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Step 2 OBGYN 7-8-2016

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ruhland1's version from 2016-07-08 16:22

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Question Answer
Inominate OutflareASIS more lateral on ipsi, PSIS more medial (on side of + standing flexion)
Inominate inflareASIS and PSIS closer to umbilicus on contralateral side
Common compensatory patternSidebent OA left Cerviothoracic right thoracolumar Left lumbarsacro
2ndary amennorhea1st get BHCG then thyroid then prolactin then progestin challenge (BTPP)
Primary ammenorrhea1st step get transvag u/s
Female athlete triadenergy def (+/- eating d/o), menstrual disturbances/amenorhhea, bone loss/osteopor(stress frx)
IUD in and preggersmanual removal with gentle string traction before 12 weeks, remain in place after 12 weeks
FSHnormally 1-15, 20-100 in post menop, high FSH indicates primary ov failrue
When to eval for 1o ammenorrheano period by 15 yo or no 2ndary characteristisc by 13
1o ovarian failure and high FSHneed to rule out turner syndrome, vanishing testes syndrome, absent testis determining factor
Vanishing testes syndromeXY develop female genitals (Swyer syndrome), give testostoren, prosthetetics, give estrogen if female identity
1o ov failure and low FSHddx is functional hypothalmic amenn, cogen GnRH def (get cranial MRI)
1o dysmennorrhea1st use NSAIDS
Dysparuneia, dysmennorhea radiating to rectum, pain on palp of posteior fornixthink endometriosis
Endometriosis1st line is combination OCP (up atrophy of ectopic endometrium), can cause infertility
3rd trim TARTlumbar m spasm, shallow sacral sulci, ant rot inominate
1st dx for 3rd trim bleedtransabdm u/s
Initial preeclampisaMgSO4 and hydralazine
Placenta previapelvic exam contra
Changes in abd shapeuterine rupture
Repitive decelerationssign of fetal distress
Placental separationfetal distress and px bleed
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Question Answer
BMI less than 18.5 and preggersgain 28-40lb
BMI 18.5-24.9 and preggersgain 25-35lb
BMI 25-29.9 and preggain 15-25lb
BMI greater than 30 and preggain 11-20lb
Rhogamgive all Rh - pt with - AB screen when any possibilty of exposure to fetal blood ( to avoid Rh sensitization)
MCC of spont abortionchromosomal abnormalities
Uncomplicated preg and Rh -give Rhogam at 28wks and within 72 hours following delivery
Think ovarian cxdn weight, abd girth, early satiety, asictes, new pelvic mass
CA-125non-specific, great from baseline and monitoring
AFPup in HCCx and yolk sac tmx, malignant teratoma
HCCxMRI enhancing lesion with contrast dye washout
Carcinoembryonic Antigencolon cx
Calcitoninmedularry thyroid carcinoma (think about it being adj to parathyroid glands)
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Question Answer
Medullary thyroid cxflushing diarhea and pruritus, up calictonin
MEN Ipit, parathyoid, panc, (wermer synd)
MEN 2 Amedularry thyroid cx, pheo, parathyoid (Sipple Syndrome)
MEN 2 BMEN 2A + mucosal neuromas, marfinoid body habitus (Wagenmann-Froboese synd)
Standing flexion+ when the ASIS moved more superiorly than the other
Tender pubic symphyhsis and SI jointfound in inflares and outflare
Negative seated flexioncan rule out sacral involve ment
Chorionic villus samplingat 9-11 wks to assess fetal karyotype (up risk limb abn)
Aminocentesis15-20 weeks,
Fetal fibronectinused to predict probaility of preterm labor
GERD and preg and failed lifestyleH2 preferred over PPI
Chronic chough ddxGERD, asthma, allergies
PMS vs PMDDPMS has physical and behavioral, PMDD has atleast 5 of these
Vasa previavaginal bleeding, a sign of fetal vessel rupture that lies over cervial os, feta testing shows fetal demise or sinusoidal varitation
Reactive non-stress test meansnormal (2 or more accelerations in 20 min)
Accelerationup 15 bpm for 15 sec if over 32 wk, 10 bpm 10 sec at or below 32 wk
Non reactive non stress testless than 2 accel in 20 min over 40 minutes
u/s solid echoes with numerous anechoic spacescomplete molar “snowstorm”
Partial molar peg2 sperm one egg (69 XXY, XXX) fetus present
Complete mole46 XX empty egg otih 2 sperm, no fetus
Molar pregD and C or methotrexate, monitor BHCG to 0 (do a D and C and use MTX if histo if choriocx)
Molar Preg riskup choriocarcnioma, up uterine rupture
HELLP syndhemolysis, elevated liver, low pl8 (N/V abd px, htn, tachy, RUQ px)
Tylenolgo below 4000mg/day
Preelampsiadx is greater than 140/90 and 1-2+ protein urine
Galatorrhea only prolactinomagive bromcriptine
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Question Answer
Cervical insuff cogenital up recuurent abortbicornate uterus, ehler danlos, DES exposure
Cerival insuff acquired up recurrent abortmechanical dilation (prior D and C, hysteroscopy,LEEP) ostetrical trx
DES (diethylstilbestrol)up reccurent pxless spont abort b/c up cervical incompetence, up clear cell adenocx
DES indicprostate cx and vaginits, used also in preggers to prevent complications ( NOT USED now)
Colon cxup in high fat, low fiber and polyps
Endomet cxup proportional to estrogen exposure
Incompetent cervixplace cervical cerclage (place sutures at cervical os)
Pessary devicetemporary treatment of uterine prolapse
Gestational htngreater than 140/90 2x 6 hr apart, must occur after 20 weeks with prev normal bp
Chronic htn and pregpressures greater than 140 / 90 before 20 weeks
Mild preeclampsiahtn and prouria, greater than 20 weeks, no-end organ dmg
Mild preecalmpsiaddx from gest htn if > 300 mg in 24 hr
Severe preeclampsia>160/110 2x 6 hr apart, starts after 20 wks, prouria at 5g over 24 hr
Pregnant and testing scheduleevery 4 week from 0-28wk, every 2 wk from 29-35, every week from 36 to birth
Preg initial visitget CBC, Rh factor, blood type and screan, UA and culture, rubella, HBsAg, RPR/VDRL, gonn, chylmida, PPD, HIV and PAP smear
Anatomic screen u/sat 18-20 weeks
Glucose challenge test24-25 weeks
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Question Answer
Inguinal LAD and px ulcerHaemoph Ducrey
Haemoph ducreyiCeftriaxone or AZT
Chylmidialymphogranuloma venerus, px ulcer, 2nd stage is px inguinal nodes, 3rd stage is protocolitis/rectal stricure/rectovagina fistula/elephantiasis (LN and surrounding tissue destroyed…)
Pthirus Pubiscrabs, vesicles, burrows
Treponema Pallidumpx round firm ulcer with raised edges.
Fetal fibronectinthe glue that holds fetal sac to uterine lining (screen of preterrm delivery)
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Bishop
Question Answer
Dilation0, 1-2, 3-4, 5+
Effacement0-30, 40-50, 60-70, 80+
Station-3,-2,-1/0,½
Positionpost, middle, ant
Consisthard, med, soft
Labour is unlikely to start w/o inductionscore <5
Labor commence spont>10
Add a point+ pre-eclamisia, for every previous vag delivery
Subtract a pointpostdate preg, nulliparity, PPROM
Bishop 0-450% chance induction failure, use prostglandin
Bishop 5-910% chance induction failure, use oxytocin
InductionDO NOT use prostaglandins(misoprostol) and oxytocin together
TertbutalineB-2 Ag used as a tocolytic, uterine smooth muscle relaxor
B-2 Ag used as a tocolytic, uterine smooth muscle relaxorritodrine
Uterine atonydrugs include carboprost, oxytocin, methylergonovine
Carboprostavoid in asthma (up bronchoconstrict)
Oxytocin1st line, if given too quickly can cause hypotn
Metyhylergonovineavoid in hypertensive (sertonin ags cause vasocon), think of imitrex in migraines
MCC of postpartum hemmuterine atony
Postpartum hemm definition>500ml in 24 hrs, 1000ml with cesasrean
Uterine atony txbimanual massage, meds and resus, if refract embolize uterine atery, or hysterectomy
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Question Answer
Quad screenmaternal serum AFP, estriol, B-hcg, inhibin A (offer at 15-20 weeks)
Pregnancy-associated plasma protein A levelsdetermined at 9-14 weeks gest, screen in low risk for Downs
Fetal fibronectinaid in dx of preterm labor
Downsup BHCG and inhibin A, dn AFP and Estriol
Trisomy 18all dn on quad screen
Neural Tube Defectup AFP ud E3 and BHCG
Multiple gestup AFP and BHCG ud E3
fetal death (stillbirth)up AFP dn E3 BHCG
Level 2 u/s(=targeted u/s) indic in hi-risk assess fetal limb development and cardiac func
CT scanavoid in preggers, also radiogrpahs
All woman of child bearing age(15-45)take 0.4mg folic acid/day (most NTD occurs at 3-4wk preg)
Historry of NTD in prior pregtake 4 mg folic a day
Fe suppstart 30mg/day of elemental iron at 1st prenatal visit
Vit Adef * dn vision, excess * up neuro and teratogenic * not recommended
Endometrial cxdue to excess estrogen unopposed by progestin (up irreg bleed)
Biggest risk factor of endometrial carcinomaup estrogen b/c up adipose
Tender nodule at SI jointposterior uterus chapman
Tender nodule at superior pubic ramianterior uterus chapman
Progestinprevent endometrial hyperplasia (progesterone like)
Asx adnexal massconservative mx unless risk of torsion, hemmorhage or cx
PO42.7-4.5
Glucosuriacan be normal in preg
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Question Answer
Sertoli leydig tmxup virilization and pelvix mass. Get a unilateral salpingo-oophorectomy, if not child bearing get hyster and bil salpingo ooph
Dysgerminomain young adult, up LDH up alk phos
Granulosa cell tmxup estrogen sec, hyperplastic endomet lining, abn vag bleed, up precosisous puberty or seen in post-menopausal bleeding
Inhibintmx marker for granulosa cell tmx
Serous adenocx ovariof epithelial cells, only seen in postmenop/old
TeratomaMC type of germ cell tmx, do not secrete hormone
Sheehans syndpostpartum pit necrosis (2/2 dn vol) sx fatigue(dn TSH), dn prolactin, dn LH/FSH (dn menses), dn BP, low libidio, Must get endocrine work up if suspected.
SBS compressionfound in pt with depression
Any psychiatric illnessinitally get medical workup to assess for underlying causes
Pregnant and HSIL on cytologyget colposcopy first then cervical bx (but no bx during preg)
LEEP or cold knife in pregnantonly if confirmation of invasive disease will alter timing or mode of delivery otherwise postponse until postpartum.
RET-protooncogeneMEN assoc
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