Ob/gyn: APGO, UWorld, PreTest + Vignettes (Answered)

Ob/gyn: APGO, UWorld, PreTest + Vignettes (Answered) **** MGMT of abnormal Pap smear (low-grade) in a young healthy woman (21-24 yo) -Repeat cytology in 12 months -Repeat colposcopy in 12 months -Refer to oncology Management of abnormal Pap smear (High-grade) in a young healthy woman -Repeat cytology or high-risk HPV -Colposcopy Cytology alone and 12 months Colposcopy!!! ♻♻♻♻ All sexually active women <25 y/o get worked up for these two STI's Chlamydia & gonorrhea Screening recs for women b/t the ages of 30 to 65 regarding HPV and cytology testing HPV + cytology ("co-testing") every 5 years (preferred) FYI: cytology alone every 3 years ***** ♻♻♻♻ Lower abd pain, Adnexal tenderness, fever, friable cervix, cervical motion tenderness, mucopurulent vaginal discharge, n/v Micro? PID! Micro - chlamydia & gonorrhea; but also Bacteroides & E. coli ♻♻♻♻ Macular rash on trunk that extends to the palms and soles Syphilis > Obtain a treponemal-specific test yellow discharge - what to look for? ♻♻♻♻♻♻ tx? Trichomoniasis - motile protozoa on saline wet mount Tx - metronidazole PO both partners Gold standard for dx herpes Cx FYI: 10-20% false negative rate ***** ♻♻ 21 y/o screening ♻♻ 40 age group screenings ♻♻ 50 age group screenings ♻♻ 65 Cervical CA screen MAMMOGRAM annually COLONOSCOPY q10y DEXA scan for osteoporosis --> FYI: if fam hx (<60 yo), then screen at 40, or 10 years before the youngest relative dx + repeat 15y ♻♻♻♻ Most effective methods of birth control? 2nd? 3rd? Nexplanon (levonorgestrel dermal implant) 0.1% Depot shot (medroxyprogesterone acetate) 0.3% OCPs 0.5% (but need to account user error) Vaccines C/I in pregnancy MMR FYI: but recommended immediately postpartum! #1 proactive lifestyle change for pt. w/FamHx of heart disease Exercise / physical activity ***** Suspected PCOS (irregular menses, acanthosis nigricans, clit enlargement, deep voice) mgmt -DM screen -Lipid profile -Pelvic U/S acanthosis nigricans = insulin resistance hence, DIABEETUS (Insulin resistance + chronic anovulation are hallmarks of PCOS) A vegetarian pt. who is wanting to get pregnant should be prescribed FOLATE / folic acid suppl ♻♻ Strongest predictor of osteoporosis -Female gender -FamHx Best PPx? FamHx Weight-bearing exercise 3-4x/wk (wouldn't hurt: 1,000 mg Ca2+; 600IU Vit D daily if not in the sun 20 mins daily) Pregnancy-related decr. Hg w/normal MCV Relative hemodilution of pregnancy ♻♻ Pregnancy-related SOB + incr. WOB Mgmt? Physiologic dyspnea of pregnancy; just normal prenatal care b/c this is normal FYI: code for PE is tachycardia, tachypnea, hypoxia, chest pain, signs of DVT FYI: code for MS is diastolic murmur, signs of HF ♻♻♻♻ MGMT of pulmonary edema (difficulty breathing, cough, frothy sputum; in distress; bibasilar crackles) in pregnancy BONUS: pulm edema is a complication of which condition? Adm 20 mg Lasix IV BONUS: pre-eclampsia Pyelonephrosis (flank pain, leukocytosis) during pregnancy. MGMT? Hydronephrosis (b/l renal enlargement w/dilated renal pelvices + proximal ureters) Inc. progesterone affects SM (relaxation), which contributes to dilation of renal collecting system & as uterus rises out of pelvis, it rests on the ureters, compressing + dilating them Inpatient IV abx Hydronephrosis has same etiology (incr. progesterone) + is physiologic during pregnancy, requiring no additional mgmt Labs used to dx sickle cells? Hg electrophoresis AND CBC (not sickle cell prep) Most common disease among Caucasians Cystic fibrosis ***** Teratogenic effects of valproate neural tube defects (due to inhibition of maternal folate absorption) Uncontrolled DM (+HTN) in pregnancy can cause ___________ Bonus: Labs/tests to monitor the infant for? (2) Cardiac anomalies + fetal growth restriction; HYPOglycemia (due to hyperinsulinemia) //polycythemia, hyperbili, hypocalcemia, NRDS Doppler (DM is a vascular disease and can cause chronic prenatal vasoconstriction + ischemia w/resultant ♻uteroplacental insufficiency♻) Most common form in inherited intellectual disability Fragile X preconception counseling for pt on lamotrigine Folate suppl After establishing gestational age using LMP, what is done to confirm gestational age? U/S! FYI: An u/s performed b/t 14 and 15 6/7 weeks gestation should be used to revise the due date if there is greater than a 7-day discrepancy ♻♻ Most effective screening for Down Synd? Cell-free DNA screen ***** ♻♻♻♻♻♻ Next step in mgmt after elevated AFP U/S (rationale: can detect multiple gestations, determine accurate gestational age + visualize fetal CNS structures) ***** ♻♻♻♻ Next step in mgmt after nuchal translucency Amniocentesis ♻♻ Anticoag during pregnancy LMWH, not warfarin How is GBS screened + treated? Screen by collecting rectovaginal cx @ 36-38 wks (i.e. near anticipated delivery), unless empirically high risk like prior neonatal sepsis Treat w/abx DURING labor ♻♻ Mgmt if intrauterine pressure catheter (measures contraction strength) causes vaginal bleeding? Withdraw catheter, monitor fetus + replace if tracing reassuring (c/f placenta separation + uterine perforation) Mgmt of umbilical cord prolapse ♻♻ Etiology? ♻♻ Elevate the fetal head w/vaginal hand + C section (FYI: The concern with cord prolapse is that pressure on the cord from the baby will compromise blood flow to the baby) The etiology is abnormal fetal presentation (e.g. backup transverse lie) Complication of episiotomy or 3/4 degree obstetric lacerations Evaluation modality? Fecal incontinence MGMT - endoanal u/s ***** ♻♻♻♻♻♻♻♻♻ Late decelerations are associated with _________ Mgmt? (baby FHT stay @ baseline during contractions, THEN dips; Us) ♻♻♻♻♻♻ Early decelerations are associated with _________ (baby FHT dips DURING mom's contractions) ♻♻♻♻♻♻ Variable decelerations are associated with _________ (baby FHT occasionally dips DURING contractions/ not always associated w/contractions) Mgmt? Uteroplacental insufficiency (U are late); mgmt is repositioning to L lateral position (incr. perfusion to uterus) w/possible C-section as next step esp. if recurrent late decelerations // placental abruption OR uterine rupture // DM, HTN Fetal head compression; Umbilical cord compression/ common etiology: PPROM - low amnionic fluid (freq. cause) (Everyones prom experience is variable); mgmt is **amnioinfusion** (artifical creation of more fluid reducing compression) w/possible delivery as next step - no tocolytics Infant w/flat nasal bridge + small, rotated ears Down Synd //sandal gap toes, hypotonia, protruding tongue, short broad hands, simian creases, epicanthic folds, oblique palpebral fissures ♻♻♻♻ In twin-twin transfusion, you expect the large + plethoric twin (recipient) to have _________ Polycythemia FYI: The other twin (donor) has anemia + oligohydramnios, while recipient has polyhydramnios // HF + hydrops Mgmt of infant w/NO RESPIRATORY EFFORT Give PEEP & prepare to intubate *** ♻♻♻♻♻♻♻♻ MGMT for HIV (+) moms Type of delivery & meds Start infant on AZT IMMEDIATELY (i.e. antepartum, intrapartum, C-section + postexposure PPx for baby) Antepartum + IV zidovudine during delivery/labor as well as IV for neonate FYI: women w/optimal viral load reduction (<1,000 copies/mL) may deliver vaginally w/o AZT!!! ♻♻♻♻ APGAR calculation: HR > 120 beats/min; crying; acrocyanosis; gags when suctioned; vigorously moving all 4 extremities HR = 2 RR = 2 Reflex = 2 Activity = 2 Color =1 Next step following delivery of vigorous infant Initiate skin-to-skin contact w/mom ♻♻♻♻♻♻♻♻ Postpartum hemorrhage resulting in pituitary hypoperfusion / pituitary ischemic necrosis