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What percent of couples (woman under 35 y/o) are considered "infertile" (eligible for treatment) after one year

of unprotected sex?;10 to 15% (just remember 15); What percent of couples will become pregnant in 1 year without a contraception m ethod?;85% (15% are considered "infertile");What percent of women having unprote cted 1) 2) will are remain sex become less who ammenorrheic than 6 months pregnant? (Lactation post partum Amenorrheic Method);2%;Feared complication of p rolonged diaphragm use for contraception.;toxic shock (e.g. like tampons);Only c ontraception method known to prevent STDs.;condom;Failure rate with typical cond om use (as the only means of contraception)?;20% become pregnant;What oral birth control can be recommended for a lactating woman?;Mini Pill (Progestin Only Pil ls aka POPs);35 y/o patient who smokes wants birth control. What type is contra indicated? What is usually given instead?;Combined OCPs; give IUD;Wilson's Dise ase patient wants birth control. What type is contraindicated?;copper IUD;Incre ased risk of clotting (e.g. DVTs) with this type of contraception.;Combined OCPs ;Common blood pressure change with OCPs.;HTN;Patient with h/o pulmonary embolism . What type of contraception is contraindicated?;Combined OCPs;Patient with h/o migraine. What type of contraception is contraindicated?;Combined OCPs;Feared disease when patient has IUD in place.;PID;SLE patient desires contraception. W hat to give?;Depo-Provera shots;Poorly compliant patient needs contraception. W hat to recommend.;Depo-Provera shots;Which is safer: Vasectomy or Tubal Ligation ?;Vasectomy;Which is more effective: Vasectomy or Tubal Ligation?;Vasectomy;Woma n on calendar based contraceptive method, and using it perfectly. What is the f ailure rate?;1-2%;Perfect condom use: what is the failure rate?;4-5%;Patient use s OCP with typical compliance and timing. What is the failure rate?;4-5%;What O CP requires consistent timing (i.e. same time each day)?;Mini Pill (Progestin On ly Pills aka POPs);Mechanism of Mini Pill (Progestin Only Pill)?;mostly barrier via increased cervical mucous;Mechanism of Combined OCP? (2);Est decreases FSH = Prog no follicle decreases LH = no ovulation;Post Partum: which comes first: ovulation or me nses?;ovulation;Failure rate in IUD?;0.1%;Most effective contraceptive method in lactating women?;IUD;Definition of Premature Ovarian Failure (Premature Menopau se)?;Less than 40 y/o;Definition of EARLY Menopause?;Less than 45 y/o;How long a fter LMP before you can you clinically diagnose menopause?;requires 6 months of amenorrhea;What in social history will be a risk factor for early menopause?;tob acco use;What endocrine disorder is associated with early menopause?;DM Type 1;2 risk factors in an OB/GYN specific history which are associated with early meno pause?;1) 2) nulliparity;Usually short cycles the 1st sign of Ovarian Failure (Menopause).;Hot flashes; Confirmatory lab for Menopause diagnosis.;FSH increased (FSH/LH over 1);Treatmen t of dyspareunia secondary to vaginal dryness (e.g. Menopause patient)?;lubricat ion (e.g. Crisco oil);2 tests in work-up to follow comorbidities of Menopause.;D EXA scan Lipid Atrophy Coronary Osteoporosis Vagina profile of (osteoporosis) artery the(HLD);Menopause disease;2 cancers wreaks to think HAVOC of mnemonic.;Hot in patient with flashes HRT.;Endometrial a nd Breast;Why do post-hysterectomy patients not need progestin as a part of HRT? ;unopposed estrogen causes increased risk of endometrial cancer, which does not apply to these patients;1st line treatment of Hot Flashes in Menopause (2);1) Ve nlafaxine or 2) Clonidine;Supplements vital in Menopause patients.;Vit D and Cal cium;Medical treatment options for osteoporosis. (2);Bisphosphonates (e.g. Fosam SERMs (e.g. Roloxifine);Which patient is more likely to have Menopause symptoms: ax) Obese or Thin? Why?;Thin patient will: obese patients have more estrogen produ ced by fat cells and endometrial hyperplasia;Vital lifestyle treatment for osteo porosis.;increase weight bearing exercise;Most common cause of amenorrhea?;pregn ancy;Age definition of Primary Amenorrhea.;14 y/o without or 16 y/o with seconda ry sexual development;No menarche, breast development, or pubic hair in female: age definitions of delayed puberty vs. primary amenorrhea;13 y/o = Delayed Puber ty 14 y/o = Delayed Puberty AND Primary Amenorrhea;Why get a hand XR in someone wit h Primary Amenorrhea?;check for lack of pubertal bone growth (Constitutional Gro wth Delay, which is the most common cause of primary amenorrhea);1st lab to orde r in work-up for Amenorrhea (both primary and secondary).;beta-hCG;After ruling out pregnancy, what is the 1st test in work-up of primary amenorrhea?;hand XR (b one age test);Normal bone growth in primary amenorrhea. Next step?;LH and FSH;H igh FSH and LH in patient with primary amenorrhea; no breasts. Your top 2 diffe rential XO: turner's;3 based on Most karyotype.;XX: common causes premature of Primary ovarian Amenorrhea failure (in order).;1) Constitut ional 2) 3) Tuner Mullerian Growth Syndrome Delay Agenesis;LH and FSH levels in patient with Mullerian Agenesis.;norm

al;16 year old without menarche: normal breast development but no pubic hair. D iagnosis?;Androgen Insensitivity (XY);16 year old without menarche, but has brea st development. Next 2 steps in evaluation?;LH & FSH and get U/S abdomen;When t o get karyotype in primary amenorrhea.;if abnormal uterus on u/s OR high LH&FSH; 16 year obese female without menarche: normal breast development. Diagnosis?;PC OS;Primary Amenorrhea with normal LH and FSH and normal uterus on U/S. Most lik ely diagnosis?;Outflow Obstruction (Imperforate Hymen or Transvaginal Septum);Hi gh FSH and LH in patient with primary amenorrhea; breasts present. Your top 2 d ifferentials XY: androgen insensitivity;2 based on karyotype.;XX: labs to check PCOS in primary amenorrhea if FSH and LH a re low.;PRL and TSH (tumor or Hypothyroidism);Low GnRH with normal PRL. What is causing the primary amenorrhea?;Kallman's Syndrome;16 year thin female without menarche: normal breast development. Diagnosis?;Anorexia Nervosa (low estrogen) ;Patient with secondary amenorrhea is not pregnant. 1st step in work-up?;TSH and PRL;Secondary Amenorrhea with high PRL. What test to order?;MRI;Definition of Secondary Amenorrhea.;Discontinued menses for 6 months;How does hypothyroidism s ometimes cause amenorrhea?;TRH stimulates PRL release which blocks GnRH release; Secondary Amenorrhea with normal PRL and TSH. Next 2 steps?;Do Progestin Challe nge and order FSH and LH;Define a positive and negative Progestin Challenge?;Pos itive: withdrawal Negative: no bleed;Secondary bleed afterAmenorrhea: medroxyprogesterone withdrawal bolus bleed from progestin + high LH. Diagnosis?;PCOS;Medical Treatment for prolactinomas (2).;Bromocriptine or C abergoline (Dopamine Agonists);Medical Treatment for anovulation (2).;Clomid (SE RM) +/- Leuprolide (GnRH analog);Virulized patient with secondary amenorrhea. W hat17-hydroxyprogesterone;3 2) 3) 4) Cushings;Scarring Addisons testosterone DHEAS 4 tests to order?;1) (e.g. D&C) Dexamethasone Adrenal caused secondary causes suppression of amenorrhea. secondary test amenorrhea.;CAH or What 24 hris Urine thisCortisol called?; Asherman's Syndrome;SEVERE virulization with secondary amenorrhea. Diagnosis?;T umor (adrenal or ovarian);Of the 15% of "infertile" couples, what percent will h ave a child with the help of treatment?;85% (2% of couples are truly infertile); Of the 15% of "infertile" couples, what percent will have a child withOUT treatm ent?;50%;Rule out these 2 disorders in the Male when working up a couple for inf ertility.;Hypogonadism (check FSH, TSH, PRL) and Disordered Sperm (semen analysi s);Lab tests to order for female in work-up for infertility? (FEpRTL mnemonic) ( pRogesterone Estradiol 6);FSH LH;Why TSH pRolactin get a karytype (midluteal) in a male with infertility?;r/o Klinefelters (XXY);Treatme nt for infertility 2/2 endometriosis.;Surgery: laparoscopic resection/ablation;H ow to check for tubal/pelvic factors as a source for infertility (e.g. PID, adhe sions).;Hysterosalpingogram (HSG);4 criteria for Bacterial Vaginosis;Gray discha pHwhiff rge + Clue Trichomonas Trichomonas: Yeast over cells (Candida);3 (Candida): 4.5onyes test (fishy) KOHno;3 wet causes causes mount;3 of Vaginitis: of causes Vaginitis: oftreat Vaginitis.;Bacterial treatment?;Bacterial partners?;Bacterial Vaginosis Vaginosis: Vaginosis:Metro no nidazole Trichomonas: Yeast (Candida): TID Metronidazolex1 x 7 Fluconazole days PO or topical;Pregnant patient with vaginal yeast i nfection. Oral or Topical treatment?;Topical;vaginal odor increases after sex. Diagnosis?;Bacterial Vaginosis (semen creates a positive wiff test);pseudo hypha e on wet mount. Diagnosis?;Yeast Vaginitis;granular epithelial cells with indis tinct cell margins. Diagnosis?;Bacterial Vaginosis (clue cells);Painful Bleedin g in the 1st Trimester. Diagnosis?;Ectopic Pregnancy;Painful Bleeding in the 3r d Trimester. Diagnosis?;Abruption;1st test to order in a woman with lower quadr ant abdominal pain.;beta-hCG;AROPE mnemonic for acute pelvic pain ddx in a woman RupturedPregnancy;Ectopic .;Appendicitis Ovarian Ectopic PID Torsion Ovarian Cyst Pregnancy Treatment;methotrexate or surgery;Most commo n complication of Ectopic Pregnancy.;Rupture with internal hemorrhage (can cause hypovolemic shock);When to get a CT scan of an unstable patient.;Never!;Test to rule out Ovarian Torsion in woman with lower quadrant abd pain.;U/S;Cervical Mo tion Tenderness (chandelier sign). Diagnosis?;PID;When to start antibiotics whe n suspecting PID.;should start empirically;2 most common causes of PID.;Gonorrhe a and Chlamydia;Common history finding in patients with functional/chronic abdom inal pain.;Sexual Abuse;Acute LRQ pain with negative beta hCG. Most likely diag nosis?;Appendicitis;Most common benign neoplasm in the female genital tract.;Ute rine Leiomyoma (Fibroid);Uterine Fibroids are benign, but are often removed. Wh at 2 most commondo Infertility;Why reasons?;Menorrhagia/dysmenorrhea Uterine Fibroids increase in size during pregnacy and decreas e in size after menopause?;they are sensitive to estrogen and progesterone;Preve lance of Uterine Fibroids in Black women.;50%;Classic physical exam description of a uterus with fibroids.;Lumpy Bumpy;Imaging of choice to r/o uterine fibroids .;U/S;Woman diagnosed with uterine fibroids, but they do not regress after menop ause. What to do?;biopsy to r/o malignancy;Most common indication for surgery i n women in the U.S.;Uterine Fibroids;Post -menopausal woman w/ vaginal bleeding.

Cancer Atrophy Diagnosis?;Cancer causes causes10% 80%of of until bleeds;Most bleeds proven (97%) otherwise of Uterine even though: Cancers are this type.;Endomet rial Bladder 2-to 3-to 4-to Carcinoma Cervix Vagina/Pelvis or(glandular);Define Bowel (3c=lymph or other;Treatment nodes) the 4 stages for Uterine of Uterine Cancer.;Hysterectomy;When Cancer;1-Uterus only t o give radiation in Uterine Cancer. (What stage?);If nodes are positive (stage greater than 3c);How often to follow up on an asymptomatic Uterine Fibroid patie nt.;q6 months;At what age will oophorectomy automaticaly be recommended with hys terectomy?;over 45 y/o;Why luprolide (GnRH analog) for uterine fibroid?;supresse s estrogen which sepresses fibroids (commonly used pre-op);3 treatments of Fibro ids are myomectomy, hysterectomy, or uterine artery embolization. What is the i ndication hysterectomy: uterine artery for fertility each?;myomectomy: embolization: not desired good fertility for patients desired near menopause;Pain and menorrhag ia control in patient with Fibroids.;NSAIDS;Adnexal Mass is more commonly malign ant in reproductive age or postmenopausal?;Postmenopausal (25% are malignant);Wh at is mittelschmirz?;brief midcycle pain (usually mild);Adnexal Mass: with dyspa reunia and dysmenorrhea. Diagnosis?;endometriosis;Adnexal Mass: with sudden sev ere pain and N/V. Diagnosis?;ovarian torsion;Adnexal Mass: amenorrheic, abd pai n, vaginal bleeding. Diagnosis?;Ectopic Pregnancy;Adnexal Mass: with a large mo bile uterus and menorrhagia/dysmenorrhea. Diagnosis?;Uterine Leiomyoma (Fibroid );Adnexal Mass: with cervical motion tenderness and fever. Diagnosis?;PID;Adnex al Mass: in obese pt with hirsuitism and infertility. Diagnosis?;PCOS;Adnexal Ma ss: large, solid, irregular, non-mobile; ascites present. Diagnosis?;more likel y malignancy;2 most common mutations known to be associated with Ovarian Cancer. ;BRCA and HNPCC;Imaging for adnexal mass.;U/S;Imaging for adnexal mass which loo ks like Cancer on U/S.;CT scan (eval extent of disease);4 types of ovarian tumor s.;1) 2) 3) 4) Germ Stromal Metastatic Epithelial cell Tumors GI tumor;Most common type of ovarian tumor?;Epithelial (90%);Most common ovarian tumor in woman under 20.;Germ cell tumor (e.g. teratoma);Why rem ove a mature teratoma if it is benign?;risk of torsion;Define the 4 stages of Ov arianabdominal 2-to 3-to 4-distant pelvis Cancer;1-only (e.g.cavity omentum);Why ovaries not get a fine needle aspirate to diagnose ovarian tumor?;can seed cancer along needle track;Palpable ovarian mass in post-menopaus al. What to do?;laparotomy;When to do surgery on ovarian mass if pre-menopausal ?;if large (over 8 cm) or symptomatic;When to give chemo (e.g. pacitaxel and car boplatin) for ovarian cancer.;for stage 2c or more;Age to start PAP smears.;21;C ause of cervical cancer;HPV;How often to do PAP smear on woman aged 21-29;every 2 years;When to test HPV DNA with PAP smear. (what age?);at 30 y/o;At what age to recommendations for regular PAP smears stop.;stop at age 70;PAP shows LSIL ( aka CIN1) or ASCUS. What to do (postmenopausal or premenopausal)?;Postmenopausa l: HPV DNA testColposcopy;Positive HPV DNA test. What to do? (even if PAP is ne Premenopausal: gative);Colposcopy;PAP shows HSIL (aka CIN2). What to do?;excision (LEEP) or ab lation;Colposcopy shows CIN1. What to do?;PAP&HPV DNA in 1 year;Colposcopy show s CIN2 (aka HSIL). What to do?;excision (LEEP) or ablation;Colposcopy shows CIN 3 (aka carcinoma in situ). What to do?;Hysterectomy, staging, radiation;Colposc opy shows Carcinoma. What to do?;Hysterectomy, staging, radiation;Which HPV vir uses18 16, are (cervical covered dysplasia);How in Gardasil? (4);6, often11 to(warts) get PAP smear on patient with HIV.;ever y year;Personal history of CIN2/3 or Cervical Carcinoma. How often to f/u with PAP smear?;every year for 20 years;How often to get PAP smear on patient who has been vaccinated with gardasil?;same as if she wasn't vaccinated;Atypical Glandu lar Cells (AGC) on PAP smear. What to do?;Endometrial biopsy;OCPs decrease the risk of this cancer;Ovarian;If you decide to screen a high risk woman for ovaria n cancer, what do you do?;yearly CA-125 and Transvaginal U/S;Ovarian Tumor Marke r: epithelial;CA-125;Ovarian Tumor Marker: endodermal sinus;AFP;Ovarian Tumor Ma rkers: embryonal carcinoma;AFP, hCG;Ovarian Tumor Marker: Choriocarcinoma;hCG;Ov arian Tumor Marker: Dysgerminoma;LDH;Ovarian Tumor Marker: Granulsa Cell;Inhibin ;Treatment for Gonorrhea;Ceftriaxone to pt and partners;Treatment for Chlaymida; Doxycycline to pt and partners;What portion of women have dysmenorrhea?;50%;2 pa rt treatment OCP or Mirena;Most for primary commondysmenorrhea.;NSAIDS cause of secondary dysmenorrhea.;Endometriosis;Endomet (scheduled 24 hr before menses) riosis vs. Adenomyosis: cyclic or noncylic dysmenorrhea/pelvic pain?;Endometrios is: cyclic non-cyclic;Medical treatment options for ENDOMetriosis.;Estrogen re Adenomyosis: gulation (GnRH agonists test Medroxyprogesterone;1st OCP Danazol NSAIDS e.g. to Leuprolide) order in woman with pelvic pain.;beta-hCG;Leupro lide side effect to remember. What to do about it?;bone loss: needs vit D and c alcium ("add back therapy");Danazol side effect to remember (limiting treatment of endometriosis).;hirsuitism and voice chnages;Almost all Endometrial Cancer pr esents with this symptom.;vaginal bleeding;Test to evaluate concerning postmenop

ausal bleeding.;transvaginal u/s;When to biopsy endometrium in postmenopausal bl eeding.;if transvaginal u/s shows stripe bigger than 5 mm;When to get u/s in pat ient if more with than post-menopausal 6 months of sx;SPURT bleedingof (2urine reasons)?;if with exertion uterusor enlarged straining on e.g. exam laugh ing. Defines what?;Stress incontinence;Sudden NEED TO PEE. What type of incont inence?;Urge incontinence (detrusor instability);Continuous, uncontrolled urine loss, What type of incontinence?;Total Incontinence (e.g. fistula);Urine DRIBBLE S ocassionally. What type of incontinence?;Overflow incontinence;Chronic urine retention causes what type of incontinence?;Overflow incontinence;1st line treat ment for Stress incontinence.;kegels;Treatment for total incontinence.;surgery;T reatment for urge incontinence.;Anticholinergics or TCA (e.g. Imipramine);1st li ne medical treatment for overflow incontinence.;Prazosin or Terazosin (alpha1ant agonists);1st test in woman with incontinence. Why?;UA and Cx to r/o infection; Confirmatory test for stress incontinence.;standing stress test (stands over tow el and coughs);Test to r/o fistula and total incontinence.;cystogram;Treatment f or urethrocele, cystocele, rectocele, or enterocele.;Surgery (colporrhaphy);Blee ding between menses/periods is called.;Metrorrhagia;Bleeding too much or too lon g during menses is called.;Menorrhagia;Menstrual cycle longer than 35 days is ca lled.;Oligomenorrhea;Menstrual cycle shorter than 21 days is called.;Polymenorrh ea;Most common cause of abnormal uterine bleeding.;pregnancy;1st test to order i n woman with abnormal uterine bleeding;beta-hCG;Work-up for metrorrhagia.;PAP sm ear;Treatment of Oligomenorrhea.;Progestin x 10 days to stimulate withdrawal ble ed, then OCPs;Treatment of Polymenorrhea.;OCPs;Work-up for abnormal uterine blee ding. Rule Bleeding Uterine Mass disorder out etc. these (PT/PTT) (U/S);1st 3 causes.;Anovulatory line treatment for (TSH/PRL) abnormal uterine bleeding.;NSAIDS ;Treatment for HEAVY abnormal uterine bleeding.;High-dose Estrogen;When to do a D&C in patient with abnormal uterine bleeding.;if heavy bleeding despite estroge n;Work-up for menorrhagia: what imaging?;U/S;Most common complication of Menorrh agia.;Anemia;When to get hysterectomy in patient with abnormal uterine bleeding (2 criteria).;if 1) perimenopausal and 2) fail treatment (estrogen, D&C, and hor mones);Most common mechanism of abnormal uterine bleeding other than pregnancy.; anovulatory diseases (e.g. menarchal or menopausal);When to get an endometrial b iopsy in a premenopausal woman who has abnormal uterine bleeding. (3 rules);if o lder or BMI Diabetic;When than over 3535 to start antenatal checkups.;10 weeks is first visit;Review of Systems at each prenatal appointment. (ABCEDF mnemonic.);Amniotic fluid per vag ? Ecclampsia Dysuria Contractions FHTs;5 Vision Edema RUQ SOB;What Bleeding abdchanges symptoms px per week (HA, vag? toof Edema, listen pre-ecclampsia etc.) to FHTs for onthe review first oftime?;14 systems.;HA weeks;When do you see you r prenatal patients every 4 weeks?;10-28 weeks;When do you see your prenatal pat ients every 2 weeks?;28-36 weeks;When do you see your prenatal patients every we ek?;36 weeks-birth (up to 42 weeks);Weight gain expected in a pregnant woman wit h a normal BMI.;30 lbs;Weight gain expected in a pregnant woman with a BMI over 30;15 lbs;When to initiate Folate supplementation in pregancy?;3 months before c onception;3 supplements Calcium;What Iron week of pregancy for pregnant to get the patients.;folic U/S?;20 weeks;When acid to get glucose toler ance test (GTT) during pregnancy?;28 weeks;When to get Rhogam (if needed)?;1) 28 2) weeks under 72 hours post-partum;When to screen for Group B Strep (GBS) in pregnanc y?;36 weeks;Treatment for pregnant patient at 42 weeks?;induction or C/S;Fundus at umbilicus. How many weeks?;20 weeks;Fundus half way to umbilicus. How many weeks?;16 weeks;Treatment of VDRL positive pregnant woman.;Penicillin shot befor e 16 weeks;When is Rogam needed?;in mom who has Rh- and fetus who may have Rh+ ( just give to all Rh- moms);When the triple or quad screen might be offered to p regnant patients?;at 18 weeks;All four tests in the quad screen are elevated. D iagnosis?;Edwards syndrome (trisomy 18);2 supplements necessary in pregnant vege tarians.;Vit D and B12;Step 2 questions says failure to lactate after delivery. What is your diagnosis?;Sheehan's Syndrome;3 most common causes of Post-Partum Hemorrhage.;Uterine Lacerations/direct Retained products;Most trauma Atony common cause of Post-Partum Hemorrhage (90%).;Uterine Ato ny;Bleeding after delivery of the placenta; uterus is soft and "boggy." What is the diagnosis?;Uterine Atony;Mechanism of Uterine Atony.;fatigued myometrium;3 part treatment of Post-Partum Hemorrhage 2/2 Uterine Atony (MOM mnemonic);Manual Methergine Oxytocin Massage or Misopristol;Contraindication of Methergine;HTN;Contraindication of Hemabate (prostaglandin).;asthma;Cheapest and most stable uterotonic for Uterin e Atony.;Misopristol (Cytotec);Post Partum Hemorrhage fails to respond to Atony treatment. What to do?;D&C;Post Partum Hemorrhage fails to respond to treatment or D&C. What to do?;Bakri Balloon;Last resort therapy for Post-Partum Hemorrha

ge.;Surgery: uterine aa ligation then hysterectomy;Iatrogenic risk factor for pl acenta previa and/or accreta.;previous C-Section;Placenta invades too far. Defi nes what?;Accreta;Placenta invades all the way through the uterine wall. Define s what?;Percreta;defined as being between Accreta and Percreta.;Placenta Increta ;Active management of this stage of labor has decreased maternal mortality the m ost.;3rd stage (placenta);Painless bleeding in the 3rd trimester. Diagnosis?;Pl acenta Previa;Woman pregnant with twins: 3 total pregnancies (including this one ) and has 4 children: 1 baby the first pregnancy at 37 weeks, Triplets the secon d pregnancy at 30 weeks. G/P? and G/TPAL?;G3P2 and G3P1104;Vaginal bleeding bef ore 20 weeks. What is this called?;Threatened Abortion;How to diagnose placenta previa;U/S;Rule about prenatal manual pelvic exam with vaginal bleeding.;Don't do it;Treatment of Complete Previa.;C-Section;Why does trauma in a pregnant woma n often require immediate delivery.;Abruption often occurs with trauma;When to s chedule delivery for a patient with complete previa?;Elective C-Section at 36 we eks.;What indicates delivery for a patient with placental abruption? (2);if feta l or or ifmaternal past 36 weeks;Fetal distress Bleeding from vagina with quick fetal demise. Cause?; Vasa Previa;Quickly rule these 2 causes of 3rd trimester out when taking the his tory.;Post-Coitaltypical Hemorrhoids;Pain bleeding of placental abruption.;constant severe back pain;U/S s hows macrosomia of fetus. At what estimated fetal weight (EFW) to consider elec tive C/S?;4000 g in Diabetic; 4500 g in others;Complications of macrosomia. (2); shoulder distocia which can lead to Erb-duchenne palsy;HELPER mnemonic for shoul der elevation Leg Epesiotomy Pressure Enter Reach dystocia vagina for (suprapubic) theto treatment.;Help fetal rotate arm;What defines reposition the beginning of active Stage 1 of normal l abor?;4 cm dilated;What defines Stage 2 of normal labor?;completely dilated to d elivery of baby;How many stages of labor are there?;3;What defines the end of st age 3 of normal labor?;delivery of placenta;What test will confirm the suspicion that active phase of Stage 1 of labor is protracted from insufficient contracti on strength?;Intrauterine Pressure Catheter (IUPC);Woman in labor is passed cutoff limit for Stage II of labor. How to decide to go to C/S?;If slowly but sure ly progressing, then wait. If COMPLETE ARREST, then C/S.;What to try for failur e to progress before bringing to C/S in Stage 2 of labor?;vacuum and/or forceps; How to cord fundal *manual oxytocin traction reduce massage evacuation mortality and D&C in if Stage needed;3 3 of labor. rules that (3);ACTIVE defineMANAGEMENT: adequate uterine contra ction200 last Over at power.;q5 least MVU by 60IUPC;Pregnant min seconds or less woman at 37 weeks presents with irregular contract ions and no cervical change over 4 hours. What to do?;send her home;Treatment f or insufficient contraction power during labor.;oxytocin;C/S indication during A ctive for despite 3 hours phase adequate of Stage contraction 1 of labor power;What is Arrest. is "protracted" Define Arrest active (3);NO phase change of Stage 1 of labor?;passed cut-off limit, but still progressing (not a c/s indication);Wha t is "prolonged" Stage 2 of labor?;passed cut-off limit, but still progressing ( not a c/s indication);Latent Phase of Stage 1 of labor: what is the cut-off time Multip: limit in 14Nulliparous? hours;What is inthe Multiparous?;Nullip: cut-off time limit20 for hours active phase of Stage 1 of l abor in less Multip: Nulliparous? than 1.5in cm/hr Multiparous?;Nullip: = protracted;Whatless is the than cut-off 1 cm/hr time = protracted for Stage 2 of labor in Nulliparous? in Multiparous?;Nullip: over 2 hours (or 3 if epidural) = Multip: prolonged over 1 hour (or 2 if epidural) = prolonged;Race which has multiple gesta tion more often?;Black;Why has the incidence of dizygotic twins increased, but m onozygotic twin rate has not increased?;reproductive technology causes hyperovul ation, but has little/no effect on embryonic division;cheapest way to confirm di angosis of twins.;separate heart beats;1 twin is small at birth and has anemia; the other has CHF and polycythemia. Diagnosis?;Twin-Twin Transfusion;When to st art activity restrictions in a multiple gestation pregnancy to avoid preterm lab or?;24 weeks;When can a multiple gestation pregnancy be delivered vaginally.;If 1st twin is cephalic presentation;How often to get U/S in a multiple gestation?; q4 wks after 20 wks;Embryonic division before 3 days. What form of monozygotic twin? (1/3 of twins);diamniotic dichorionic (separate placentas);Embryonic divis ion 3-8 days. What form of monozygotic twin? (2/3s of twins);diamniotic monocho rionic;Embryonic division 8-13 days. What form of monozygotic twin? (1% of twin s);monoamnionic (50% die);Embryonic division after 13 days. What form of monozy gotic twin?;conjoined;hCG, MSAFP, and hPL are all high for gestational age. Sus pect what?;multiple gestation;What antihypertensive for pregnant woman?;methyldo pa;Why not ACEI or Diuretics for pregnant woman.;risk of uterine ischemia;Gestat ional Hypertension (aka Pregnancy Induced Hypertension) is defined as developing when?;after 20 weeks;Pre-Ecclampsia is diagnosed when a woman has PIH plus what

Low enzymes ?;proteinuria;What Liver Elevated Platelets;Ecclampsia isis HELLP Pre-Ecclampsia syndrome?;Hemolysis plus what?;new seizure;The only cure for Pre-Ecclampsia known.;delivery;When is delivery indicated in mild Pre-Ecclampsia ?;at 37 weeks;When is delivery indicated in severe Pre-Ecclampsia? (2);at 34 wee ks or if end-organ damage;Diet for a Pre-Ecclampsia patient.;low salt; protein rest rictionto Mg;How not control shown HTN to help;2 crisispart in Pre-Ecclampsia: medical treatment Short-term for Pre-Ecclampsia;Steroids or Long-term?;Short-t erm: Labatelol Long-term: Nifedipine;Severe or Hydralazinepre-ecclampsia diagnosed when . . . What lung probl em?;SOB (pulmonary edema);Severe pre-ecclampsia diagnosed when . . . What renal problems? (3);Crt Proteinuria Oliguria;Severe overpre-ecclampsia 5over g 2 diagnosed when . . . What fetal problems? (2);Oli IUGR;Severe gohydramnios vision Seizure changes (Ecclampsia);Severe pre-ecclampsia diagnosed pre-ecclampsia when .diagnosed . . What when CNS changes? . . . What (3);HA liver probl ems? (2);RUQ pre-ecclampsia HELLP;Severe pain (hepatic capsular diagnosed swelling) when BP reaches this threshold?;over 160/1 10;Ecclamptic Treatment: diazepam;What seizure: prevention kind of decel and treatment?;Prevention: indicates fetal hypoxemia Mg (uteroplacental insufficiency)?;late (decel starts around the peak of contraction);What is Whit e DM Class A1?;GDM, diet controlled;What is White DM Class A2?;GDM, insulin cont rolled;What is White DM Class B?;onset >20 y/o or duration <10 yrs;What is White DM Class C?;onset 10-19 y/o or duration 10-19 yrs;What is White DM Class D?;ons et <10 y/o or duration <20 yrs;What is White DM Class F?;diabetic neFropathy;Wha t is White DM Class R?;Proliferative retinopathy;What is White DM Class RF?;Reti nopathy and nephropathy;What is White DM Class H?;Ischemic heart disease;What is White DM Class T?;Prior renal transplant;2 numbers to remember after screening Glucose over 140Tolerance = needs 3Test day glucose (GTT) oftolerance 50g.;overtest;What 200 = GDMis the 3 day prep for the 100 g Oral Glucose Tolerance Test (OGTT) as follow up for a high screening GTT?;3 da y hr 8 then carbo fast 100 diet mg overnight glucose load;4 numbers to remember after confirmatory 100g OGTT. (an y 2 = 3 after GDM);before 1 2 hr: over 140;Diabetic 180 155 glucose load: patient over 95 gets pregnant. What lab to run along with initial screening labs at first visit?;A1C;Treatment for Diabetes during pregna ncy. (2);Insulin and ADA diet;Biophysical Profile: 5 parts (Test the Baby MAN mn emonic);Tones Amniotic Movement Breathing Nonstress fluid test;What (FHTs) volume is a "Reactive" (reassuring) nonstress test (NST)?;2 or more accelerations within 20 minutes in Fetal Heart Rate (increase in at least 15 bp m for at least 15 seconds);Difference between a variable and a late decel. (2);L ate ones decelerate for over 30 seconds before coming back up AND have consisten t onset points compared to contractions;Fetus should "kick" at least this many t imes per hour while it is awake.;6;Complication which can occur in baby if diabe tic mom is not controlled on insulin drip during labor.;Mom's hyperglycemia will cause fetal hyperinsulinemia which will result in hypoglycemia after birth.;Mos t common identifiable cause of Preterm Premature Rupture of Membranes (PPROM).;U TI;What is Premature (or Prolonged) Rupture of Membranes (PROM)?;ROM for over 18 hours before birth (may or may not have contractions);When to do a manual pelvi c exam on a patient whose water has broken?;DON'T DO IT;Test to confirm amniotic Ferning fluid pooling under microscope;When (ROM)? (2);Nitrazine to deliever positive PPROM? (2);if fetal or maternal distre ss or if past 32 weeks (some say 34);Most common complication of PROM.;chorioamnion itits;3 symptoms tachycardia fever (mom and of Chorioamnionitis;tender fetus);Most common neonatal fundus complication after PROM.;ARDS;T reatment for fetus during PROM if fetal lung immaturity exists.;corticosteroids; Treatment of PROM of Bedrest;Treatment if PROM less to than prevent 32 weeks infection.;Prophylactic to prevent labor (2);Tocolytics Ampicillin and Eryt hromicin;Monitoring of PROM patient.;Inpatient and frequent NSTs;What to give fo r inadequate dilation during stage 1 of labor? (2);Misopristol (Cytotec) and Oxy tocin (Pitocin);What is a Blighted ovum?;zygote attaches & sac may develop, but no embryo 2/2 chromosomal abnormalities;What is a Complete Abortion?;bleeding + passing tissue + NO retained products;What is a Incomplete Abortion?;bleeding + passing tissue + retained products;What is a Threatened Abortion?;bleeding + FHT s (happens in 25% of pregnancies: half of the 25% proceed to abort);What is a Mi ssed Abortion?;completely retained failed pregnancy;What is a Septic Abortion?;i nfection + bleeding + dilation etc.;What is a Inevitable Abortion?;ROM and dilat ion;What is a Induced Abortion?;elective: medical or surgical;Unknown blood type with vaginal bleeding in pregnant woman. Immediate treatment?;Rhogam!;What blo od level to follow in an abortion?;quantative beta-hCG;What to do about a incomp lete abortion?;most will resolve on their own; otherwise D&C;Does emotional/psyc hological stress cause spontaneous abortion?;NO;Can physical stress/trauma cause spontaneous abortion?;yes;Most common reason for abortion (other than elective murder)?;chromosomal abnormalities;Early multiple gestation pregnancies can have high hCG even when too small to see by U/S. How to rule out ectopic?;follow hC G (multiples will increase faster); if over 2000 re-ultrasound remains negative

= ectopic;What is the doubling time for hCG in a normal pregnancy?;every 2 days (during 1st trimester);race which has increased incidence of molar pregnancies.; asian;Chromosome count and source of a Complete Mole (90% of moles)?;46 XX (both sets from Dad);Chromosome count and source of a Partial Mole (10% of moles)?;69 XXY (triploid: one from egg, 1 each from 2 different sperm);Snow Storm uterus o n ultrasound. Diagnosis?;Molar pregnancy;Multiple gestation pregnancies can hav e high hCG and large uterus for gestational age. How to rule out molar pregnanc y?;U/S (will show multiple gestation or snow storm);Preparation for D&C to remov e a molar pregnancy.;get 4 units of blood ready (lots of bleeding usually);Medic ine treatment for molar pregnancy and malignant disease from molar pregnancy.;Me thotrexate (100% cure rate);What blood level to follow after treatment of a mola r pregnancy (monthly for 1 year)? Why?;beta-hCG to rule out metastasis or missed invasive molar tissue;A1C greater than 8 in pregnant woman. What test? Why?;U/ S to look for congenital defects;When to start U/S screening q 4 weeks for DM in pregnancy?;start at normal time (20 weeks);Treatment for headache during pregna ncy?;tylenol; watch for CNS signs of Pre-Ecclampsia;What is the BRAT diet for mo rning and Toast Applesauce Rice Multiple Nulliparous;2 Doxylamine sickness?;Bananas gestation Tea;3 (antihistamine);Treatment treatments risk factors for more for hyperemesis mild for hyperemesis severe gravidum.;Molar hyperemesis gravidum;B6 gravidum.;antiemetic pregnancy s and IVF;Treatment of constipation in pregnancy.;Fiber and water! (can use sto ol softeners too);2 supplements which have been shown to have some efficacy in m orning sickness.;B6 and Ginger;Lifestyle change to manage morning sickness.;freq uent small meals;Lifestlye treatment of GERD (e.g. during pregnancy).;no food be fore bedhead of bed while sleeping;Vaginal discharge during pregnancy is probabl elevate y normal. and Vaginitis 2 things (infectious);1st to r/o.;Ruptured line antiemetic Membranes (SROM) for morning sickness.;Phenergen ( promethazine);2nd line antiemetic for morning sickness.;Ondansetron (Zofran);Mor tality rate of hydrops fetalis from rhesus hemolytic disease if untreated?;100% die without treatment;Postnatal treatment of rhesus hemolytic disease.;Photother apy (and exchange transfusion if severe);What monitoring of Rh- pregnant woman w ho has history of Rh sensitization (previous pregnancy or otherwise)?;u/s q4 wee ks;What do you check for on U/S for Rh hemolytic disease?;increased viscosity;If Rh hemolytic disease evidence found on U/S, what to do?;Umbilical Blood sample and transfuse if Hct less than 30.;When to deliver a fetus with Rh hemolytic dis ease?;at 32 weeks (some say 34);What to test for in woman with h/o recurrent mis carriages: uterine abnormalities;What 2 things.;coagulation/bleeding is Fetal Fibronectin disorders test?;Negative = 99% sensitive f or NO deliver innext 7 days;Treatment for Preterm labor if mom and fetus are not distressed.;Tocolytics;Preterm labor without signs of infection. Why give anti biotics?;GBS prophylaxis;Why give steroids to mom with preterm labor?;helps with fetal lung development;3 general categories of causes of preterm labor;Infectio n Fetal Uterine causes;Treatment causes of uterine causes of preterm labor.;Bedrest and tocolytic s;2 neonatal complications of prematurity to remember.;NEC and ARDS;what is comp lete breech?;bum down, knees flexed (feet at bum);What is frank breech?;bum down , knees extended (feet at head);

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