, only to C/S if condition calls for it
coag neg staph
skin
endometriosis and adenomyosis
endometrial tissue inside uterus (endometriosis) if OUTSIDE like uterine muslce (adenomyosis)
ruptured fetal umbilical vessel
antepartum hemorrhage, fetal heart changes from tacky to brady (late decal) vasa previa
abruptio placenta
premature placental separation, dark red antepartum hemorrhage, and pain, uterin tenderness, increased uterine tone
placenta previa
abd insertion of placenta on lower segment of uterus over os, painless antepartum hemorrhage
ideal maternal fasting glucose?
75-90
is low grade fever worrisome postpartum?
not first 24 hr, chills also normal, also d/c lochia rubra--> serosa--> alba
adenomyosis
>40yo, severe dysmenorrhea, menorrhagia, enlarged and generlaly symmetric uterus
syphillis ulcer
punched out base, raised, indurated margins
chancroid
deep purulent are, painful lymphadenopathy, gram +, h. ducreyi, tx ceftriaxone, erythromycin, azithromycin
granuloma inguinale (donovanosis)
painless genital ulcer red beefy base, NO adenopathy, donovan bodies, tx: doxy or TMP-SMX
what test results predicts downs
increase bHCG, inhibit A, decrease AFP and esriol
chrorionic villus sampling
fetal chr abnl first trimester (10-12 wk)
amniocentesis
16-18 wks, early amnio can be done before 15 wks, but only for pts
when to do cordocentesis or percutaneous umbilical blood sampling
rapid karyotype analysis or fetal blood dyscrasias (fetal anemia or Rh isoimmunization) or when mosaicism suspected by CVS or amniocentesis
sinusoidal fetal heart rate pattern
uniform oscillations of 3-5 cycles/ min, sign of fetal distress, inability of CNS to control HR
pregnant woman with syphillis tx
penicillin remains drug of choice, if allergic-- penicillin desensitzation
thyroid tests during pregnancy
increased total T3, T4, and nl free T3,T4, TSH
what ovarian tumor secretes thyroid hormone?
struma ovarii
threatened abortion
hemorrhage before 20 wk, cervix closed, no passage of tissue
inevitable abortion
vaginal bleeding, dilated cervix, ruptured or collapsed gestational sac w/o fetal cardiac motion
mild preeclampsia
140/90, proteinuria >300 mg/24hr, edema
severe preeclampsia
160/110, >5g proteinuria, oliguria, elevated liver enzymes, thrombocytopenia, pul edema
false labor
irregular, lower abdomen, last few weeks can mimic it more and may be regular
tx of patient with simple or complex hyperplasia without atypic in endometrial biopsy
cycli progestins
preeclampsia and liver
stretching of capsule causes pain. centrilobular necrosis, hematoma formation, thrombi in portal system
fibrinogen levels above nl after intrauterine fetal demise…
not need to do emergent c/s
management of variable decels
change position, give o2 --> trandelenburg --> aminoinfusion
when can you see a pregnancy with transvaginal u/s
1500-2000
lichen sclerosus
chronic inflamm condition, autoimmune possibily, porcelain white polygonal macules and patches with atrophic cigarette paper quality, obliteration of labia minor and clitoris, decrease diameter of introitus
risks of chronic htn during pregnanc
placental abruption
post op hyponatremia? pregnant?
pain and narcotics (rarely adrenal insuff- also hypotension); oxytocin
potassium and ca can't be corrected without
magnesium correted
what condition commonly causes hypomag?
alcoholism
fluid for pt not eating
1/2 nl saline 5% dextose in adult, children 1/4 to 1/3 nl saline and dextose
human milk
70% whey 30% casein, lactoferrin, lysozyme, immunoglobulin A
PPROM what wk give corticosteroids?
<32 wks
hypogonadotropic hypogonadism can result from...
strenuous exercise, anorexia nervosa, marijuana, starvation, stress, depression, chronic illness
postpartum endometritis
prolonged rupture of membranes, prolonged labor, c/s, intrauterine pressure cath or fetal scalp electrodes-- usually polymicrobial
gonococcemia
polyarthralgia, tenosynovitis, painless vesiculopustular skin lesions
erbs duchenne paralysis
wrist and fingers flexed, adduction and pronation, secondary to traction on infant head during delivery
b/l solid nodules on ovaries during pregnancy
pregnancy luteoma
BPP
nl 8-10, 6 w/o oligo (contracture stress tes), 4 delivery considered, <4 delivery
drugs causing peripheral neuropathy
cisplatin, vincristine, phenytoin, -taxel, isonizid, amiodarone, hydralazine
carcinoid syndrome
flushing ,diarrhea, valvular disease, can have def of niacin
wernicke
encephalopathy, oculomotor dysfunction, gait ataxia
pneumonia
louder bronchial sounds esp on expiration, dull to percussion
incontinence in diabetes
overflow
pericardial effusion on xray
waterbottle heart
causes of biphasic pulse
aortic regurg and HCM
fried rice, vom hrs later
bacillus cereus
s. aureus food poisoning
egg, salad, meat, dairy
shock with normal MVo2?
septic shock
new case of AIDS
PPD, HIV RNAx2, CD4, VDRL, anti toxo antibody, MMS, pneumococcal vaccine, hep A&B screen and vaccines
how to confirm intrauterine fetal demise?
real time u/s
what does sheehan's syndrome present like?
lymphocytic hypophysitis- headaches, visual disturbances, pit failure (neoplasm)
primary dysmenorrhea- lower abd pain hrs before menses
from prostaglandins
plan b
good for 120hrs, levonorgestrel
inhibin
by granulosa cells, exert feedback on FSH
trichomonal
metronidazole (avoid ETOH), ph 5-6, erythematous vaginal mucosa, motile pear shaped organisms
when to screen for gestational diabetes?
24-28 wks with 1 hr 50g oral glucose tolerance test (>140--> 3 hr 100g OGTT>140)
OGTT by hr that are considered positive
fasting >95, 1hr>180, 2hr>155, 3hr >140
when is physiologic jaundice
after 24 hrs, usually peak in first few days
menopause hormones
decreased estrogen, increased FSH and LH
what is he most prevalent preventable cause of fetal growth restriction in the US
smoking
hormone tests for infertility
early follicular phase FSH, clomiphene challenge test, inhibit b level
why do PCOS patients have anovulation
abnl GnRH secretion, excess LH and insuff FSH
what measure to use for FGR?
>3 less than gestational age --> abdominal circumference (decreased in symmetric and asymmetric growth restriction)
de quervain tenosynovitis
in new mothers, pain with flexion of thumb, fibrosis as pass through sheath at radial styloid process,
ovulatory phase cervical mucus
thin, clear, profuse
pre and post ovulatory cervical mucus
scant, thick, opaque
pseudocyesis
signs/ sympt of pregnancy, nl endometrial stripe, neg office preg test, strong desire to be pregnant, type of conversion d/o
HPV warts
pink/ skin colored, teardrop shaped, smooth, tx with trichloroacetic acid or podophyllin,
symmetric vs asymmetric FGR
symmetric: earlier than 28wks, chr abnl, congenital infections,congenital anomalies vs asymmetric: from maternal causes like HTN
acid base changes of pregnancy
resp alk with renal compensation
meig's synd
ovarian fibroma, R hydrothorax, ascites
primary amenorrhea
16yo, 14yo NO sex characteristics
contra to estrogen
relative: seizure, HTN, leiomyoma, familial hyperlipidemia, migraines, thrombophebitis, endometriosis, gallbladder disease definite: unexplained vag bleeding, thromboembolism, active liver disease, breast or endometrial ca
most common cause of female infertility
endometriosis
ratio of LH:FSH in PCOS
>3
lactobacilli on wet mount
nl
which diseases do you tx the partners for as well
trichomonas, chlamydia, gonorrhea
lymphogranuloma venereum
Chlamydia, papule painless --> heals, inguinal buboes--> elephantiasis, fistula, abscess, tx: tetracycline, doxy, erythromycin
what do you look at when there is bloody d/c
excisional biopsy, ductal lavage
what is the false neg for FNA
20%
fatty liver of pregnancy
third trimester or postpartum, increased LFTs, prolonged PT and PTT
tx of HELLP after 34 wks
delivery