USMLE done
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| Müllerian agenesis rare, congenital defect in which the Müllerian ducts fail to fuse, | - atretic uterus, cervix, and upper-third of the vagina.
- primary amenorrhea
- normal secondary sexual characteristics.
- normal ovaries
🗑
|
||||
| pt had ambiguous genitalia as an infant & now with primary amenorrhea, severe acne, tall stature, & several fractures following minor trauma. her mother had virilization during pregnancy. | - features are suggestive of low estrogen and high androgen levels.
Aromatase deficiency;
--normal internal genitalia
-- tall
-- cystic ovaries
🗑
|
||||
| Aromatase deficiency | tall stature due to a delayed fusion of the epiphyseal growth plates and signs of osteoporosis (e.g., bone fractures after minor trauma), caused by estrogen deficiency.
🗑
|
||||
| pt with obesity exhibits signs of isolated adrenarche and pubarche in the absence of thelarche and menarche, indicating peripheral precocious puberty (PPP). | obesity related hyperandrogenemia
GnRH pulsatility is not increased in PPP,
🗑
|
||||
| Early secondary sexual development with an advance bone age in a 6-year-old girl is indicative of precocious puberty. Elevation of serum LH levels after stimulation with a GnRH agonist indicates central precocious puberty | next step in management
- MRI of brain
🗑
|
||||
| development of secondary sexual characteristics in a 7-year-old girl indicates precocious puberty. The lack of elevation of LH levels following GnRH agonist stimulation indicates | peripheral precocious puberty.
-Granulosa cell tumor is a common cause of PPP
finding of a palpable mass in the lower abdomen and pelvic imaging shows enlarged ovaries
🗑
|
||||
| an adolescents with primary amenorrhea despite normal uterine development, negative pregnancy test. | gonadotropin levels should be tested.
- check serum FSH, LH levels
🗑
|
||||
| Vaginismus Genito-pelvic pain/penetration disorder | female psychosexual disorder
- involuntary tightening of the pelvic floor muscles during vagina penetration
- seen in ppl with relationship issues (sexual problem in the partner), poor body image, psychiatric disorders
🗑
|
||||
| Psychogenic dyspareunia | - pain during sexual intercourse
- not due to an underlying organic cause (e.g., endometriosis, vaginal infections)
🗑
|
||||
| Genito-pelvic pain/penetration disorder management | Pelvic floor physical therapy
🗑
|
||||
| onset of lower abdominal pain, dysuria, dyspareunia, and vaginal discharge, along with physical findings such as uterine tenderness in a sexually active woman, are highly suggestive of | pelvic inflammatory disease (PID)
- intramuscular ceftriaxone and oral doxycycline is the first-line treatment for PID
- Oral administration of levofloxacin and azithromycin is suitable for pts with penicillin allergies.
🗑
|
||||
| Trichomonas vaginalis | - flagellated protozoa that can cause sexually transmitted infections such as vaginitis or urethritis
🗑
|
||||
| Patients with recent use of antibiotics, foul-smelling, frothy, yellow-green, purulent vaginal discharge with a pH > 4.5. | Trichomonas vaginalis
🗑
|
||||
| HPV-16 and HPV-18 | the oncogenic high-risk HPV strains
🗑
|
||||
| HPV strains 6 and 11 | 90% of genital warts, or condylomata acuminata.
- lesions are cauliflower-like , a flat, papular, or pedunculated shape
- commonly found on the mucosa or along the epithelium of the anogenital tract.
🗑
|
||||
| pt presents with septic shock (leukocytosis, fever, tachycardia, low blood pressure), diffuse erythematous rash, skin peeling, acute kidney injury, & thrombocytopenia. This presentation indicates ? | toxic shock syndrome (TSS), likely due to Staphylococcus aureus
🗑
|
||||
| test of choice in the diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae | Nucleic acid amplification test of vaginal fluid, urine
🗑
|
||||
| Rx of choice for Disseminated gonococcal infection? | Intravenous ceftriaxone
🗑
|
||||
| Pt has thin whitish vaginal discharge, PH 5.1 and the wet mount showing vaginal epithelial cells covered with bacteria , this patient most likely has ? | bacterial vaginosis caused by Gardnerella vaginalis.
Rx; Metronidazole
🗑
|
||||
| pregnant pt's with vulvar pruritus, dysuria, & whitish, chunky discharge, combined with pseudohyphae & hyphae with budding yeast on wet mount with potassium hydroxide, indicates | - a vaginal yeast infection.
appropriate treatment for pregnant women;
Intravaginal clotrimazole
🗑
|
||||
| The USPSTF recommends screening for N. gonorrhoeae and C. trachomatis infections in ? | - sexually active women ≤ 24 years of age
- older women with specific risk factors (e.g., women with new or multiple sex partners).
🗑
|
||||
| Fluorescent treponemal antibody absorption test (FTA-ABS) | - detects specific antibodies to treponemal antigens.
- confirmatory test
- performed after positive nontreponemal test such as venereal disease research laboratory (VDRL) or rapid plasma reagin (RPR) test
🗑
|
||||
| effective treatment of syphilis in pregnant women. | Penicillin
- desensitization to penicillin should be performed in all patients with penicillin allergies who are diagnosed with syphilis
🗑
|
||||
| sexually active patient presents with mucopurulent, foul-smelling vaginal discharge and cervical erythema, indicating cervicitis. | - NAAT is the test of choice to diagnose chlamydial genitourinary infection
- detects chlamydial RNA or DNA from vaginal swabs.
- 1 dose of oral azithromycin is first-line Rx both in pregnant & nonpregnant pts
🗑
|
||||
| Pt is a sexually active adolescent, has multiple hyperkeratotic exophytic papules over the valvula and turns white on application of 3% acetic acid indicates? | HPV infection.
- Condylomata acuminata
vaccine given starting at the age of 11–12 years
rx; cryotherapy
🗑
|
||||
| toddler presents with treatment-resistant, blood-tinged, foul-smelling vaginal discharge, and vaginal erythema, which suggest | - vulvovaginitis that appears to be caused by a vaginal foreign body (tissue paper)
Rx; vaginal irrigation with warm saline water.
***In children presenting with a vaginal foreign body, the possibility of sexual abuse should always be considered.
🗑
|
||||
| pt with a left-sided, erythematous, edematous tender mass in the left inner labia that is causing pain with movement and dyspareunia. These features are consistent with? | a Bartholin gland abscess.
Rx; Incision and drainage followed by irrigation and packing
** change packing regularly and remove within 2 days.
OR
- fistulization with a Word catheter
🗑
|
||||
| Bartholin gland abscess | - acute infection of a Bartholin gland or Bartholin gland cyst,
- commonly due to E. coli. Strep, Staph
- unilateral pain & swelling of the vulva
- dyspareunia
🗑
|
||||
| patient presents with a mass that is characteristically found only at the four and eight o'clock positions of the vestibule of the vagina. mass shows no sign of inflammation | Bartholin gland cyst
Obstruction of the orifice of Bartholin gland duct by inflammation or trauma --> formation of palpable mass in posterior vaginal introitus
🗑
|
||||
| Bartholin gland cyst management | Sitz baths to facilitate rupture of the cyst.
🗑
|
||||
| Granuloma inguinale Donovanosis | STI by Klebsiella granulomatis
- painless nodules that eventually ulcerate to form large, beefy-red lesions that bleed easily.
- regional lymph nodes are typically spared
🗑
|
||||
| painful purulent and necrotic ulcers and lymphadenopathy suggest a sexually transmitted infection with a gram-negative organism. | Chancroid/ Soft chancre
STD
- by Haemophilus ducreyi.
- Pt's present with one or more painful genital ulcers
- with painful, suppurative inguinal lymphadenopathy
rx; single dose oral azithromycin or intramuscular ceftriaxone.
🗑
|
||||
| What is the appropriate treatment for pyelonephritis during pregnancy? | pregnant women with pyelonephritis should be admitted and receive IV cefotaxime therapy.
🗑
|
||||
| pt present with dysuria & tenderness to palpation over pelvic region, elevated WBCs in the urine, positive nitrites, and bacteriuria, are consistent with | cystitis
- caused by an ascending bacterial infection from urethra
- E. coli is the most common causative organism
🗑
|
||||
| Cystitis | Escherichia coli ( urinary nitrites)
Staphylococcus saprophyticus ( no urinary nitrites )
🗑
|
||||
| first-line treatment for acute uncomplicated cystitis in nonpregnant women is | TMP-SMX for 5 days
Alternative first-line Rx; nitrofurantoin for 3 days
or fosfomycin 1 dose.
🗑
|
||||
| Pts with a urinary tract infection (UTI) (suprapubic tenderness, urine nitrites, >WBC, urine bacteria, alkaline urine (pH > 7)) with delirium and an indwelling urinary catheter | most likely infected with Proteus mirabilis.
- converts urea in urine into ammonia --> an alkalizing effect.
- empiric Rx; parenteral ceftriaxone/ciprofloxacin,
- urine culture & sensitivity testing,
- replacement of the urinary catheter
🗑
|
||||
| pt with bladder discomfort for 5 months, > urinary frequency, suprapubic tenderness, dyspareunia. urine dipstick is negative for leukocyte esterase, pyuria, or nitrites. | Interstitial cystitis
Bladder pain syndrome
- diagnosis of exclusion & other causes of cystitis such as UTI, STI, /bladder masses must be ruled out first.
🗑
|
||||
| Pyelonephritis | infection of the renal pelvis and parenchyma
- presents with flank pain,
- costovertebral angle tenderness,
- fever,
- features of cystitis (e.g., dysuria, frequency).
🗑
|
||||
| pt has no urinary frequency or dysuria. Her urinalysis is positive for leukocyte esterase and nitrite. urine culture grows E. coli. This indicates? | asymptomatic bacteriuria.
- Screening for asymptomatic bacteriuria is recommended for all pregnant women in the first trimester.
🗑
|
||||
| first-line antibiotic agent for asymptomatic bacteriuria during pregnancy? | Amoxicillin/clavulanate
🗑
|
||||
| Other antibiotic agents used to treat cystitis that are safe during pregnancy include | - oral cephalosporins (e.g., cefpodoxime, cephalexin),
- fosfomycin,
- nitrofurantoin (during the 2nd and 3rd trimesters)
** fluoroquinolones (cipro) are contraindicated during pregnancy.
🗑
|
||||
| Complicated urinary tract infection | factors that > risk of infection/failed therapy
- male sex
- pregnancy
- childhood, functional/anatomical abnormalities (BPH, kidney stones)
- immunocompromise, multi-drug resistant bacteria, catheterization or instrumentation, recent antibiotic use.
🗑
|
||||
| pregnant Pt with increased urinary frequency, dysuria, flank pain & positive leukocyte esterase, urine nitrites. costovertebral tenderness on palpation. | likely has an acute urinary tract infection (UTI)
- Hormonal changes during pregnancy affect the urinary tract --> risk of asymptomatic bacteriuria --> acute cystitis, acute pyelonephritis
Rx: intravenous empiric antibiotics (e.g., ceftriaxone)
🗑
|
||||
| UTI in pregnancy | > progesterone in pregnancy -> ureteral smooth muscle relaxation and ureteral dilation.
expanding uterus pressure on bladder -> ureteral dilation.
Ureteral dilation --> urinary stasis & ureterovesical reflux -> ascending bacterial infections.
🗑
|
||||
| Pts with recurrent UTI should be treated with prophylactic antibiotics for at least 3 months after eradication of their current UTI. | Continuous or postcoital trimethoprim-sulfamethoxazole
alternatives; nitrofurantoin/ cephalexin /ciprofloxacin.
🗑
|
||||
| Recurrent UTI management | Supportive; consistent postcoital voiding & > fluid intake to increase frequency of micturition.
- self-medication at first onset of symptoms; short course of TMP-SMX / quinolone
- Continuous /postcoital TMP-SMX, nitrofurantoin, cephalexin, quinolone,
🗑
|
||||
| Amoxicillin-clavulanate | - second-line agent for acute uncomplicated cystitis in nonpregnant women
- first-line agent for uncomplicated cystitis in pregnant women.
🗑
|
||||
| Urge incontinence | increased detrusor muscle activity--> involuntary detrusor muscle contraction & urinary tenesmus --> sudden release of urine.
RX; Anticholinergic agents ( oxybutynin
🗑
|
||||
| Stress incontinence | - involuntary leakage of urine,
- activity associated with increased intra-abdominal pressure (e.g., coughing, sneezing).
-caused by sphincteric resistance overcome by bladder pressure (pelvic floor weakness, intrinsic sphincter deficiency,).
🗑
|
||||
| Urethral hypermobility | one of the most common causes of stress incontinence.
- urethral hypermobility can result from postmenopausal estrogen loss and as part of the normal aging process.
🗑
|
||||
| elderly pt presents after the acute onset (2 weeks) of urinary incontinence, urgency, and frequency, which suggests a possibly reversible cause of incontinence. | UTI is a common cause of acute urinary incontinence in elderly patients;
urinalysis should be performed to screen for signs of infection.
🗑
|
||||
| If urinalysis is positive in elderly Pts | empiric treatment; TMP-SMX or fosfomycin
If symptoms still persist after 48-72 hrs complicated UTI (e.g., due to resistant bacteria) is likely; administer fluoroquinolones
🗑
|
||||
| first-line surgical procedure for stress incontinence | A urethral sling
done if conservative therapy; pelvic floor muscle exercises (Kegel exercises),
lifestyle changes (e.g., weight loss, alcohol cessation),
& use of continence pessaries have failed.
🗑
|
||||
| Pelvic pain and/or pressure, which worsens on standing or walking, in presence of posterior vaginal wall protrusion & lax sphincter tone on pelvic examination, is diagnostic of ? | enterocele.
- Herniation of a peritoneum-lined sac, containing a portion of the small bowel, into the rectovaginal space.
🗑
|
||||
| pt's 6 hrs after giving birth has involuntary loss of urine, Blood-red vaginal discharge abdominal distention, & tenderness after administration of epidural analgesia suggest ? | overflow incontinence
- Postpartum urinary retention
***Blood-red vaginal discharge (lochia rubra) is a normal finding during the first 4 days after birth
🗑
|
||||
| Postpartum urinary retention risk factors | - spinal anesthesia (< bladder & internal sphincter contractility as well as the micturition reflex)
- vaginal delivery (perineal trauma can injure the pudendal nerve -> dysfunction external urethral sphincter.)
- episiotomy,
- primiparity.
🗑
|
||||
| Combined oral contraceptive pills (those containing both estrogen and progestin) are contraindicated in | - women over 35 years who smoke due to an increased risk of venous thromboembolism.
- cardiovascular diseases , metabolic disorders ,
- estrogen-dependent tumors,
- SLE, and/or vasculitis.
🗑
|
||||
| viable option for postpartum contraception | - breastfeeding women, progestin-only contraceptive pills (minipill) or progestin-only implants.
- estrogen-containing combined contraceptives may reduce breast milk production (inhibition of prolactin activity) & enter milk
🗑
|
||||
| estrogen-containing oral contraceptives increases the risk of | - cardiovascular events; hypertension & thromboembolism.
- headaches
- hyperlipidemia
- a mild increase in the incidence of hepatic adenomas.
🗑
|
||||
| Estrogen found within OCPs decreases | protein S levels.
- protein S is an essential cofactor for protein C, which inactivates procoagulant factors Va and VIIIa,
🗑
|
||||
| the recommendation for preventing thrombosis and pregnancy-related complications in pregnant women with antiphospholipid syndrome? | A regimen of low-dose aspirin and low molecular weight heparin (e.g., such as enoxaparin),
🗑
|
||||
| pt's has galactorrhea, irregular menses, vaginal atrophy, headaches & confirmatory hormone assays, positive findings on MRI (probably an intrasellar mass) are suggestive of | hyperprolactinemia.
prolactin-secreting pituitary adenoma (i.e., prolactinoma)
🗑
|
||||
| first-line treatments of prolactinomas | Dopamine receptor agonists (cabergoline or bromocriptine )
- induce regression of tumor size,
-decrease prolactin secretion
🗑
|
||||
| Primary hypothyroidism | In addition to increasing TSH production,
excessive TRH also stimulates the lactotroph cells of the anterior pituitary to release prolactin,
🗑
|
||||
| Anorexia nervosa complication | Severe bone loss and subsequent fractures
prolonged QT interval.
functional cardiac abnormalities, including hypotension, bradycardia
🗑
|
||||
| Osteopenia | A reduction of bone mineral density with a T-score of -1 to -2.5.
- lack of estrogen or testosterone,
- lack of exercise,
- alcohol and cigarette consumption, and use of glucocorticoids
🗑
|
||||
| Osteoporosis | affects postmenopausal women and the elderly population,
- loss of bone mineral density leads to decreased bone strength --> increased susceptibility to fractures.
🗑
|
||||
| combination of a painful, itchy breast lump and erythematous, edematous overlying skin with axillary lymphadenopathy in a postmenopausal woman is suggestive | inflammatory breast cancer
- results from the infiltration of the dermal lymphatics,
🗑
|
||||
| pt with LCIS that is ER positive. She is being treated with the selective estrogen receptor modulator (SERM) tamoxifen, which has both agonist and antagonist effects on ER in the body. | - antagonist effects on the breast tissue
- agonist effects in the bone and uterine tissue.
🗑
|
||||
| pt has multiple risk factors for breast cancer, including nulliparity, late menopause & HRT. What is the most appropriate next step in a patient with a high risk of breast cancer and suspicious findings on mammography? | ultrasound-guided core needle biopsy
🗑
|
||||
| pt presents with fatigue, ascites, weight loss, and a right adnexal mass, all of which are suggestive of | diagnosis of ovarian cancer.
elevated CA-125
- CA-125 levels should be used with transvaginal u/s to assess the size & characteristic of her adnexal mass,
followed by surgery to conclusively determine pathology
🗑
|
||||
| Despite a pt's relatively young age (< 35 years), a nontender, firm, nonmobile breast mass is concerning for breast cancer. | Mammography is the recommended imaging modality for the evaluation of a breast lump in women older than 30 years of age.
🗑
|
||||
| diagnostic and therapeutic procedures used as a first-line intervention in pts with newly diagnosed invasive ductal carcinoma. | - lumpectomy (breast-conserving surgery) followed by whole-breast radiation therapy
- sentinel node biopsy
🗑
|
||||
| Early-stage infiltrating lobular carcinoma is usually treated with breast-conserving therapy and adjuvant systemic therapy. however treatment for pregnant women is? | regimen with low risk of fetal damage
- Surgical resection with adjuvant radiation therapy after delivery
- surgical resection with chemotherapy after 1st trimester.
- or complete mastectomy
🗑
|
||||
| pt has early stage, invasive breast cancer with a large breast/tumor ratio and no clinically apparent skin, nipple, or axillary lymph node involvement. | RX of early stage invasive breast cancer involves;
- breast-conserving therapy with lumpectomy followed by radiation therapy,
- sentinel lymph node biopsy to evaluate for spread
- adjuvant hormone therapy (e.g., tamoxifen) if ER +ve
🗑
|
||||
| pt's with menorrhagia has multiple intramural masses, visualized on ultrasound. what is next step in preoperative therapy in this pt with a leiomyoma? | The goal of preoperative therapy is;
- decrease size of the leiomyomatous uterus
- to correct anemia by decreasing blood loss
- prescribe GnRH agonist (e.g., leuprolide)
🗑
|
||||
| Paget disease of the breast | - ductal carcinoma that infiltrates the nipple-areola complex
- a scaly erythematous rash of the nipple and areola.
- pruritus, burning, and/or nipple retraction.
🗑
|
||||
| a postmenopausal women with endometrial thickness > 5 mm and no evidence of atypia or invasion on endometrial biopsy, is diagnostic of? | endometrial hyperplasia.
Rx of choice is progestin therapy.
Follow-up with ultrasound after 3–6 months
🗑
|
||||
| HER2/neu positive tumors management | trastuzumab & chemotherapeutic agents such as anthracyclines and taxanes.
AVR; cardiotoxic (e.g., dilated cardiomyopathy with systolic CHF).
Before RX, an echocardiogram should be performed to evaluate cardiac function,
🗑
|
||||
| if a Pap smear shows a HSIL, or if atypical squamous cells are seen but HSIL cannot be ruled out (ASC-H). | Colposcopy should be performed
🗑
|
||||
| if the patient showed premalignant cervical changes | A directed cervical biopsy would be performed
🗑
|
||||
| if the initial Pap smear had shown atypical squamous cells of undetermined significance (ASC-US). | repeat Pap smear (exfoliative cytology) in 6–12 months
🗑
|
||||
| A Pap smear should be conducted to screen for cervical cell dysplasia | every 3 years starting at 21 years or every 5 years at 30 years, if combined with HPV testing
🗑
|
||||
| According to the USPSTF, women should start breast cancer screening at the age of | 50 with a mammogram every 2 years until the age of 74.
- women who have several risk factors for breast cancer (early menarche, nulliparity) or a first-degree relative who had breast cancer, mammography should be recommended at 40
🗑
|
||||
| Pregnancy luteoma Luteoma | A rare, benign tumor of the ovary thought to be caused by the hormonal effects of pregnancy.
- manifest with symptoms of virilization..
- Larger ones --> increased mass effect, torsion and lead to secondary hemorrhage
- expectant management
🗑
|
||||
| pt presents with virilization (hirsutism and deepening of the voice), a palpable adnexal mass, which suggests | a testosterone-producing ovarian tumor.
-Sertoli-Leydig cell tumors
- increased levels of testosterone, DHEA, androstenedione, and dihydrotestosterone.
- DHEA-S is normal
🗑
|
||||
| Lymphangiosarcoma/Angiosarcoma of the breast | - condition occurs as a result of chronic lymphedema
- is now rare, since breast-sparing surgery techniques are favored & radical mastectomy has become less common.
- multiple purple-colored, macules, and/or papules,
🗑
|
||||
| HPV immunization | - 2 doses of HPV vaccine should be administered 6 months apart to all individuals 9–14 years of age.
-unvaccinated female patients 15–26 years of age, 3 doses of nine-valent HPV vaccine.
🗑
|
||||
| If a Pap smear shows LSIL, in a pt 25 years of age or older. | immediate colposcopy is performed
🗑
|
||||
| If a Pap smear shows LSIL, in a pt 21 - 24 years of age | Pap smear should be repeated twice at 12-month intervals
lesion usually spontaneously resolves over time
🗑
|
||||
| pt presents with a high-grade squamous intraepithelial lesion (HSIL) and signs of CIN 2, 3 on colposcopy. Since the patient is pregnant, management is | Reevaluation with cytology and colposcopy 6 weeks after birth
OR
reevaluation with cytology and colposcopy not more often than every 12 weeks during pregnancy
options such as neoadjuvant chemotherapy or termination of pregnancy IN ADVANCED
🗑
|
||||
| Vaginal carcinoma | - postmenopausal bleeding,
- pelvic exam will usually show a mass (or plaque) on the vaginal wall,
- symptoms related to local extension; such as urinary frequency.
-diagnosis requires a biopsy of the suspicious lesion and histological confirmation.
🗑
|
||||
| Pts with high-risk findings on Pap smear such as atypical glandular cells, HSIL, and ASC-H | - endocervical sampling and colposcopy
- also endometrial sampling in pts who are above 35 years / have > risk factors for endometrial adenocarcinoma (unexplained vaginal bleeding, chronic anovulation)
🗑
|
||||
| hx of C-section followed by fever, uterine tenderness, and foul smelling lochia indicates postpartum endometritis | polymicrobial infection;
both gram-positive (Staphylococcus epidermidis and group B Streptococcus) and gram-negative (Gardnerella vaginalis) bacteria.
Rx; combination of IV clindamycin and gentamicin.
🗑
|
||||
| Cesarean delivery (especially when performed after onset of labor) is the most important risk factor for this condition. Prolonged labor is a further risk factor for this condition | Postpartum endometritis
several days after a cesarean delivery for prolonged labor;
- lower abdominal pain,
- uterine tenderness,
- foul-smelling lochia,
- fever, tachycardia,
- leukocytosis
🗑
|
||||
| During pregnancy, a certain gland becomes significantly enlarged, making it prone to damage. | Pituitary ischemia is the underlying pathophysiology of Sheehan syndrome.
hypopituitarism ; ischemia of the anterior pituitary
posterior pituitary gland hormones, ADH and oxytocin, are not typically affected in sheehan
🗑
|
||||
| postpartum deep venous thrombosis (DVT) | - peak in the first 6 weeks postpartum
- Smoking
- immobilization after delivery
- surgical delivery
- maternal age > 35 years, and preterm delivery
🗑
|
||||
| the initial treatment of choice for postpartum deep venous thrombosis (DVT) | LMWH, administered subcutaneously,
- its immediate antithrombotic effect and safety during breastfeeding
- before introducing an oral anticoagulation
🗑
|
||||
| Uterine atony | Failure of the uterus to effectively contract after delivery
- most common cause of postpartum hemorrhage.
-soft and enlarged uterus
-abnormal vaginal bleeding
- non contracted uterus after delivery
🗑
|
||||
| Uterine atony management | -Bimanual uterine massage
- uterotonic agents (oxytocin, misoprostol, carboprost)
- Tranexamic acid should be given as soon as possible after bleeding onset to stop fibrinolysis
-B-Lynch uterine compression suture
** carboprost is a NO in asthma pt
🗑
|
||||
| Placenta accreta | - placenta is directly adherent to the myometrium (without penetrating)
- delayed placental detachment,
- massive life-threatening postpartum hemorrhage at the time of attempted manual separation of the placenta,
🗑
|
||||
| pt presents with brisk postpartum hemorrhage, a round mass protruding from the vagina, and no fundus (top of the uterus) in place after vaginal delivery. Which condition could cause these clinical findings? | Uterine inversion
- uterine fundus collapses into the endometrial cavity --> turns the uterus partially or completely inside out.
-severe postpartum hemorrhage
- a round, protruding mass from the cervix or vagina.
🗑
|
||||
| Uterine inversion management | - discontinue Oxytocin
- crystalloids and blood products administered as needed.
** surgical repair If the uterus cannot be repositioned manually after administration of a uterine relaxant (e.g., nitroglycerine)
🗑
|
||||
| Uterine atony first line management | Bimanual uterine massage
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
beccao
Popular USMLE sets