Most Common Cancers: In women - Breast Cancer Gynecological - Endometrial Cancer Gynecological cancer associated with highest mortality

(in women of course) - Ovarian Cancer In women, associated with highest mortality (overall) - Lung Cancer Cardiac Changes in Pregnancy: Cardiac output increases --> increased HR, increased SV Decreased peripheral vascular resistance BP decreases during first 24 weeks with gradual return to non-pregnant levels by term Diastolic Murmurs are not normal finding Kallman Syndrome Hypogonadotropic hypogonadism (a lack of the pituitary hormones LH and FSH) Congenital (present from birth) anosmia (complete inability to smell) or hyposmia (decreased ability to smell) Indications for C-Section Cephalopelvic disproportion Failed induction of labor Active genital herpes; untreated HIV; cervical cancer Prior C-section Prior uterine rupture Obstruction of the birth canal; fibroids; ovarian tumors Non-reassuring Fetal testing: Bradycardia, absence of FHR variability; cord prolapse; fetal malpresentation; multiple gestations - non-vertex first twin; fetal anomalies Placental abruption; placenta previa

Velamentous insertion of the umbilical cord [http://www.vasaprevia.org/vasaprevia/velamentous.htm] - What effects can be seen in pregnancy?
Normally, the veins of the baby run from the middle of the placenta via the umbilical cord to the baby. Velamentous insertion means that the veins, unprotected by Wharton's jelly, traverse the membranes before they come together into the umbilical cord. The umbilical cord inserts on the placental mass in about 99% of cases. The insertion site may vary from the center of the fetal surface to the border of the placenta. The term velamentous insertion is used to describe the condition in which the umbilical cord inserts on the chorioamniotic membranes rather than on the placental mass.

Therefore, a variable segment of the umbilical vessels runs between the amnion and the chorion, losing the protection of the Wharton's jelly. The incidence of this condition is about 1.1% in singleton pregnancies and 8.7% in twin gestations. In twin pregnancies it is higher in monochorionic placentation or when the placentas are fused than when the placentasare non-fused. The incidence of velamentous insertion is even higher in early pregnancy; in spontaneous abortions it has been estimated to be 33% between the 9th and 12th weeks and 26% between the 13th and 16th weeks. The most significant clinical problem arising from a velamentous insertion of the umbilical cord is vasa previa, a dangerous condition in which the velamentous umbilical vessels traverse the fetal membranes in the lower uterine segment below the presenting part. In 6% of singleton pregnancies with a velamentous insertion, vasa previa is a coexisting condition. These unprotected vessels may rupture at any time during pregnancy, causing fetal exsanguination and death. Although spontaneous rupture has been reported before labor and with or without intact membranes, this accident occurs most often during amniotomy. One liners (not really...) You are a family practitioner in the ER, where you have to see an OB patient: you would refer her to the OB specialist after doing your initial evaluation Adverse effect of Epidural: The primary problem associated with receiving epidural anesthesia is low blood pressure, otherwise known as hypotension, because of the blocking of sympathetic fibers in the epidural space. The decreased peripheral resistance that results in the circulatory system causes dilation of peripheral blood vessels Most common cause of LATE post-partum hemorrhage - Uterine Atony Most common cause of EARLY post-partum hemorrhage - Failure to pass all of the placenta Main hormone from the ovaries - Estrogen (mainly Estradiol) [http://en.wikipedia.org/wiki/Endocrine_system]; if estrogen is not in the choices - ??? Human chorionic gonadotropin (hCG) is a glycoprotein hormone produced in pregnancy that is made by the developing embryo soon after conception and later by the syncytiotrophoblast (part of the placenta). Ovulation is controlled by the Endocrine system Operate within 15 minutes of the "decision to do a C-Section" - this was a question but 15 mins was not one of the answer choices!! choices were: 10, 20, 30, 60 mins Tumor/Cancer that is most sensitive to radiation - Dysgerminoma (Germ Cell tumor); slow growing Tumor/Cancer that is most sensitive to chemotherapy - rapidly growing tumor like choriocarcinoma Drug safe to use in pregnancy for seizures - Phenobarbital; Lamotrigine and Topiramate (may be); Definitely not Valproate I chose carbamazepine There's no fetal movement for 48 hours, would you do: C-section or NATURAL BIRTH What is worse - transverse septum of vagina; vertical septum; IMPERFORATE HYMEN Amniocentesis - Risk is that the fetal blood may pass into the maternal circulation -> Rheseus disease there was another question like this - chose mixing of the two bloods 20 y/o with irregular cycle; heavy bleeding - what to do? OCP BV - Vaginal discharge; Gardenerella; fishy odor; whiff test; Clue cells Trichomonas - Strawberry cervix; Green/Gray/Yellowish discharge Woman taking ampicillin for an infection has Candida infection Honeymoon UTI --> E-Coli Diagnose GDM with 1 hour OGTT --> 50g --> <140mg/dl Confirm with 3 hour test

Fibroids - Major side effect in Pregnancy - IUGR; Anemia Choricarcinoma - marker --> hcg Granulosa Theca Cell tumor --> Estrogen Ovarian cancer in general --> CA-125 Diagnosis for Breast Cancer --> Lymph node + If Lymph node negative --> low risk, low recurrence, no need for mastectomy Management of Abruptio Placenta - vaginal delivery is preferred as long as bleeding is controlled and no signs of fetal distress are seen Less than 50% deliver vaginally Marginal Placental Previa - Don't do a vaginal exam for placenta previa

Marginal Placenta Previa - placenta extends to the margin of the internal cervix opening; Partial Placenta Previa - placenta partially covers the internal cervical opening; Complete Placenta Previa - placenta completely covers internal cervical opening. Management of Vasa Previa - Emergency C-section Intracranial hemorrhage in fetus (3-4 qs) Appears as a hyperechoic region in the fetal brain or an echogenic structure in a ventricle Look up ultrasound images on google In the germinal matrix, the hemorrhage is located in the caudothalamic notch adjacent to the frontal horns of the lateral ventricles The echogenic mass represents a clot that is seen within the ventricles CT/MRI few months later will show calcifications germinal stage 1 - where does the blood collect?
http://www.sonoworld.com/fetus/page.aspx?id=1946

HIV in pregnancy --> C-Section + AZT Acardiac Twinning [http://www.jultrasoundmed.org/cgi/content/full/23/12/1663] which way does the blood flow? In this condition, the structurally normal pump twin provides blood supply to the parasitic acardiac twin in a retrograde, paradoxical fashion through a single superficial artery-to-artery anastomosis. Acardiac twinning, also known as the reversed arterial perfusion sequence, is a unique complication of monochorionic placentation occurring in 1% of monozygotic twins and 1 per every 35,000 pregnancies. In this condition, the structurally normal "pump" twin provides blood supply to the parasitic acardiac twin in a retrograde,

paradoxical fashion through a single superficial artery-to-artery anastomosis. In many cases, the continuous growth of the acardiac twin and the associated "vascular steal" phenomenon may lead to cardiac insufficiency and polyhydramnios in the pump twin. In such cases, intrauterine treatment to interrupt blood flow to the acardiac twin could be the only way to prevent perinatal death of the pump twin. Pre-eclampsia classified as: >140/90

Severe Pre-eclampsia classified as: SBP greater than 160 or DBP > 110; marked proteinuria; oliguria; increased creatinine; CNS disturbance; headache; vision blurriness Patient has male karyotype but has a rudimentary uterus with undescended testes - MIF deficient Pregnant woman (of course) with hyperthyroidism -- safe drug to use is PTU PTT problem in a pregnant woman (of course) - heparin; NEVER GIVE WARFARIN in Pregnancy (Warfarin is for PT problems) THere were 2 questions on this stuff: just know what structures you would see with each type of US - like what is each one used to look at specifically. Hyperechoic vs Hypoechoic ultrasound Hyperechoic is bright white Hypoechoic is dark - leiomyomas, endometriomas Hyperbilirubinemia in neonates treated with phototherapy IUGR Symmetrical - ALL parameters are smaller - Biparietal diameter of skull; abdominal circumfrence; femur length; cerebellar diameter Asymmetrical - Biparietal diameter is OK; abdominal circumfrence is small What causes diabetes in pregnancy - Human placental lactogen human chorionic somatomammotropin, is a polypeptide placental hormone. Its structure and function is similar to that of human growth hormone. It modifies the metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus. HPL is an anti-insulin. Best presentation in a twin pregnancy - Vertex/Vertex Epidural in the latent phase of labor [http://anesthesiadotcalm.org/Research/EpAnStOneLabor.htm] significantly prolong the first and second stages of labor, double the need for oxytocin augmentation, significantly delay cervical dilatation and produce more instrumental deliveries Most common ovarian cancer in the elderly - Serous Cystadenocarcinoma (epithelial origin) Stress incontinence - Treat with Terbutaline Most common complication of an IUD - infection Serious complication of an IUD - Uterine perforation Most common C-section cut - Infraumbilical (below the belly button) transverse cut Do not administer PGE or Oxytocin for a hypercontractile uterus Postpartum depression Cystocele - herniation or bulging of the anterior vaginal wall and overlying bladder base into the vaginal lumen Rectocele - herniation or bulging of the posterior vaginal wall and underlying rectum into the vaginal lumen Enterocele - herniation of the pouch of douglas into the vaginal lumen Molluscum Contagiosum are umbilicated papules; Pox virus; sharing towels; skin contact ASCUS Management - Pap Smear Repeat cytology in 3-6 months

HPV DNA typing Colposcopy and biopsy Folate intake important during pregnancy in women (of course) - Remember Neural Tube Defects Bicornuate Uterus = top middle portion is indented there was a girl who couldnt get pregnant and got a bimanual exam and they explained what they were feeling - sounded like bicornuate Septate Uterus = septum that runs down the inside of the uterus (pretty much dividing into two) Multiple cysts in the ovaries of reproductive age woman (Ultrasound shows) = Physiologic think of this first - corpus luteum or follicular cyst. disappears by themselves. check in a few months. may prescribe OCP. PCOS if other symptoms like hirsutism, hot flashes. Malignant Breast Cancer, lymph node negative - management Breast masses --differentials. For molar pregnancy - MTX can be used upto 9 weeks (???) Pain with defacation - Endometriosis Acyclic Bleeding (METRORRHAGIA) - Metrorrhagia refers to vaginal

bleeding among premenopausal women that is not synchronized with their menstrual period. It is often referred to as spotting.

Amenorrhea - absence of mensturation. Primary - Female (of course) who has NEVER had a period Secondary - Female (of course) who used to have a period but not anymore. absence of cycle for more than 90 days. Menorrhagia - Heavy periods Menometrorrhagia - Heavy irregular bleeding in females (of course) Infertility - 30% males, 30% females; 20% both... - so base your answer on this For checking infertility in a couple, it is always easier to check the male - do this first Female test is more invasive as I have read Phenytoin in pregnancy

Most common cause of nipple discharge - The most common cause of clinically significant discharge is intraductal growth of the ductal epithelium, resulting from hyperplasia, micropapillary proliferation, solitary papillomas, and/or ductal carcinoma (both in situ and invasive). Most of the intraductal changes that lead to nipple discharge are situated within 14 cm of the nipple. Choices were intraductal papilloma and other cancers - i think it was IP http://emedicine.medscape.com/article/347305-overview Down's - AFP is DOWN; Estriol is DOWN; hcg is UP Trisomy 18 - AFP, Estriol, hcg - DOWN NTD - AFP is UP, Estriol is normal; hcg is normal U/S - 10-14 weeks for fetal heart rate Amniocentesis - 15-20 weeks - asked about when you would see a change or variation in AFP readings during an amniocentesis procedure - mixing of maternal and fetal blood during procedure could alter results Obese african lady with a bunch of health hx - what factor will put her most at risk for endometrial ca = Obesity best dates to check for sex of baby = 20 weeks

The characteristics of fetal hydantoin syndrome include IUGR with small head circumference, dysmorphic facies, orofacial clefts, cardiac defects, and distal digital hypoplasia with small nails facial clefting, vitamin K and D deficiencies, heart malformations, limb deformities, and neurologic defects

Molar pregnancy will show a snowstorm appearance on the ultrasound - didnt see this q Medial cut for episiotomy - risk for tertiary tear - they asked what tissues would be saved if you had a tertiary tear - ans: rectal mucosa Frank position in a breach is most common - 10% of US babies delivered in breech position Ovulation induction - Clomiphene + Perganol (HMG) Adenomyosis - girl dx with abnormal bleeds retroverted vagina - myometrial nodules = adenomyosis is ans, fibroids - - small sized baby if mom were pregnant fibroids in uterus of AAF, bleeding, anemia - whats wrong with her? ans: fibroids

50something yo - malignant br.ca - tx: masectomy and chemo what does premature baby not get from breast milk? - calcium, fats, ?