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Prego’s, Hoo-ha’s and Beans (oh my!)

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Presentation on theme: "Prego’s, Hoo-ha’s and Beans (oh my!)"— Presentation transcript:

1 Prego’s, Hoo-ha’s and Beans (oh my!)
Board Review for Ob/Gyn and Renal Tracie Shea, MD January 17, 2008

2 What is Chadwick’s sign and when does it develop?

3 Chadwick’s sign is a bluish discoloration of the cervix
Chadwick’s sign is a bluish discoloration of the cervix. It is a sign of pregnancy that develops at 6-8 weeks.

4 What is the normal pCO2 in pregnancy?

5 30 mmHg Decreases due to the increases in minute volume.

6 Physiologic Changes of Pregnancy
Pulmonary  RR and VT Cardiovascular  CO and HR  BP Renal  BUN and Cr  GFR Heme  Volume, WBC, D-dimer  Hgb and platelet

7 Name one physiologic parameter that decreases in pregnancy
Name one physiologic parameter that decreases in pregnancy? (hint: on previous slide)

8 FRC BP BUN and Cr Hgb Platelets

9 What immunization is contraindicated in pregnancy?

10 Any live immunizations.
MMR Smallpox

11 What is the most common cause of spontaneous abortions?

12 Chromosomal abnormalities Then:
Autoimmune disease Drugs Maternal illness Increased maternal age Conception early in post partum period

13 What are the general landmarks for gestational height?

14 12 weeks – Pubic Symphysis
20 weeks – Umbilicus 36 weeks – Costal Margin

15 What is the discriminatory zone for transabdominal ultrasound?
And at what week should a gestational sac be visualized?

16 ß-HCG > 6500 mIU 6 weeks

17 Endovaginal ultrasound?

18 ß- HCG >1500 mIU 5 weeks

19 Name a risk factor for ectopic pregnancy that is not PID or previous ectopic?

20 IUD Pelvic surgery Infertility treatments

21 What is the mechanism of methotrexate?

22 Inhibits the formation of nucleosides

23 What are the contraindications for methotrexate use?

24 ß- HCG > 5,000 Evidence of rupture Active renal or liver disease Inability to provide/obtain adequate follow up

25 What is the criteria for hyperemesis gravidarum?

26 Ketonemia Electrolyte disturbance Loss of >5% of pre-pregnancy weight

27 Ultrasound findings of a molar pregnancy?

28 Snowstorm appearance

29 What is the difference between a complete and partial molar pregnancy?

30 Complete mole- 46 XX- both paternal in origin, no fetal tissue.
Partial mole- 69 XXY- may have viable fetus ß-HCG higher than expected

31 What is the most sensitive indicator for placental abruption?

32 Fetal distress Not ultrasound or vaginal bleeding

33 What are the indications for Rh immunoprophylaxis?

34 Any Rh-negative mother who is/may be carrying a Rh-positive baby and are exposed to any event, which puts them at risk for developing isoimmunization.

35 What are the dosings for Rho-GAM and when does it need to be administered?

36 50 mcg IM < 12 weeks gestation
Must be administered within 72 hours of the event.

37 What is the leading cause of maternal death in preeclampsia?

38 Intracranial hemorrhage

39 What is the treatment for preterm labor?

40 MgSO4 – 6g IV then 2g/hour Terbutaline 0.25 – 5 mg SQ Steroids if pt < 34 weeks

41 Signs of amniotic fluid vs. vaginal fluid?

42 “pooling” of fluid in vaginal vault
“ferning” on glass slide  pH (nitrazine paper turns blue)

43 Define mild preeclampsia

44 BP > 140/90 with proteinuria

45 Define sever preeclampsia

46 BP > 160/90 Or ANY symptom: oliguria, cerebral or visual disturbances, pulmonary edema, epigastric RUQ pain, impaired LFTs, thrombocytopenia, fetal growth restriction.

47 Treatment for preeclampsia

48 MgSO4 4g IV then 1-2 g per hour
Benzos for seizures Hydralazine 5mg IV or labetalol 20-40mg IV for BP Delivery of fetus

49 What is a normal fetal heart rate?

50 bpm

51 Name the 5 measurements of the APGAR score?

52 Appearance (color) Pulse Grimace (reflex) Activity (tone) Respiration

53 Define HELPP syndrome

54 Hemolysis Elevated liver enzymes Low platelets Address coag deficits

55 How many weeks following the last menses do ectopic pregnancies most commonly present?

56 5-8 weeks

57 What is the next approach if a nuchal cord is unable to be reduced?

58 The cord should be cut prior to delivery
and the child quickly delivered.

59 What is the treatment for mastitis?

60 Dicloxacillin 500 mg qid x 1 week
1st generation cephalosporin I&D if necessary

61 POINT TALLY!!!

62 What is the treatment for a bartholin’s abscess?

63 I & D Place Word catheter GC/Chlamydia cultures F/u Ob/Gyn

64 For what length of time should a ward catheter be placed for a Bartholin Abscess?

65 4-6 weeks

66 What is the 2nd line treatment for GC?

67 Cefixime 400mg PO 1st line- Ceftriaxone 125mg IM

68 What is the 2nd line treatment for Chlamydia?

69 Doxycycline 100mg PO BID x 7d
1st line- Azithromycin 1 gm PO

70 What are the indications for hospitalization for PID?

71 Cannot exclude surgical abdomen
Pregnancy Failed outpatient treatment Severe illness (N/V/high fever) Tubo-ovarian abscess Inadequate follow-up.

72 What is the inflammation of the liver capsule resulting in adhesions secondary to PID?
What is it commonly caused by?

73 Fitz-Hugh-Curtis Syndrome
N. gonorrhea

74 What should we always consider in older women with tubo-ovarian abscess?

75 Always consider malignancy or diverticular disease.

76 Name some predisposing factors for adnexal (ovarian) torsion.

77 Cyst Hyperstimulation Tumor Pregnancy PID Pelvic surgery

78 What is the gold standard for diagnosing ovarian torsion?

79 Laparoscopy U/S lacks sensitivity and normal blood flow does NOT r/o torsion

80 Most ovarian tumors are derived from what tissue?

81 Epithelial

82 Name some causes of dysfunctional uterine bleeding.

83 Anovulatory states Polycystic ovarian disease Weight gain or loss Eating disorders Hypothyroidism Fibroids (leiomyomata) Exogenous gonadal steroids IUD Cervicitis Coagulopathies Endometrial hyperplasia/malignancy

84 POINT TALLY!!!

85 In which of the causes of acute renal failure (prerenal, renal or postrenal) is the microscopic urinalysis abnormal?

86 Renal

87 Prerenal vs. Renal (ATN)
Urine sodium > 40 mEq/L Dilute urine

88 Renal (ATN)

89 Prerenal vs. Renal Urine/plasma creatinine ratio < 20

90 Prerenal vs. Renal PreRenal Renal < 20 > 40 > 40 < 20
Urine Sodium Urine/plasma Cr PreRenal < 20 > 40 Renal > 40 < 20

91 What are the indications for emergency dialysis?

92 A – acidosis (pronounced)
E – electrolyte imbalance (esp. hyper K) I – intoxication (methanol, ethylene glycol) O – overload (fluid) U - uremia

93 What is the most common cause of renal azotemia?

94 Acute Tubular Necrosis

95 What is the most immediate life-threatening complication of acute renal failure (ARF)?

96 Hyperkalemia

97 What is the most sensitive test for detecting rhabdomyolysis?

98 Serum creatnine kinase (CK)

99 What are the most important electrolyte abnormality occuring in association with rhabdomyolysis?

100 Hyperkalemia and hypocalcemia

101 Which type of kidney stone occurs in association with chronic UTI’s due to urea-splitting organisms?

102 Struvite Stones

103 Name 2 diseases that produce uric acid stones.

104 Myeloproliferative disease or leukemia
Gout

105 What type of renal stones are radiolucent?

106 Uric acid and xanthine stones

107 What is the most common cause of infection of vascular access in hemodialysis patients?

108 Staphylococcal

109 Most UTI’s are caused by which organism?

110 E. coli

111 What is the definitive diagnosis of UTI based on?

112 Isolating 105 colony-forming units on bacterial culture.
Associated with > 10 WBC per hpf

113 What is the most common cause of nongonococcal urethritis?

114 Chlamydia

115 If a gram stain from a painless penile ulcer reveals Donovan bodies it is indicative of what disease?

116 Granuloma inguinale

117 What is the treatment for granuloma inguinale?

118 Bactrim or doxycycline for a minimum of 3 weeks.

119 What are the predominant causative organisms of Fournier’s Gangrene?

120 Bacteroides fragilis E. coli

121 Which of the following urologic conditions requires emergency treatment?
Phimosis Paraphimosis Peyronie’s disease

122 Paraphimosis

123 Phimosis- inability to retract foreskin
Paraphimosis- inability to replace retracted foreskin back over the glans Peyronie’s- penile fibromatosis

124 POINT TALLY!!!

125 What is the initial treatment of choice for both reversible and irreversible priapism?

126 Sub Q terbutaline Along with hydration, oxygen, pain control. Also can try alpha-agonists, aspiration of corpus cavernosum, HBO Rarely requires surgery; urology should be consulted

127 What are the most common ages for testicular torsion to occur?

128 First few days of life Between years

129 What are the “classic” exam findings for testicular torsion?

130 Swollen, firm, high-riding testicle with a transverse lie.
NO cremasteric reflex

131 A positive Tzank smear confirms the diagnosis of what?

132 Herpes simplex Although this is no longer done. Diagnosis is usually clinical or with PCR testing.

133 What is the organism most likely to cause prostatitis?

134 E. coli Followed by GC/Chlamydia Klebsiella Enterobacter Proteus
Pseudomonas

135 Name the systemic diseases that are associated with orchitis?

136 Syphillis Mumps Viral illness Bacterial spread of epididymitis

137 What are the presenting signs/symptoms of polycystic kidney disease?

138 Pain Hematuria Nocturia (due to concentrating deficit) HTN (renal insufficiency) UTI’s and pyelonephritis Family history

139 What is the major cause of staghorn calculi?

140 Urea splitting organism (struvite stones)

141 What imaging modality should be used to diagnose polycystic kidney disease?

142 Ultrasound

143 What is the most common testicular tumor?

144 Seminomas

145 What organism must be considered in patients with recent or indwelling foley catheters with UTIs?

146 Pseudomonas

147 What is the leading cause of perinephric abscess?

148 Pyelonephritis

149 What causes painful penile ulcers?

150 Herpes Haemophilus ducreyi

151 What is the treatment for H. ducreyi?

152 Single dose: Azithromycin Ceftriaxone

153 What is Prehn’s sign and what does it distinguish?

154 Elevation of painful testicle decreases pain
Seen in epididymitis

155 What are some causes of nontraumatic hematuria?

156 GU tumors Vigorous exercise Renal disease/infection Bleeding disorders Dyes

157 What is the triad of HUS?

158 Hemolytic anemia Thrombocytopenia Renal insufficiency

159 Do we treat HUS or TTP with plasma exchange, FFP or Steroids?

160 TTP Treat HUS with supportive care.

161 POINT TALLY!!!

162 The End


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