<div class=card><span class=cloze>[...]</span> is a <u>preterm</u> baby with <u>premature</u> rupture of membranes without contractions<b>.</b></div><div class=card><span class=cloze>Preterm Premature Rupture of Membranes (PPROM)</span> is a <u>preterm</u> baby with <u>premature</u> rupture of membranes without contractions<b>.</b></div> <br> <br> <div class=extra>preterm AND premature rupture.</div> <!--<div class=tags>OBgyn obstetrics_gynecology</div>-->
<div class=card>What is the estimated week of gestation if the measured fundal height is at the navel?<div><br /></div><div><span class=cloze>[...]</span></div></div>"<div class=card>What is the estimated week of gestation if the measured fundal height is at the navel?<div><br /></div><div><span class=cloze>20 weeks</span></div></div> <br> <br> <div class=extra><div><i>fundal height ~ gestational age +/- 3 weeks</i></div><img src=""L20871.jpg"" /></div> <!--<div class=tags>OBGYN obstetrics_gynecology</div>-->"
<div class=card>Before which gestational age should <b>Betamethasone</b> (BMZ) always be given to mothers admitted to labour &amp; delivery?<div><br /></div><div><span class=cloze>[...]</span></div></div><div class=card>Before which gestational age should <b>Betamethasone</b> (BMZ) always be given to mothers admitted to labour &amp; delivery?<div><br /></div><div><span class=cloze>Before <b>36 and 6</b>&nbsp;weeks</span></div></div> <br> <br> <div class=extra></div> <!--<div class=tags>obstetrics pregnancy</div>-->
<div class=card>How does <b>prior C-section and</b>&nbsp;<b>placenta previa </b>change the risk of <b>Placenta Accreta?</b><div><br /></div><div><span class=cloze>[...]</span></div></div><div class=card>How does <b>prior C-section and</b>&nbsp;<b>placenta previa </b>change the risk of <b>Placenta Accreta?</b><div><br /></div><div><span class=cloze>Increase</span></div></div> <br> <br> <div class=extra><i>accreta = placenta stuck on uterus ... gotta go digging deeper for gold if there's prior scarring/bad implantation.</i></div> <!--<div class=tags>obstetrics pregnancy</div>-->
<div class=card><span class=cloze>[...]</span> occurs when placental villi attach <b>directly</b> onto the myometrium.</div>"<div class=card><span class=cloze>Placenta Accreta</span> occurs when placental villi attach <b>directly</b> onto the myometrium.</div> <br> <br> <div class=extra><i>leading to inability to separate from uterus during delivery<br /></i><div><i><br /></i></div><div><i><img src=""19163.jpg"" /></i></div></div> <!--<div class=tags>obstetrics pregnancy</div>-->"
<div class=card>What are Braxton Hicks contractions?<div><br /></div><div><span class=cloze>[...]</span></div></div><div class=card>What are Braxton Hicks contractions?<div><br /></div><div><span class=cloze>Uterine contractions <u>absent</u> from cervical changes</span></div></div> <br> <br> <div class=extra>Irregular, weak uterine contractions that do not increase in frequency, intensity or duration. These contractions may be noticed by the patient starting in the second trimester. They usually occur infrequently (typically ≤ 2/hour), last for up to 1 minute, and are not associated with cervical changes or descent of the presenting part. They typically stop with rest, walking, and/or a change in position.</div> <!--<div class=tags>labour_delivery obstetrics</div>-->
<div class=card>What is the classic triad of signs of placental separation (during delivery)?<div><br /></div><div><span class=cloze>[...]</span></div></div><div class=card>What is the classic triad of signs of placental separation (during delivery)?<div><br /></div><div><span class=cloze>Gushing of blood; umbilical cord lengthening; Rising and firming of the uterine fundus</span></div></div> <br> <br> <div class=extra></div> <!--<div class=tags>labour_delivery obstetrics</div>-->
<div class=card>What are the 3 tests for&nbsp;rupture of membranes (ROM)?<div><br /></div><div><span class=cloze>[...]</span></div></div>"<div class=card>What are the 3 tests for&nbsp;rupture of membranes (ROM)?<div><br /></div><div><span class=cloze><b><u>Vaginal</u> </b>pooling via <u>speculum</u> exam; <u>Nitrazine and Ferning </u>test on <u style=""font-weight: bold; "">vaginal</u>&nbsp;fluid</span></div></div> <br> <br> <div class=extra>Nitrazine test turns <font color=""#5500ff""><b>blue</b></font><div><b>Ferning</b> on glass slide</div><div>Test vaginal fluid, not cervix.&nbsp;</div></div> <!--<div class=tags>labour_delivery obstetrics</div>-->"
"<div class=card>What are the ""3 P's"" for the causes of abnormal labour?<div><br /></div><div><span class=cloze>[...]</span></div></div>""<div class=card>What are the ""3 P's"" for the causes of abnormal labour?<div><br /></div><div><span class=cloze><b>Power</b>&nbsp;(uterine contractions); <b>Passenger</b> (fetus); <b>Passage</b> (pelvis)</span></div></div> <br> <br> <div class=extra></div> <!--<div class=tags>labour_delivery obstetrics</div>-->"
"<div class=card>What is the cause of <b>late FHR decelerations</b>?<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""paste-506136126029825.jpg"" /></div></div>""<div class=card>What is the cause of <b>late FHR decelerations</b>?<div><br /></div><div><span class=cloze>Uteroplacental insufficiency and insufficient fetal blood flow/oxygenation</span></div><div><br /></div><div><img src=""paste-506136126029825.jpg"" /></div></div> <br> <br> <div class=extra><br /><div><i>Hence can be caused by abruptio placentae, excessive uterine conractions, maternal hypotension, maternal anaemia, IUGR.</i></div><div><i>Associated with <b>progressive fetal hypoxia</b>&nbsp;and <b>acidemia</b>.</i></div><div><i><br /></i></div><div><i><img src=""paste-326451874234371_1529603012320.jpg"" /></i></div></div> <!--<div class=tags>FHR obstetrics</div>-->"
<div class=card>What constitutes a reactive NST?<div><br></div><div><span class=cloze>[...]</span></div></div>"<div class=card>What constitutes a reactive NST?<div><br></div><div><span class=cloze>2 FHR accelerations in 20 minutes</span></div></div> <br> <br> <div class=extra><br /><div><i>NST is recorded for a maximum 40 minutes.</i></div><div><i>Remember, a FHR acceleration is an increase by ≥ 15 bpm for ≥ 15 seconds.</i></div><div><i><br /></i></div><div><i><img src=""paste-19542101197514.jpg"" /></i></div></div> <!--<div class=tags>FHR obstetrics</div>-->"
<div class=card>What is the most common cause of<b> postpartum hemorrhage?</b><div><br /></div><div><span class=cloze>[...]</span></div></div>"<div class=card>What is the most common cause of<b> postpartum hemorrhage?</b><div><br /></div><div><span class=cloze>Uterine Atony (90%)</span></div></div> <br> <br> <div class=extra><i>uterus is ""tired"" and cannot contract; causes listed below.</i><div><i><b><br /></b></i></div><div><i><b><img src=""paste-315263484428289.jpg"" /></b></i></div></div> <!--<div class=tags>labour_delivery obstetrics</div>-->"
<div class=card>What is the contraindication for&nbsp;Prostaglandin F2_alpha&nbsp;(Hemabate) in postpartum hemorrhage?<div><br /></div><div><span class=cloze>[...]</span></div></div><div class=card>What is the contraindication for&nbsp;Prostaglandin F2_alpha&nbsp;(Hemabate) in postpartum hemorrhage?<div><br /></div><div><span class=cloze>Asthma</span></div></div> <br> <br> <div class=extra><i>smooth muscle constrictor for decreasing uterine bleeding but also <b>bronchoconstricts.</b></i></div> <!--<div class=tags>labour_delivery obstetrics</div>-->
<div class=card>What is the most common cause of abnormal uterine bleeding in <b>postmenopausal</b>&nbsp;women?<div><br /></div><div><span class=cloze>[...]</span></div></div>"<div class=card>What is the most common cause of abnormal uterine bleeding in <b>postmenopausal</b>&nbsp;women?<div><br /></div><div><span class=cloze>Atrophic vaginitis</span></div></div> <br> <br> <div class=extra><br /><div><i>Due to the loss of estrogen after menopause and the subsequent drying and atrophy of vaginal dermal tissue; treat with <b>estrogen cream</b>;&nbsp;however, <b>still get biopsy to r/o endometrial cancer.</b></i></div><div><i><br /></i></div><div><i><img src=""paste-30588757082113_1529603012320.jpg"" /></i></div></div> <!--<div class=tags>gynaecology uterine_bleeding</div>-->"
<div class=card>What malignancy must be ruled out in all postmenopausal women with uterine bleeding?<div><br /></div><div><span class=cloze>[...]</span></div></div>"<div class=card>What malignancy must be ruled out in all postmenopausal women with uterine bleeding?<div><br /></div><div><span class=cloze>Endometrial carcinoma</span></div></div> <br> <br> <div class=extra><br /><div><i>Ruled out with endometrial Bx.</i></div><div><i>In fact, <b>vaginal bleeding in a postmenopausal woman is cancer until proven otherwise</b>.</i></div><div><i><br /></i></div><div><i><img src=""paste-30588757082113_1529603012320.jpg"" /></i></div></div> <!--<div class=tags>gynaecology uterine_bleeding</div>-->"
<div class=card>What procedure offers a definitive diagnosis for Endometriosis?<div><br /></div><div><span class=cloze>[...]</span></div></div>"<div class=card>What procedure offers a definitive diagnosis for Endometriosis?<div><br /></div><div><span class=cloze>Diagnostic Laparoscopy</span></div></div> <br> <br> <div class=extra><i>only way to <b>visualize</b> the ectopic endometrial tissue and adhesions.</i><div><div><i><br /></i></div><div><i><img src=""big_59ee14beb646c.jpg"" /></i></div></div></div> <!--<div class=tags>endometriosis gynaecology</div>-->"
<div class=card>Which antidiabetic is used to treat infertility in&nbsp;Polycystic Ovarian Syndrome (PCOS)?<div><br /></div><div><span class=cloze>[...]</span></div></div><div class=card>Which antidiabetic is used to treat infertility in&nbsp;Polycystic Ovarian Syndrome (PCOS)?<div><br /></div><div><span class=cloze>Metformin</span></div></div> <br> <br> <div class=extra><i>helps with inducing ovulation (<b>clomiphene</b> is better, though)</i></div> <!--<div class=tags>gynaecology gynecology</div>-->
<div class=card>Which class of drugs is known to prevent <b>ovarian cancer?</b><div><br /></div><div><span class=cloze>[...]</span></div></div><div class=card>Which class of drugs is known to prevent <b>ovarian cancer?</b><div><br /></div><div><span class=cloze>OCPs</span></div></div> <br> <br> <div class=extra><i>decrease damage to ovaries from ovulation.</i></div> <!--<div class=tags>gynaecology gynecological_oncology gynecology oncology</div>-->
<div class=card>What is the medical treatment for ectopic pregnancy?<div><br /></div><div><span class=cloze>[...]</span></div></div>"<div class=card>What is the medical treatment for ectopic pregnancy?<div><br /></div><div><span class=cloze>Methotrexate</span></div></div> <br> <br> <div class=extra><i>gestational size must be &lt; <b>3 </b>cm, b-HCG &lt; <b>5000</b>, and <b>no fetal heart tones</b> must be present (success of methotrexate requires early gestation).&nbsp;</i><div><i><br /></i></div><div><i><img src=""paste-278940946006017.jpg"" /><br /></i><div><br /></div><div><img src=""paste-259205571280897.jpg"" /><br /><div><i><b><br /></b></i></div><div><i><b></b></i><i><img src=""paste-53725745905665.jpg"" /></i></div></div></div></div> <!--<div class=tags>gynaecology gynecology obstetrics</div>-->"
<div class=card>What is the only IUD that can <b>increase</b>&nbsp;bleeding?<div><br /></div><div><span class=cloze>[...]</span></div></div>"<div class=card>What is the only IUD that can <b>increase</b>&nbsp;bleeding?<div><br /></div><div><span class=cloze>Paraguard (copper IUD)</span></div></div> <br> <br> <div class=extra><br /><div><i>Hence, avoid it in women with heavier menses.</i></div><div><i><br /></i></div><div><i><img src=""dangit.png"" /></i></div></div> <!--<div class=tags>contraception gynaecology gynecology</div>-->"
ASCUS. HPV pos, next step?Colposcopy
How many stools should a baby produce over 24 hours? Wet diapers?3-4<div>6</div>
What hormone stimulates milk letdown? What is it stimulated by?Oxytocin<div>Suckling</div>
What in is resp depression in pt on MgSO4 a sign of? What should be done?Mag toxicity<div>Stop Mag, start Ca gluconate</div>
What are the <u>exceptions</u> to universal screening of <b>GBS</b>?<div><br /></div><div>1. <span class=cloze>[...]</span><br />2.&nbsp;<span class=cloze>[...]</span></div><div><br /></div><div>Why:&nbsp;<span class=cloze>[...]</span>.</div>"What are the <u>exceptions</u> to universal screening of <b>GBS</b>?<div><br /></div><div>1. <span class=cloze>History of <b>GBS bacteriuria</b> at any point during <u>current</u> pregnancy</span><br />2.&nbsp;<span class=cloze>Invasive early-onset GBS disease in a <u>prior</u> child</span></div><div><br /></div><div>Why:&nbsp;<span class=cloze>These patients are empirically treated</span>.</div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>Streptococcus agalactiae (group B Streptococcus [GBS]) causes the most common neonatal infection that is acquired by exposure to colonized amniotic fluid after rupture of membranes. &nbsp;Screening for GBS and administering intrapartum antibiotic prophylaxis (IAP) to high-risk women have markedly reduced the incidence of early-onset neonatal GBS disease. &nbsp;However, GBS colonization may be transient and screening is most accurate if performed 3-5 weeks prior to the estimated delivery date. &nbsp;In patients who show no signs of preterm labor, universal screening occurs at 35-37 weeks gestation to increase the likelihood of having an accurate result in anticipation of labor at 40-42 weeks gestation. &nbsp;Culture of the vagina and rectum is the most sensitive screening method for GBS.</li><li>The exceptions to universal screening include a history of GBS bacteriuria at any point during the current pregnancy or invasive early-onset GBS disease in a prior child. &nbsp;These high-risk patients should receive IAP (Choice A) as their urogenital tract colonization is more likely to persist and spread to the newborn.</li><li>Women who miss screening (unknown GBS status) should be treated in labor if they are at &lt;37 weeks gestation, develop an intrapartum fever, or have rupture of membranes for &gt;18 hours; otherwise, their risk of transmission is low. &nbsp;Women who are GBS negative do not need antibiotic prophylaxis for prolonged rupture of membranes as over-treatment may result in antibiotic resistance or emergence of other neonatal pathogens.</li><li>Penicillin is the prophylactic agent of choice; it reaches therapeutic levels in the amniotic fluid and fetus without toxicity and has a narrow spectrum of coverage, minimizing the risk of resistance. &nbsp;Prophylaxis should be given 4 hours before delivery.</li></ol></div><div><img src=""paste-25817048416259.jpg"" /></div></div> "
Is <b>intra-amniotic infection</b> an indication for <u>C-section</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"Is <b>intra-amniotic infection</b> an indication for <u>C-section</u>?<div><br /></div><div><span class=cloze>No</span></div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>Cesarean delivery is reserved for standard obstetric indications (eg, nonreassuring fetal tracing, breech presentation, prior uterine surgeries). &nbsp;Although this heart rate tracing indicates fetal tachycardia, it is reassuring overall due to moderate variability and no decelerations.</li><li>Thus, management is<b> IV antibiotics</b> (eg, ampicillin, gentamicin, clindamycin) and immediate delivery via<b> induction of labor</b>&nbsp;(to remove the source of infection).</li></ol></div><img src=""paste-60060822667267.jpg"" /></div> "
What can cause <u>uterine distension</u> in <b>placental abruption?</b><div><br /></div><div><span class=cloze>[...]</span></div>"What can cause <u>uterine distension</u> in <b>placental abruption?</b><div><br /></div><div><span class=cloze>Concealed bleedeing behind the placenta</span></div><hr> <div class=mystyle1><div><i>concealed bleeding can lead to not much vaginal bleeding on exam.</i></div><div><i><br /></i></div><img src=""paste-83580063580163.jpg"" /></div> "
"When a mom presents with <b>third-trimester bleeding</b>, what is your <u>differential</u>?<div><br></div><div><u>Painless</u>:&nbsp;<span class=""clozed c1""><span class=cloze>[most common]</span></span>,&nbsp;<span class=cloze>[...]</span></div><div><u>Painful</u>:&nbsp;<span class=""clozed c1"">Abruptio placentae</span>,&nbsp;uterine rupture</div>""When a mom presents with <b>third-trimester bleeding</b>, what is your <u>differential</u>?<div><br></div><div><u>Painless</u>:&nbsp;<span class=""clozed c1""><span class=cloze>Placenta previa</span></span>,&nbsp;<span class=cloze>vasa previa</span></div><div><u>Painful</u>:&nbsp;<span class=""clozed c1"">Abruptio placentae</span>,&nbsp;uterine rupture</div><hr> <div class=mystyle1><div><strong>P</strong>revia = Preview = baby is a ""pre"" human = <strong>p</strong>ainless</div><div><br /></div><img src=""paste-41016937677326.jpg"" /></div> "
How do you manage <b>placental previa</b>?<div><br /></div><div>Diagnose: <span class=cloze>[...]</span></div><div>Treat: <span class=cloze>[...]</span></div>"How do you manage <b>placental previa</b>?<div><br /></div><div>Diagnose: <span class=cloze>ultrasound (transverse lie)</span></div><div>Treat: <span class=cloze>C-section</span></div><hr> <div class=mystyle1><div>If it’s not a previa early in pregnancy on US (second trimester), it never will be. Many previas found on second trimester US will resolve as the baby and uterus grow.</div><div><br /></div><img src=""paste-42902428320264.jpg"" /><img src=""paste-41016937677326.jpg"" /></div> "
What is the <u>mechanism</u> of <b>systemic progestins</b> as a <u>contraceptive</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <u>mechanism</u> of <b>systemic progestins</b> as a <u>contraceptive</u>?<div><br /></div><div><span class=cloze>Suppresses GnRH/FSH/LH release -&gt; inhibiting ovulation</span></div><hr> <div class=mystyle1><div><i>pill, patch, ring.</i></div><div><i><br /></i></div><div><img src=""paste-199368086913025.jpg"" /></div><div><br /></div><img src=""paste-13005160972289.jpg"" /><img src=""paste-945318006882305 (1).jpg"" /></div> "
What is the <u>mechanism</u> of <b>copper IUD</b> as a <u>contraceptive</u>?<div><br /></div><div><span class=cloze>[...]</span> →&nbsp;impairs&nbsp;<span class=cloze>[...]</span></div>"What is the <u>mechanism</u> of <b>copper IUD</b> as a <u>contraceptive</u>?<div><br /></div><div><span class=cloze>Creates chronic <b>inflammatory</b> response in uterus</span> →&nbsp;impairs&nbsp;<span class=cloze>sperm migration</span></div><hr> <div class=mystyle1><img src=""paste-13000866004993_1529603012320.jpg"" /></div> "
<span class=cloze>[...]</span> is the <u>most effective</u> group of <b>contraception</b>."<span class=cloze>Long-acting reversible contraception (LARC)</span> is the <u>most effective</u> group of <b>contraception</b>.<hr> <div class=mystyle1><div><i></i><i>LARCs consist of two forms, <b>IUD </b>(in uterus), and <b>non-IUD</b> (Nexplanon, under skin)</i></div><div><br /></div><div><img src=""paste-958280218181633.jpg"" /></div><div><i><img src=""paste-2682683817721857.jpg"" /><img src=""paste-66206920867841 (2).jpg"" /></i></div></div> "
"<b>Depo-provera</b> is an injection of <span class=cloze>[...]</span> that lasts for&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>.""<b>Depo-provera</b> is an injection of <span class=cloze>progesterone</span> that lasts for&nbsp;<span class=""clozed c1""><span class=cloze>three months</span></span>.<hr> <div class=mystyle1><i><div></div>IM injection.</i><div><i><img src=""paste-974867381878785.jpg"" /></i></div><div><i><img src=""paste-2682683817721857.jpg"" /></i></div></div> "
Which group of contraceptives have the HIGHEST risk of <b>DVT/PE</b> among contraceptives?<div><br /></div><div><span class=cloze>[...]</span></div>"Which group of contraceptives have the HIGHEST risk of <b>DVT/PE</b> among contraceptives?<div><br /></div><div><span class=cloze>Patches</span></div><hr> <div class=mystyle1><i>Any form of oral contraceptive with <b>estrogen</b> increases the risk of clots; imagine <b><u>patching</u> your vessels and getting a clot. </b>it's because the patch directly diffuses into bloodstream = higher levels of estrogen.</i><div><i><br /></i></div><div><i>Risk of clots increases substantially with combination of 3 things:</i></div><div><i><b>Estrogen</b> based contraception</i></div><div><i>Age <b>&gt; 35</b></i></div><div><i><b>Smoking</b></i></div><div><i><b><br /></b></i></div><div><i><b></b></i><i><img src=""paste-2682683817721857.jpg"" /></i></div></div> "
<b>Mini-pill</b> is composed of only <span class=cloze>[...]</span> and acts locally"<b>Mini-pill</b> is composed of only <span class=cloze>progestin</span> and acts locally<hr> <div class=mystyle1><i>low levels of progesterone → only <b>local</b> effects (cervical mucus thickening, endometrial lining thinning) - does NOT inhibit ovulation. think (mini = less = local effects)</i><div><div><i><br /></i></div><div><i><img src=""paste-2682683817721857.jpg"" /></i></div></div></div> "
How do you&nbsp;<u>treat</u> <b>GBS (intrapartum)?</b><div><br /></div><div>First-line:&nbsp;<span class=cloze>[...]</span></div><div>Second-line:&nbsp;Cefazolin&nbsp;</div><div>Third-line:&nbsp;Clindamycin</div><div>Last-line: Vancomycin</div>"How do you&nbsp;<u>treat</u> <b>GBS (intrapartum)?</b><div><br /></div><div>First-line:&nbsp;<span class=cloze>Ampicillin/PCN</span></div><div>Second-line:&nbsp;Cefazolin&nbsp;</div><div>Third-line:&nbsp;Clindamycin</div><div>Last-line: Vancomycin</div><hr> <div class=mystyle1><div><i>intrapartum = during child birth</i></div><div><i><img src=""paste-48846663057828.jpg"" /></i></div></div> "
"Management of a mother with <b>HBV</b> consists of:<div><br /></div><div><span class=cloze>[delivery method]</span> +&nbsp;<div>administration of&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;and&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;to baby at time of delivery.</div></div>""Management of a mother with <b>HBV</b> consists of:<div><br /></div><div><span class=cloze>Planned C-section</span> +&nbsp;<div>administration of&nbsp;<span class=""clozed c1""><span class=cloze>IVIg Hep B</span></span>&nbsp;and&nbsp;<span class=""clozed c1""><span class=cloze>Hep B vaccine</span></span>&nbsp;to baby at time of delivery.</div></div><hr> <div class=mystyle1><div><i><br /></i></div></div> "
<div>The&nbsp;<b><span class=cloze>[...]</span> gland</b>&nbsp;is present on each side of the vaginal canal and produces mucus-like fluid that drains via ducts into the&nbsp;<b>lower vestibule.</b></div><div><b><br></b></div>"<div>The&nbsp;<b><span class=cloze>bartholin</span> gland</b>&nbsp;is present on each side of the vaginal canal and produces mucus-like fluid that drains via ducts into the&nbsp;<b>lower vestibule.</b></div><div><b><br></b></div><hr> <div class=mystyle1><div><i>fixed mass in the gland in a post-menopausal female is suspicious for <b>malignancy.</b></i></div><div><i><b><br /></b></i></div><img src=""paste-919123001646.jpg"" /></div> "
<div><b><span class=cloze>[...]</span></b>, also known as&nbsp;<b>sarcoma botryoides</b>, presents with bleeding and a <u>grape</u><u>-like mass</u> protruding from the vagina or penis of a&nbsp;<b>child</b></div>"<div><b><span class=cloze>Embryonal rhabdomyosarcoma</span></b>, also known as&nbsp;<b>sarcoma botryoides</b>, presents with bleeding and a <u>grape</u><u>-like mass</u> protruding from the vagina or penis of a&nbsp;<b>child</b></div><hr> <div class=mystyle1><div><i>type of <b>vaginal cancer&nbsp;</b>classically seen in a newborn girl &lt; 5 years old</i></div><div><i><br /></i></div><img src=""paste-5050881540639.jpg"" /><div><img src=""paste-5089536246000.jpg"" /></div></div> "
<div><b>Vaginal squamous cell carcinoma</b>&nbsp;is usually&nbsp;<i>secondary</i>&nbsp;to <span class=cloze>[...]</span>&nbsp;SCC</div><div><b>Vaginal squamous cell carcinoma</b>&nbsp;is usually&nbsp;<i>secondary</i>&nbsp;to <span class=cloze>cervical</span>&nbsp;SCC</div><hr> <div class=mystyle1><i>rarely occurs as a primary vaginal carcinoma secondary to HPV infection</i></div> <div><div>What is the most supported theory for the&nbsp;<u>etiology</u>&nbsp;of&nbsp;<b>endometriosis</b>?</div><div><br /></div><div><span class=cloze>[...]</span>&nbsp;</div></div><div><div>What is the most supported theory for the&nbsp;<u>etiology</u>&nbsp;of&nbsp;<b>endometriosis</b>?</div><div><br /></div><div><span class=cloze>Retrograde menstruation</span>&nbsp;</div></div><hr> <div class=mystyle1><i>other theories include metaplastic transformation of multiplastic cells and transportation of endometrial tissue via the lymphatic system</i></div> <div><div>What is the <i>gross</i> <i>appearance</i> of an&nbsp;<b>ovarian endometrioma</b>?&nbsp;</div><div><br /></div><div><span class=cloze>[...]</span>&nbsp;</div></div>"<div><div>What is the <i>gross</i> <i>appearance</i> of an&nbsp;<b>ovarian endometrioma</b>?&nbsp;</div><div><br /></div><div><span class=cloze>chocolate cyst (blood-filled)</span>&nbsp;</div></div><hr> <div class=mystyle1><div><i>cystic lesion in ovary filled with accumulated menstrual products</i></div><div><i><img src=""paste-372442384039937.jpg"" /></i></div><div><img src=""paste-51200305136233.jpg"" /></div></div> "
<div>Gross examination of&nbsp;<span class=cloze>[...]</span>&nbsp;shows&nbsp;<b>multiple</b>, <b>well-defined</b>,&nbsp;<b>white</b>,&nbsp;<b>whorled</b>&nbsp;<b>masses</b>&nbsp;that may distort the uterus and impinge on pelvic structures</div>"<div>Gross examination of&nbsp;<span class=cloze><b>leiomyoma</b>&nbsp;(fibroid)</span>&nbsp;shows&nbsp;<b>multiple</b>, <b>well-defined</b>,&nbsp;<b>white</b>,&nbsp;<b>whorled</b>&nbsp;<b>masses</b>&nbsp;that may distort the uterus and impinge on pelvic structures</div><hr> <div class=mystyle1><div><i>leiomyosarcoma is usually a single mass with hemorrhage or necrosis</i>&nbsp;</div><div><img src=""paste-55074365637224.jpg"" /></div><div><img src=""paste-55422257987919.jpg"" /></div></div> "
<div><b>Hydatidiform mole</b>&nbsp;presents with a&nbsp;'<span class=cloze>[...]</span>' appearance on ultrasound&nbsp;</div>"<div><b>Hydatidiform mole</b>&nbsp;presents with a&nbsp;'<span class=cloze>snow-storm</span>' appearance on ultrasound&nbsp;</div><hr> <div class=mystyle1><img src=""paste-115672059216293.jpg"" /></div> "
<div><b><span class=cloze>[...]</span> tumor</b>&nbsp;is a fibroadenoma-like tumor with&nbsp;overgrowth of the fibrous component, causing&nbsp;<b>'leaf-like' projections.</b></div><div><b><br /></b></div>"<div><b><span class=cloze>Phyllodes</span> tumor</b>&nbsp;is a fibroadenoma-like tumor with&nbsp;overgrowth of the fibrous component, causing&nbsp;<b>'leaf-like' projections.</b></div><div><b><br /></b></div><hr> <div class=mystyle1><img src=""paste-152419799400451_1529603012320.jpg"" /></div> "
What is the <i>recommended treatment</i>&nbsp;for <b>lichen simplex chronicus</b>?<div><br /></div><div><span class=cloze>[...]</span></div>What is the <i>recommended treatment</i>&nbsp;for <b>lichen simplex chronicus</b>?<div><br /></div><div><span class=cloze>high-potency topical corticosteroids +/- antihistamines</span></div><hr> <div class=mystyle1></div> <b>Placental sulfatase deficiency</b>&nbsp;is a risk factor for&nbsp;<span class=cloze>[...]</span>-term delivery"<b>Placental sulfatase deficiency</b>&nbsp;is a risk factor for&nbsp;<span class=cloze>post</span>-term delivery<hr> <div class=mystyle1><i>other risk factors include fetal adrenal <b>hypo</b>plasia and anencephaly</i><div><i><br /></i></div><div><i><img src=""paste-221590247702529.jpg"" /></i></div></div> "
<b>Renal pelvis</b> and <b>ureter</b> <u><span class=cloze>[constriction or dilation]</span></u> during pregnancy occurs due to <i>compression</i> by the <b>uterus</b> and <b>ovarian</b>&nbsp;<b>vein</b>"<b>Renal pelvis</b> and <b>ureter</b> <u><span class=cloze>dilation</span></u> during pregnancy occurs due to <i>compression</i> by the <b>uterus</b> and <b>ovarian</b>&nbsp;<b>vein</b><hr> <div class=mystyle1><div><i><b>decreased smooth muscle</b> tone also occurs 2/2 <b><font color=""#ff0000"">progesterone</font></b>, which increases risk of UTI.</i></div><img src=""paste-233787954823169.jpg"" /></div> "
<div>Why does&nbsp;<b>lactation</b>&nbsp;not occur during pregnancy, even though&nbsp;<b>prolactin</b>&nbsp;levels are&nbsp;<u>increasing</u>?&nbsp;</div><div><br /></div><div><span class=cloze>[...]</span></div><div>Why does&nbsp;<b>lactation</b>&nbsp;not occur during pregnancy, even though&nbsp;<b>prolactin</b>&nbsp;levels are&nbsp;<u>increasing</u>?&nbsp;</div><div><br /></div><div><span class=cloze>estrogen and progesterone block the action of prolactin on the breast</span></div><hr> <div class=mystyle1><i>after pregnancy, <b>sharp decrease in progesterone and estrogen</b> stops inhibition of prolactin's effects</i></div> <span class=cloze>[...]</span> describes the passage of a small amount of <b>blood</b> or <b>blood-tinged mucus</b> through the vagina near the <u>end</u> of pregnancy<span class=cloze>Bloody show</span> describes the passage of a small amount of <b>blood</b> or <b>blood-tinged mucus</b> through the vagina near the <u>end</u> of pregnancy<hr> <div class=mystyle1><i>typically occurs in early labor as the cervix changes shape, freeing mucus and blood in the cervical glands/os (signals <b>ROM</b>)</i></div> <b>Oral contraceptives</b>&nbsp;are <u>contraindicated</u> in women <u>&gt;</u>&nbsp;<span class=cloze>[...]</span> that use tobacco&nbsp;"<b>Oral contraceptives</b>&nbsp;are <u>contraindicated</u> in women <u>&gt;</u>&nbsp;<span class=cloze>35</span> that use tobacco&nbsp;<hr> <div class=mystyle1><div><i>other contraindications include history of venous thromboembolic disease, uncontrolled <b>hypertension</b> (&gt; 160/110), and liver disease</i></div><img src=""this is painful.png"" /></div> "
<b>Hormone replacement&nbsp;</b><b>therapy (E+P)&nbsp;</b>for <u>vasomotor</u> postmenopausal symptoms <i>increases</i> the risk for&nbsp;<span class=cloze>[...]</span> cancer.<div><br /></div>"<b>Hormone replacement&nbsp;</b><b>therapy (E+P)&nbsp;</b>for <u>vasomotor</u> postmenopausal symptoms <i>increases</i> the risk for&nbsp;<span class=cloze>breast</span> cancer.<div><br /></div><hr> <div class=mystyle1><i>WHI showed that estrogen-only didn't increase the risk of breast cancer - perhaps <b>progestin </b>is the culprit.&nbsp;</i><br /><div><i><br /></i></div><div><i><img src=""paste-3214495258247169.jpg"" /></i></div></div> "
When a patient comes in with <b>galactorrhea</b> and <b>amenorrhea</b>, you should first screen her <span class=cloze>[...]</span> level and order a(n)&nbsp;<span class=cloze>[...]</span> if it's elevated."When a patient comes in with <b>galactorrhea</b> and <b>amenorrhea</b>, you should first screen her <span class=cloze>prolactin</span> level and order a(n)&nbsp;<span class=cloze>MRI</span> if it's elevated.<hr> <div class=mystyle1><i>Remember. Her clinical vignette already possibly points to either prolactinoma or drug induced prolactinemia. You want to get an <b>MRI</b> to catch the pituitary tumor.</i><div><i><br /></i></div><div><i>HOWEVER, bear in mind, if you already got a Hx of a certain drug she's using that's causing this, you don't need MRI. You found your culprit.</i></div><div><i><br /></i></div><div><i><img src=""paste-6257767350273.jpg"" /></i></div></div> "
Which etiology of <b>hirsutism</b> presents with <u>elevated testosterone</u>, a <u>LH:FSH ≥ 3:1</u>, and typically affects <u>both ovaries</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"Which etiology of <b>hirsutism</b> presents with <u>elevated testosterone</u>, a <u>LH:FSH ≥ 3:1</u>, and typically affects <u>both ovaries</u>?<div><br /></div><div><span class=cloze>PCOS</span></div><hr> <div class=mystyle1><img src=""paste-35854386987572.jpg"" /></div> "
"Patient presents with unilateral Cafe-au-lait spots, polyostotic fibrous dysplasia,<b> precocious puberty</b>, and multiple endocrine abnormalities. Diagnosis?<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""Representative-Cafe-au-lait-Spots-Seen-in-McCune-Albright-Syndrome-A-spectrum-of-spots.png"" /></div>""Patient presents with unilateral Cafe-au-lait spots, polyostotic fibrous dysplasia,<b> precocious puberty</b>, and multiple endocrine abnormalities. Diagnosis?<div><br /></div><div><span class=cloze>McCune-Albright syndrome</span></div><div><br /></div><div><img src=""Representative-Cafe-au-lait-Spots-Seen-in-McCune-Albright-Syndrome-A-spectrum-of-spots.png"" /></div><hr> <div class=mystyle1><img src=""mas_1529603012320.PNG"" /></div> "
"Which etiology of <b>peripheral precocious pubery</b>&nbsp;is an <u>estrogen-producing tumor</u>?<div><br /></div><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div>""Which etiology of <b>peripheral precocious pubery</b>&nbsp;is an <u>estrogen-producing tumor</u>?<div><br /></div><div><span class=""clozed c1""><span class=cloze>Granulosa cell tumor</span></span></div><hr> <div class=mystyle1><i>recall granulosa cells convert T - E via aromatase.</i></div> "
<span class=cloze>[...]</span> are forms of <b>LARCs</b> that are <u>matchstick-sized rods implanted under the skin</u>."<span class=cloze>Etonogestrel implants (Nexplanon/Implanon)</span> are forms of <b>LARCs</b> that are <u>matchstick-sized rods implanted under the skin</u>.<hr> <div class=mystyle1><div><i>inhibits ovulation, thickens cervical mucus, and thins endometrium (does everything, systemic!)</i></div><div><i><br /></i></div><img src=""paste-16166256902145_1529603012320.jpg"" /><div><i><br /></i></div><div><i><img src=""paste-2682683817721857.jpg"" /></i><div><br /></div><div><br /></div></div></div> "
<div>If egg fertilization occurs post-tubal ligation, there's a VERY HIGH risk of <span class=cloze>[...]</span>.</div><div>If egg fertilization occurs post-tubal ligation, there's a VERY HIGH risk of <span class=cloze>ectopic pregnancy</span>.</div><hr> <div class=mystyle1></div> "<b>Combined estrogen-progesterone</b> contraceptive options include <u>monthly</u>&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>, <u>weekly</u>&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>, and <u>daily</u>&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>.""<b>Combined estrogen-progesterone</b> contraceptive options include <u>monthly</u>&nbsp;<span class=""clozed c1""><span class=cloze>rings</span></span>, <u>weekly</u>&nbsp;<span class=""clozed c1""><span class=cloze>patches</span></span>, and <u>daily</u>&nbsp;<span class=""clozed c1""><span class=cloze>pills</span></span>.<hr> <div class=mystyle1><i><div></div></i><i><img src=""paste-979578961002497.jpg"" /></i><div><i><br /></i></div><img src=""paste-2682683817721857.jpg"" /></div> "
The <u>biggest problem</u> with <b>mini-pills</b> is that they require <span class=cloze>[...]</span>."The <u>biggest problem</u> with <b>mini-pills</b> is that they require <span class=cloze>daily compliance down to the hour</span>.<hr> <div class=mystyle1><img src=""paste-2682683817721857.jpg"" /></div> "
"The <u>structural</u> causes of <b>vaginal bleeding</b> can be remembered with the mnemonic,&nbsp;<b><font color=""#fc0107"">PALM</font></b>:<div><br /></div><div><b><font color=""#fc0107"">P</font></b><span class=cloze>[...]</span><div><span class=""clozed c1""><b><font color=""#fc0107"">A</font></b><span class=cloze>[...]</span></span></div><div><span class=""clozed c1""><b><font color=""#fc0107"">L</font></b><span class=cloze>[...]</span></span></div><div><b><font color=""#fc0107"">M</font></b><span class=cloze>[...]</span></div></div>""The <u>structural</u> causes of <b>vaginal bleeding</b> can be remembered with the mnemonic,&nbsp;<b><font color=""#fc0107"">PALM</font></b>:<div><br /></div><div><b><font color=""#fc0107"">P</font></b><span class=cloze>olyps</span><div><span class=""clozed c1""><b><font color=""#fc0107"">A</font></b><span class=cloze>denomyosis</span></span></div><div><span class=""clozed c1""><b><font color=""#fc0107"">L</font></b><span class=cloze>eiomyoma (fibroids)</span></span></div><div><b><font color=""#fc0107"">M</font></b><span class=cloze>alignancy (endometrial and cervical cancer)</span></div></div><hr> <div class=mystyle1><i><img src=""paste-14555644166816.jpg"" /></i></div> "
"<div>The <u>non-structural</u>&nbsp;causes of&nbsp;<b>vaginal bleeding</b>&nbsp;can be remembered with the mnemonic,&nbsp;<b><font color=""#fc0107"">COEIN</font></b>:<div><br /></div><b><font color=""#fc0107"">C</font></b><span class=cloze>[...]</span><div><b><font color=""#fc0107"">O</font></b><span class=cloze>[...]</span></div><div><b><font color=""#fc0107"">E</font></b><span class=cloze>[...]</span></div><div><b><font color=""#fc0107"">I</font></b><span class=cloze>[...]</span></div><div><b><font color=""#fc0107"">N</font></b>ot yet classified</div></div>""<div>The <u>non-structural</u>&nbsp;causes of&nbsp;<b>vaginal bleeding</b>&nbsp;can be remembered with the mnemonic,&nbsp;<b><font color=""#fc0107"">COEIN</font></b>:<div><br /></div><b><font color=""#fc0107"">C</font></b><span class=cloze>oagulopathy</span><div><b><font color=""#fc0107"">O</font></b><span class=cloze>vulatory dysfunction</span></div><div><b><font color=""#fc0107"">E</font></b><span class=cloze>ndometrial problems (endometriosis)</span></div><div><b><font color=""#fc0107"">I</font></b><span class=cloze>atrogenic (IUD)</span></div><div><b><font color=""#fc0107"">N</font></b>ot yet classified</div></div><hr> <div class=mystyle1><i></i><i><img src=""paste-14551349199520.jpg"" /></i></div> "
What <b>acid-base changes</b> are seen in pregnancy?<div><br /></div><div><span class=cloze>[...]</span></div>"What <b>acid-base changes</b> are seen in pregnancy?<div><br /></div><div><span class=cloze>Chronic respiratory alkalosis</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>The normal hyperventilation of pregnancy is characterized by increased tidal volume, increased minute ventilation, and chronic respiratory alkalosis. &nbsp;The increased minute ventilation increases the PaO2 (usually to 100-110 mm Hg) to meet the metabolic demands of pregnancy. &nbsp;The respiratory alkalosis usually lowers the PaCO2 to 27-32 mm Hg. &nbsp;As the progesterone concentration increases during the later stages of pregnancy, there is increased pH to 7.40-7.45 with some metabolic compensation with decreased serum HCO3, as seen in this patient.</li></ol><img src=""paste-219253785493507.jpg"" /></div> "
"How does the <u>heart</u>&nbsp;change during&nbsp;<b>pregnancy</b>?<div><br /></div><div><span class=cloze>[↑/↓]</span> Heart rate and&nbsp;<span class=""clozed c1""><span class=cloze>[↑/↓]</span>&nbsp;</span>stroke volume, resulting in <span class=""clozed c1""><span class=cloze>[...]</span> cardiac output</span></div>""How does the <u>heart</u>&nbsp;change during&nbsp;<b>pregnancy</b>?<div><br /></div><div><span class=cloze>↑</span> Heart rate and&nbsp;<span class=""clozed c1""><span class=cloze>↑</span>&nbsp;</span>stroke volume, resulting in <span class=""clozed c1""><span class=cloze>increased</span> cardiac output</span></div><hr> <div class=mystyle1><i>offsets the ↓ TPR due to progesterone</i><div><i>MAP = CO * TPR</i></div></div> "
How do you <u>diagnose</u> <b>leiomyoma/adenomyosis via imaging?&nbsp;</b><span class=cloze>[...]</span>"How do you <u>diagnose</u> <b>leiomyoma/adenomyosis via imaging?&nbsp;</b><span class=cloze>Pelvic ultrasound</span><hr> <div class=mystyle1><i><br /></i><div><i><br /></i></div><div><i><img src=""paste-14658723382074.jpg"" /></i></div></div> "
<b>Endometrial polyps</b> are <span class=cloze>[surgically/medically]</span> removed"<b>Endometrial polyps</b> are <span class=cloze>surgically</span> removed<hr> <div class=mystyle1><div><i>often presents with <b>intermenstrual</b> <b>bleeding</b>; removed with <b>polypectomy</b>&nbsp;</i></div><div><i><br /></i></div><i><img src=""paste-58351425683457_1530277536797.jpg"" /></i><div><i><img src=""paste-14658723382074.jpg"" /></i></div></div> "
How does <b>renal basement permeability</b> change in pregnancy?<div><br /></div><div><span class=cloze>[...]</span></div>"How does <b>renal basement permeability</b> change in pregnancy?<div><br /></div><div><span class=cloze>Increase</span></div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>This contributes to increased protein excretion (1+ protein normal in pregnancy)</li></ol></div><div><br /></div><img src=""paste-181088706101251.jpg"" /></div> "
How much <u>weight</u> a woman should gain during <b>pregnancy</b>?<div><br /></div><div>Underweight: BMI &lt; 18.5: <span class=cloze>[...]</span> lb/week</div><div>Normal: BMI 18.5-25: <span class=cloze>[...]</span> lb/week</div><div>Overweight: BMI = 25-30: <span class=cloze>[...]</span> lb/week</div><div>Morbidly obese: BMI &gt; 30: <span class=cloze>[...]</span> lb/week</div>"How much <u>weight</u> a woman should gain during <b>pregnancy</b>?<div><br /></div><div>Underweight: BMI &lt; 18.5: <span class=cloze>+1</span> lb/week</div><div>Normal: BMI 18.5-25: <span class=cloze>+0.75</span> lb/week</div><div>Overweight: BMI = 25-30: <span class=cloze>+0.5</span> lb/week</div><div>Morbidly obese: BMI &gt; 30: <span class=cloze>+0.25</span> lb/week</div><hr> <div class=mystyle1><div>""quarters""</div><img src=""paste-321650100797660.jpg"" /></div> "
Patient presents with <b>pruritic black lesions in her genitals</b>.<div><br /></div><div>Suspected cancer: <span class=cloze>[...]</span></div>"Patient presents with <b>pruritic black lesions in her genitals</b>.<div><br /></div><div>Suspected cancer: <span class=cloze>Vulvar/vaginal cancer</span></div><hr> <div class=mystyle1><i>In vulvar cancer secondary to Paget's disease, it's actually RED! </i><div><i><br /></i></div><div><i><img src=""paste-188965676122113.jpg"" /></i></div></div> "
"Risk of <b>endometrial cancer</b>&nbsp;<span class=""clozed c1""><span class=cloze>[↑/↓]</span></span>&nbsp;with <u>exposure</u> to estrogen and&nbsp;<span class=""clozed c1""><span class=cloze>[↑/↓]</span></span>&nbsp;with exposure to <u>progesterone</u>""Risk of <b>endometrial cancer</b>&nbsp;<span class=""clozed c1""><span class=cloze>increases</span></span>&nbsp;with <u>exposure</u> to estrogen and&nbsp;<span class=""clozed c1""><span class=cloze>decreases</span></span>&nbsp;with exposure to <u>progesterone</u><hr> <div class=mystyle1><i><b>E</b>strogen is <b>e</b>xposure. <b>P</b>rogesterone is <b>p</b>rotective.</i><div><i><br /></i></div><div><i><img src=""paste-107163729002762.jpg"" /></i></div></div> "
<span class=cloze>[...]</span> is the <u>most potent risk factor</u> for <b>endometrial cancer</b> due to unopposed estrogen and decreased progesterone."<span class=cloze>Anovulation</span> is the <u>most potent risk factor</u> for <b>endometrial cancer</b> due to unopposed estrogen and decreased progesterone.<hr> <div class=mystyle1><i>e.g.,&nbsp;<b>PCOS</b>&nbsp;(no ovulation = no protective progesterone in setting of high estrogen)</i><div><i><br /></i></div><div><i><img src=""paste-108069967102168.jpg"" /></i></div></div> "
Diagnosis of <b>endometrial carcinoma</b> requires <span class=cloze>[...]</span>.Diagnosis of <b>endometrial carcinoma</b> requires <span class=cloze>biopsy</span>.<hr> <div class=mystyle1><i><br /></i></div> A patient presents with <u>uterine bleeding</u> and a <b>precancerous endometrial biopsy</b>.<div><br /></div><div><div>Suspected diagnosis: <span class=cloze>[...]</span></div><div>Treatment: <span class=cloze>[...]</span></div></div>"A patient presents with <u>uterine bleeding</u> and a <b>precancerous endometrial biopsy</b>.<div><br /></div><div><div>Suspected diagnosis: <span class=cloze>Endometrial hyperplasia</span></div><div>Treatment: <span class=cloze>High-dose progesterone</span></div></div><hr> <div class=mystyle1><div><i>Progesterone protects</i></div><div><br /></div><img src=""paste-108546708472364.jpg"" /></div> "
If a <u>reproductive age female</u> presents with an <b>adnexal mass</b>, it is likely a(n) <span class=cloze>[...]</span>."If a <u>reproductive age female</u> presents with an <b>adnexal mass</b>, it is likely a(n) <span class=cloze>cyst</span>.<hr> <div class=mystyle1><img src=""paste-46239617908737_1529603012320.jpg"" /></div> "
If a <u>post-menopausal woman</u> presents with an <b>adnexal mass</b>, it is likely <span class=cloze>[...]</span>."If a <u>post-menopausal woman</u> presents with an <b>adnexal mass</b>, it is likely <span class=cloze>epithelial tumor</span>.<hr> <div class=mystyle1><img src=""paste-46295452483585_1529603012320.jpg"" /></div> "
If a <u>premenstrual female</u> presents with an <b>adnexal mass</b>, it is likely a(n) <span class=cloze>[...]</span>."If a <u>premenstrual female</u> presents with an <b>adnexal mass</b>, it is likely a(n) <span class=cloze>germ cell tumor</span>.<hr> <div class=mystyle1><img src=""paste-46291157516289_1529603012320.jpg"" /></div> "
What is the <u>initial chief complaint</u> of people with <b>ovarian torsion</b>?<div><br /></div><div><span class=cloze>[...]</span></div>What is the <u>initial chief complaint</u> of people with <b>ovarian torsion</b>?<div><br /></div><div><span class=cloze>Completely spontaneous unilateral abdominal pain</span></div><hr> <div class=mystyle1><i>- Patient may present with toxic fever/leukocytosis because the ovary is dying.</i><div><i>- Patient may show peritoneal signs as a result of ovarian necrosis.</i></div><div><i>- A typical scenario would be a girl sitting at her computer doing nothing when suddenly she presents with severe pain.</i></div></div> Diagnosis of <b>ovarian torsion</b> is best done with <span class=cloze>[...]</span>.Diagnosis of <b>ovarian torsion</b> is best done with <span class=cloze>ultrasound with doppler</span>.<hr> <div class=mystyle1><div><i>You add a doppler to it because you want to see a decreased blood flow to the ovary.</i></div></div> A patient presents with <b>adnexal mass</b> and transvaginal ultrasound revealing a <u>smooth, small cyst without septations</u>.<div><br /></div><div><div>Suspected diagnosis: <span class=cloze>[...]</span></div></div>A patient presents with <b>adnexal mass</b> and transvaginal ultrasound revealing a <u>smooth, small cyst without septations</u>.<div><br /></div><div><div>Suspected diagnosis: <span class=cloze>Simple cyst</span></div></div><hr> <div class=mystyle1><i>This is a physiologic phenomenon. Nothing is malignant about this.</i></div> A patient presents with <b>adnexal mass</b> and a transvaginal ultrasound revealing <u>irregular large cysts with septation and loculated fluid</u>.<div><br /><div>Suspected diagnosis: <span class=cloze>[...]</span></div></div>A patient presents with <b>adnexal mass</b> and a transvaginal ultrasound revealing <u>irregular large cysts with septation and loculated fluid</u>.<div><br /><div>Suspected diagnosis: <span class=cloze>Complex cyst</span></div></div><hr> <div class=mystyle1></div> What is the <u>next best step</u> in management of a&nbsp;<u>premenopausal</u> patient with a&nbsp;<b>complex cyst</b> on TVUS?<div><br /></div><div><span class=cloze>[...]</span></div>What is the <u>next best step</u> in management of a&nbsp;<u>premenopausal</u> patient with a&nbsp;<b>complex cyst</b> on TVUS?<div><br /></div><div><span class=cloze>Biopsy</span></div><hr> <div class=mystyle1><i><br /></i></div> <b>Teratomas</b>&nbsp;are usually <span class=cloze>[benign or malignant]</span> in women.<b>Teratomas</b>&nbsp;are usually <span class=cloze>benign</span> in women.<hr> <div class=mystyle1><i>Unlike in men...</i><div><i><br /></i></div><div><i>Most common ovarian germ cell tumors and most common ovarian neoplasms in women under 30.</i></div></div> The best initial test for <b>ovarian cancer</b> after palpating for adnexal mass is <i>always</i> <span class=cloze>[...]</span>."The best initial test for <b>ovarian cancer</b> after palpating for adnexal mass is <i>always</i> <span class=cloze>transvaginal ultrasound</span>.<hr> <div class=mystyle1><i>Remember. If a female patient presents with adnexal mass, the first thing that should pop in your mind regarding next step is <b><u>transvaginal ultrasound</u></b>!&nbsp;</i><div><i><br /></i><div><i><img src=""paste-3951369913140.jpg"" /></i></div></div></div> "
What type of <b>ovarian cancer</b> would you suspect in a <u>teenage girl with asymptomatic mass</u>?<div><br /></div><div><span class=cloze>[...]</span></div>What type of <b>ovarian cancer</b> would you suspect in a <u>teenage girl with asymptomatic mass</u>?<div><br /></div><div><span class=cloze>Germ cell cancer</span></div><hr> <div class=mystyle1>&lt; 30 years old = germ cell<div>&gt; 30 years old = epithelial</div></div> What is the treatment for <b>germ cell cancer</b> in a teenage female?<div><br /></div><div><span class=cloze>[...]</span></div>What is the treatment for <b>germ cell cancer</b> in a teenage female?<div><br /></div><div><span class=cloze>Unilateral salpingo-oophorectomy</span></div><hr> <div class=mystyle1><i>NOT bilateral. Remember. The patient most likely wants to maintain fertility and have kids in the future. You don't want to eff that up.</i></div> What is the <u>treatment</u> for <b>epithelial cell cancer (post-menopausal)</b>?<div><br /></div><div><span class=cloze>[...]</span> and <b>paclitaxel</b> chemotherapy<br /></div>What is the <u>treatment</u> for <b>epithelial cell cancer (post-menopausal)</b>?<div><br /></div><div><span class=cloze>Total abdominal hysterectomy w/ bilateral salpingo-oophorectomy</span> and <b>paclitaxel</b> chemotherapy<br /></div><hr> <div class=mystyle1><i>Remember. This will most likely present in a post-menopausal female, and having more kids is a non-issue for them, since they're infertile. So it's okay to remove the whole thing unlike the management of germ cell tumors of female adolescents.</i></div> <b>Endodermal sinus tumor (yolk sac)</b> can be monitored with <span class=cloze>[...]</span>."<b>Endodermal sinus tumor (yolk sac)</b> can be monitored with <span class=cloze>AFP</span>.<hr> <div class=mystyle1><div><i><div>SAC<div>&nbsp; &nbsp;F</div><div>&nbsp; &nbsp;P</div></div><div><img src=""paste-294046345986049.jpg"" /></div><div><br /></div></i></div><img src=""paste-38899518799873_1529603012320.jpg"" /></div> "
<b>Choriocarcinoma</b> can be monitored with <span class=cloze>[...]</span>."<b>Choriocarcinoma</b> can be monitored with <span class=cloze>β-hCG</span>.<hr> <div class=mystyle1><div><i>babysitter</i></div><div><i><img src=""paste-3633692656271361.jpg"" /></i></div><div><i><br /></i></div><img src=""paste-38899518799873_1529603012320.jpg"" /></div> "
Which type of <b>ovarian cancer subtype</b>&nbsp;is associated with <u>ovulation in its pathogenesis</u>?<div><br /></div><div><span class=cloze>[...]</span></div>Which type of <b>ovarian cancer subtype</b>&nbsp;is associated with <u>ovulation in its pathogenesis</u>?<div><br /></div><div><span class=cloze>Surface <b>epithelial</b> cancer</span></div><hr> <div class=mystyle1><i>The more ovulation a patient has, the more the epithelium is damaged in the process.</i></div> <u>Pregnancies</u> and <u>OCPs</u> <span class=cloze>[increase or decrease]</span> the risk of <b>surface epithelial cancer</b> of ovaries.<u>Pregnancies</u> and <u>OCPs</u> <span class=cloze>decrease</span> the risk of <b>surface epithelial cancer</b> of ovaries.<hr> <div class=mystyle1><i>This is because both of these inhibit ovulation.</i></div> "What are the <u>two genetic conditions</u> associated with increased risk of <b>surface epithelial cell tumors</b>?<div><br /></div><div><span class=cloze>[...]</span><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div></div>""What are the <u>two genetic conditions</u> associated with increased risk of <b>surface epithelial cell tumors</b>?<div><br /></div><div><span class=cloze>BRCA 1/2</span><div><span class=""clozed c1""><span class=cloze>Lynch syndrome</span></span></div></div><hr> <div class=mystyle1></div> "
What is the protocol for women with <u>BRCA1/2 genes</u> for preventing <b>ovarian cancer</b>?<div><br /></div><div><span class=cloze>[...]</span></div>What is the protocol for women with <u>BRCA1/2 genes</u> for preventing <b>ovarian cancer</b>?<div><br /></div><div><span class=cloze>Screen annually with transvaginal US and CA-125</span></div><hr> <div class=mystyle1><i>these should be the initial tests for suspected ovarian cancer.</i></div> Once the <b>BRCA 1/2 patient</b>&nbsp;is at least 35 years old or is <u>done having kids</u>, you can perform <span class=cloze>[...]</span>.Once the <b>BRCA 1/2 patient</b>&nbsp;is at least 35 years old or is <u>done having kids</u>, you can perform <span class=cloze>total abdominal hysterectomy and bilateral salpingo-oophorectomy</span>.<hr> <div class=mystyle1></div> Which <b>stromal cell tumor</b> is associated with female showing <u>rapid</u>&nbsp;signs of&nbsp;<u>hirsutism/virilization</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"Which <b>stromal cell tumor</b> is associated with female showing <u>rapid</u>&nbsp;signs of&nbsp;<u>hirsutism/virilization</u>?<div><br /></div><div><span class=cloze>Sertoli-Leydig tumor</span></div><hr> <div class=mystyle1><i>e.g., voice deepening, male-pattern baldness, increased muscle bulk, clitoromegaly.</i><div><i><br /></i></div><div><i><img src=""paste-1139222895394819.jpg"" /></i></div></div> "
How do you <b>evacuate the uterus <u>medically</u></b> in the <u>first trimester</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"How do you <b>evacuate the uterus <u>medically</u></b> in the <u>first trimester</u>?<div><br /></div><div><span class=cloze>Misoprostol</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>For evacuating after abortions by inducing cervical ripening and expulsion of the products of conception.&nbsp;</li><li>Gold standard is mifepristone and misoprostol, but misoprostol can be used alone.</li><li>""Miss"" your baby in the ""process"" of expulsion</li></ol>&nbsp;<img src=""paste-275212914393089.jpg"" /></div> "
When is&nbsp;<u>suction curettage</u> indicated for <b>spontaneous abortion</b>?<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div>"When is&nbsp;<u>suction curettage</u> indicated for <b>spontaneous abortion</b>?<div><br /></div><div><span class=cloze>Hemodynamically <u>unstable</u> (eg, hypotensive, tachycardic) patients with anemia from acute blood loss</div><div><br /></div><div>Note: It is NOT used for unstable ectopic pregnancy (surgical exploration).</span></div><div><br /></div><hr> <div class=mystyle1><div><img src=""paste-370415159476227.jpg"" /></div><ol type=""1"" start=""1""><li>Suction curettage removes the retained products of conception, which stops the bleeding.&nbsp;</li><li>Expectant or medical (eg, misoprostol) management is appropriate in hemodynamically stable patients with minimal bleeding. &nbsp;Both types of management avoid the risk of surgical complications (eg, uterine perforation, intrauterine adhesions) but typically require a longer time until treatment is completed and are, therefore, inappropriate for a hemodynamically unstable, bleeding patient.</li></ol><div><img src=""paste-370462404116483_1529603012320.jpg"" />&nbsp;<img src=""L29918.png"" />&nbsp;<img src=""paste-189777424941057.jpg"" /></div></div> "
<div><i>Following uterine evacuation of a <b>spontaneous abortion</b></i>, all <u>Rh- mothers with Rh+ husband/fetus</u> need to be given <span class=cloze>[...]</span> within 72 hours.</div><div><i>Following uterine evacuation of a <b>spontaneous abortion</b></i>, all <u>Rh- mothers with Rh+ husband/fetus</u> need to be given <span class=cloze>Rhogam</span> within 72 hours.</div><hr> <div class=mystyle1>Also, perform an ultrasound&nbsp;to make sure there are no fetal parts&nbsp;remaining. If there are, get them out with a D&amp;C.</div> "What is the most common cause of <b>fetal demise</b>?<div><br /></div><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div>""What is the most common cause of <b>fetal demise</b>?<div><br /></div><div><span class=""clozed c1""><span class=cloze>Idiopathic</span></span></div><hr> <div class=mystyle1><i>Death of fetus &gt; <b>20</b> weeks gestation<br /></i><div><i><br /></i></div><div><i><img src=""paste-59236188946435_1496784870471.jpg"" /></i></div></div> "
What is the <u>potential complication</u> of <b>intrauterine fetal demise</b> that is <u>retained in utero</u> for several weeks?<div><br /><span class=cloze>[...]</span></div>"What is the <u>potential complication</u> of <b>intrauterine fetal demise</b> that is <u>retained in utero</u> for several weeks?<div><br /><span class=cloze>Coagulopathy (e.g., <b>DIC</b>)</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>Due to <b>thromboplastin </b>produced by placenta/dead fetus, activating <b>coagulation cascade and causing DIC.</b></li><li>A fibrinogen level screens for coagulopathy</li></ol><img src=""paste-59236188946435_1496784870471.jpg"" /></div> "
What is the cause of <u>hyperreflexia</u> in the setting of a <b>hydatidiform mole</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the cause of <u>hyperreflexia</u> in the setting of a <b>hydatidiform mole</b>?<div><br /></div><div><span class=cloze>Hyperthyroidism from elevated b-hCG</span></div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>Note: Hydatidiform mole can cause <b>hyperemesis gravidarum</b>, which is normally associated with hyporeflexia (due to hypokalemia).</li></ol></div><img src=""paste-83245056131073 (1).jpg"" /></div> "
"Which cancer presents as a ""<b>grape-like mass</b>"" in the <u>vagina</u>?<div><br></div><div><span class=cloze>[...]</span></div>""Which cancer presents as a ""<b>grape-like mass</b>"" in the <u>vagina</u>?<div><br></div><div><span class=cloze>Sarcoma botyroides (type of <b>vaginal</b> cancer)</span></div><hr> <div class=mystyle1><i>Contrast this with molar pregnancy, which presents with ""grape-like mass"" in UTERUS!</i></div> "
What is the general&nbsp;<u>treatment</u> for a <b>choriocarcinoma</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the general&nbsp;<u>treatment</u> for a <b>choriocarcinoma</b>?<div><br /></div><div><span class=cloze>Chemotherapy</span></div><hr> <div class=mystyle1><div><div><ol type=""1"" start=""1""><li><b>MAC:&nbsp;</b>Methotrexate, Actinomycin D, Cyclophosphamide with possible surgery.&nbsp;</li><li>Choriocarcinoma is a form of gestational trophoblastic neoplasia, a malignancy that arises from placental trophoblastic tissue and secretes β-hCG. &nbsp;Although it most commonly follows a hydatidiform mole, choriocarcinoma can occur after a normal gestation or spontaneous abortion. &nbsp;Choriocarcinoma typically presents &lt;6 months after a pregnancy. &nbsp;Presenting symptom include irregular vaginal bleeding, an enlarged uterus, and pelvic pain. &nbsp;Choriocarcinoma is an aggressive type of gestational trophoblastic neoplasia; the most common site of metastatic spread is to the lungs. &nbsp;Symptoms of pulmonary metastasis include chest pain, hemoptysis, and dyspnea. &nbsp;When choriocarcinoma is suspected, obtaining a quantitative β-hCG level helps to confirm the diagnosis.</li></ol></div></div><div><img src=""paste-38010460569603_1529603012320.jpg"" /></div><div><br /></div></div> "
<div>How do you treat <b>ectopic pregnancy</b>?</div><div><br /></div>Unruptured, early: <span class=cloze>[medical management]</span><div>Unruptured, advanced:&nbsp;<span class=cloze>[...]</span></div><div>Ruptured:&nbsp;<span class=cloze>[...]</span></div>"<div>How do you treat <b>ectopic pregnancy</b>?</div><div><br /></div>Unruptured, early: <span class=cloze>methotrexate</span><div>Unruptured, advanced:&nbsp;<span class=cloze>salpingostomy</span></div><div>Ruptured:&nbsp;<span class=cloze>salpingectomy</span></div><hr> <div class=mystyle1><i><div></div></i><i>-ectomy = removal of the tube</i><img src=""paste-280826436648961.jpg"" /><div><i><br /></i></div><div><i><img src=""paste-281715494879233.jpg"" /></i></div></div> "
What is the <u>next step in management</u> of a <b>positive first-trimester combined test</b> or <b>second-trimester quadruple screen</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <u>next step in management</u> of a <b>positive first-trimester combined test</b> or <b>second-trimester quadruple screen</b>?<div><br /></div><div><span class=cloze><b>Chorionic villus sampling</b>&nbsp;(10-13 weeks) or <b>amniocentesis</b> (15-20 weeks))</span></div><hr> <div class=mystyle1><div><i>For <b>karyotype</b> analysis of fetus; villus sampling examines the <b>placenta </b>while amniocentesis examines the <b>amniotic fluid.&nbsp;</b></i></div><div><i><img src=""paste-437627102691329.jpg"" /></i><img src=""paste-439624262483969.jpg"" /><i><img src=""paste-438683664646145.jpg"" /></i></div><div><i><br /></i></div><ol type=""1"" start=""1""><li><i>Prenatal screening for congenital abnormalities should be offered to all women.&nbsp;</i></li><li><i>The first-trimester screen can be performed at 9-13 weeks gestation and is a screening, not diagnostic, test.&nbsp;The quadruple marker screen is a screening test for aneuploidy performed at 15-22 weeks gestation. &nbsp;It has a sensitivity and specificity comparable to the first-trimester screen and, for that reason, is not indicated as a follow-up to an abnormal first-trimester screen.</i></li><li><i>Follow-up for these findings is a diagnostic test that allows for fetal karyotyping.&nbsp;</i></li><li><i>If the patient declines invasive testing, an anatomy ultrasound and cell-free fetal DNA test (which has a higher sensitivity and specificity than the first-trimester screen) can be used to further analyze the risk for fetal aneuploidy. &nbsp;However, these tests are also nondiagnostic and cannot provide a definitive genetic or chromosomal diagnosis.</i></li></ol><div><br /></div></div> "
Which pregnancies require&nbsp;<b><u>weekly</u>&nbsp;antepartum fetal surveillance&nbsp;</b>starting at&nbsp;<b>32 weeks</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"Which pregnancies require&nbsp;<b><u>weekly</u>&nbsp;antepartum fetal surveillance&nbsp;</b>starting at&nbsp;<b>32 weeks</b>?<div><br /></div><div><span class=cloze>Pregnancies with&nbsp;<b>maternal</b>&nbsp;comorbidities or&nbsp;<b>fetal</b>&nbsp;conditions</span></div><hr> <div class=mystyle1><div><img src=""paste-101795019882497.jpg"" /></div><div><br /></div><ol type=""1"" start=""1""><li>Antepartum fetal surveillance evaluates for<b> fetal hypoxia</b>. &nbsp;It is performed in pregnancies with a high risk of fetal demise due to maternal (eg, hypertension, diabetes mellitus) or fetal (eg, post-term pregnancy,<b> growth restriction</b>) conditions. &nbsp;The most common surveillance modality is the <b>biophysical profile (BPP),</b> which includes a nonstress test (NST) and an ultrasound evaluation of amniotic fluid, fetal tone, movement, and breathing movement. &nbsp;Each parameter is assigned a score of 0 or 2 and summed for a total of 0-10.</li></ol><div><img src=""paste-2744630131032065.jpg"" /></div><div><br /></div><div><img src=""L18832.jpg"" />&nbsp;<img src=""paste-28643136897025_1529603012320.jpg"" /></div></div> "
A <b>nonstress test</b> assesses the <u>fetal well-being</u> by measuring heart for <span class=cloze>[...]</span> and <span class=cloze>[...]</span>."A <b>nonstress test</b> assesses the <u>fetal well-being</u> by measuring heart for <span class=cloze>accelerations</span> and <span class=cloze>variability</span>.<hr> <div class=mystyle1><div>Acceleration is considered adequate if there is a&nbsp;<b>15</b> bpm rise in heart rate sustained for <b>15 </b>seconds, occurring <font color=""#ff0000"">twice in 20 minutes </font>when the fetus is <u>&gt; </u><b><u>32</u> </b>weeks.</div><div><br /></div><div>Acceleration is considered adequate if there is a&nbsp;<b>10 </b>bpm rise in heart rate sustained for <b>10</b> seconds, occurring <font color=""#ff0000"">twice in 20 minutes</font> when the fetus is <b><u>&lt; 32</u></b> weeks.</div><div><br /></div><div><img src=""paste-19542101197514.jpg"" /></div></div> "
"An acceleration in the <b>non-stress test</b> of a <u>fetus &gt; 32 weeks</u> is considered <u>adequate</u> if&nbsp;there is a<!--anki-->(n)&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;bpm rise in heart rate sustained for&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;seconds, occurring&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;in&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;minutes.""An acceleration in the <b>non-stress test</b> of a <u>fetus &gt; 32 weeks</u> is considered <u>adequate</u> if&nbsp;there is a<!--anki-->(n)&nbsp;<span class=""clozed c1""><span class=cloze>15</span></span>&nbsp;bpm rise in heart rate sustained for&nbsp;<span class=""clozed c1""><span class=cloze>15</span></span>&nbsp;seconds, occurring&nbsp;<span class=""clozed c1""><span class=cloze>twice</span></span>&nbsp;in&nbsp;<span class=""clozed c1""><span class=cloze>20</span></span>&nbsp;minutes.<hr> <div class=mystyle1>""<i>15 by 15, 2 in 20""</i><div><i><br /></i></div><div><i><img src=""paste-19542101197514.jpg"" /></i></div></div> "
<div>What is the <u>next best step</u> in working up a fetus with a <b>nonreactive NST</b>?</div><div><br /></div><div><span class=cloze>[...]</span></div>"<div>What is the <u>next best step</u> in working up a fetus with a <b>nonreactive NST</b>?</div><div><br /></div><div><span class=cloze>Repeat NST after <b>vibroacoustic stimulation</b></span></div><hr> <div class=mystyle1><i>Maybe the baby is sleeping. With this, you can wake the baby up if it's normal, and yield reactive stress test results, and you're done.</i><div><i><br /></i></div><div><i><img src=""paste-20431159428692.jpg"" /></i></div></div> "
<span class=cloze>[...]</span> is similar to APGAR but in utero, and uses information from <u><b>NST and ultrasound</b>.</u>"<span class=cloze>Biophysical profile</span> is similar to APGAR but in utero, and uses information from <u><b>NST and ultrasound</b>.</u><hr> <div class=mystyle1><i><img src=""paste-20431159428692.jpg"" /></i></div> "
What is <u>management</u> of a <b>biophysical profile of 8</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is <u>management</u> of a <b>biophysical profile of 8</b>?<div><br /></div><div><span class=cloze>Normal (8-10); can repeat in a week</span></div><hr> <div class=mystyle1><div><div><img src=""paste-28643136897025_1529603012320.jpg"" /><img src=""paste-263079631781891.jpg"" /></div></div></div> "
Of what the following <b>decelerations</b> on <u>contraction stress testing</u> indicative?<div><br /></div><div>Early: <span class=cloze>[...]</span></div><div>Variable:&nbsp;<span class=cloze>[...]</span></div><div>Late:&nbsp;<span class=cloze>[...]</span></div>"Of what the following <b>decelerations</b> on <u>contraction stress testing</u> indicative?<div><br /></div><div>Early: <span class=cloze>head compression</span></div><div>Variable:&nbsp;<span class=cloze>cord compression</span></div><div>Late:&nbsp;<span class=cloze>uteroplacental insufficiency</span></div><hr> <div class=mystyle1><div><i>An adequate test requires<b> 3 contractions every 10 minutes.&nbsp;</b></i></div><div><br /></div><img src=""paste-23081154249228.jpg"" /></div> "
The <u>onset to nadir</u> in a <b>variable deceleration</b> must be <span class=cloze>[...]</span> seconds."The <u>onset to nadir</u> in a <b>variable deceleration</b> must be <span class=cloze>&lt;30</span> seconds.<hr> <div class=mystyle1><div><i>think about V shape, fast &lt; 30 seconds</i></div><div><i><img src=""paste-327147658936323.jpg"" /></i></div></div> "
Which is the only <b>deceleration</b> on <u>contraction stress testing</u> that's worrisome?<div><br /></div><div><span class=cloze>[...]</span></div>Which is the only <b>deceleration</b> on <u>contraction stress testing</u> that's worrisome?<div><br /></div><div><span class=cloze>Late deceleration</span></div><hr> <div class=mystyle1><i>Indicates utero-placental insufficiency. The other two are nonworrisome</i></div> The <u>onset to nadir</u> in an <b>early or late deceleration</b> must be <span class=cloze>[...]</span> seconds."The <u>onset to nadir</u> in an <b>early or late deceleration</b> must be <span class=cloze>&gt;30</span> seconds.<hr> <div class=mystyle1><div><div><img src=""paste-326696687370243.jpg"" /></div></div></div> "
"What is a <b>normal baseline heart rate</b> and <b>moderate&nbsp;baseline variability</b>, as determined by <u>electronic fetal monitoring</u>?<div><br /></div><div>Heart rate:&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;bpm</div><div>Variability: <span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;bpm fluctuations from baseline</div>""What is a <b>normal baseline heart rate</b> and <b>moderate&nbsp;baseline variability</b>, as determined by <u>electronic fetal monitoring</u>?<div><br /></div><div>Heart rate:&nbsp;<span class=""clozed c1""><span class=cloze>110-160</span></span>&nbsp;bpm</div><div>Variability: <span class=""clozed c1""><span class=cloze>5-25</span></span>&nbsp;bpm fluctuations from baseline</div><hr> <div class=mystyle1><img src=""paste-25250112733552.jpg"" /><img src=""paste-25262997635526.jpg"" /></div> "
At what <u>β-hCG level</u> can a <b>transvaginal ultrasound detect a fetus</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"At what <u>β-hCG level</u> can a <b>transvaginal ultrasound detect a fetus</b>?<div><br /></div><div><span class=cloze>&gt;1500 IU/L</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>The patient is currently hemodynamically stable with a nonsurgical abdomen. &nbsp;Because an intrauterine pregnancy would not likely be visible at a β-hCG of 1000 IU/L, this patient's levels should be remeasured in 2 days. &nbsp;Once β-hCG is &gt;1500 IU/L, a TVUS should be repeated.</li></ol><img src=""L16263.jpg"" /></div> "
When is an <b>increased AFP</b> in pregnancy <u>normal</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"When is an <b>increased AFP</b> in pregnancy <u>normal</u>?<div><br /></div><div><span class=cloze>Multiple gestation</span></div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>Less commonly, an increased MSAFP can be seen in fetal congenital nephrosis and benign obstructive uropathy.</li></ol></div><img src=""paste-85620173045763.jpg"" /></div> "
"<span class=""clozed c1"">The <u>risk factors</u> associated with <b>placenta previa</b> can be remembered with the mnemonic&nbsp;<font color=""#fc0107""><b>MMAP</b></font>:</span><div><br /><div><span class=""clozed c1""><span class=""clozed c2""><b><font color=""#fc0107"">M</font></b><span class=cloze>[...]</span></span></span></div><div><span class=""clozed c1""><b><font color=""#fc0107"">M</font></b><span class=""clozed c2""><span class=cloze>[...]</span></span></span></div><div><span class=""clozed c1""><span class=""clozed c2""><b><font color=""#fc0107"">A</font></b></span></span><span class=cloze>[...]</span></div><div><span class=""clozed c1""><span class=""clozed c2""><b><font color=""#fc0107"">P</font></b></span></span><span class=cloze>[...]</span></div></div>""<span class=""clozed c1"">The <u>risk factors</u> associated with <b>placenta previa</b> can be remembered with the mnemonic&nbsp;<font color=""#fc0107""><b>MMAP</b></font>:</span><div><br /><div><span class=""clozed c1""><span class=""clozed c2""><b><font color=""#fc0107"">M</font></b><span class=cloze>ultiparity</span></span></span></div><div><span class=""clozed c1""><b><font color=""#fc0107"">M</font></b><span class=""clozed c2""><span class=cloze>ultiple gestations</span></span></span></div><div><span class=""clozed c1""><span class=""clozed c2""><b><font color=""#fc0107"">A</font></b></span></span><span class=cloze>dvanced maternal age</span></div><div><span class=""clozed c1""><span class=""clozed c2""><b><font color=""#fc0107"">P</font></b></span></span><span class=cloze>revious placenta previa</span></div></div><hr> <div class=mystyle1><img src=""paste-42902428320264.jpg"" /><img src=""paste-41016937677326.jpg"" /></div> "
Where is <u>pain located</u> in <b>abruptio placentae</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"Where is <u>pain located</u> in <b>abruptio placentae</b>?<div><br /></div><div><span class=cloze>Abdomen OR<b>&nbsp;back</b></span></div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>Abruptio placentae typically presents with abdominal and/or back pain and vaginal bleeding, which can range from severe to absent, as bleeding may be concealed behind the placenta. &nbsp;Blood may have an uterotonic effect, causing a firm uterus and unusually low-amplitude but frequent contractions.</li><li>The extent of the placental detachment also can vary. &nbsp;Smaller separations can be tolerated by the fetus, whereas larger separations can compromise fetal oxygenation and result in heart rate tracing abnormalities (eg, absent variability, recurrent decelerations, or fetal bradycardia).</li><li>This patient presents with tachycardia, constant back pain, vaginal bleeding, frequent contractions, an abnormal fetal heart rate tracing, and a distended uterus. &nbsp;Although her visible bleeding appears low in volume, the fetal heart rate tracing abnormalities suggest that a significant separation has occurred. &nbsp;Concealed bleeding is likely present and causing uterine distension (eg, fundal height larger than expected).</li></ol></div><div><img src=""paste-83696027697155.jpg"" /></div></div> "
"<b>Isoimmunization</b> occurs when a(n)&nbsp;<u><span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;mom</u> has a(n)&nbsp;<u><span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;baby</u>.&nbsp;On the first exposure she develops&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;that&nbsp;<span class=""clozed c2"">does NOT cross the placenta, leading to&nbsp;</span><span class=""clozed c2"">nothing;</span>&nbsp;on the subsequent exposure she develops&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;that&nbsp;<span class=""clozed c2"">does</span>&nbsp;crosses the placenta leading to&nbsp;<span class=""clozed c2""><b>fetal anemia</b> and <b>hydrops</b></span>.""<b>Isoimmunization</b> occurs when a(n)&nbsp;<u><span class=""clozed c1""><span class=cloze>RhD-</span></span>&nbsp;mom</u> has a(n)&nbsp;<u><span class=""clozed c1""><span class=cloze>RhD+</span></span>&nbsp;baby</u>.&nbsp;On the first exposure she develops&nbsp;<span class=""clozed c1""><span class=cloze><u>IgM</u></span></span>&nbsp;that&nbsp;<span class=""clozed c2"">does NOT cross the placenta, leading to&nbsp;</span><span class=""clozed c2"">nothing;</span>&nbsp;on the subsequent exposure she develops&nbsp;<span class=""clozed c1""><span class=cloze><u>IgG</u></span></span>&nbsp;that&nbsp;<span class=""clozed c2"">does</span>&nbsp;crosses the placenta leading to&nbsp;<span class=""clozed c2""><b>fetal anemia</b> and <b>hydrops</b></span>.<hr> <div class=mystyle1><div><i><b>hydrops</b> characterized by collection of fluid in &gt; 2 body cavities (e.g., ascites, pericardial or pleural fluid, scalp edema).</i></div><div><i><br /></i></div><img src=""paste-1876900708920.jpg"" /><img src=""paste-3624952398354.jpg"" /></div> "
"<b>Isoimmunization</b> occurs when a(n)&nbsp;<u><span class=""clozed c1"">RhD-</span>&nbsp;mom</u> has a(n)&nbsp;<u><span class=""clozed c1"">RhD+</span>&nbsp;baby</u>.&nbsp;On the first exposure she develops&nbsp;<span class=""clozed c1""><u>IgM</u></span>&nbsp;that&nbsp;<span class=""clozed c2""><span class=cloze>[does/does NOT]</span> cross the placenta, leading to&nbsp;</span><span class=""clozed c2""><span class=cloze>[...]</span>;</span>&nbsp;on the subsequent exposure she develops&nbsp;<span class=""clozed c1""><u>IgG</u></span>&nbsp;that&nbsp;<span class=""clozed c2""><span class=cloze>[does/does NOT]</span></span>&nbsp;crosses the placenta leading to&nbsp;<span class=""clozed c2""><span class=cloze>[...]</span></span>.""<b>Isoimmunization</b> occurs when a(n)&nbsp;<u><span class=""clozed c1"">RhD-</span>&nbsp;mom</u> has a(n)&nbsp;<u><span class=""clozed c1"">RhD+</span>&nbsp;baby</u>.&nbsp;On the first exposure she develops&nbsp;<span class=""clozed c1""><u>IgM</u></span>&nbsp;that&nbsp;<span class=""clozed c2""><span class=cloze>does NOT</span> cross the placenta, leading to&nbsp;</span><span class=""clozed c2""><span class=cloze>nothing</span>;</span>&nbsp;on the subsequent exposure she develops&nbsp;<span class=""clozed c1""><u>IgG</u></span>&nbsp;that&nbsp;<span class=""clozed c2""><span class=cloze>does</span></span>&nbsp;crosses the placenta leading to&nbsp;<span class=""clozed c2""><span class=cloze><b>fetal anemia</b> and <b>hydrops</b></span></span>.<hr> <div class=mystyle1><div><i><b>hydrops</b> characterized by collection of fluid in &gt; 2 body cavities (e.g., ascites, pericardial or pleural fluid, scalp edema).</i></div><div><i><br /></i></div><img src=""paste-1876900708920.jpg"" /><img src=""paste-3624952398354.jpg"" /></div> "
"In identifying <u>fetal risk</u> for<b> anemia</b>, what titer of <u>atypical antibodies</u> in the mother's circulation is concerning?<div><br /></div><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div>""In identifying <u>fetal risk</u> for<b> anemia</b>, what titer of <u>atypical antibodies</u> in the mother's circulation is concerning?<div><br /></div><div><span class=""clozed c1""><span class=cloze>Greater than or equal to 1:8</span></span></div><hr> <div class=mystyle1><div><br /></div><img src=""paste-3672197038876.jpg"" /></div> "
What is the <u>next best step</u> in working up/managing an infant with&nbsp;<b>fetal anemia</b>, as determined by <u>transcranial doppler</u>?<div><br /></div><div>Gestational age &lt; 32 weeks:&nbsp;<span class=cloze>[may be multiple things that you must do]</span></div><div>Gestational age &gt; 32 weeks:&nbsp;<span class=cloze>[may be multiple things that you must do]</span></div>"What is the <u>next best step</u> in working up/managing an infant with&nbsp;<b>fetal anemia</b>, as determined by <u>transcranial doppler</u>?<div><br /></div><div>Gestational age &lt; 32 weeks:&nbsp;<span class=cloze>PUBS for transfusion</span></div><div>Gestational age &gt; 32 weeks:&nbsp;<span class=cloze>deliver</span></div><hr> <div class=mystyle1><div><div><i>PUBS for transfusion</i></div></div><div><br /></div><div><br /></div><img src=""paste-3672197038876.jpg"" /></div> "
"<i>To prevent <b>isoimmunization</b></i>, <b>Rhogam-D </b>is given to Rh-antigen-<span class=""clozed c1""><span class=cloze>[...]</span></span>, Rh-antibody-<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;moms at&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;weeks and within&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;hours of delivery.""<i>To prevent <b>isoimmunization</b></i>, <b>Rhogam-D </b>is given to Rh-antigen-<span class=""clozed c1""><span class=cloze>negative</span></span>, Rh-antibody-<span class=""clozed c1""><span class=cloze>negative</span></span>&nbsp;moms at&nbsp;<span class=""clozed c1""><span class=cloze>28</span></span>&nbsp;weeks and within&nbsp;<span class=""clozed c1""><span class=cloze>72</span></span>&nbsp;hours of delivery.<hr> <div class=mystyle1><div><div>Rhogam-D is never given to a mother who is already Rh- Antibody-Positive because the goal is to bind up all the antigen before mom can make antibodies to it. If she already has the antibodies, it’s too late. Giving her more antibodies doesn’t help.</div></div><div><br /></div><img src=""paste-3672197038876.jpg"" /></div> "
What test is used to determine the <u>dose</u> of <b>anti-D immune globulin</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What test is used to determine the <u>dose</u> of <b>anti-D immune globulin</b>?<div><br /></div><div><span class=cloze>Kleihauer-betke test</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>Red blood cells from the maternal circulation are fixed on a slide. &nbsp;The slide is exposed to an acidic solution and adult hemoglobin lyses, leaving ""ghost"" cells. &nbsp;The dose of anti-D immune globulin is calculated from the percentage of remaining <b><u>fetal</u></b> hemoglobin.&nbsp;</li></ol><img src=""paste-11123965296643.jpg"" /></div> "
<b>Hypertension in pregnancy</b> is associated with&nbsp;<span class=cloze>[PPROM/preterm delivery]</span>"<b>Hypertension in pregnancy</b> is associated with&nbsp;<span class=cloze>preterm delivery</span><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>Hypertension does not increase the risk for PPROM.</li><li>PPROM is associated with <b>genital tract infection and a history of prior PPROM. &nbsp;</b></li></ol><img src=""paste-36876589203459.jpg"" /></div> "
What causes <u>right upper quadrant pain</u> in <b>HELLP syndrome</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What causes <u>right upper quadrant pain</u> in <b>HELLP syndrome</b>?<div><br /></div><div><span class=cloze>Distension of the hepatic (Glisson's) capsule</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>HELLP syndrome may be a variation of severe preeclampsia and affects 10%–20% of women with preeclampsia. &nbsp;Serious liver problems include centrilobular necrosis, hematoma formation, and thrombi in the portal capillary system. &nbsp;These processes can cause<b> liver swelling with distension of the hepatic (Glisson's) capsule, resulting in right upper quadrant or epigastric pain</b>. &nbsp;The diagnosis is based on clinical presentation and laboratory findings (Table). &nbsp;This patient is hypertensive and has signs of hemolysis (anemia with indirect hyperbilirubinemia), elevated hepatic transaminases, and thrombocytopenia. &nbsp;Alkaline phosphatase is normally elevated in pregnancy.</li></ol><div><img src=""paste-79087527788547.jpg"" /></div></div> "
What <u>treatment</u> for <b>preeclampsia</b> has both <u>anti-HTN</u> and <u>anti-epileptic</u> properties?<div><br /></div><div><span class=cloze>[...]</span></div>"What <u>treatment</u> for <b>preeclampsia</b> has both <u>anti-HTN</u> and <u>anti-epileptic</u> properties?<div><br /></div><div><span class=cloze>Magnesium</span></div><hr> <div class=mystyle1><i>That's why it's used for severe preeclampsia and eclampsia.</i><div><i><br /></i></div><div><i>It causes hypotension and relaxation of all nerves, getting rid of both HTN and seizures.</i></div><div><i><br /></i></div><div><i><img src=""paste-3676492005880.jpg"" /></i></div></div> "
"What do you <u>administer</u> to <b>reverse magnesium's toxicity</b>?<div><br /></div><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div>""What do you <u>administer</u> to <b>reverse magnesium's toxicity</b>?<div><br /></div><div><span class=""clozed c1""><span class=cloze>IV calcium gluconate</span></span></div><hr> <div class=mystyle1><i>Mg2+ is a calcium channel antagonist. Supplemental Ca2+ will compete with Mg2+ and restore function to the calcium channels; do this to <b>reverse respiratory depression</b>.</i></div> "
What is <u>treatment</u> of <b>magnesium toxicity</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is <u>treatment</u> of <b>magnesium toxicity</b>?<div><br /></div><div><span class=cloze>Calcium gluconate</span></div><hr> <div class=mystyle1><img src=""paste-159643934392323.jpg"" /></div> "
"What are <u>target glucose values</u> for <b>pregnant diabetics</b>?<div><br /></div><div>Fasting blood sugar: &lt;&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;mg/dL</div><div>1-hour post-meal:&nbsp;&lt;&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;mg/dL</div><!--anki--><div><b>2</b>-hour post-meal:&nbsp;&lt;&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;mg/dL</div><!--anki-->""What are <u>target glucose values</u> for <b>pregnant diabetics</b>?<div><br /></div><div>Fasting blood sugar: &lt;&nbsp;<span class=""clozed c1""><span class=cloze>95</span></span>&nbsp;mg/dL</div><div>1-hour post-meal:&nbsp;&lt;&nbsp;<span class=""clozed c1""><span class=cloze>140</span></span>&nbsp;mg/dL</div><!--anki--><div><b>2</b>-hour post-meal:&nbsp;&lt;&nbsp;<span class=""clozed c1""><span class=cloze>1<b>2</b>0</span></span>&nbsp;mg/dL</div><!--anki--><hr> <div class=mystyle1><img src=""paste-41339060224003.jpg"" /><img src=""paste-88935887798275_1496784870471.jpg"" /><div><br /></div><div><br /></div></div> "
What are the <u>exceptions</u> to universal screening of <b>GBS</b>?<div><br /></div><div>1. <span class=cloze>[...]</span><br />2.&nbsp;<span class=cloze>[...]</span></div><div><br /></div><div>Why:&nbsp;<span class=cloze>[...]</span>.</div>"What are the <u>exceptions</u> to universal screening of <b>GBS</b>?<div><br /></div><div>1. <span class=cloze>History of GBS bacteriuria at any point during <u>current</u> pregnancy</span><br />2.&nbsp;<span class=cloze>Invasive early-onset GBS disease in a <u>prior</u> child</span></div><div><br /></div><div>Why:&nbsp;<span class=cloze>These patients are empirically treated (intrapartum PCN)</span>.</div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>Streptococcus agalactiae (group B Streptococcus [GBS]) causes the most common neonatal infection that is acquired by exposure to colonized amniotic fluid after rupture of membranes. &nbsp;Screening for GBS and administering intrapartum antibiotic prophylaxis (IAP) to high-risk women have markedly reduced the incidence of early-onset neonatal GBS disease. &nbsp;However, GBS colonization may be transient and screening is most accurate if performed 3-5 weeks prior to the estimated delivery date. &nbsp;In patients who show no signs of preterm labor, universal screening occurs at 35-37 weeks gestation to increase the likelihood of having an accurate result in anticipation of labor at 40-42 weeks gestation. &nbsp;Culture of the vagina and rectum is the most sensitive screening method for GBS.</li><li>The exceptions to universal screening include a history of GBS bacteriuria at any point during the current pregnancy or invasive early-onset GBS disease in a prior child. &nbsp;These high-risk patients should receive IAP (Choice A) as their urogenital tract colonization is more likely to persist and spread to the newborn.</li><li>Women who miss screening (unknown GBS status) should be treated in labor if they are at &lt;37 weeks gestation, develop an intrapartum fever, or have rupture of membranes for &gt;18 hours; otherwise, their risk of transmission is low. &nbsp;Women who are GBS negative do not need antibiotic prophylaxis for prolonged rupture of membranes as over-treatment may result in antibiotic resistance or emergence of other neonatal pathogens.</li><li>Penicillin is the prophylactic agent of choice; it reaches therapeutic levels in the amniotic fluid and fetus without toxicity and has a narrow spectrum of coverage, minimizing the risk of resistance. &nbsp;Prophylaxis should be given 4 hours before delivery.</li></ol></div><div><img src=""paste-25817048416259.jpg"" /></div></div> "
What kind of <u>fetal monitoring is contraindicated</u> during labor in <b>mothers with hepatitis C</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What kind of <u>fetal monitoring is contraindicated</u> during labor in <b>mothers with hepatitis C</b>?<div><br /></div><div><span class=cloze>Fetal scalp electrodes</div><div><br /></div><div>Can promote the mixing of fetal and maternal blood.</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>This also applies to other infections (HIV, active herpes).</li></ol><div><br /></div><div><img src=""paste-302511726526467.jpg"" /></div></div> "
"How do you manage<b>&nbsp;HIV during pregnancy for <u>mom</u>&nbsp;(intrapartum)?</b><div><div><br /></div><div><b>Viral load ≥ 1000: </b>ART +&nbsp;<span class=cloze>[delivery method]</span> +&nbsp;<font color=""#ff0000"">zidovudine (AZT)</font> at time of delivery</div></div><div><br /></div><div><b>Unknown HIV status:&nbsp;</b><span class=""clozed c1""><font color=""#ff0000"">Zidovudine (AZT)</font>&nbsp;</span>at time of delivery</div><div><br /></div><div><b>Viral load &lt; 1000: </b>ART +&nbsp;<span class=cloze>[delivery method]</span></div><div><b><br /></b></div>""How do you manage<b>&nbsp;HIV during pregnancy for <u>mom</u>&nbsp;(intrapartum)?</b><div><div><br /></div><div><b>Viral load ≥ 1000: </b>ART +&nbsp;<span class=cloze>C-section at 38 weeks</span> +&nbsp;<font color=""#ff0000"">zidovudine (AZT)</font> at time of delivery</div></div><div><br /></div><div><b>Unknown HIV status:&nbsp;</b><span class=""clozed c1""><font color=""#ff0000"">Zidovudine (AZT)</font>&nbsp;</span>at time of delivery</div><div><br /></div><div><b>Viral load &lt; 1000: </b>ART +&nbsp;<span class=cloze>Vaginal delivery</span></div><div><b><br /></b></div><hr> <div class=mystyle1><img src=""Screen Shot 2017-03-22 at 5.05.16 PM.jpg"" /><img src=""paste-1194005203255297.jpg"" /></div> "
What is <u>management of an <b>infant</b></u> whose <b>mother has HIV with viral load &gt;1,000 copies/mL</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is <u>management of an <b>infant</b></u> whose <b>mother has HIV with viral load &gt;1,000 copies/mL</b>?<div><br /></div><div><span class=cloze>Multi-drug ART</div><div><br /></div><div>Zidovidine should be administered to the neonate for &gt;6 weeks.</span></div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>&gt; 1000 = give more</li><li>The most important intervention for preventing the spread of HIV from mother to child is administration of combination antiretroviral therapy to the mother throughout pregnancy. &nbsp;Antiviral therapy should be initiated as soon as possible during pregnancy (even during the first trimester), regardless of maternal CD4 count or viral load. &nbsp;Antenatal combination therapy is the best way to suppress maternal HIV and prevent transplacental or perinatal acquisition by the infant. &nbsp;Mothers with undetectable viral loads at delivery have &lt;1% risk of transmitting the infection to their infants. &nbsp;The 3-drug regimen should consist of 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor. &nbsp;An NRTI with good placental transfer (eg, zidovudine, tenofovir) should be administered. &nbsp;Zidovudine should be administered to the neonate for &gt;6 weeks.</li></ol></div><div><img src=""paste-34338263531523_1529603012320.jpg"" /></div></div> "
What is <u>management of an <b>infant</b></u> whose <b>mother has HIV with viral load &lt;1,000 copies/mL</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is <u>management of an <b>infant</b></u> whose <b>mother has HIV with viral load &lt;1,000 copies/mL</b>?<div><br /></div><div><span class=cloze>Zidovudine alone (immediately after delivery)</span></div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>&lt; 1000 = only zidovudine</li><li>The most important intervention for preventing the spread of HIV from mother to child is administration of combination antiretroviral therapy to the mother throughout pregnancy. &nbsp;Antiviral therapy should be initiated as soon as possible during pregnancy (even during the first trimester), regardless of maternal CD4 count or viral load. &nbsp;Antenatal combination therapy is the best way to suppress maternal HIV and prevent transplacental or perinatal acquisition by the infant. &nbsp;Mothers with undetectable viral loads at delivery have &lt;1% risk of transmitting the infection to their infants. &nbsp;The 3-drug regimen should consist of 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus a non-nucleoside reverse transcriptase inhibitor or a protease inhibitor. &nbsp;An NRTI with good placental transfer (eg, zidovudine, tenofovir) should be administered. &nbsp;Zidovudine should be administered to the neonate for &gt;6 weeks</li></ol></div><div><img src=""paste-1195534211612673.jpg"" /></div></div> "
Patients with <b>intrahepatic cholestasis of pregnancy</b> typically present with what <u>derm</u> symptom?<div><br /></div><div><span class=cloze>[...]</span></div>"Patients with <b>intrahepatic cholestasis of pregnancy</b> typically present with what <u>derm</u> symptom?<div><br /></div><div><span class=cloze>Pruritis</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>Intrahepatic cholestasis of pregnancy is characterized by elevated bilirubin and transaminases as well as generalized pruritus.</li><li>Vs Acute fatty liver of pregnancy:</li><ol><li>Nausea/vomiting</li><li>Abdominal pain</li><li>Jaundice</li></ol></ol><span style=""color: rgb(255, 255, 255)""><img src=""paste-23553600651267_1496784870471.jpg"" /></span></div> "
<b>Ursodeoxycholic acid</b> is used to treat which <u>pregnancy complication</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"<b>Ursodeoxycholic acid</b> is used to treat which <u>pregnancy complication</u>?<div><br /></div><div><span class=cloze>Intrahepatic cholestasis of pregnancy</span></div><hr> <div class=mystyle1><div><i>deliver at 37 weeks gestation;<b> improves itching </b>2/2 bile salt retention.</i></div><div><i><br /></i></div><div><i><img src=""paste-567463964049411.jpg"" /></i></div><span style=""color: rgb(255, 255, 255)""><img src=""paste-23553600651267_1496784870471.jpg"" /></span></div> "
Contractions generating &gt;<span class=cloze>[...]</span>&nbsp;Montevideo units (MVUs) in a 10-minute interval are considered <b>adequate</b>."Contractions generating &gt;<span class=cloze>200</span>&nbsp;Montevideo units (MVUs) in a 10-minute interval are considered <b>adequate</b>.<hr> <div class=mystyle1><div><div><i>MVU = # uterine contractions in 10 minutes x contraction strength.</i></div><div><i><img src=""mvu.png"" /></i></div><ol type=""1"" start=""1""><li><i>The first stage of labor begins with the onset of regular contractions and ends when the patient is 10 cm dilated. &nbsp;It consists of a latent phase involving gradual cervical dilation and an active phase with rapid dilation. &nbsp;The transition between the latent and active phase typically occurs at 6 cm dilation.</i></li><li><i>Patients who are &gt;6 cm dilated with slow dilation (labor protraction) or absence of further dilation (labor arrest) have an active phase abnormality. &nbsp;The etiology of active-phase labor abnormalities can be uterine (eg, inadequate contractions), fetal (eg, malpresentation, nonocciput anterior position, macrosomia), or pelvic (deformity or fracture). &nbsp;Arrest of active labor occurs when there is no cervical change for &gt;4 hours with adequate contractions or no cervical change for &gt;6 hours with inadequate contractions.</i></li><li><i>With an intrauterine pressure catheter in place, the peak contraction pressure minus the baseline intrauterine pressure (both in mm Hg) determines the number of Montevideo units (MVUs) for the contraction. &nbsp;Contractions generating &gt;200 MVUsin a 10-minute interval are considered adequate. &nbsp;This patient has arrest of active labor as she has had no cervical change in 4 hours despite adequate contractions. Cesarean delivery is therefore indicated.</i></li></ol></div><div><i><br /></i></div><i><img src=""paste-135261405052931.jpg"" /></i></div> "
On average, <u>how long</u> does the <b>latent phase</b> last for a nulli? Multiparous?<div><br /></div><div>Nulli: <span class=cloze>[...]</span> hours</div><div>Multi: <span class=cloze>[...]</span> hours</div>"On average, <u>how long</u> does the <b>latent phase</b> last for a nulli? Multiparous?<div><br /></div><div>Nulli: <span class=cloze>20</span> hours</div><div>Multi: <span class=cloze>14</span> hours</div><hr> <div class=mystyle1><img src=""paste-25709674234398.jpg"" /></div> "
How is <b>progression of the second stage of labor</b> evaluated?<div><br /></div><div><span class=cloze>[...]</span></div>"How is <b>progression of the second stage of labor</b> evaluated?<div><br /></div><div><span class=cloze><b>Station</b></div><div><br /></div><div>Cervix/effacement is at maximum already.</span></div><hr> <div class=mystyle1><div><div><ol type=""1"" start=""1""><li><img src=""paste-1078504942731265.jpg"" /></li><li>The second stage of labor begins when the cervix is 10 cm dilated and ends with fetal delivery. &nbsp;The duration of the second stage is affected by parity and use of neuraxial anesthesia. &nbsp;<b>Progression during the second stage is evaluated by determining the fetal station, which measures the descent of the presenting part through the pelvis.</b></li><li>An arrested second stage occurs when there is no fetal descent after pushing for &gt;3 hours in nulliparous patients or &gt;2 hours in multiparous patients. &nbsp;The most common cause of a prolonged or arrested second stage is <b>fetal malposition</b>. &nbsp;The fetal position is the relationship of the fetal presenting part to the maternal pelvis. &nbsp;The optimal fetal position is occiput anterior as it facilitates the cardinal movements of labor. &nbsp;Deviations from this position (eg, occiput transverse, occiput posterior) can cause cephalopelvic disproportion and arrest of the second stage.</li><li>Fetal presentation refers to the lowest part of the fetus in the maternal pelvis. &nbsp;The most common presentation (seen in this patient) is vertex, in which the fetal occiput is the lowest presenting part. &nbsp;Malpresentation refers to any nonvertex presentation (eg, face, breech) and can cause labor protraction.</li><li>Inadequate contractions (eg, &lt;3 contractions in 10 minutes, soft to palpation) are the most common cause of a protracted first stage of labor. &nbsp;This patient's contractions are regular (every 2-3 minutes) and firm on palpation and, therefore, are likely adequate.</li><li>Maternal obesity is a risk factor for protraction and arrest during the first and second stages of labor. &nbsp;This patient was underweight prior to pregnancy and gained an appropriate amount of weight during pregnancy.</li><li>Molding is the change in fetal head shape caused by pressure from maternal expulsive efforts. &nbsp;This occurs as the fetal head attempts to adapt to the shape of the maternal pelvis to facilitate delivery. &nbsp;Molding of the fetal head with an arrest of descent is suggestive of cephalopelvic disproportion, not poor maternal effort.</li></ol></div></div><div><img src=""paste-43486543872003.jpg"" /></div></div> "
What is the <u>indication</u> of <b>methylergonovine</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <u>indication</u> of <b>methylergonovine</b>?<div><br /></div><div><span class=cloze>Uterine atony</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>The first-line uterotonic is oxytocin, which is generally administered via intravenous infusion.&nbsp;If oxytocin and bimanual massage fail, the next step is to administer other uterotonic agents. &nbsp;</li><li>Methylergonovine is an uterotonic drug that causes smooth muscle constriction, uterine contraction, and vasoconstriction. Because vasoconstriction can cause hypertension, a history of hypertension is a contraindication to methylergonovine. &nbsp;</li><li>Carboprost is a synthetic prostaglandin that stimulates uterine contraction. Carboprost causes bronchoconstriction, and asthma is a contraindication to its use in this patient</li></ol></div> "
What is a <u>contraindication</u> to <b>methylergonovine</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is a <u>contraindication</u> to <b>methylergonovine</b>?<div><br /></div><div><span class=cloze>Hypertension (since it causes vasoconstriction)</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>The first-line uterotonic is oxytocin, which is generally administered via intravenous infusion.&nbsp;If oxytocin and bimanual massage fail, the next step is to administer other uterotonic agents. &nbsp;</li><li>Methylergonovine (Choice E) is an uterotonic drug that causes smooth muscle constriction, uterine contraction, and vasoconstriction. &nbsp;Because vasoconstriction can cause hypertension, a history of hypertension is a contraindication to methylergonovine. &nbsp;</li><li>Carboprost (Choice D) is a synthetic prostaglandin that stimulates uterine contraction. &nbsp;Carboprost causes bronchoconstriction, and asthma is a contraindication to its use in this patient</li></ol></div> "
<b>Retraction of the fetal head into the perineum</b> after delivery (eg, turtle sign) is suggestive of <u>what obstetric complication</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"<b>Retraction of the fetal head into the perineum</b> after delivery (eg, turtle sign) is suggestive of <u>what obstetric complication</u>?<div><br /></div><div><span class=cloze>Shoulder dystocia</span></div><hr> <div class=mystyle1><img src=""paste-43130061586435.jpg"" /></div> "
<span class=cloze>[...]</span> is a <u>term</u> baby with rupture of membranes <u>without</u>&nbsp;contractions.&nbsp;<span class=cloze>Premature rupture of membrane (PROM)</span> is a <u>term</u> baby with rupture of membranes <u>without</u>&nbsp;contractions.&nbsp;<hr> <div class=mystyle1><i><br /></i></div> "<i>If the <b>amniotic membrane has ruptured</b></i>, you can <u>confirm</u> this with <span class=cloze>[...]</span> to look for&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;in the <u>posterior vaginal fornix</u>.""<i>If the <b>amniotic membrane has ruptured</b></i>, you can <u>confirm</u> this with <span class=cloze>speculum exam</span> to look for&nbsp;<span class=""clozed c1""><span class=cloze>pooling of amnioitic fluid</span></span>&nbsp;in the <u>posterior vaginal fornix</u>.<hr> <div class=mystyle1><i>You will see pooling of <b>vaginal fluid</b> in the posterior vagina. With this, you either have a choice grabbing the fluid and put it on the slide to look for <b>ferning</b>, or perform <b>nitrazine</b> test and see if it turns blue, which is normal.&nbsp;</i></div> "
What is <u>management</u> of <b>premature rupture of membranes</b> at term?<div><br /><div><span class=cloze>[...]</span><br /></div></div>"What is <u>management</u> of <b>premature rupture of membranes</b> at term?<div><br /><div><span class=cloze>Induction of labor (oxytocin)</span><br /></div></div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>Refers to rupture of membranes before onset of labor contractions.&nbsp;</li><li>Give antibiotics to prevent GBS and delay labor.</li></ol></div><div style=""color: rgb(255, 255, 255); ""><span style=""color: rgb(255, 255, 255)""><br /></span></div><img src=""paste-5415953760258.jpg"" /></div> "
When are <u>antibiotics</u> indicated for <b>PPROM</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"When are <u>antibiotics</u> indicated for <b>PPROM</b>?<div><br /></div><div><span class=cloze>Always</span></div><hr> <div class=mystyle1><div><div><i>delays delivery and prevents GBS infection</i></div><div><i><img src=""paste-336953069273090.jpg"" /></i></div></div></div> "
<b>Prolonged rupture of membrane</b> is if there's a <u>prolonged time between ROM and delivery</u> that&nbsp;is greater than <span class=cloze>[...]</span> hours.<b>Prolonged rupture of membrane</b> is if there's a <u>prolonged time between ROM and delivery</u> that&nbsp;is greater than <span class=cloze>18</span> hours.<hr> <div class=mystyle1></div> What is the <u>complication</u> of <b>prolonged rupture of membranes</b> for the fetus and mom?<div><br /></div><div><span class=cloze>[...]</span></div>What is the <u>complication</u> of <b>prolonged rupture of membranes</b> for the fetus and mom?<div><br /></div><div><span class=cloze>Chorioamnionitis/endometritis</span></div><hr> <div class=mystyle1><i>These two have nearly identical presentation (fever/toxic + prolonged ROM), but in the former, the baby is still inside, while in the latter, the baby has come out.</i></div> Why is <b>magnesium sulfate</b> given to mothers at risk for <u>delivery at &lt;32 weeks gestation</u>?<div><br /></div><div><span class=cloze>[...]</span></div>Why is <b>magnesium sulfate</b> given to mothers at risk for <u>delivery at &lt;32 weeks gestation</u>?<div><br /></div><div><span class=cloze>Decreases risk of cerebral palsy in infants</span></div><hr> <div class=mystyle1></div> "Which <u>tocolytic agent</u>&nbsp;works by <b>competing with Ca²⁺&nbsp;for muscle depolarization (e.g., myometrium)</b>?<div><br /></div><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div>""Which <u>tocolytic agent</u>&nbsp;works by <b>competing with Ca²⁺&nbsp;for muscle depolarization (e.g., myometrium)</b>?<div><br /></div><div><span class=""clozed c1""><span class=cloze>Magnesium sulfate</span></span></div><hr> <div class=mystyle1></div> "
<b>Indomethacin</b> is <u>contraindicated</u> at which gestational age?<div><br /></div><div><span class=cloze>[...]</span></div>"<b>Indomethacin</b> is <u>contraindicated</u> at which gestational age?<div><br /></div><div><span class=cloze>&gt;&nbsp;32 weeks gestation&nbsp;</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>Tocolysis is not indicated after 34 weeks gestation as risks of the therapies exceed those of preterm delivery. &nbsp;Indomethacin, a common tocolytic, is contraindicated after 32 weeks gestation due to<b> potential closure of the ductus arteriosus.&nbsp;</b></li></ol></div> "
Until what gestational age are <b>tocolytics</b> given in the management of <b>preterm labor</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"Until what gestational age are <b>tocolytics</b> given in the management of <b>preterm labor</b>?<div><br /></div><div><span class=cloze>&lt;34 weeks</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li><i>Give along with steroids (for lung maturity)</i></li><li>At &gt;34 weeks gestation, tocolytics such as indomethacin and nifedipine (Choices A and C) are not recommended as the risks of indomethacin (oligohydramnios, closure of the ductus arteriosus) and nifedipine (maternal hypotension/tachycardia) outweigh the risks of premature delivery.</li><li>Indomethacin, a common tocolytic, is contraindicated after 32 weeks gestation due to potential closure of the ductus arteriosus.&nbsp;</li><li>Treatment for preterm labor at &lt;34 weeks includes tocolytics (eg, indomethacin, nifedipine) to postpone delivery and corticosteroids (eg, betamethasone) to decrease the risk of neonatal respiratory distress syndrome. &nbsp;In addition, magnesium sulfate administration at &lt;32 weeks gestation lowers the risk of neonatal neurological morbidities (eg, cerebral palsy). &nbsp;Although magnesium sulfate has weak tocolytic properties, it is used primarily for fetal neuroprotectionin patients at &lt;32 weeks gestation who are expected to deliver within the next 24 hours. &nbsp;Magnesium sulfate can be administered concurrently with indomethacin.</li></ol><img src=""paste-255314330910721.jpg"" /></div> "
What is an <b>umbilical cord prolapse</b>?<div><br /></div><div><span class=cloze>[...]</span>&nbsp;</div>"What is an <b>umbilical cord prolapse</b>?<div><br /></div><div><span class=cloze>When the umbilical cord delivers through the cervix ahead of the presenting fetal part.</span>&nbsp;</div><hr> <div class=mystyle1><div><div><i>fetal head can compress umbilical cord causing variable decelerations and <b>fetal</b> <b>bradycardia</b>; <b>C-section is indicated.</b></i></div></div><div><br /></div><img src=""paste-25696789331971_1529603012320.jpg"" /></div> "
<u>Vacuum extractor delivery</u> risks to the baby include <b>facial</b>&nbsp;<b>laceration</b> and <span class=cloze>[...]</span>."<u>Vacuum extractor delivery</u> risks to the baby include <b>facial</b>&nbsp;<b>laceration</b> and <span class=cloze>cephalohematoma</span>.<hr> <div class=mystyle1><div><i>Imagine a vacuum sucking skin out and making a hematoma</i></div><img src=""paste-11025181048833.jpg"" /><img src=""paste-69780333658115.jpg"" /><img src=""paste-32130650342294.jpg"" /></div> "
What is <u>management of labor</u> in woman who have <b>contraindications to pushing</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is <u>management of labor</u> in woman who have <b>contraindications to pushing</b>?<div><br /></div><div><span class=cloze>Operative vaginal delivery (eg, vacuum, forceps)</span></div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>Maternal comorbidities that make pushing ineffective (eg, neuromuscular disorders) or for which Valsalva is contraindicated (eg,cerebrovascular disease, cardiac disease).</li></ol></div><img src=""paste-104363410325507_1529603012320.jpg"" /></div> "
Among the 3 outcomes of subsequent pregnancies after C-section, the <b>best outcome</b> is <span class=cloze>[...]</span>, while the <b>worst outcome</b> is <span class=cloze>[...]</span>."Among the 3 outcomes of subsequent pregnancies after C-section, the <b>best outcome</b> is <span class=cloze>VBAC</span>, while the <b>worst outcome</b> is <span class=cloze>TOLAC</span>.<hr> <div class=mystyle1><div><i>successful vaginal birth &gt; planned C-section &gt; unplanned C-section</i></div><div><i><br /></i></div><i><img src=""paste-37404870181362.jpg"" /><img src=""paste-32130650342294.jpg"" /></i></div> "
Is a <u>trial of labor contraindicated</u> in a patient with <b>history of a low transverse cesarean delivery</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"Is a <u>trial of labor contraindicated</u> in a patient with <b>history of a low transverse cesarean delivery</b>?<div><br /></div><div><span class=cloze>No</span></div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li><img src=""paste-139564962283523.jpg"" /></li><li>The risk of uterine rupture is greatest in laboring patients with prior uterine surgery, particularly a prior classical (vertical) cesarean delivery or a prior myomectomy that was extensive or entered the uterine cavity (eg, during removal of intramural or submucosal fibroids).&nbsp;</li><li>Vaginal delivery is safe after a low transverse (horizontal uterine incision) cesarean delivery. &nbsp;</li><li>In contrast, patients with either a classical cesarean delivery or an extensive myomectomy are delivered via cesarean delivery at 36-37 weeks gestation. &nbsp;When these patients present in labor, urgent laparotomy and delivery are required. &nbsp;Further management is determined by intraoperative findings. &nbsp;If uterine rupture has occurred, delivery is typically through the rupture site and a uterine repair is performed. &nbsp;If the uterus is unruptured, a hysterotomy (ie, cesarean delivery) is performed. &nbsp;Expectant management for a vaginal delivery is generally contraindicated in patients with prior classical cesarean delivery or extensive myomectomy.</li></ol></div><img src=""paste-139564962283523.jpg"" /></div> "
Is a <u>trial of labor contraindicated</u> in a patient with <b>history of a classical (vertical) cesarean delivery</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"Is a <u>trial of labor contraindicated</u> in a patient with <b>history of a classical (vertical) cesarean delivery</b>?<div><br /></div><div><span class=cloze>Yes</span></div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>Schedule a C-section at 37 weeks.</li><li><img src=""paste-139564962283523.jpg"" /></li><li>The risk of uterine rupture is greatest in laboring patients with prior uterine surgery, particularly a prior classical (vertical) cesarean delivery or a prior myomectomy that was extensive or entered the uterine cavity (eg, during removal of intramural or submucosal fibroids).&nbsp;</li><li>Vaginal delivery is safe after a low transverse (horizontal uterine incision) cesarean delivery. &nbsp;</li><li>In contrast, patients with either a classical cesarean delivery or an extensive myomectomy are delivered via cesarean delivery at 36-37 weeks gestation. &nbsp;When these patients present in labor, urgent laparotomy and delivery are required. &nbsp;Further management is determined by intraoperative findings. &nbsp;If uterine rupture has occurred, delivery is typically through the rupture site and a uterine repair is performed. &nbsp;If the uterus is unruptured, a hysterotomy (ie, cesarean delivery) is performed. &nbsp;Expectant management for a vaginal delivery is generally contraindicated in patients with prior classical cesarean delivery or extensive myomectomy.</li></ol></div><img src=""paste-139564962283523.jpg"" /></div> "
<div>Which episiotomy can cause a<b> fourth</b> degree laceration and thus turn into a <b>recto-vaginal fistula?&nbsp;</b></div><div><br /></div><div><span class=cloze>[...]</span></div>"<div>Which episiotomy can cause a<b> fourth</b> degree laceration and thus turn into a <b>recto-vaginal fistula?&nbsp;</b></div><div><br /></div><div><span class=cloze>Medial</span></div><hr> <div class=mystyle1><img src=""paste-35592393982312.jpg"" /><img src=""paste-32130650342294.jpg"" /></div> "
"What is known as a ""<b>high spinal</b>"" or ""<b>total spinal</b>""?<div><br /></div><div><span class=cloze>[...]</span></div>""What is known as a ""<b>high spinal</b>"" or ""<b>total spinal</b>""?<div><br /></div><div><span class=cloze>Depression of cervical spinal cord and brainstem activity when <b>local anesthesia ascends</b> toward the head</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>It may happen with <b>intrathecal</b> injection or <b>overdose</b> of the anesthetic. &nbsp;First signs include hypotension, bradycardia, and respiratory difficulty, and later, diaphragmatic paralysis and possibly cardiopulmonary arrest.</li></ol><img src=""paste-394385371955203.jpg"" /></div> "
<span class=cloze>[...]</span> involves the <u>instillation of fluid into the uterine cavity</u> to treat <b>variable decelerations</b>."<span class=cloze><b>Amnioinfusion</b></span> involves the <u>instillation of fluid into the uterine cavity</u> to treat <b>variable decelerations</b>.<hr> <div class=mystyle1><ol type=""1"" start=""1""><li>Maternal repositioning (eg, left lateral) is the first-line intervention and may reduce cord compression and improve blood flow to the placenta. &nbsp;Should these efforts fail, amnioinfusion is a reasonable second-line intrauterine resuscitation option. &nbsp;Because cord compression may result from the reduction of amniotic fluid after rupture of membranes, the<b> instillation of saline into the amniotic sac may decrease cord compression and eliminate variable decelerations. </b>It is contraindicated in a patient with uterine surgery. &nbsp;This patient's fetal heart rate tracing is normal; the low amniotic fluid index is an expected finding after membrane rupture and does not require treatment. It is not performed in anhydramnios (no amniotic fluid, which is lethal).</li></ol></div> "
When is <b>amnioinfusion</b> <u>contraindicated</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"When is <b>amnioinfusion</b> <u>contraindicated</u>?<div><br /></div><div><span class=cloze>In a patient with a history of <b>uterine surgery</b> (eg, C-section, presumably due to risk of rupture)</span></div><hr> <div class=mystyle1><ol type=""1"" start=""1""><li>Amnioinfusion involves the placement of an intrauterine pressure catheter for an intrauterine infusion to decrease <b>umbilical cord compression</b> and resolve<b> variable decelerations</b></li></ol></div> "
What is the supsected diagnosis when the patient has a <b>postpartum hemorrhage</b> and the <u>uterus can't be felt</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the supsected diagnosis when the patient has a <b>postpartum hemorrhage</b> and the <u>uterus can't be felt</u>?<div><br /></div><div><span class=cloze>Uterine inversion</span></div><hr> <div class=mystyle1><i>Risk increases with <b>oxytocin</b> use and <b>umbilical cord traction (i.e., me pulling cord)</b>. It can also be caused by excessive traction during the treatment of atony.</i><div><i><br /></i></div><div><i>Management would be to do the speculum exam and push the uterus back with your bare hands, and if necessary, give tocolytics right aftewards, but you have to give uterotonics no matter what to contract it down to where it's supposed to be.</i><div><i><br /></i></div><div><i><!--anki--></i><i><img src=""paste-42799349105968.jpg"" /></i></div></div></div> "
In a <u>pregnant patient</u>, ultrasound findings of&nbsp;<b>intraplacental villous lakes</b> is suggestive of what?<div><br /></div><div><span class=cloze>[...]</span></div>"In a <u>pregnant patient</u>, ultrasound findings of&nbsp;<b>intraplacental villous lakes</b> is suggestive of what?<div><br /></div><div><span class=cloze>Placenta accreta</span></div><hr> <div class=mystyle1><div><ol type=""1"" start=""1""><li>Placenta accreta is typically diagnosed by antenatal ultrasound findings that include irregularity or absence of the placental-myometrial interface and intraplacental villous lakes.&nbsp;</li></ol></div><img src=""paste-54945516617731.jpg"" /></div> "
"<b>Placenta&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;</b>refers to a placenta that has grown too deeply into the wall of the uterus with <u>no separation between the placenta and the myometrium</u>.&nbsp;<div><b><br /></b></div><div><b>Placenta&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span></b>&nbsp;burrows into the <u>myometrium</u></div><div><br /></div><div><b>Placenta&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;</b>embeds through the <u>myometrium and uterine serosa</u>.</div>""<b>Placenta&nbsp;<span class=""clozed c1""><span class=cloze>accreta</span></span>&nbsp;</b>refers to a placenta that has grown too deeply into the wall of the uterus with <u>no separation between the placenta and the myometrium</u>.&nbsp;<div><b><br /></b></div><div><b>Placenta&nbsp;<span class=""clozed c1""><span class=cloze>increta</span></span></b>&nbsp;burrows into the <u>myometrium</u></div><div><br /></div><div><b>Placenta&nbsp;<span class=""clozed c1""><span class=cloze>percreta</span></span>&nbsp;</b>embeds through the <u>myometrium and uterine serosa</u>.</div><hr> <div class=mystyle1><!--anki--><i><div></div></i><i><div></div></i><i>A-I-P (ABC order)</i><div><i>Accreta, Increta, Percreta</i></div><div><i><br /></i></div>Percreta may actually go into other organs. The uterus is a vascular bed, much like an oil well. The placenta goes drilling for blood. Sometimes it goes wide and sometimes it goes deep. In a fresh uterus (no pregnancies) the vascular supply is rich; the placenta doesn’t have to go deep or wide. When the uterus is used (multiple pregnancies) the placenta will go either wide (which can result in a placenta previa) or deep (accreta). So risk increases with increasing pregnancies.<div><i><br /></i></div><div><i><img src=""paste-47132971107244.jpg"" /><img src=""paste-42799349105968.jpg"" /></i></div></div> "
How do you treat <b>retained placenta</b>?<div><br /></div><div>First-line:&nbsp;<span class=cloze>[...]</span></div><div>Refractory:&nbsp;<span class=cloze>[...]</span></div>"How do you treat <b>retained placenta</b>?<div><br /></div><div>First-line:&nbsp;<span class=cloze>D&amp;C</span></div><div>Refractory:&nbsp;<span class=cloze>hysterectomy</span></div><hr> <div class=mystyle1><div><i>placenta burrowed deeply, leaving blood vessels stuck on the uterus</i></div><img src=""paste-47128676139948.jpg"" /></div> "
"<div class=card>pregnancy = <span class=cloze>[↑↓↔]</span> hematocrit</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>pregnancy = <span class=cloze>↓</span> hematocrit</div><br><br> <div class=extra><div><div><i><u style=""font-weight: bold; "">Plasma Volume:</u>&nbsp;</i>divert blood away from mom to placenta; RAAS activated.</div><div><i><u style=""font-weight: bold; "">RBC Volume:</u>&nbsp;</i><b>&nbsp;</b><i>↑&nbsp;</i>EPO = ↑ RBC mass</div></div><div><br /></div><div><b><i>Dilutional anemia</i></b>&nbsp;d/t Plasma volume &gt;&gt; RBC volume</div><div><br /></div><div><img src=""paste-112133006163969.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><u><b>Inferior Vena Cava Syndrome</b></u>&nbsp;causes&nbsp;<span class=cloze>[...]</span> blood pressure when&nbsp;<u>supine</u>&nbsp;during pregnancy.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u><b>Inferior Vena Cava Syndrome</b></u>&nbsp;causes&nbsp;<span class=cloze>decreased</span> blood pressure when&nbsp;<u>supine</u>&nbsp;during pregnancy.</div><br><br> <div class=extra><div><i>decreased venous return (preload) due to large baby compressing IVC</i></div><div><div><i><img src=""paste-10097721515966465.jpg"" /><img src=""Pregnancy_Uterus_Compression_of_Structures.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>blood pressure in pregnancy <span class=cloze>[...]</span>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>blood pressure in pregnancy <span class=cloze>decreases</span>.</div><br><br> <div class=extra><div>MAP = CO * <b style=""font-style: italic; "">TPR</b>&nbsp;</div><div>2/2 progesterone.</div><div><br /></div><div><img src=""paste-65416646885379_1529603012320.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b>Maternal adaptations</b>&nbsp;to pregnancy include a(n) <span class=cloze>[...]</span>&nbsp;<b>tidal</b>&nbsp;<b>volume</b>&nbsp;and <span class=cloze>[...]</span>&nbsp;<b>respiratory</b>&nbsp;<b>rate</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Maternal adaptations</b>&nbsp;to pregnancy include a(n) <span class=cloze><u>increased</u></span>&nbsp;<b>tidal</b>&nbsp;<b>volume</b>&nbsp;and <span class=cloze><u>normal</u></span>&nbsp;<b>respiratory</b>&nbsp;<b>rate</b>&nbsp;</div><br><br> <div class=extra><i>due to effects of&nbsp;<u>progesterone</u>&nbsp;stimulating respiratory center in brain; results in an&nbsp;<b>increased minute ventilation</b>&nbsp;(minute ventilation = tidal volume x respiratory rate); imagine a big tide washing over a baby.&nbsp;</i><div><i><br /></i><div><div><i><img src=""WHY DIFF CHARTS.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>pregnancy = <span class=cloze>[↑↓↔]</span> GFR + <span class=cloze>[↑↓↔]</span> creatinine/BUN</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>pregnancy = <span class=cloze>↑</span> GFR + <span class=cloze>↓</span> creatinine/BUN</div><br><br> <div class=extra><div><i></i><i>more blood to push out through glomerulus</i></div><div><i><br /></i><div><i><img src=""WHY DIFF CHARTS.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>Pregnancy</b> causes <span class=cloze>[...]</span> mobility of GI system.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Pregnancy</b> causes <span class=cloze>↓</span> mobility of GI system.</div><br><br> <div class=extra><div><i></i><i>causing&nbsp;<b>constipation</b></i></div><div><i></i><i><br /></i></div><div><div><i><img src=""WHY DIFF CHARTS.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>Which&nbsp;<u>hormone</u>&nbsp;affects&nbsp;<b>respiration in pregnancy</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which&nbsp;<u>hormone</u>&nbsp;affects&nbsp;<b>respiration in pregnancy</b>?<div><br /></div><div><span class=cloze>Progesterone (increases tidal volume)</span></div></div><br><br> <div class=extra><div><i><b>Dyspnea</b> is also common; progesterone induces increased minute ventilation through an increase in<b> tidal volume (respiratory center stimulation)</b>, but the respiratory rate is unchanged. &nbsp;The enlarging uterus causes the diaphragm to be elevated, resulting in decreased functional residual capacity;&nbsp;</i><i>imagine a big tide washing over a baby.&nbsp;</i></div><div><i><br /></i></div><div><i><img src=""paste-65416646885379_1529603012320.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>The levels of&nbsp;<u>TBG</u>&nbsp;and&nbsp;<u><b>total</b>&nbsp;T4&nbsp;</u>are <i>increased</i>&nbsp;with&nbsp;<b><span class=cloze>[state]</span></b>&nbsp;and&nbsp;<b>oral contraceptive use</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The levels of&nbsp;<u>TBG</u>&nbsp;and&nbsp;<u><b>total</b>&nbsp;T4&nbsp;</u>are <i>increased</i>&nbsp;with&nbsp;<b><span class=cloze>pregnancy</span></b>&nbsp;and&nbsp;<b>oral contraceptive use</b>&nbsp;</div><br><br> <div class=extra><div><i><b>↑&nbsp;TBG&nbsp;</b>=&nbsp;↑&nbsp;<b>Total</b>&nbsp;T4&nbsp;</i></div><div><div><i><div></div></i><i><br /></i></div><div><i><b><u>free</u></b>&nbsp;T3/T4 and TSH remains&nbsp;<b>normal</b>&nbsp;(the HPP axis is normal, so the thyroid has less negative feedback due to less free T3/T4 and produces more T3/T4)&nbsp;</i></div></div><div><i><br /></i></div><div><i><img src=""potay.png"" /></i></div><div><i></i><i><img src=""paste-2671912039743489.jpg"" /><img src=""paste-2698476412469249.jpg"" /><img src=""paste-2701663278202881.jpg"" /><img src=""paste-2673522652479489.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>The levels of&nbsp;<u>TBG</u>&nbsp;and&nbsp;<u><b>total</b>&nbsp;T4&nbsp;</u>are <i>increased</i>&nbsp;with&nbsp;<b>pregnancy</b>&nbsp;and&nbsp;<b><span class=cloze>[...]</span> use</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The levels of&nbsp;<u>TBG</u>&nbsp;and&nbsp;<u><b>total</b>&nbsp;T4&nbsp;</u>are <i>increased</i>&nbsp;with&nbsp;<b>pregnancy</b>&nbsp;and&nbsp;<b><span class=cloze>oral contraceptive</span> use</b>&nbsp;</div><br><br> <div class=extra><div><i><b>↑&nbsp;TBG&nbsp;</b>=&nbsp;↑&nbsp;<b>Total</b>&nbsp;T4&nbsp;</i></div><div><div><i><div></div></i><i><br /></i></div><div><i><b><u>free</u></b>&nbsp;T3/T4 and TSH remains&nbsp;<b>normal</b>&nbsp;(the HPP axis is normal, so the thyroid has less negative feedback due to less free T3/T4 and produces more T3/T4)&nbsp;</i></div></div><div><i><br /></i></div><div><i><img src=""potay.png"" /></i></div><div><i></i><i><img src=""paste-2671912039743489.jpg"" /><img src=""paste-2698476412469249.jpg"" /><img src=""paste-2701663278202881.jpg"" /><img src=""paste-2673522652479489.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Choriocarcinoma</b>&nbsp;is a tumor with&nbsp;early, diffuse&nbsp;<u>hematogenous</u>&nbsp;spread, especially to the <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Choriocarcinoma</b>&nbsp;is a tumor with&nbsp;early, diffuse&nbsp;<u>hematogenous</u>&nbsp;spread, especially to the <span class=cloze>lungs</span></div><br><br> <div class=extra><div><i>presents as hemoptysis, shortness of breath, and/or chest pain; other common sites of metastasis include the&nbsp;<b>vagina</b>&nbsp;and&nbsp;<b>brain</b></i></div><div><i><b><br /></b></i></div><img src=""chorio.png"" /></div> <div class=tags></div>"
"<div class=card>Vaccinations recommended for&nbsp;<u>all</u>&nbsp;pregnant women during each pregnancy include&nbsp;<u>inactivated</u>&nbsp;<b>influenzae</b>&nbsp;and <span class=cloze>[...]</span>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Vaccinations recommended for&nbsp;<u>all</u>&nbsp;pregnant women during each pregnancy include&nbsp;<u>inactivated</u>&nbsp;<b>influenzae</b>&nbsp;and <span class=cloze><b>Tdap</b></span>&nbsp;</div><br><br> <div class=extra><div><i>vaccination during the third trimester protects the mother against pertussis and provides passive immunity to the infant; live vaccines are contraindicated.</i></div><div><i><br /></i></div><img src=""hm (5).png"" /></div> <div class=tags></div>"
"<div class=card>What is the OB/GYN history for a patient that is G3P1112?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>What is the OB/GYN history for a patient that is G3P1112?<div><br /></div><div><span class=cloze>3 pregnancies; 1 term delivery, 1 preterm delivery, 1 abortion, 2 living children</span></div></div><br><br> <div class=extra><div><br /></div><div><div><i>G = Gravida = # of pregnancies regardless of outcome</i></div><div><i>P = Parity = # of deliveries regardless of outcome</i></div><div><i>Parity is subdivided into Term, Preterm, Abortion and Living Children (<b>P_TPAL</b>)</i></div></div></div> <div class=tags></div>
"<div class=card>Frequency of checkups:<div><br /></div><div><div>Until the <b>28th</b> week of pregnancy: q4w</div><div>From the <b>28th</b> week until the <b>36th</b> week: <span class=cloze>[...]</span></div><div>From the <b>36th</b> week until <b>birth</b>: q1w</div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Frequency of checkups:<div><br /></div><div><div>Until the <b>28th</b> week of pregnancy: q4w</div><div>From the <b>28th</b> week until the <b>36th</b> week: <span class=cloze>q2w</span></div><div>From the <b>36th</b> week until <b>birth</b>: q1w</div></div></div><br><br> <div class=extra>4/2/1<div>4 x 7 = 28</div></div> <div class=tags></div>
"<div class=card>The&nbsp;<i>diagnosis</i>&nbsp;of&nbsp;<b>sickle cell disease</b>&nbsp;can be confirmed with&nbsp;<span class=cloze>[...]</span>.<div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The&nbsp;<i>diagnosis</i>&nbsp;of&nbsp;<b>sickle cell disease</b>&nbsp;can be confirmed with&nbsp;<span class=cloze>hemoglobin electrophoresis</span>.<div><br /></div></div><br><br> <div class=extra><br /><div><div><div><div><div><div><div><img src=""paste-326451874234843.jpg"" /></div><div><br /></div><div><img src=""paste-619188255195137.jpg"" /></div></div></div></div></div></div><div><br /></div></div></div> <div class=tags></div>"
"<div class=card><b>Maternal diabetes</b>&nbsp;in the&nbsp;<u><span class=cloze>[...]</span> trimester</u>&nbsp;is associated with&nbsp;<i>increased</i>&nbsp;risk of&nbsp;<b>cardiac</b>,&nbsp;<b>limb</b>, and&nbsp;<b>neural</b>&nbsp;<b>tube defects</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Maternal diabetes</b>&nbsp;in the&nbsp;<u><span class=cloze>first</span> trimester</u>&nbsp;is associated with&nbsp;<i>increased</i>&nbsp;risk of&nbsp;<b>cardiac</b>,&nbsp;<b>limb</b>, and&nbsp;<b>neural</b>&nbsp;<b>tube defects</b></div><br><br> <div class=extra><div><div><div><i>i.e.&nbsp;<b>pregestational diabetes - this is when organogenesis occurs!</b></i></div><div><i><b><br /></b></i></div><img src=""IDM my bff jill.png"" /></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>initial screening test</i>&nbsp;of choice for&nbsp;<b>fetal</b>&nbsp;<b>aneuploidy</b>&nbsp;in pregnant women at&nbsp;<b>&gt; 10 weeks </b>gestation with&nbsp;<u>high-risk factors</u>&nbsp;(e.g. age&nbsp;<u>&gt;</u>&nbsp;35)?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>initial screening test</i>&nbsp;of choice for&nbsp;<b>fetal</b>&nbsp;<b>aneuploidy</b>&nbsp;in pregnant women at&nbsp;<b>&gt; 10 weeks </b>gestation with&nbsp;<u>high-risk factors</u>&nbsp;(e.g. age&nbsp;<u>&gt;</u>&nbsp;35)?<div><br /></div><div><span class=cloze>Cell-free fetal DNA testing</span></div></div><br><br> <div class=extra><i>higher sensitivity and specificity for detecting <b>aneuploidies (e.g., trisomies)</b>&nbsp;than both the first-trimester combined test and second-trimester quadruple screen;&nbsp;must confirm with <b>CVS</b> or <b>amniocentesis</b></i><div><i><br /></i></div><div><i><br /></i><div><i><img src=""not happy about it.png"" /></i></div><div><i><img src=""prenatal testing.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>most common cause</i>&nbsp;of&nbsp;<u><b>inherited</b></u>&nbsp;<b>intellectual disability</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>most common cause</i>&nbsp;of&nbsp;<u><b>inherited</b></u>&nbsp;<b>intellectual disability</b>?<div><br /></div><div><span class=cloze>Fragile X syndrome</span></div></div><br><br> <div class=extra><u style=""font-weight: bold; "">#1 genetic</u>&nbsp;cause = Down's (Fragile X is #2 genetic cause)<div><br /></div><div><img src=""paste-5997286173704193.jpg"" /><img src=""paste-5997299058606081.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><div><div>Compared to&nbsp;<u>normal</u>, what changes detected by a&nbsp;<b>neonatal&nbsp;quad screen</b>&nbsp;would be indicative of&nbsp;<b>trisomy 18</b>&nbsp;(Edward syndrome)?</div></div><div><br /></div><div><div><u>AFP</u>: <span class=cloze>[...]</span></div><div><u>Estriol</u>: <span class=cloze>[...]</span></div><div><u>hCG</u>: <span class=cloze>[...]</span></div></div><div><u>Inhibin A</u>: <span class=cloze>[...]</span></div><div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div><div>Compared to&nbsp;<u>normal</u>, what changes detected by a&nbsp;<b>neonatal&nbsp;quad screen</b>&nbsp;would be indicative of&nbsp;<b>trisomy 18</b>&nbsp;(Edward syndrome)?</div></div><div><br /></div><div><div><u>AFP</u>: <span class=cloze>decreased</span></div><div><u>Estriol</u>: <span class=cloze>decreased</span></div><div><u>hCG</u>: <span class=cloze>decreased</span></div></div><div><u>Inhibin A</u>: <span class=cloze>decreased</span></div><div><br /></div></div><br><br> <div class=extra><b><u><div></div></u></b><b><u>Edward is feeling LOW about the election (18)<br /></u></b><img src=""paste-650275228483585.jpg"" /></div> <div class=tags></div>"
"<div class=card>The&nbsp;<b><u>first</u>-trimester combined test</b>&nbsp;analyzes the risk for&nbsp;<u>fetal trisomy 18 &amp; 21</u>&nbsp;by measuring maternal&nbsp;serum&nbsp;pregnancy-associated plasma protein (<b>PAPP-A</b>) and&nbsp;<span class=cloze>[...]</span>, as well as <span class=cloze>[...]</span>&nbsp;<b>translucency</b>&nbsp;on ultrasound</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The&nbsp;<b><u>first</u>-trimester combined test</b>&nbsp;analyzes the risk for&nbsp;<u>fetal trisomy 18 &amp; 21</u>&nbsp;by measuring maternal&nbsp;serum&nbsp;pregnancy-associated plasma protein (<b>PAPP-A</b>) and&nbsp;<span class=cloze><b>beta-hCG</b></span>, as well as <span class=cloze><b>nuchal</b></span>&nbsp;<b>translucency</b>&nbsp;on ultrasound</div><br><br> <div class=extra><div><i>performed between 9 - 13 weeks of gestation;&nbsp;<u>not</u>&nbsp;diagnostic and must be confirmed with <b>villus sampling / amniocentesis.&nbsp;</b></i></div><div><i><br /></i></div><img src=""prenatal testing.png"" /></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>most accurate</u>&nbsp;measurement of&nbsp;<b>gestational age</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>most accurate</u>&nbsp;measurement of&nbsp;<b>gestational age</b>?<div><br /></div><div><span class=cloze>First trimester ultrasound with <b>crown-rump length </b>measurement</span></div></div><br><br> <div class=extra><div><i><b>last menstrual period</b> may be used to estimate gestational age if the patient has <u>normal</u> 28-day cycle with fertilization occuring on day 14 and a reliable LMP; <b>don't</b> change measurements based on later imaging.&nbsp;</i></div><div><i><span style=""color: rgb(255, 255, 255)""><div><br /></div><div><img src=""crl.jpg"" /><div></div></div></span></i><i><img src=""GA (1).png"" /></i></div><div><i><br /></i></div><div><font color=""#ffffff""><i><br /></i></font></div></div> <div class=tags></div>"
"<div class=card>folic acid in <b>low</b>-risk patients = <span class=cloze>[...]</span><div>folic acid in <b>high</b>-risk patients = <span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>folic acid in <b>low</b>-risk patients = <span class=cloze>0.4 mg</span><div>folic acid in <b>high</b>-risk patients = <span class=cloze>4 mg</span></div></div><br><br> <div class=extra><i><b>high risk </b></i>=<i>&nbsp;previous neural tube defect, overt diabetes, or taking anticonvulsants.</i></div> <div class=tags></div>
"<div class=card>What is the&nbsp;<i>most common cause</i>&nbsp;of&nbsp;<u>elevated</u>&nbsp;<b>maternal serum AFP</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>What is the&nbsp;<i>most common cause</i>&nbsp;of&nbsp;<u>elevated</u>&nbsp;<b>maternal serum AFP</b>?<div><br /></div><div><span class=cloze>Incorrect dating (i.e. <u>underestimation</u> of gestational age)</span></div></div><br><br> <div class=extra>next step → obtain <b>u/s </b>to confirm gestational age.</div> <div class=tags></div>
"<div class=card><b>quad screening</b> is done in the <span class=cloze>[first/second]</span> trimester</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>quad screening</b> is done in the <span class=cloze>second (13-28)</span> trimester</div><br><br> <div class=extra><div>vs. <b>combined</b> <b>screening</b> in first trimester (nuchal, hcg, PAPP-A)</div><div><br /></div><img src=""paste-454613698347009.jpg"" /><img src=""paste-12953621364739_1496784870471.jpg"" /><div><img src=""IMG_7761.png"" /></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>best screening test</i>&nbsp;for&nbsp;<b>gestational diabetes mellitus</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>best screening test</i>&nbsp;for&nbsp;<b>gestational diabetes mellitus</b>?&nbsp;<div><br /></div><div><span class=cloze>50g 1-hour glucose challenge</span></div></div><br><br> <div class=extra><div><i></i><i>if &gt; <b>140</b>, follow with<b>&nbsp;100g, 3-hour</b> glucose tolerance test; do after<b> 24 weeks <u>except</u>&nbsp;if have risk factors (prior diabetes, obese) - can do at first visit.</b></i></div><div><i><br /></i><div style=""font-weight: bold; ""><i><img src=""routine pnc.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>Maternal sensitization to a fetus'&nbsp;<font color=""#ff0000"">Rh⁺&nbsp;blood</font>&nbsp;may be reduced using <span class=cloze>[treatment]</span>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Maternal sensitization to a fetus'&nbsp;<font color=""#ff0000"">Rh⁺&nbsp;blood</font>&nbsp;may be reduced using <span class=cloze>Rh-immune globulin (Rhogam)</span>.</div><br><br> <div class=extra><div><i>prevents <b>maternal&nbsp;antibody production</b></i></div><div><i>give at <b>28</b> <b>weeks</b> <u>and </u><b>within 72</b> <b>hours</b> of delivery (each dose lasts 12 weeks)</i></div></div> <div class=tags></div>"
"<div class=card>After&nbsp;<b>20 weeks of pregnancy</b>, an&nbsp;<u>increased flow</u>&nbsp;caught by&nbsp;<u>intracranial doppler</u>&nbsp;is indicative of <span class=cloze>[...]</span>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>After&nbsp;<b>20 weeks of pregnancy</b>, an&nbsp;<u>increased flow</u>&nbsp;caught by&nbsp;<u>intracranial doppler</u>&nbsp;is indicative of <span class=cloze>fetal anemia</span>.</div><br><br> <div class=extra><i><img src=""paste-353931074994608.jpg"" /></i></div> <div class=tags></div>"
"Do you treat <b>asymptomatic bacteriuria</b> in <u>pregnant women</u>?<div><br /></div><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div>""Do you treat <b>asymptomatic bacteriuria</b> in <u>pregnant women</u>?<div><br /></div><div><span class=""clozed c1""><span class=cloze>YES!</span></span></div><hr> <div class=mystyle1><div><i>with <b>Amoxicillin or Nitrofurantoin&nbsp;</b></i></div><i><img src=""paste-334590837261712.jpg"" /></i></div> "
How do you manage <b>pyelonephritis in pregnancy</b>?<div><br /></div><div>Treat: IV&nbsp;<span class=cloze>[...]</span></div><div>If refractory:&nbsp;<span class=cloze>[...]</span></div>"How do you manage <b>pyelonephritis in pregnancy</b>?<div><br /></div><div>Treat: IV&nbsp;<span class=cloze>ceftriaxone</span></div><div>If refractory:&nbsp;<span class=cloze><b>U/S</b> to rule out abscess</span></div><hr> <div class=mystyle1><div><i>In refractory pyelo, you treat with 14 days of antibiotics, and use <b>ultrasound</b> to check for abscess. You do NOT use CT in this case because of radiation and she's pregnant.</i></div><div><br /></div><div><img src=""paste-19460496819136.jpg"" /></div></div> "
"<div class=card><font color=""#ff0000"">hyper</font>thyroidism +&nbsp;<font color=""#ff0000"">1st&nbsp;</font>trimester&nbsp;<font color=""#ff0000"">pregnancy</font>&nbsp;= <span class=cloze>[drug]</span><div><font color=""#ff0000"">hyper</font>thyroidism +&nbsp;<font color=""#ff0000"">2nd/3rd&nbsp;</font>trimester&nbsp;<font color=""#ff0000"">pregnancy</font>&nbsp;= <span class=cloze>[drug]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">hyper</font>thyroidism +&nbsp;<font color=""#ff0000"">1st&nbsp;</font>trimester&nbsp;<font color=""#ff0000"">pregnancy</font>&nbsp;= <span class=cloze>propylthiouracil (PTU)</span><div><font color=""#ff0000"">hyper</font>thyroidism +&nbsp;<font color=""#ff0000"">2nd/3rd&nbsp;</font>trimester&nbsp;<font color=""#ff0000"">pregnancy</font>&nbsp;= <span class=cloze>methimazole</span></div></div><br><br> <div class=extra><div><b>P</b> for initial <b>P</b>regnancy</div><div><br /></div><div><img src=""paste-2382031812034561.jpg"" /></div><div><img src=""Screen Shot 2017-05-01 at 4.30.03 PM.png"" /></div></div> <div class=tags></div>"
"<div class=card>seizures +&nbsp;<font color=""#ff0000"">pregnancy</font>&nbsp;= <span class=cloze>[antiepileptic]</span> or levetiracetam</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>seizures +&nbsp;<font color=""#ff0000"">pregnancy</font>&nbsp;= <span class=cloze>lamotrigine</span> or levetiracetam</div><br><br> <div class=extra><div><b>pregnant lamb levitating</b></div></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">hypertension</font>&nbsp;during&nbsp;<font color=""#ff0000"">pregnancy</font>&nbsp;= labetalol, nifedipine, a-methyldopa, <span class=cloze>[drug]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">hypertension</font>&nbsp;during&nbsp;<font color=""#ff0000"">pregnancy</font>&nbsp;= labetalol, nifedipine, a-methyldopa, <span class=cloze>hydralazine</span></div><br><br> <div class=extra><div><i>(from 2019 ACOG guidelines,<b> labetalol and nifedipine are preferred</b>);&nbsp;</i></div><div><i>- hydralazine &gt; labetalol if bradycardic.</i></div><div><i><br /></i></div><div><b><i><img src=""paste-1181502553456641.jpg"" /></i></b></div><div><b><i><img src=""wohp.png"" /></i></b></div><div><b><i><br /></i></b></div><div><i><b><div><br /></div><div><img src=""paste-15019500634601.jpg"" /></div><div><img src=""paste-474563821437401.jpg"" /><img src=""paste-474228813988315.jpg"" /></div></b><b><div style=""display: inline !important; ""><img src=""paste-28278064677451.jpg"" /><img src=""paste-435973540282848.jpg"" /></div></b></i><b><div><div><div><i><br /></i></div><div><br /></div></div></div></b></div></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">hypertension</font>&nbsp;during&nbsp;<font color=""#ff0000"">pregnancy</font>&nbsp;= labetalol, nifedipine, <span class=cloze>[...]</span>, hydralazine</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">hypertension</font>&nbsp;during&nbsp;<font color=""#ff0000"">pregnancy</font>&nbsp;= labetalol, nifedipine, <span class=cloze>a-methyldopa</span>, hydralazine</div><br><br> <div class=extra><div><i>(from 2019 ACOG guidelines,<b> labetalol and nifedipine are preferred</b>);&nbsp;</i></div><div><i>- hydralazine &gt; labetalol if bradycardic.</i></div><div><i><br /></i></div><div><b><i><img src=""paste-1181502553456641.jpg"" /></i></b></div><div><b><i><img src=""wohp.png"" /></i></b></div><div><b><i><br /></i></b></div><div><i><b><div><br /></div><div><img src=""paste-15019500634601.jpg"" /></div><div><img src=""paste-474563821437401.jpg"" /><img src=""paste-474228813988315.jpg"" /></div></b><b><div style=""display: inline !important; ""><img src=""paste-28278064677451.jpg"" /><img src=""paste-435973540282848.jpg"" /></div></b></i><b><div><div><div><i><br /></i></div><div><br /></div></div></div></b></div></div> <div class=tags></div>"
"<div class=card>pregnancy + hypothyroidism = <span class=cloze>[...]</span> dose of thyroid hormone</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>pregnancy + hypothyroidism = <span class=cloze>↑</span> dose of thyroid hormone</div><br><br> <div class=extra><div><i>due to ↑<b> thyroid binding globulin</b>, leaving less T3/T4 available</i></div><div><b><i><br /></i></b></div><div><b><i><img src=""paste-2671912039743489.jpg"" /></i></b></div></div> <div class=tags></div>"
"<div class=card>First-line treatment options for&nbsp;<b>asymptomatic bacteriuria</b>&nbsp;during&nbsp;<u>pregnancy</u>&nbsp;include cephalexin, <span class=cloze>[...]</span>, and nitrofurantoin</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>First-line treatment options for&nbsp;<b>asymptomatic bacteriuria</b>&nbsp;during&nbsp;<u>pregnancy</u>&nbsp;include cephalexin, <span class=cloze>amoxicillin-clavulanate</span>, and nitrofurantoin</div><br><br> <div class=extra><div><i>all women are screened during the first prenatal visit due to risk of&nbsp;<b>pyelonephritis</b>,&nbsp;<b>preterm</b>&nbsp;<b>birth</b>, and&nbsp;<b>low</b>&nbsp;<b>birth</b>&nbsp;<b>weight</b>&nbsp;associated with ASB (<u>always treat UTI in pregnancy)</u></i></div><div><i><br /></i></div><img src=""daaangit.png"" /></div> <div class=tags></div>"
"<div class=card>First-line treatment options for&nbsp;<b>asymptomatic bacteriuria</b>&nbsp;during&nbsp;<u>pregnancy</u>&nbsp;include cephalexin, amoxicillin-clavulanate, and <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>First-line treatment options for&nbsp;<b>asymptomatic bacteriuria</b>&nbsp;during&nbsp;<u>pregnancy</u>&nbsp;include cephalexin, amoxicillin-clavulanate, and <span class=cloze>nitrofurantoin</span></div><br><br> <div class=extra><div><i>all women are screened during the first prenatal visit due to risk of&nbsp;<b>pyelonephritis</b>,&nbsp;<b>preterm</b>&nbsp;<b>birth</b>, and&nbsp;<b>low</b>&nbsp;<b>birth</b>&nbsp;<b>weight</b>&nbsp;associated with ASB (<u>always treat UTI in pregnancy)</u></i></div><div><i><br /></i></div><img src=""daaangit.png"" /></div> <div class=tags></div>"
"<div class=card>What is management of&nbsp;<b>gestational diabetes mellitus</b>&nbsp;<u>unresponsive to dietary modifications and exercise</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is management of&nbsp;<b>gestational diabetes mellitus</b>&nbsp;<u>unresponsive to dietary modifications and exercise</u>?<div><br /></div><div><span class=cloze>Insulin</div><div><br /></div><div>Oral medications (eg, glyburide, metformin) are equivalent in efficacy and are widely used as first-line pharmacotherapy.</span></div></div><br><br> <div class=extra><div><div><br /></div></div><div><img src=""paste-41339060224003.jpg"" />&nbsp;<img src=""paste-88935887798275_1496784870471.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>How does&nbsp;<b>maternal insulin resistance</b>&nbsp;change in pregnancy?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>How does&nbsp;<b>maternal insulin resistance</b>&nbsp;change in pregnancy?<div><br /></div><div><span class=cloze>Increase</span></div></div><br><br> <div class=extra>Especially during 2/3 trimesters, which leads to<b> hyperglycemia</b>.</div> <div class=tags></div>
"<div class=card>In testing for&nbsp;<b>gestational diabetes</b>, if the&nbsp;<u>1 hour glucose challenge test</u>&nbsp;reveals a glucose of&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>+, move on to the&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In testing for&nbsp;<b>gestational diabetes</b>, if the&nbsp;<u>1 hour glucose challenge test</u>&nbsp;reveals a glucose of&nbsp;<span class=""clozed c1""><span class=cloze>140</span></span>+, move on to the&nbsp;<span class=""clozed c1""><span class=cloze>3-hour glucose tolerance test</span></span>.</div><br><br> <div class=extra></div> <div class=tags></div>"
The <u>transition</u> between the <b>latent and active phase of <u>first</u> stage of labor</b> typically occurs at <span class=cloze>[...]</span> dilation."The <u>transition</u> between the <b>latent and active phase of <u>first</u> stage of labor</b> typically occurs at <span class=cloze>6 cm</span> dilation.<hr> <div class=mystyle1><div><div><img src=""paste-25713969201694.jpg"" /></div></div><div><br /></div><img src=""paste-135261405052931.jpg"" /></div> "
<b>Station 0 in fetal delivery</b> is what <u>anatomic landmark</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"<b>Station 0 in fetal delivery</b> is what <u>anatomic landmark</u>?<div><br /></div><div><span class=cloze>Ischial spine</span></div><hr> <div class=mystyle1><div>Fetal station = where baby is</div><div><b>(-) </b>= farthest away from vaginal opening</div><div><b>(+) </b>= closest to vaginal opening.</div><div><br /></div><div><img src=""Th8G1zku9Jxh37BJllaOZCXbRKFH0Gjx_lg.jpg"" /></div><img src=""paste-27131308409262.jpg"" /></div> "
"The cervix changes from <b>rigid to loose</b> by breaking&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>&nbsp;and infusing&nbsp;<span class=""clozed c1""><b>water</b></span>. This is stimulated by <u>fetal head engagement</u> and the production of&nbsp;<span class=""clozed c1""><span class=cloze>[...]</span></span>.""The cervix changes from <b>rigid to loose</b> by breaking&nbsp;<span class=""clozed c1""><span class=cloze>disulfide bonds</span></span>&nbsp;and infusing&nbsp;<span class=""clozed c1""><b>water</b></span>. This is stimulated by <u>fetal head engagement</u> and the production of&nbsp;<span class=""clozed c1""><span class=cloze>prostaglandin E2</span></span>.<hr> <div class=mystyle1><i></i><i>As contraction forces the baby's head into the cervix, the cervix responds to the pressure by undergoing biochemical changes to facilitate delivery.</i><div><i><br /></i></div><div><i>Cervical changes can be facilitated with balloons or medications (misoprostol or oxytocin).</i></div><div><i><br /></i></div><div><i><img src=""Cervix-During-Birth-Or-Labor.jpg"" /></i></div></div> "
"<div class=card><img src=""paste-187144609988609 (2).jpg"" /><div><span class=cloze>[...]</span></div><div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><img src=""paste-187144609988609 (2).jpg"" /><div><span class=cloze><img src=""paste-187251984171009 (1).jpg"" /></span></div><div><br /></div></div><br><br> <div class=extra><b>B</b>reech <b>B</b>utt first (Transverse aka Transverse breech)<div>Cephalic head first</div></div> <div class=tags></div>"
"<div class=card>Breech baby = <span class=cloze>[delivery method]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Breech baby = <span class=cloze>C-section</span></div><br><br> <div class=extra><img src=""paste-187990718545921.jpg"" /></div> <div class=tags></div>"
"<div class=card>There are <span class=cloze>[...]</span> stages of labor</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>There are <span class=cloze>three</span> stages of labor</div><br><br> <div class=extra><div><br /></div><img src=""paste-25713969201694.jpg"" /></div> <div class=tags></div>"
"<div class=card>The <b>first</b> stage of labor is from <u>onset</u> of labor until cervix is completely <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The <b>first</b> stage of labor is from <u>onset</u> of labor until cervix is completely <span class=cloze>dilated</span></div><br><br> <div class=extra><div><br /></div><img src=""paste-25713969201694.jpg"" /></div> <div class=tags></div>"
"<div class=card>normal fetal heart rate = <span class=cloze>[...]</span> -160 bpm</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>normal fetal heart rate = <span class=cloze>110</span> -160 bpm</div><br><br> <div class=extra>&lt; 110 = bradycardia<div>&gt; 160 = tachycardia</div></div> <div class=tags></div>
"<div class=card>normal fetal heart rate = 110 -<span class=cloze>[...]</span> bpm</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>normal fetal heart rate = 110 -<span class=cloze>160</span> bpm</div><br><br> <div class=extra>&lt; 110 = bradycardia<div>&gt; 160 = tachycardia</div></div> <div class=tags></div>
"<div class=card>Strep agalactiae (GBS) is passed through the vaginal canal during delivery.&nbsp;<div><br /></div><div>Therefore, at what time do pregnant women need to be screened/cultured?&nbsp;<span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Strep agalactiae (GBS) is passed through the vaginal canal during delivery.&nbsp;<div><br /></div><div>Therefore, at what time do pregnant women need to be screened/cultured?&nbsp;<span class=cloze>35 weeks</span></div></div><br><br> <div class=extra><i>Give penicillin for GBS prophylaxis</i><div><i><br /></i></div><div><i><img src=""Screen Shot 2017-01-19 at 9.06.21 PM.jpg"" /></i><div></div></div></div> <div class=tags></div>"
"<div class=card>fetal accelerations are <span class=cloze>[good/bad]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>fetal accelerations are <span class=cloze>good</span></div><br><br> <div class=extra><i><img src=""paste-246428043575297.jpg"" /></i><div><div></div></div></div> <div class=tags></div>"
"<div class=card><img src=""paste-100871601913857 (1).jpg"" /><span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><img src=""paste-100871601913857 (1).jpg"" /><span class=cloze><img src=""paste-45891725557763.jpg"" /></span></div><br><br> <div class=extra><div>Imagine Frank at the tips of the toes.&nbsp;</div><div>Completely <u>flexed</u> <b>knees/hips</b></div><div>Foot through requires <b>hips</b> to be <u>extended</u></div><img src=""paste-25031069401302.jpg"" /></div> <div class=tags></div>"
"<div class=card><b><u>Arrest</u> of <u>active</u>&nbsp;1^st&nbsp;phase of labor</b>&nbsp;is defined as no cervical changes after <span class=cloze>[...]</span> hours of <u>adequate</u> contraction or <span class=cloze>[...]</span> hours of <u>any other contraction.</u></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><u>Arrest</u> of <u>active</u>&nbsp;1^st&nbsp;phase of labor</b>&nbsp;is defined as no cervical changes after <span class=cloze>4</span> hours of <u>adequate</u> contraction or <span class=cloze>6</span> hours of <u>any other contraction.</u></div><br><br> <div class=extra><div><i><b>adequate</b> contraction = <b>200 </b>MVUs&nbsp;</i></div><div><i><br /></i></div><div><i><img src=""paste-135261405052931.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-28716151342038.jpg"" /></i></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card>What is the definition of&nbsp;<b>second stage arrest of labor</b>&nbsp;in a&nbsp;<u>nulliparous vs. multiparous woman</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the definition of&nbsp;<b>second stage arrest of labor</b>&nbsp;in a&nbsp;<u>nulliparous vs. multiparous woman</u>?<div><br /></div><div><span class=cloze>Insufficient fetal descent after pushing for <b>&gt; 3 hours vs. &gt; 2 hours</b></span></div></div><br><br> <div class=extra><div><i>The second stage of labor begins when the cervix is <b>10</b> cm dilated and ends with fetal delivery.&nbsp;</i></div><div><i><img src=""paste-28716151342038.jpg"" /></i></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card>If the<b> fetal HR</b> cannot be confirmed using <u>external</u> methods, use <span class=cloze>[...]</span> to determine HR.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>If the<b> fetal HR</b> cannot be confirmed using <u>external</u> methods, use <span class=cloze>fetal scalp electrode</span> to determine HR.</div><br><br> <div class=extra><i>During birth, the FHR may be monitored <b>internally</b> via an electrode that is attached to the fetal head (<b>fetal scalp electrode</b>); rupture of the membranes must have occurred or an amniotomy performed.</i></div> <div class=tags></div>
"<div class=card>Intrauterine pressure catheter (IUPC) placement + frank blood = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Intrauterine pressure catheter (IUPC) placement + frank blood = <span class=cloze>withdraw catheter</span></div><br><br> <div class=extra><i>possibility of placenta separation or uterine perforation.</i><div><i><br /></i></div><div><i><br /></i></div></div> <div class=tags></div>
"<div class=card>episiotomies are generally <span class=cloze>[indicated/contraindicated]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>episiotomies are generally <span class=cloze>contraindicated</span></div><br><br> <div class=extra><i>A routine episiotomy is not recommended with assisted vaginal delivery because of the <b>risk of poor healing and anal sphincter injury!</b></i><div><i><b><br /></b></i></div><div><i><b><img src=""paste-3126534328025089.jpg"" /></b></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>most common</u>&nbsp;cause for&nbsp;<b>premenarchal vaginal bleeding</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>most common</u>&nbsp;cause for&nbsp;<b>premenarchal vaginal bleeding</b>?<div><br /></div><div><span class=cloze>foreign body</span></div></div><br><br> <div class=extra><div><i>Most likely placed there by the girl herself.</i></div><img src=""paste-30588757082113_1529603012320.jpg"" /></div> <div class=tags></div>"
"<div class=card><div><font color=""#ff0000"">dilated</font> cervix + products of conception <u>not&nbsp;outside</u> uterine cavity = <span class=cloze>[condition]</span></div><div><br /></div><font color=""#ff0000"">dilated</font>&nbsp;cervix + products of conception <u>within and outside</u> of uterine cavity&nbsp;= <span class=cloze>[condition]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div><font color=""#ff0000"">dilated</font> cervix + products of conception <u>not&nbsp;outside</u> uterine cavity = <span class=cloze>inevitable abortion</span></div><div><br /></div><font color=""#ff0000"">dilated</font>&nbsp;cervix + products of conception <u>within and outside</u> of uterine cavity&nbsp;= <span class=cloze>incomplete abortion</span></div><br><br> <div class=extra><div>""incompletely out""</div><img src=""paste-15040975470593 (1).jpg"" /><div><br /></div><div><img src=""Spontaneous+Miscarriage.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">closed</font> cervical os + no parts on ultrasound = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">closed</font> cervical os + no parts on ultrasound = <span class=cloze>complete abortion</span></div><br><br> <div class=extra><img src=""paste-18902151069697 (1).jpg"" /></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">closed</font>&nbsp;cervix +&nbsp;<font color=""#ff0000"">dead </font>baby on ultrasound = <span class=cloze>[condition]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">closed</font>&nbsp;cervix +&nbsp;<font color=""#ff0000"">dead </font>baby on ultrasound = <span class=cloze>missed abortion</span></div><br><br> <div class=extra><div><i>- missed, so dead baby is still inside and cervix closed already</i><i>&nbsp;(e.g. no fetal heartbeat, empty gestational sac)</i></div><i></i><div><i>- pregnancy symptoms (nausea, breast tenderness) abruptly stop with decreasing hCG levels.</i></div><div><i><br /></i></div><i><img src=""paste-21281562951681.jpg"" /><img src=""types of miscarriage.png"" /></i></div> <div class=tags></div>"
"<div class=card><b>ectopic pregnancies</b>&nbsp;are confirmed with <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>ectopic pregnancies</b>&nbsp;are confirmed with <span class=cloze>ultrasound</span></div><br><br> <div class=extra><img src=""paste-3363779731521537.jpg""><div><i><img src=""paste-53725745905665.jpg""></i></div><div><br></div></div> <div class=tags></div>"
"<div class=card><b>intrauterine pregnancy</b> will <span class=cloze>[...]</span> b-HCG <b>every 2 days.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>intrauterine pregnancy</b> will <span class=cloze>double</span> b-HCG <b>every 2 days.</b></div><br><br> <div class=extra>ectopic will not.<div><i><br /></i></div><div><i><img src=""paste-53562537148417.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a hemodynamically stable young woman with&nbsp;<b>RLQ pain</b>&nbsp;and a&nbsp;<b>beta-hCG level of 1000 IU/L</b>? Transvaginal ultrasound reveals&nbsp;<u>no</u>&nbsp;intrauterine or extrauterine pregnancy.<div><br /></div><div><span class=cloze>[...]</span>&nbsp;</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a hemodynamically stable young woman with&nbsp;<b>RLQ pain</b>&nbsp;and a&nbsp;<b>beta-hCG level of 1000 IU/L</b>? Transvaginal ultrasound reveals&nbsp;<u>no</u>&nbsp;intrauterine or extrauterine pregnancy.<div><br /></div><div><span class=cloze>Repeat serum beta-hCG in 2 days</span>&nbsp;</div></div><br><br> <div class=extra><i></i><i>in a&nbsp;<u>viable</u>&nbsp;pregnancy, beta-hCG levels should&nbsp;<b>double every 2 days</b>&nbsp;(ectopic and non-viable pregnancies are associated with a slower rise); once beta-hCG is &gt; 1500 IU/L, a transvaginal ultrasound should be repeated</i><div><i><br /><div></div></i><i><img src=""fakk.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><div>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>pregnant</b>&nbsp;woman (as per UPT) who comes in with&nbsp;<b>vaginal bleeding</b>,&nbsp;an&nbsp;<u>equivocal&nbsp;transvaginal ultrasound</u>, and a&nbsp;<u>β-hCG quantitative test <b>over 1500</b></u><b>?</b></div><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>pregnant</b>&nbsp;woman (as per UPT) who comes in with&nbsp;<b>vaginal bleeding</b>,&nbsp;an&nbsp;<u>equivocal&nbsp;transvaginal ultrasound</u>, and a&nbsp;<u>β-hCG quantitative test <b>over 1500</b></u><b>?</b></div><div><br /></div><div><span class=cloze>Ultrasound to assess for ectopic pregnancy</span></div></div><br><br> <div class=extra><i></i><i>If you catch intrauterine pregnancy, you're done.</i><div><i><br /></i></div><div><i>If not, assume there's ectopic pregnancy.</i></div><div><i><br /></i></div><div><i><img src=""paste-53725745905665.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><div><div>The presence of&nbsp;<b>endometrial glandular tissue</b>&nbsp;into the uterine&nbsp;<b><u>myometrium</u></b>&nbsp;is known as&nbsp;<b><span class=cloze>[...]</span>,&nbsp;</b>which presents with a diffusely enlarged soft ""globular"" uterus</div></div><div><br /></div><div><img src=""paste-12385766558662657.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div><div>The presence of&nbsp;<b>endometrial glandular tissue</b>&nbsp;into the uterine&nbsp;<b><u>myometrium</u></b>&nbsp;is known as&nbsp;<b><span class=cloze>adenomyosis</span>,&nbsp;</b>which presents with a diffusely enlarged soft ""globular"" uterus</div></div><div><br /></div><div><img src=""paste-12385766558662657.jpg"" /></div></div><br><br> <div class=extra><div><i>1)&nbsp;<b>enlarged/boggy/soft</b>&nbsp;uterus (increased&nbsp;<u>soft&nbsp;</u>glands in the myometrium makes the uterus soft)</i><div><div><i>2)&nbsp;<b>other symptoms:</b>&nbsp;heavy bleeding and painful menstruation</i></div></div></div><div><i><br /></i></div><div><i><img src=""paste-360588274302977.jpg"" /></i></div><div><i><br /></i></div><img src=""AUB.png"" /></div> <div class=tags></div>"
"<div class=card><div><div>The presence of&nbsp;<b>endometrial glandular tissue</b>&nbsp;into the uterine&nbsp;<b><u>myometrium</u></b>&nbsp;is known as&nbsp;<b>adenomyosis,&nbsp;</b>which presents with a <span class=cloze>[...]</span> uterus</div></div><div><br /></div><div><img src=""paste-12385766558662657.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div><div>The presence of&nbsp;<b>endometrial glandular tissue</b>&nbsp;into the uterine&nbsp;<b><u>myometrium</u></b>&nbsp;is known as&nbsp;<b>adenomyosis,&nbsp;</b>which presents with a <span class=cloze>diffusely enlarged soft ""globular""</span> uterus</div></div><div><br /></div><div><img src=""paste-12385766558662657.jpg"" /></div></div><br><br> <div class=extra><div><i>1)&nbsp;<b>enlarged/boggy/soft</b>&nbsp;uterus (increased&nbsp;<u>soft&nbsp;</u>glands in the myometrium makes the uterus soft)</i><div><div><i>2)&nbsp;<b>other symptoms:</b>&nbsp;heavy bleeding and painful menstruation</i></div></div></div><div><i><br /></i></div><div><i><img src=""paste-360588274302977.jpg"" /></i></div><div><i><br /></i></div><img src=""AUB.png"" /></div> <div class=tags></div>"
"<div class=card><span class=cloze>[...]</span>&nbsp;is a&nbsp;<b>benign</b>&nbsp;tumor of myometrium (smooth muscle);&nbsp;<u>growth</u>&nbsp;is due to estrogen exposure</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze><b>Leiomyoma (</b><b>fibroid)</b></span>&nbsp;is a&nbsp;<b>benign</b>&nbsp;tumor of myometrium (smooth muscle);&nbsp;<u>growth</u>&nbsp;is due to estrogen exposure</div><br><br> <div class=extra><i><img src=""paste-14663018349370.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><b>Leiomyoma (</b><b>fibroid)</b>&nbsp;is a&nbsp;<b>benign</b>&nbsp;tumor of <span class=cloze>[layer of uterus]</span>;&nbsp;<u>growth</u>&nbsp;is due to <span class=cloze>[hormone]</span> exposure</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Leiomyoma (</b><b>fibroid)</b>&nbsp;is a&nbsp;<b>benign</b>&nbsp;tumor of <span class=cloze>myometrium (smooth muscle)</span>;&nbsp;<u>growth</u>&nbsp;is due to <span class=cloze>estrogen</span> exposure</div><br><br> <div class=extra><i><img src=""paste-14663018349370.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>What is the preferred&nbsp;<i>initial imaging modality</i>&nbsp;for suspected&nbsp;<b>gynecological tumors</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the preferred&nbsp;<i>initial imaging modality</i>&nbsp;for suspected&nbsp;<b>gynecological tumors</b>?<div><br /></div><div><span class=cloze>Pelvic ultrasound</span></div></div><br><br> <div class=extra><i>high sensitivity for diagnosing uterine fibroids and ovarian pathology</i><div><i><br /></i><div><i><img src=""ez (4).png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in diagnosis for a woman that presents with&nbsp;<b>stress urinary incontinence</b>&nbsp;with an&nbsp;<u>irregularly enlarged uterus</u>&nbsp;on physical exam?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in diagnosis for a woman that presents with&nbsp;<b>stress urinary incontinence</b>&nbsp;with an&nbsp;<u>irregularly enlarged uterus</u>&nbsp;on physical exam?<div><br /></div><div><span class=cloze>Pelvic ultrasound</span></div></div><br><br> <div class=extra><i>SUI due to direct pressure of fibroids on the bladder</i><div><i><img src=""im sad tho.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>What&nbsp;<u>medical therapy</u>&nbsp;may be used for&nbsp;<i><b>short</b>-term</i>&nbsp;treatment of symptomatic&nbsp;<b>fibroids</b>&nbsp;refractory to OCPs and NSAIDs?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What&nbsp;<u>medical therapy</u>&nbsp;may be used for&nbsp;<i><b>short</b>-term</i>&nbsp;treatment of symptomatic&nbsp;<b>fibroids</b>&nbsp;refractory to OCPs and NSAIDs?<div><br /></div><div><span class=cloze>GnRH agonists (e.g. leuprolide)</span></div></div><br><br> <div class=extra><i><div>- GnRH agonists desensitize the pituitary via <b>overstimulation</b> → diminished release of LH and FSH → <b>reduced estrogen </b>synthesis → volume reduction (deprives fibroid of its growth stimulus), amenorrhea, improved anemia.&nbsp;</div><div><br /></div><div>- They are an optimal treatment <b>prior to surgery, </b>but are not suited for long-term monotherapy (&gt; 6 months) because they cause rebound growth and bone demineralization (osteoporosis). <b>Fibroids continue to grow once therapy is discontinued!</b></div><div></div></i><i></i><i><br /></i><img src=""ez (4).png"" /></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>pregnant</b>&nbsp;woman (as per UPT) who comes in with&nbsp;<b>vaginal bleeding</b>,&nbsp;an&nbsp;<u>equivocal&nbsp;transvaginal ultrasound</u>, and a&nbsp;<u>β-hCG quantitative test under&nbsp;1500</u>?<div><br /></div><div><span class=cloze>[...]</span> and diagnose&nbsp;<b>IUP</b>&nbsp;if <span class=cloze>[...]</span> (ectopic otherwise).</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>pregnant</b>&nbsp;woman (as per UPT) who comes in with&nbsp;<b>vaginal bleeding</b>,&nbsp;an&nbsp;<u>equivocal&nbsp;transvaginal ultrasound</u>, and a&nbsp;<u>β-hCG quantitative test under&nbsp;1500</u>?<div><br /></div><div><span class=cloze>Repeat hCG testing in 48 hrs</span> and diagnose&nbsp;<b>IUP</b>&nbsp;if <span class=cloze>it at least doubles</span> (ectopic otherwise).</div></div><br><br> <div class=extra><i>- ""Too soon"" (low hCG)</i><div><i>- If beta-hCG shows <b>double</b> original levels =&nbsp;<b>intrauterine pregnancy</b></i><div><i>- If beta-hCG fails to double, likely&nbsp;<b>ectopic pregnancy.</b></i></div><div><i><br /></i></div><div><i><img src=""paste-53562537148417.jpg"" /></i></div></div><div><i><img src=""paste-270080428474369.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><div>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>pregnant</b>&nbsp;woman (as per UPT) who comes in with&nbsp;<b>vaginal bleeding</b>,&nbsp;an&nbsp;<u>equivocal&nbsp;transvaginal ultrasound</u>, and a&nbsp;<u>β-hCG quantitative test over 1500</u>?</div><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>pregnant</b>&nbsp;woman (as per UPT) who comes in with&nbsp;<b>vaginal bleeding</b>,&nbsp;an&nbsp;<u>equivocal&nbsp;transvaginal ultrasound</u>, and a&nbsp;<u>β-hCG quantitative test over 1500</u>?</div><div><br /></div><div><span class=cloze>Ultrasound to assess for ectopic pregnancy</span></div></div><br><br> <div class=extra><i>If you catch IUP, you're done.</i><div><i><br /></i></div><div><i>If not, assume there's ectopic pregnancy.</i></div><div><i><br /></i></div><div><i><img src=""paste-53725745905665.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>hemodynamically unstable</b>&nbsp;female patient presents with&nbsp;<b>vaginal bleeding</b>&nbsp;and a&nbsp;<u>positive&nbsp;urine&nbsp;pregnancy test</u>?<br /><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>hemodynamically unstable</b>&nbsp;female patient presents with&nbsp;<b>vaginal bleeding</b>&nbsp;and a&nbsp;<u>positive&nbsp;urine&nbsp;pregnancy test</u>?<br /><div><br /></div><div><span class=cloze>Immediate surgery consultation</span></div></div><br><br> <div class=extra><i>Had she been hemodynamically stable, you would've ordered transvaginal US.<br /></i><div><i><br /></i></div><div><i><img src=""paste-53725745905665.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>hemodynamically stable</b>&nbsp;female patient presents with&nbsp;<b>vaginal bleeding</b>&nbsp;and a&nbsp;<u>positive urine pregnancy test</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>hemodynamically stable</b>&nbsp;female patient presents with&nbsp;<b>vaginal bleeding</b>&nbsp;and a&nbsp;<u>positive urine pregnancy test</u>?<div><br /></div><div><span class=cloze>Transvaginal ultrasound</span></div></div><br><br> <div class=extra><i></i><i>Had she been hemodynamically <b>unstable</b>, you would order immediate surgical consultation.</i><br /><div><i><br /></i></div><div><i><img src=""paste-53725745905665.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What drug is used to&nbsp;<u>induce ovulation</u>&nbsp;in patients with&nbsp;<b>polycystic ovarian syndrome</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What drug is used to&nbsp;<u>induce ovulation</u>&nbsp;in patients with&nbsp;<b>polycystic ovarian syndrome</b>?&nbsp;<div><br /></div><div><span class=cloze>Clomiphene citrate</span></div></div><br><br> <div class=extra><div>↑ GnRH starts the cycle up.</div><div><br /></div><div><img src=""paste-475968275742721.jpg"" /></div><img src=""paste-291645459268232.jpg"" /><img src=""pcos.png"" /></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span></b>,&nbsp;a&nbsp;K⁺&nbsp;sparing diuretic, may be used to treat symptoms of&nbsp;<u>androgen excess</u>&nbsp;in&nbsp;<b>polycystic ovarian syndrome (PCOS)</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Spironolactone</span></b>,&nbsp;a&nbsp;K⁺&nbsp;sparing diuretic, may be used to treat symptoms of&nbsp;<u>androgen excess</u>&nbsp;in&nbsp;<b>polycystic ovarian syndrome (PCOS)</b></div><br><br> <div class=extra><div>spears coming out of breast = anti-androgen</div><img src=""paste-356692738966004.jpg"" /></div> <div class=tags></div>"
"<div class=card>Treatment of <b>incompetent cervix </b>leading to repeated <b>second</b>-trimester pregnancy losses:&nbsp;<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Treatment of <b>incompetent cervix </b>leading to repeated <b>second</b>-trimester pregnancy losses:&nbsp;<span class=cloze>cervical cerclage at 14 weeks</span></div><br><br> <div class=extra><i><b><div></div></b></i><i>Cervical cerclage involves a circumferential cervical suture, providing external support to the weak cervix.</i><div><i><br /></i></div><div><i><br /></i></div><div><i><img src=""paste-414464344064001.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span></b>&nbsp;is pregnancy-induced hypertension&nbsp;<b>with</b>&nbsp;protein<u><b>uria</b></u> or end-organ dysfunction&nbsp;<i>after</i>&nbsp;20th week of gestation&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Preeclampsia</span></b>&nbsp;is pregnancy-induced hypertension&nbsp;<b>with</b>&nbsp;protein<u><b>uria</b></u> or end-organ dysfunction&nbsp;<i>after</i>&nbsp;20th week of gestation&nbsp;</div><br><br> <div class=extra><i></i><i><div></div></i><i></i><div><i><img src=""i found chart!.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Preeclampsia</b>&nbsp;is pregnancy-induced <span class=cloze>[...]</span>&nbsp;<b>with</b>&nbsp;protein<u><b>uria</b></u> or end-organ dysfunction&nbsp;<i>after</i>&nbsp;20th week of gestation&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Preeclampsia</b>&nbsp;is pregnancy-induced <span class=cloze>hypertension</span>&nbsp;<b>with</b>&nbsp;protein<u><b>uria</b></u> or end-organ dysfunction&nbsp;<i>after</i>&nbsp;20th week of gestation&nbsp;</div><br><br> <div class=extra><i></i><i><div></div></i><i></i><div><i><img src=""i found chart!.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Preeclampsia</b>&nbsp;is pregnancy-induced hypertension&nbsp;<b>with</b>&nbsp;<span class=cloze>[...]</span> or <span class=cloze>[...]</span>&nbsp;<i>after</i>&nbsp;20th week of gestation&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Preeclampsia</b>&nbsp;is pregnancy-induced hypertension&nbsp;<b>with</b>&nbsp;<span class=cloze>protein<u><b>uria</b></u></span> or <span class=cloze>end-organ dysfunction</span>&nbsp;<i>after</i>&nbsp;20th week of gestation&nbsp;</div><br><br> <div class=extra><i></i><i><div></div></i><i></i><div><i><img src=""i found chart!.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span></b>&nbsp;is defined as&nbsp;<b>preeclampsia</b>&nbsp;with&nbsp;<b>seizures</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Eclampsia</span></b>&nbsp;is defined as&nbsp;<b>preeclampsia</b>&nbsp;with&nbsp;<b>seizures</b></div><br><br> <div class=extra><i></i><i><div></div></i><i></i><div><i><img src=""i found chart!.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Eclampsia</b>&nbsp;is defined as&nbsp;<b>preeclampsia</b>&nbsp;with&nbsp;<b><span class=cloze>[...]</span></b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Eclampsia</b>&nbsp;is defined as&nbsp;<b>preeclampsia</b>&nbsp;with&nbsp;<b><span class=cloze>seizures</span></b></div><br><br> <div class=extra><i></i><i><div></div></i><i></i><div><i><img src=""i found chart!.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><div>How do you treat or prevent seizures in&nbsp;<b>preeclampsia</b>&nbsp;or&nbsp;<b>eclampsia?</b></div><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>How do you treat or prevent seizures in&nbsp;<b>preeclampsia</b>&nbsp;or&nbsp;<b>eclampsia?</b></div><div><br /></div><div><span class=cloze>IV magnesium sulfate</span></div></div><br><br> <div class=extra><i></i><i><div></div></i><i></i><div><i><img src=""i found chart!.png"" /><img src=""paste-242438018957313.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">HELLP syndrome</font>&nbsp;is a&nbsp;<b>severe</b>&nbsp;version of pre-eclapmsia that includes:<div><br /></div><div><span class=cloze>[symptoms]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">HELLP syndrome</font>&nbsp;is a&nbsp;<b>severe</b>&nbsp;version of pre-eclapmsia that includes:<div><br /></div><div><span class=cloze><font color=""#ff0000"">H</font>emolysis<br /><font color=""#ff0000"">E</font>levated&nbsp;<font color=""#ff0000"">L</font>iver enzymes<br /><font color=""#ff0000"">L</font>ow&nbsp;<font color=""#ff0000"">P</font>latelets</span></div></div><br><br> <div class=extra><i></i><i><div></div></i><i></i><div><i><div></div></i><i>this triad may present clinically as&nbsp;<b>anemia</b>,&nbsp;<b>RUQ pain</b>, and&nbsp;<b>bruising/bleeding</b></i></div><div><i><b><br /></b></i></div><div><i><img src=""i found chart!.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">HELLP syndrome</font>&nbsp;is a&nbsp;<b>severe</b>&nbsp;version of <span class=cloze>[...]</span> that includes:<div><br /></div><div><font color=""#ff0000"">H</font>emolysis<br /><font color=""#ff0000"">E</font>levated&nbsp;<font color=""#ff0000"">L</font>iver enzymes<br /><font color=""#ff0000"">L</font>ow&nbsp;<font color=""#ff0000"">P</font>latelets</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">HELLP syndrome</font>&nbsp;is a&nbsp;<b>severe</b>&nbsp;version of <span class=cloze>pre-eclapmsia</span> that includes:<div><br /></div><div><font color=""#ff0000"">H</font>emolysis<br /><font color=""#ff0000"">E</font>levated&nbsp;<font color=""#ff0000"">L</font>iver enzymes<br /><font color=""#ff0000"">L</font>ow&nbsp;<font color=""#ff0000"">P</font>latelets</div></div><br><br> <div class=extra><i></i><i><div></div></i><i></i><div><i><div></div></i><i>this triad may present clinically as&nbsp;<b>anemia</b>,&nbsp;<b>RUQ pain</b>, and&nbsp;<b>bruising/bleeding</b></i></div><div><i><b><br /></b></i></div><div><i><img src=""i found chart!.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>prolonged rupture of membrane to treat<b> chorio/endometritis</b> = <span class=cloze>[treatment]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>prolonged rupture of membrane to treat<b> chorio/endometritis</b> = <span class=cloze>amp/gent + clinda</span></div><br><br> <div class=extra><div><i>covers gram (-) and anaerobes</i><div><br /></div><div><img src=""paste-6811818131459_1529603012320.jpg"" /><img src=""paste-2654766530297857.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card>contractions with cervical changes + gestational age 21- 36 weeks = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>contractions with cervical changes + gestational age 21- 36 weeks = <span class=cloze>preterm labor</span></div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card>&gt; <span class=cloze>[...]</span> weeks = term labor<div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>&gt; <span class=cloze>37</span> weeks = term labor<div><br /></div></div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card>What BP defines&nbsp;<b>preeclampsia with severe features</b>?<div><br></div><div><span class=cloze>[...]</span>&nbsp;</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What BP defines&nbsp;<b>preeclampsia with severe features</b>?<div><br></div><div><span class=cloze>&gt;<b>160/</b>110 mm Hg</span>&nbsp;</div></div><br><br> <div class=extra><div><br></div><img src=""paste-3676492005880.jpg""></div> <div class=tags></div>"
"<div class=card>In&nbsp;<b>severe preeclampsia</b>,&nbsp;<u>headache</u>&nbsp;and&nbsp;<u>vision changes</u>&nbsp;are due to <span class=cloze>[...]</span>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In&nbsp;<b>severe preeclampsia</b>,&nbsp;<u>headache</u>&nbsp;and&nbsp;<u>vision changes</u>&nbsp;are due to <span class=cloze>vasoconstriction of carotid artery branches</span>.</div><br><br> <div class=extra><div><i>You will notice that a lot of the problems in this pathology involves vasoconstriction of many arteries.</i><div><i><br /></i></div><div><i><img src=""paste-3624952398212.jpg"" /></i></div></div><div><i><br /></i></div><div><i><br /></i></div><img src=""paste-3676492005880.jpg"" /></div> <div class=tags></div>"
"<div class=card>pre-eclampsia <u>without</u> severe features treatment:<div><br /></div><div>&lt; 37 weeks = <span class=cloze>[...]</span></div><div>&gt; 37 weeks = <span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>pre-eclampsia <u>without</u> severe features treatment:<div><br /></div><div>&lt; 37 weeks = <span class=cloze>bed rest</span></div><div>&gt; 37 weeks = <span class=cloze>deliver</span></div></div><br><br> <div class=extra><div><i><br /></i></div><div><i><br /></i></div><div><i><br /></i></div><img src=""paste-3676492005880.jpg"" /></div> <div class=tags></div>"
"<div class=card>pre-eclampsia with <b>severe</b> features, eclampsia, or HELLP = <span class=cloze>[treatment]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>pre-eclampsia with <b>severe</b> features, eclampsia, or HELLP = <span class=cloze>magnesium + deliver</span></div><br><br> <div class=extra><div><i><br /></i></div><div><i><br /></i></div><div><i><br /></i></div><img src=""paste-3676492005880.jpg"" /></div> <div class=tags></div>"
"<div class=card>gestational hypertension or eclampsia diagnosis starts &gt; <span class=cloze>[...]</span> weeks</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>gestational hypertension or eclampsia diagnosis starts &gt; <span class=cloze>20</span> weeks</div><br><br> <div class=extra><div><i><br /></i></div><div><i><br /></i></div><div><i><br /></i></div><img src=""paste-3676492005880.jpg"" /></div> <div class=tags></div>"
"<div class=card>thrombocytopenia in severe eclampsia is a contraindication to expectant management. T/F?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>thrombocytopenia in severe eclampsia is a contraindication to expectant management. T/F?<div><br /></div><div><span class=cloze>T</span></div></div><br><br> <div class=extra><div><i>in addition to&nbsp;refractory&nbsp;<b>hypertension</b>,&nbsp;<b>non-reassuring</b>&nbsp;fetal surveillance, 2x normal&nbsp;<b>LFTs</b>,&nbsp;<b>eclampsia</b>,&nbsp;<b>CNS</b>&nbsp;sx,&nbsp;<b>oliguria</b></i></div><div><i><b><br /></b></i></div><div><i></i><i><img src=""i found chart!.png"" /></i></div><div><i><br /></i></div><div><i><br /></i></div><img src=""paste-3676492005880.jpg"" /></div> <div class=tags></div>"
"<div class=card><span class=cloze>[Monozygotic/Digyzotic]</span> twins may be of&nbsp;<u>different sexes</u></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>Dizygotic</span> twins may be of&nbsp;<u>different sexes</u></div><br><br> <div class=extra><div><b>Monozygotic twins</b>&nbsp;= single oocyte + sperm =&nbsp;<u>same sex and appearance</u></div><div><b>Dizygotic Twins =&nbsp;</b>2 sperms + 2 eggs&nbsp;</div><div><br /></div><img src=""paste-275225799294977.jpg"" /></div> <div class=tags></div>"
"<div class=card>twin pregnancies are divided into mono<span class=cloze>[...]</span> and di<span class=cloze>[...]</span> pregnancies.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>twin pregnancies are divided into mono<span class=cloze>zygotic</span> and di<span class=cloze>zygotic</span> pregnancies.</div><br><br> <div class=extra><div><i>monozygotic = <u>single</u>&nbsp;oocyte divides</i></div><div><i>dizygotic = <u>two</u>&nbsp;oocytes are fertilized.</i></div><div><i><br /></i></div><div><i><img src=""paste-141188459921409.jpg"" /></i></div><i><img src=""paste-275225799294977.jpg"" /></i><div><i><br /></i></div><div><i></i><i><img src=""paste-38779259717026.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>The twins share a placenta and have individual amniotic sacs = <span class=cloze>[...]</span>chorionic-<span class=cloze>[...]</span>amniotic</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The twins share a placenta and have individual amniotic sacs = <span class=cloze>mono</span>chorionic-<span class=cloze>di</span>amniotic</div><br><br> <div class=extra><div><i>2 amniotic sacs</i></div><div><i><br /></i></div><div><i><img src=""paste-142704583376897.jpg"" /></i></div><div><i><br /></i></div><i><img src=""paste-275225799294977.jpg"" /></i><div><i><br /></i></div><div><i></i><i><img src=""paste-38779259717026.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>twins share both the placenta and amniotic sac = <span class=cloze>[...]</span>chorionic-<span class=cloze>[...]</span>amniotic</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>twins share both the placenta and amniotic sac = <span class=cloze>mono</span>chorionic-<span class=cloze>mono</span>amniotic</div><br><br> <div class=extra><div><i><br /></i></div><div><i><br /></i></div><div><i><img src=""paste-142704583376897.jpg"" /></i></div><div><i><br /></i></div><i><img src=""paste-275225799294977.jpg"" /></i><div><i><br /></i></div><div><i></i><i><img src=""paste-38779259717026.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What type of pregnancy does<b> Twin-twin Transfusion Syndrome </b>occur in?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What type of pregnancy does<b> Twin-twin Transfusion Syndrome </b>occur in?<div><br /></div><div><span class=cloze>Monochorionic</span></div></div><br><br> <div class=extra><div><i>- when two amnions share the SAME<font color=""#ff0000""> blood</font> supply (chorion = &nbsp;placenta), <b>unbalanced&nbsp;AV anastomoses</b> are present between shared placental vessels shunting blood from one baby to another.&nbsp;</i></div><div><i>- monozygotic <u><b>monochorionic</b></u> diamniotic and monozygotic <u><b>monochorionic</b></u> monoamniotic</i></div><div><i><br /></i></div><div><i><img src=""paste-1117662159568897.jpg"" /></i></div><div><i><img src=""paste-152814936391681.jpg"" /></i></div><div><i><img src=""paste-1100800117964801.jpg"" /></i></div><div><i><img src=""paste-545108659274508.jpg"" /><img src=""paste-1033051303837697.jpg"" /></i></div><div><i><br /></i></div><i><div></div></i><i></i><i><img src=""paste-38779259717026.jpg"" /></i><img src=""paste-275225799294977.jpg"" /><div><i><br /></i></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card>""zygotic"" = # of <span class=cloze>[...]</span><div>""chorionic"" = # of placentas</div><div>""amniotic"" = # of amniotic sacs</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>""zygotic"" = # of <span class=cloze>fertilizations</span><div>""chorionic"" = # of placentas</div><div>""amniotic"" = # of amniotic sacs</div></div><br><br> <div class=extra><div><i>zygotic: 2 vs. 1 fertilization</i></div><div><i><img src=""paste-151474906595329.jpg"" /></i></div><div><i><br /></i></div><i><div></div></i><i></i><i><img src=""paste-38779259717026.jpg"" /></i><img src=""paste-275225799294977.jpg"" /><div><i><br /></i></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card>""zygotic"" = # of fertilizations<div>""chorionic"" = # of <span class=cloze>[...]</span></div><div>""amniotic"" = # of amniotic sacs</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>""zygotic"" = # of fertilizations<div>""chorionic"" = # of <span class=cloze>placentas</span></div><div>""amniotic"" = # of amniotic sacs</div></div><br><br> <div class=extra><div><i>zygotic: 2 vs. 1 fertilization</i></div><div><i><img src=""paste-151474906595329.jpg"" /></i></div><div><i><br /></i></div><i><div></div></i><i></i><i><img src=""paste-38779259717026.jpg"" /></i><img src=""paste-275225799294977.jpg"" /><div><i><br /></i></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card>""zygotic"" = # of fertilizations<div>""chorionic"" = # of placentas</div><div>""amniotic"" = # of <span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>""zygotic"" = # of fertilizations<div>""chorionic"" = # of placentas</div><div>""amniotic"" = # of <span class=cloze>amniotic sacs</span></div></div><br><br> <div class=extra><div><i>zygotic: 2 vs. 1 fertilization</i></div><div><i><img src=""paste-151474906595329.jpg"" /></i></div><div><i><br /></i></div><i><div></div></i><i></i><i><img src=""paste-38779259717026.jpg"" /></i><img src=""paste-275225799294977.jpg"" /><div><i><br /></i></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card>In&nbsp;<b>twin-twin transfusion syndrome,</b>&nbsp;the <span class=cloze>[...]</span> is <u>polycythemic</u>, overloaded, and at risk for heart failure&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In&nbsp;<b>twin-twin transfusion syndrome,</b>&nbsp;the <span class=cloze>recipient</span> is <u>polycythemic</u>, overloaded, and at risk for heart failure&nbsp;</div><br><br> <div class=extra><img src=""paste-152810641424385.jpg"" /></div> <div class=tags></div>"
"<div class=card><b>Monozygotic twins</b>&nbsp;arise from <span class=cloze>[...]</span> egg + <span class=cloze>[...]</span> sperm, with time of cleavage determining # chorions and amnions:<div><br /></div><div><div><b>ƒƒCleavage 0–4 days:</b>&nbsp;<span class=cloze>[...]</span></div><div><b>ƒƒCleavage 4–8 days</b>: <span class=cloze>[...]</span></div><div><b>ƒƒCleavage 8–12 days:</b>&nbsp;<span class=cloze>[...]</span></div><div>ƒƒ<b>Cleavage 13+ days:&nbsp;</b><span class=cloze>[...]</span></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Monozygotic twins</b>&nbsp;arise from <span class=cloze>1</span> egg + <span class=cloze>1</span> sperm, with time of cleavage determining # chorions and amnions:<div><br /></div><div><div><b>ƒƒCleavage 0–4 days:</b>&nbsp;<span class=cloze><b>S</b>eparate chorion and amnion</span></div><div><b>ƒƒCleavage 4–8 days</b>: <span class=cloze><u>shared</u>&nbsp;<b>C</b>horion</span></div><div><b>ƒƒCleavage 8–12 days:</b>&nbsp;<span class=cloze><u>shared</u>&nbsp;<b>A</b>mnion</span></div><div>ƒƒ<b>Cleavage 13+ days:&nbsp;</b><span class=cloze><u>shared</u><b>&nbsp;B</b>ody (conjoined)</span></div></div></div><br><br> <div class=extra><div><b><u>Di</u>zygotic</b>&nbsp;= 2 eggs/2 sperm = 2 amnions, chorions, placentas (all separate)</div><div>(SCAB)</div><img src=""paste-4310867264929793.jpg"" /></div> <div class=tags></div>"
"<div class=card>Which&nbsp;<u>twin classification(s)</u>&nbsp;is associated with&nbsp;<b>umbilical cord entanglement</b>&nbsp;as a complication?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which&nbsp;<u>twin classification(s)</u>&nbsp;is associated with&nbsp;<b>umbilical cord entanglement</b>&nbsp;as a complication?<div><br /></div><div><span class=cloze>Monozygotic monochorionic monoamniotic</span></div></div><br><br> <div class=extra><div><i>same amniotic sac → tangle; therefore, deliver at 32-34 weeks via<b> C-section</b></i></div><div><i><b><br /></b></i></div><div><b><i><img src=""paste-1127373080625153.jpg"" /></i></b></div><div><i><b><img src=""paste-177884660498433.jpg"" /></b></i></div><div><i><b><br /></b></i></div><div><i><b><img src=""paste-1033055598804993.jpg"" /></b></i></div><div><i><b><br /></b></i></div><i><img src=""paste-4310867264929793.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><span class=cloze>[...]</span><u>chorionic</u> twins: <b>L</b>ambda sign<div><span class=cloze>[...]</span><u>chorionic</u> twins: <b>T</b>-sign&nbsp;</div><div><br /></div><div><img src=""paste-178490250887169.jpg"" /><img src=""paste-178812373434369.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze><b>D</b>i</span><u>chorionic</u> twins: <b>L</b>ambda sign<div><span class=cloze><b>M</b>ono</span><u>chorionic</u> twins: <b>T</b>-sign&nbsp;</div><div><br /></div><div><img src=""paste-178490250887169.jpg"" /><img src=""paste-178812373434369.jpg"" /></div></div><br><br> <div class=extra><div><i><b>D is closer to L </b>- Lambda sign where the two placentas and intertwin membrane (amnion) meet.</i></div><div><i><b>M closer to T</b> - T shape is the 90 degree angle between the placenta and intertwin membrane (amnions)</i></div><div><i><br /></i></div><div><i><img src=""paste-1052095188828161.jpg"" /><img src=""paste-1053400858886145.jpg"" /></i></div><div></div><div><i><span style=""""><br /></span></i></div><div><i><span style=""font-style: normal;""><br /></span></i></div><img src=""paste-4310867264929793.jpg"" /></div> <div class=tags></div>"
"<div class=card>Proper <span class=cloze>[...]</span> is a good way to&nbsp;prevent <u>premature</u> low birth-weight babies in <u>twin</u> gestation</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Proper <span class=cloze>weight gain</span> is a good way to&nbsp;prevent <u>premature</u> low birth-weight babies in <u>twin</u> gestation</div><br><br> <div class=extra><i><b>premature labor</b> is much more common in multiple gestation.</i><div><i><br /></i></div><div><i><img src=""paste-2429628639608833.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>PPH + boggy uterus = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>PPH + boggy uterus = <span class=cloze>uterine atony</span></div><br><br> <div class=extra><i><div></div></i><i></i><i>no contraction = boggy, not doing anything.</i><div><img src=""paste-42799349105968.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>post partum hemorrhage + <u>absent</u> uterus = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>post partum hemorrhage + <u>absent</u> uterus = <span class=cloze>uterine inversion</span></div><br><br> <div class=extra><i><div></div></i><i></i><div><i>since the uterus ""births"" itself through the vagina it's no longer in normal place.</i></div><div><i><br /></i></div><img src=""paste-42799349105968.jpg"" /></div> <div class=tags></div>"
"<div class=card>uterine atony = <span class=cloze>[first line physical treatment]</span> and oxytocin</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>uterine atony = <span class=cloze>uterine massage</span> and oxytocin</div><br><br> <div class=extra><i><div></div></i><i></i><div><i>since the cause is absent uterine contractions; if these don't work use <b>TXA</b></i></div><img src=""paste-42799349105968.jpg"" /></div> <div class=tags></div>"
"<div class=card><span class=cloze>[Diagnosis]</span> = obstetric emergency in which the <u>uterine fundus collapses into the endometrial cavity</u>, turning the uterus partially or completely inside out following vaginal birth</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>uterine inversion</span> = obstetric emergency in which the <u>uterine fundus collapses into the endometrial cavity</u>, turning the uterus partially or completely inside out following vaginal birth</div><br><br> <div class=extra><i><div></div></i><i></i><div><i><br /></i></div><div><i><img src=""cmrcr-3-122-001.gif"" /></i></div><img src=""paste-42799349105968.jpg"" /></div> <div class=tags></div>"
"<div class=card>uterine inversion = <span class=cloze>[physical treatment]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>uterine inversion = <span class=cloze>manual replacement</span></div><br><br> <div class=extra><i><div></div></i><i></i><div><i>stop contractions, reposition, then start contractions again</i></div><div><i><br /></i></div><div><i><img src=""paste-279190054109185.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""cmrcr-3-122-001.gif"" /></i></div><img src=""paste-42799349105968.jpg"" /></div> <div class=tags></div>"
"<div class=card>Label each type of deceleration<div><br /></div><div><img src=""paste-466759865860097.jpg"" /></div><div><br /></div><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Label each type of deceleration<div><br /></div><div><img src=""paste-466759865860097.jpg"" /></div><div><br /></div><div><br /></div><div><span class=cloze><img src=""paste-23081154249228.jpg"" /></span></div></div><br><br> <div class=extra><i><div></div></i><i></i><div><i><b>Early</b>: symmetric with contraction</i></div><div><i><b>Late</b>: starts at middle of contraction</i></div><div><i><br /></i></div><div><i><img src=""paste-326451874234371_1529603012320.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What should be done of pt is not progressing in labor but contracting?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>What should be done of pt is not progressing in labor but contracting?<div><br /></div><div><span class=cloze><b>IUPC</b> to monitor strength of contractions</span></div></div><br><br> <div class=extra><i>assesses whether oxytocin is needed.</i></div> <div class=tags></div>
"<div class=card><img src=""paste-499874063712257.jpg"" /><div><br /></div><div>What kind of deceleration is this?</div><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><img src=""paste-499874063712257.jpg"" /><div><br /></div><div>What kind of deceleration is this?</div><div><br /></div><div><span class=cloze>Variable</span></div></div><br><br> <div class=extra><i>steep slope; d/t cord compression</i><div><i><br /></i></div><div><i><img src=""paste-382011571175425.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>An initial measure to treat fetal hypoperfusion causing <b>late decels</b> is to move mom into the <span class=cloze>[...]</span> position</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>An initial measure to treat fetal hypoperfusion causing <b>late decels</b> is to move mom into the <span class=cloze>left lateral</span> position</div><br><br> <div class=extra><i><b>treat with ""intrauterine resuscitation:""&nbsp;</b></i><i>Various interventions with the specific aim of increasing delivery of oxygen to the placenta and fetus (e.g., oxygen, treat hypotension, stop oxytocin, IVF); if this fails do <b>C-section</b></i><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card><b>placenta </b>implants <u>across cervical os</u>, leading to <b>baby bleeding</b> when the cervical os dilates = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>placenta </b>implants <u>across cervical os</u>, leading to <b>baby bleeding</b> when the cervical os dilates = <span class=cloze>placenta previa</span></div><br><br> <div class=extra><div><i><img src=""2906_Placenta_Previa-02.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-41016937677326.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>placental abruption = pain<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>placental abruption = pain<span class=cloze>ful</span></div><br><br> <div class=extra><div><i>painf<b>u</b>l = <b>u</b>terine = mom = can feel. (placenta off the <b>uterus</b>, which is mom's)</i></div><div><i><img src=""Placental-Abruption.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-41016937677326.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>tearing of placenta off uterus = <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>tearing of placenta off uterus = <span class=cloze>placental abruption</span></div><br><br> <div class=extra><div><i><img src=""Placental-Abruption.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-41016937677326.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>placental <span class=cloze>[...]</span> is often due to<b> trauma, cocaine, or hypertension.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>placental <span class=cloze>abruption</span> is often due to<b> trauma, cocaine, or hypertension.</b></div><br><br> <div class=extra><div><i>imagine blowing the placenta off the uterus with all these high force things.</i></div><div><i><img src=""Placental-Abruption.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-41016937677326.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>vaginal birth after <span class=cloze>[...]</span> = ↑ risk of <b>uterine rupture</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>vaginal birth after <span class=cloze>c-section</span> = ↑ risk of <b>uterine rupture</b></div><br><br> <div class=extra><div><i>prior C-section = weak scar, easier for uterus to rupture; leads to <b>bleeding, abdominal pain, fetal HR decels.</b></i></div><div><i><img src=""Uterine-Rupture-1.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-41016937677326.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>uterus rips apart, leading to baby birthed into peritoneum = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>uterus rips apart, leading to baby birthed into peritoneum = <span class=cloze>uterine rupture</span></div><br><br> <div class=extra><div><i><br /></i></div><div><i><img src=""Uterine-Rupture-1.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-41016937677326.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>conception - <span class=cloze>[...]</span> weeks = 1st trimester<div><div>13 to 27 weeks = 2nd trimester</div><div>28 weeks to birth = 3rd trimester</div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>conception - <span class=cloze>12</span> weeks = 1st trimester<div><div>13 to 27 weeks = 2nd trimester</div><div>28 weeks to birth = 3rd trimester</div></div></div><br><br> <div class=extra><b><i><br /></i></b></div> <div class=tags></div>
"<div class=card>conception - 12 weeks = 1st trimester<div><div><span class=cloze>[...]</span> to <span class=cloze>[...]</span> weeks = 2nd trimester</div><div><span class=cloze>[...]</span> weeks to birth = 3rd trimester</div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>conception - 12 weeks = 1st trimester<div><div><span class=cloze>13</span> to <span class=cloze>27</span> weeks = 2nd trimester</div><div><span class=cloze>28</span> weeks to birth = 3rd trimester</div></div></div><br><br> <div class=extra><b><i><br /></i></b></div> <div class=tags></div>
"When a mom presents with <b>third-trimester bleeding</b>, what is your <u>differential</u>?<div><br></div><div><u>Painless</u>:&nbsp;<span class=""clozed c1"">Placenta previa</span>,&nbsp;vasa previa</div><div><u>Painful</u>:&nbsp;<span class=""clozed c1""><span class=cloze>[most common]</span></span>,&nbsp;<span class=cloze>[...]</span></div>""When a mom presents with <b>third-trimester bleeding</b>, what is your <u>differential</u>?<div><br></div><div><u>Painless</u>:&nbsp;<span class=""clozed c1"">Placenta previa</span>,&nbsp;vasa previa</div><div><u>Painful</u>:&nbsp;<span class=""clozed c1""><span class=cloze>Abruptio placentae</span></span>,&nbsp;<span class=cloze>uterine rupture</span></div><hr> <div class=mystyle1><div><strong>P</strong>revia = Preview = baby is a ""pre"" human = <strong>p</strong>ainless</div><div><br /></div><img src=""paste-41016937677326.jpg"" /></div> "
"<div class=card>painless bleeding <u>after </u>rupture of membranes with <b>fetal bradycardia </b>= <span class=cloze>[diagnosis&nbsp;]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>painless bleeding <u>after </u>rupture of membranes with <b>fetal bradycardia </b>= <span class=cloze>vasa previa</span></div><br><br> <div class=extra><div><i>blood vessels cross the os due to accessory lobe of placenta; <b>fetal</b> <b>bradycardia</b> because blood is from the fetus (vs. placenta previa, from mom means no bradycardia); presents after rupture of membranes since that's when the vessels will rip.&nbsp;</i></div><div><i><br /></i></div><i><img src=""paste-41016937677326.jpg"" /></i><div><i><br /></i></div><div><i><img src=""paste-44156558770838.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>painful</b> bleeding + <b>loss of contractions</b> + <b>loss of fetal station </b>+ fetal distress with a history of <b>c-section</b> = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>painful</b> bleeding + <b>loss of contractions</b> + <b>loss of fetal station </b>+ fetal distress with a history of <b>c-section</b> = <span class=cloze>uterine rupture</span></div><br><br> <div class=extra><div><i>baby birthed into peritoneum, so lost fetal station (e.g., 0 to -3) and no more contractions; <b>immediate C-section.</b></i></div><div><i><b><br /></b></i></div><i><img src=""paste-41016937677326.jpg"" /></i><div><i><br /></i></div><div><i><img src=""paste-44156558770838.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>If father is Rh-antigen (-), do you do anything else?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>If father is Rh-antigen (-), do you do anything else?<div><br /></div><div><span class=cloze>No</span></div></div><br><br> <div class=extra><div><i>Baby cannot be Rh (+) antigen</i></div><div><br /></div><img src=""paste-3672197038876.jpg"" /></div> <div class=tags></div>"
How do you&nbsp;<u>treat</u> <b>GBS (intrapartum)?</b><div><br /></div><div>First-line:&nbsp;Ampicillin/PCN</div><div>Second-line:&nbsp;<span class=cloze>[if mild PCN allergy]</span>&nbsp;</div><div>Third-line:&nbsp;Clindamycin</div><div>Last-line: Vancomycin</div>"How do you&nbsp;<u>treat</u> <b>GBS (intrapartum)?</b><div><br /></div><div>First-line:&nbsp;Ampicillin/PCN</div><div>Second-line:&nbsp;<span class=cloze>Cefazolin</span>&nbsp;</div><div>Third-line:&nbsp;Clindamycin</div><div>Last-line: Vancomycin</div><hr> <div class=mystyle1><div><i>intrapartum = during child birth</i></div><div><i><img src=""paste-48846663057828.jpg"" /></i></div></div> "
How do you&nbsp;<u>treat</u> <b>GBS (intrapartum)?</b><div><br /></div><div>First-line:&nbsp;Ampicillin/PCN</div><div>Second-line:&nbsp;Cefazolin&nbsp;</div><div>Third-line:&nbsp;<span class=cloze>[if severe PCN allergy]</span></div><div>Last-line: Vancomycin</div>"How do you&nbsp;<u>treat</u> <b>GBS (intrapartum)?</b><div><br /></div><div>First-line:&nbsp;Ampicillin/PCN</div><div>Second-line:&nbsp;Cefazolin&nbsp;</div><div>Third-line:&nbsp;<span class=cloze>Clindamycin</span></div><div>Last-line: Vancomycin</div><hr> <div class=mystyle1><div><i>intrapartum = during child birth</i></div><div><i><img src=""paste-48846663057828.jpg"" /></i></div></div> "
"<div class=card><div><b>Diagnostics: HIV/AIDS in pregnancy?</b></div><div><br /></div><div>&lt;18 months → <span class=cloze>[...]</span></div><div><br /></div><div>&gt;18 months → <span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><div><b>Diagnostics: HIV/AIDS in pregnancy?</b></div><div><br /></div><div>&lt;18 months → <span class=cloze>DNA PCR.</span></div><div><br /></div><div>&gt;18 months → <span class=cloze>ELISA/western blot.</span></div></div><br><br> <div class=extra><b>&lt;18&nbsp;</b>months, an&nbsp;<b>ELISA cannot be used</b>&nbsp;to determine an infants HIV status because&nbsp;<b>maternal antibodies result in false positives.</b></div> <div class=tags></div>
"How do you manage<b>&nbsp;HIV during pregnancy for <u>mom</u>&nbsp;(intrapartum)?</b><div><div><br /></div><div><b>Viral load ≥ 1000: </b>ART +&nbsp;C-section at 38 weeks +&nbsp;<font color=""#ff0000""><span class=cloze>[...]</span></font> at time of delivery</div></div><div><br /></div><div><b>Unknown HIV status:&nbsp;</b><span class=""clozed c1""><font color=""#ff0000""><span class=cloze>[...]</span></font>&nbsp;</span>at time of delivery</div><div><br /></div><div><b>Viral load &lt; 1000: </b>ART +&nbsp;Vaginal delivery</div><div><b><br /></b></div>""How do you manage<b>&nbsp;HIV during pregnancy for <u>mom</u>&nbsp;(intrapartum)?</b><div><div><br /></div><div><b>Viral load ≥ 1000: </b>ART +&nbsp;C-section at 38 weeks +&nbsp;<font color=""#ff0000""><span class=cloze>zidovudine (AZT)</span></font> at time of delivery</div></div><div><br /></div><div><b>Unknown HIV status:&nbsp;</b><span class=""clozed c1""><font color=""#ff0000""><span class=cloze>Zidovudine (AZT)</span></font>&nbsp;</span>at time of delivery</div><div><br /></div><div><b>Viral load &lt; 1000: </b>ART +&nbsp;Vaginal delivery</div><div><b><br /></b></div><hr> <div class=mystyle1><img src=""Screen Shot 2017-03-22 at 5.05.16 PM.jpg"" /><img src=""paste-1194005203255297.jpg"" /></div> "
"<div class=card><b>T/F: </b>Combined antiretroviral therapy (cART) is recommended throughout pregnancy for HIV (+) moms.<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>T/F: </b>Combined antiretroviral therapy (cART) is recommended throughout pregnancy for HIV (+) moms.<div><br /></div><div><span class=cloze>T</span></div></div><br><br> <div class=extra><div><span style=""font-weight: 800;"">""2 + 1"" </span>with 2 NRTIs (eg, zidovudine, tenofovir)</div><div><span style=""font-weight: 800;""><br /></span></div><b><img src=""paste-34338263531523_1529603012320.jpg"" /></b></div> <div class=tags></div>"
"<div class=card>Congenital&nbsp;<b><span class=cloze>[TORCH]</span></b>&nbsp;presents as&nbsp;<b>chorioretinitis</b>, <b><u>bi</u>lateral</b>&nbsp;<b>hydrocephalus,</b>&nbsp;and <u>diffuse</u>&nbsp;<b>intracranial calcifications</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Congenital&nbsp;<b><span class=cloze>toxoplasmosis</span></b>&nbsp;presents as&nbsp;<b>chorioretinitis</b>, <b><u>bi</u>lateral</b>&nbsp;<b>hydrocephalus,</b>&nbsp;and <u>diffuse</u>&nbsp;<b>intracranial calcifications</b></div><br><br> <div class=extra><div><b><i><div><img src=""paste-12236361826782.jpg"" /><img src=""paste-12266426597860.jpg"" /><br /><div><img src=""paste-11978663788751.jpg"" /></div></div><div><br /></div><img src=""help .png"" /><br /></i><div><img src=""peniss.png"" /></div><div><img src=""Screen Shot 2017-03-03 at 1.37.06 PM.png"" /></div><div><br /></div></b></div></div> <div class=tags></div>"
"<div class=card>A positive&nbsp;<b>screening</b>&nbsp;test for&nbsp;<i>Treponema pallidum&nbsp;</i>(via VDRL or RPR) is&nbsp;<u>confirmed</u>&nbsp;via&nbsp;<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>A positive&nbsp;<b>screening</b>&nbsp;test for&nbsp;<i>Treponema pallidum&nbsp;</i>(via VDRL or RPR) is&nbsp;<u>confirmed</u>&nbsp;via&nbsp;<span class=cloze><b>FTA-ABS</b>&nbsp;(fluorescent treponemal antibody-absorption)</span></div><br><br> <div class=extra><div><i><div><div>specifically detects Abs against Treponema pallidum (<b>secondary syphillis)</b></div><div style=""font-weight: bold; ""><img src=""Xnip2018-04-106_17-27-29.jpg"" /></div><b><img src=""paste-2443836391777.jpg"" /></b></div></i></div></div> <div class=tags></div>"
"<div class=card>A positive&nbsp;<b>screening</b>&nbsp;test for&nbsp;<i><span class=cloze>[...]</span>&nbsp;</i>(via VDRL or RPR) is&nbsp;<u>confirmed</u>&nbsp;via&nbsp;<b>FTA-ABS</b>&nbsp;(fluorescent treponemal antibody-absorption)</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>A positive&nbsp;<b>screening</b>&nbsp;test for&nbsp;<i><span class=cloze>Treponema pallidum</span>&nbsp;</i>(via VDRL or RPR) is&nbsp;<u>confirmed</u>&nbsp;via&nbsp;<b>FTA-ABS</b>&nbsp;(fluorescent treponemal antibody-absorption)</div><br><br> <div class=extra><div><i><div><div>specifically detects Abs against Treponema pallidum (<b>secondary syphillis)</b></div><div style=""font-weight: bold; ""><img src=""Xnip2018-04-106_17-27-29.jpg"" /></div><b><img src=""paste-2443836391777.jpg"" /></b></div></i></div></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span></b> <b>syphillis</b> is diagnosed with <u><b>CSF</b></u> studies of RPR / FTA-Abs</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Tertiary</span></b> <b>syphillis</b> is diagnosed with <u><b>CSF</b></u> studies of RPR / FTA-Abs</div><br><br> <div class=extra><div><i><div><div>Tertiary = neuro = CSF</div><div><br /></div><div><img src=""paste-2735894167555.jpg"" /></div></div></i></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[...]</span> is a form of syphilis that presents with&nbsp;<b>saber shin&nbsp;</b>and&nbsp;<b>saddle nose</b>.<div><br /></div><div><img src=""paste-106068512342019.jpg"" /><img src=""paste-3491043907469313.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>Congenital Syphilis</span> is a form of syphilis that presents with&nbsp;<b>saber shin&nbsp;</b>and&nbsp;<b>saddle nose</b>.<div><br /></div><div><img src=""paste-106068512342019.jpg"" /><img src=""paste-3491043907469313.jpg"" /></div></div><br><br> <div class=extra><div><i><div><div><br /></div><div><br /></div></div></i></div></div> <div class=tags></div>"
"<div class=card>snuffles = <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>snuffles = <span class=cloze>congenital syphillis</span></div><br><br> <div class=extra><div><i><div style=""display: inline !important; ""><div style=""display: inline !important; ""><div style=""display: inline !important; "">rhinitis</div></div></div></i><i><div><div><img src=""paste-3647840278544385.jpg"" /></div></div></i></div></div> <div class=tags></div>"
"<div class=card>congenital&nbsp;<font color=""#ff0000"">PDA</font>,&nbsp;<font color=""#ff0000"">cataracts</font>,&nbsp;<font color=""#ff0000"">deafness</font>&nbsp;=&nbsp;<span class=cloze>[congenital infection]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>congenital&nbsp;<font color=""#ff0000"">PDA</font>,&nbsp;<font color=""#ff0000"">cataracts</font>,&nbsp;<font color=""#ff0000"">deafness</font>&nbsp;=&nbsp;<span class=cloze>rubella</span></div><br><br> <div class=extra><div><i><img src=""paste-51737176047842.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""Screen Shot 2017-04-24 at 10.00.41 AM.png"" /><img src=""Screen Shot 2017-04-24 at 10.01.09 AM.png"" /><img src=""Screen Shot 2017-04-24 at 10.01.24 AM.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>What type of vaccine is the&nbsp;<b>MMRV vaccine</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What type of vaccine is the&nbsp;<b>MMRV vaccine</b>?<div><br /></div><div><span class=cloze>Live, attenuated</span></div></div><br><br> <div class=extra><div><i><div></div></i><i>measles, mumps, rubella, varicella; therefore <b>cannot give in pregnancy!</b></i></div><i><img src=""paste-99179384799705.jpg"" /><img src=""paste-1282339795632129.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><b>Congenital CMV</b>&nbsp;is associated with <span class=cloze>[...]</span> calcifications.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Congenital CMV</b>&nbsp;is associated with <span class=cloze><u>periventricular</u></span> calcifications.</div><br><br> <div class=extra><i>versus toxoplasmosis, which is associated with diffuse intracerebral calcifications</i><div><img src=""peniss.png"" /></div><div><img src=""Screen Shot 2017-03-03 at 1.37.06 PM.png"" /></div><div><br /></div></div> <div class=tags></div>"
"<div class=card><b>Congenital <span class=cloze>[...]</span></b>&nbsp;is associated with <u>periventricular</u> calcifications.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Congenital <span class=cloze>CMV</span></b>&nbsp;is associated with <u>periventricular</u> calcifications.</div><br><br> <div class=extra><i>versus toxoplasmosis, which is associated with diffuse intracerebral calcifications</i><div><img src=""peniss.png"" /></div><div><img src=""Screen Shot 2017-03-03 at 1.37.06 PM.png"" /></div><div><br /></div></div> <div class=tags></div>"
"<div class=card><b>Herpes simplex virus</b>&nbsp;is definitively diagnosed with <span class=cloze>[gold standard]</span> or <span class=cloze>[...]</span>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Herpes simplex virus</b>&nbsp;is definitively diagnosed with <span class=cloze>cultures</span> or <span class=cloze>PCR</span>.</div><br><br> <div class=extra><div><i>Tzanck smear is the quickest test, but isn't specific or sensitive.</i></div><div><i><br /></i></div><div><i><img src=""paste-936302870864.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>mom has active herpes lesions - delivery method?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>mom has active herpes lesions - delivery method?<div><br /></div><div><span class=cloze>C-section</span></div></div><br><br> <div class=extra><div><i><img src=""paste-557568359399425.jpg"" /></i></div></div> <div class=tags></div>"
What are the <i>most common causes</i>&nbsp;(2) of <b>hyperandrogenism</b>&nbsp;in <u>pregnancy</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"What are the <i>most common causes</i>&nbsp;(2) of <b>hyperandrogenism</b>&nbsp;in <u>pregnancy</u>?<div><br /></div><div><span class=cloze>luteomas and theca luteum cysts</span></div><br> <i>2/2 <b>b-hCG</b> stimulation; may manifest as new-onset hirsutism and/or acne; appear as <b>solid, bilateral ovarian masses</b></i><div><b><i><br /></i></b><div><i><img src=""this is gonna suck.png"" /></i></div></div>"
What is the <i>recommended management&nbsp;</i>for a pregnant woman with a suspected <b>luteoma</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended management&nbsp;</i>for a pregnant woman with a suspected <b>luteoma</b>?<div><br /></div><div><span class=cloze>Observation and expectant management</span></div><br> <i>masses typically <u>regress spontaneously</u> after delivery; luteomas are occasionally complicated by ovarian torsion or symptoms related to mass effect (e.g. hydronephrosis)&nbsp;</i><div><i><img src=""this is gonna suck.png"" /></i></div>"
<u><span class=cloze>[...]</span></u> maternal serum alpha-fetoprotein (AFP) is associated with&nbsp;<b>neural</b> <b>tube</b>&nbsp;<b>defects</b>,&nbsp;<b>abdominal</b> <b>wall</b>&nbsp;<b>defects</b>, and&nbsp;<b>multiple</b> <b>gestation</b>"<u><span class=cloze>Elevated</span></u> maternal serum alpha-fetoprotein (AFP) is associated with&nbsp;<b>neural</b> <b>tube</b>&nbsp;<b>defects</b>,&nbsp;<b>abdominal</b> <b>wall</b>&nbsp;<b>defects</b>, and&nbsp;<b>multiple</b> <b>gestation</b><br> <div><i>typically measured between 15 - 20 weeks and correlated with <b>ultrasound evaluation</b></i></div><img src=""msafp.png"" />"
What is the <i>next step</i>&nbsp;in management for a mother with <b>post-partum hemorrhage</b> following a <u>forceps-assisted vaginal delivery</u>? The patient is afebrile and the uterus is normal-sized and firm.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step</i>&nbsp;in management for a mother with <b>post-partum hemorrhage</b> following a <u>forceps-assisted vaginal delivery</u>? The patient is afebrile and the uterus is normal-sized and firm.&nbsp;<div><br /></div><div><span class=cloze>Genital tract inspection</span></div><br> <i><u>genital tract injury</u> is a common cause of PPH after <b>operative</b> vaginal deliveries; other causes of PPH typically result in an enlarged, soft uterus (e.g. atony, retained placental tissue) and/or fever (e.g. endometritis)</i><div><i><br /></i><div><i><img src=""helpp.png"" /></i></div></div>"
What is the <i>next step</i>&nbsp;in management for a pregnant woman at 25 weeks gestation that presents after feeling <b>no fetal movement</b> for the past two days? Fetal heart sounds are <u>not</u> heard on Doppler.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step</i>&nbsp;in management for a pregnant woman at 25 weeks gestation that presents after feeling <b>no fetal movement</b> for the past two days? Fetal heart sounds are <u>not</u> heard on Doppler.&nbsp;<div><br /></div><div><span class=cloze><u>Transabdominal</u> ultrasound</span></div><br> <i>the patient likely has <b>intrauterine fetal</b> <b>demise</b> (fetal death at <u>&gt;</u>&nbsp;20 weeks), which must be confirmed by the absence of fetal cardiac activity on ultrasound&nbsp;</i><div><i><br /></i><div><i><img src=""sad (2).png"" /></i></div><div><i><img src=""part 2.png"" /></i></div></div>"
What is the <i>next step</i>&nbsp;in management for a pregnant woman at 28 weeks gestation with confirmed <b>intrauterine</b> <b>fetal</b> <b>demise</b>? The fetus is in the <u>breech</u> position on ultrasound.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step</i>&nbsp;in management for a pregnant woman at 28 weeks gestation with confirmed <b>intrauterine</b> <b>fetal</b> <b>demise</b>? The fetus is in the <u>breech</u> position on ultrasound.&nbsp;<div><br /></div><div><span class=cloze>Induced vaginal delivery</span></div><br> <div><i>vaginal delivery is preferred <u>regardless of fetal position</u>; <b><u>prior</u> to 24 weeks</b> (e.g. 20-23 weeks), patients may elect to have <b>dilation and evacuation&nbsp;</b></i></div><div><i><b><br /></b></i></div><img src=""sad (2).png"" />"
What is the <i>recommended management</i>&nbsp;for patients with <u>PPROM</u>&nbsp;at <b>&lt; 34 weeks</b> <b>gestation</b> and <u>NO signs of infection/fetal compromise?</u><div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended management</i>&nbsp;for patients with <u>PPROM</u>&nbsp;at <b>&lt; 34 weeks</b> <b>gestation</b> and <u>NO signs of infection/fetal compromise?</u><div><br /></div><div><span class=cloze>antibiotics, corticosteroids, and <b>expectant</b> <b>management</b></span></div><br> <i><u>don't need to deliver</u></i> <i>until</i>&nbsp;<i><b>34</b> weeks gestation or if signs of infection/fetal compromise develop; antibiotics prolongs duration until labor and decreases infection risk (GBS).</i><div><i><img src=""gonna be a long day.png"" /></i></div>"
What is the&nbsp;<i>recommended management</i>&nbsp;for patients with&nbsp;<u>PPROM</u>&nbsp;at&nbsp;<b><u>&gt;</u> 34 weeks</b>&nbsp;<b>gestation</b>?<div><br></div><div><span class=cloze>[...]</span></div>"What is the&nbsp;<i>recommended management</i>&nbsp;for patients with&nbsp;<u>PPROM</u>&nbsp;at&nbsp;<b><u>&gt;</u> 34 weeks</b>&nbsp;<b>gestation</b>?<div><br></div><div><span class=cloze>delivery, antibiotics +/- corticosteroids</span></div><br> <i>decreases the incidence of <b>chorioamnionitis</b></i><div><i><img src=""gonna be a long day.png"" /></i></div>"
What is the&nbsp;<i>recommended management</i>&nbsp;for patients with&nbsp;<u>PPROM</u>&nbsp;at&nbsp;<b>&lt; 34 weeks</b>&nbsp;<b>gestation</b>&nbsp;and <u>signs of infection/fetal compromise</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the&nbsp;<i>recommended management</i>&nbsp;for patients with&nbsp;<u>PPROM</u>&nbsp;at&nbsp;<b>&lt; 34 weeks</b>&nbsp;<b>gestation</b>&nbsp;and <u>signs of infection/fetal compromise</u>?<div><br /></div><div><span class=cloze>corticosteroids, antibiotics, <b>delivery</b> +/- magnesium</span></div><br> <div><i>- tachycardia/fever/maternal leukocytosis/purulent amniotic fluid → indiciative of <b>chorioamnionitis</b> (fever, fetal tachy) → <b>delivery </b>regardless of age.</i></div><div><i><b>-</b> <b>antibiotics</b> delay labor and prevent infection</i></div><img src=""gonna be a long day.png"" />"
What is the likely <i>diagnosis</i>&nbsp;in a hemodynamically <u>unstable</u> patient with a <b>gestational sac in the</b> <b>uterine</b> <b>cornu</b> and <b>free fluid in the posterior cul-de-sac</b> on transvaginal ultrasound?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a hemodynamically <u>unstable</u> patient with a <b>gestational sac in the</b> <b>uterine</b> <b>cornu</b> and <b>free fluid in the posterior cul-de-sac</b> on transvaginal ultrasound?<div><br /></div><div><span class=cloze>Ruptured ectopic pregnancy</span></div><br> <i>i.e. a cornual or interstitial ectopic pregnancy; often presents as abdominal pain and vaginal bleeding</i><br /><div><i><img src=""paste-235561776316417.jpg"" /><img src=""okie (4).png"" /></i></div><div><i><img src=""ectopic.png"" /></i></div>"
What is the <i>recommended management</i>&nbsp;for a hemodynamically <u>stable</u>&nbsp;patient with an&nbsp;<b>ectopic pregnancy</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended management</i>&nbsp;for a hemodynamically <u>stable</u>&nbsp;patient with an&nbsp;<b>ectopic pregnancy</b>?<div><br /></div><div><span class=cloze>Methotrexate</span></div><br> <img src=""ectopic.png"" />"
What is the&nbsp;<i>recommended management</i>&nbsp;for a&nbsp;hemodynamically <u>unstable</u>&nbsp;patient with a suspected&nbsp;<b>ectopic pregnancy</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the&nbsp;<i>recommended management</i>&nbsp;for a&nbsp;hemodynamically <u>unstable</u>&nbsp;patient with a suspected&nbsp;<b>ectopic pregnancy</b>?<div><br /></div><div><span class=cloze>Surgical exploration</span></div><br> <img src=""ectopic.png"" />"
<i>Maternal</i> complications associated with <u>placental abruption</u> include <b><span class=cloze>[...]</span></b> and&nbsp;<b>hypovolemic</b> <b>shock</b>"<i>Maternal</i> complications associated with <u>placental abruption</u> include <b><span class=cloze>DIC</span></b> and&nbsp;<b>hypovolemic</b> <b>shock</b><br> <div><i>- <b>DIC</b> due to tissue factor release</i></div><div><i>- fetal complications include hypoxia and preterm delivery</i></div><img src=""chart.png"" />"
What is the likely <i>diagnosis</i>&nbsp;in an obese, multiparous pregnant woman at 34 weeks gestation that presents with <b>intermittent</b>&nbsp;<b>leakage of clear fluid</b> and a <u>negative</u> nitrazine/fern test?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in an obese, multiparous pregnant woman at 34 weeks gestation that presents with <b>intermittent</b>&nbsp;<b>leakage of clear fluid</b> and a <u>negative</u> nitrazine/fern test?&nbsp;<div><br /></div><div><span class=cloze>Stress urinary incontinence</span></div><br> <i>differentiated from rupture of membranes by negative nitrazine/fern tests and absence of vaginal pooling</i><div><i><img src=""why (3).png"" /></i></div>"
What is the likely <i>diagnosis</i>&nbsp;in a woman that develops <b>abdominal pain</b> and <b>hemorrhagic shock</b> after failing to deliver the placenta? There is a <u>smooth</u>,<u> round mass</u> protruding through the vagina.&nbsp;<div><br></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a woman that develops <b>abdominal pain</b> and <b>hemorrhagic shock</b> after failing to deliver the placenta? There is a <u>smooth</u>,<u> round mass</u> protruding through the vagina.&nbsp;<div><br></div><div><span class=cloze>Uterine inversion</span></div><br> <div><i>risk factors include nulliparity, fetal macrosomia, placenta accreta, and rapid labor &amp; delivery (<b>accreta</b> = stuck, so pulls uterus out when placenta tries to come out)</i></div><div><i><br></i></div><div><i><img src=""UI2.png""></i></div><img src=""UI.png"">"
What is the&nbsp;<i>next step</i>&nbsp;in management <b><u>after</u></b><u> manual replacement of the uterus</u> in a woman with&nbsp;<b>uterine</b>&nbsp;<b>inversion</b>&nbsp;with a retained placenta?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the&nbsp;<i>next step</i>&nbsp;in management <b><u>after</u></b><u> manual replacement of the uterus</u> in a woman with&nbsp;<b>uterine</b>&nbsp;<b>inversion</b>&nbsp;with a retained placenta?<div><br /></div><div><span class=cloze>placental removal and utero<b>tonics</b></span></div><br> <i>uterotonics (e.g. oxytocin, misoprostol) cause uterine <u>contraction</u>, which helps <b>prevent further hemorrhage</b> and recurrence of the prolapse&nbsp;</i><div><i><img src=""UI2.png"" /></i></div>"
<b>Postpartum urinary retention</b>&nbsp;is typically related to bladder&nbsp;<span class=cloze>[...]</span>"<b>Postpartum urinary retention</b>&nbsp;is typically related to bladder&nbsp;<span class=cloze>atony</span><br> <i>temporary and reversible due to <b>epidural anesthesia</b>; confirmed by <u>&gt;</u>&nbsp;150 mL of urine upon urethral catheterization&nbsp;</i><div><i><br /></i><div><i><img src=""ret.png"" /></i></div></div>"
Patients in&nbsp;<u>preterm labor</u>&nbsp;at &lt; 37 weeks should receive&nbsp;<span class=cloze>[...]</span> to <i>reduce</i> <i>risk</i> of <b>neonatal respiratory distress syndrome</b>&nbsp;"Patients in&nbsp;<u>preterm labor</u>&nbsp;at &lt; 37 weeks should receive&nbsp;<span class=cloze><b>corticosteroids</b></span> to <i>reduce</i> <i>risk</i> of <b>neonatal respiratory distress syndrome</b>&nbsp;<br> <div><i>e.g. </i><b style=""font-style: italic; "">betamethasone</b>&nbsp;</div><div><br /></div><img src=""ptl.png"" />"
What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a pregnant woman at 10 weeks gestation that presents with<b>&nbsp;hyperemesis gravidarum</b>? Pelvic ultrasound reveals an intrauterine gestation&nbsp;<u>enlarged for gestational age</u>&nbsp;and&nbsp;<b>bilateral 10-cm</b>, <b>multilocular ovarian masses</b>.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a pregnant woman at 10 weeks gestation that presents with<b>&nbsp;hyperemesis gravidarum</b>? Pelvic ultrasound reveals an intrauterine gestation&nbsp;<u>enlarged for gestational age</u>&nbsp;and&nbsp;<b>bilateral 10-cm</b>, <b>multilocular ovarian masses</b>.&nbsp;<div><br /></div><div><span class=cloze>Theca lutein cysts (secondary to a complete hydatidiform mole)</span></div><br> <div><i>occurs due to ovarian hyperstimulation from <u>markedly elevated</u> <b>beta-hCG levels</b>&nbsp;from trophoblastic disease.</i></div><div><i><br /></i></div><div><i><img src=""paste-2518465743159297.jpg"" /></i></div><img src=""mm ok.png"" /><img src=""paste-2503201429389313.jpg"" />"
<b>Theca lutein cysts</b>&nbsp;arise due to <u>ovarian hyperstimulation</u>&nbsp;secondary to markedly elevated&nbsp;<span class=cloze>[...]</span> levels"<b>Theca lutein cysts</b>&nbsp;arise due to <u>ovarian hyperstimulation</u>&nbsp;secondary to markedly elevated&nbsp;<span class=cloze>beta-hCG</span> levels<br> <i>e.g. complete hydatidiform mole, multifetal gestation; these resolve after removal of the mole when hCG levels lower.&nbsp;</i><div><i><br /></i><div><i><img src=""mm ok.png"" /></i></div></div>"
What is the likely <i>diagnosis</i>&nbsp;in a sexually active woman that presents with <b>postcoital</b> <b>bleeding</b> and <b>mucopurulent</b> <b>discharge</b> with a <u>friable cervix</u> on pelvic examination?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a sexually active woman that presents with <b>postcoital</b> <b>bleeding</b> and <b>mucopurulent</b> <b>discharge</b> with a <u>friable cervix</u> on pelvic examination?<div><br /></div><div><span class=cloze>Acute cervicitis</span></div><br> <div><i>less common symptoms include dysuria, dyspareunia, and vulvovaginal pruritus</i></div><div><i><br /></i></div><img src=""cervicitis.png"" />"
What are the <i>most common causes</i> of <b>acute</b> <b>cervicitis</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What are the <i>most common causes</i> of <b>acute</b> <b>cervicitis</b>?<div><br /></div><div><span class=cloze><i>Chlamydia trachomatis</i>&nbsp;and <i>Neisseria gonorrhoeae</i>&nbsp;infection</span></div><br> <img src=""cervicitis.png"" />"
Following suction curettage for a <u>hydatidiform mole</u>, <span class=cloze>[...]</span> <b>levels</b> are measured <i>weekly</i> until undetectable and then <i>monthly</i> for <b>6 months</b>"Following suction curettage for a <u>hydatidiform mole</u>, <span class=cloze><b>beta-hCG</b></span> <b>levels</b> are measured <i>weekly</i> until undetectable and then <i>monthly</i> for <b>6 months</b><br> <img src=""mollemole.png"" />"
Following suction curettage for a <u>hydatidiform mole</u>, <b>beta-hCG</b> <b>levels</b> are measured <i>weekly</i> until undetectable and then <i>monthly</i> for <b><span class=cloze>[...]</span></b>"Following suction curettage for a <u>hydatidiform mole</u>, <b>beta-hCG</b> <b>levels</b> are measured <i>weekly</i> until undetectable and then <i>monthly</i> for <b><span class=cloze>6 months</span></b><br> <img src=""mollemole.png"" />"
Newly detectable <b>beta-hCG levels</b>&nbsp;within 6 months following suction curettage for a <u>hydatidiform mole</u> is diagnostic for <span class=cloze>[...]</span>"Newly detectable <b>beta-hCG levels</b>&nbsp;within 6 months following suction curettage for a <u>hydatidiform mole</u> is diagnostic for <span class=cloze>gestational trophoblastic disease (e.g. choriocarcinoma)</span><br> <img src=""mollemole.png"" />"
During the <b>surveillance period</b> following removal of a <u>hydatidiform mole</u>, patients must take <span class=cloze>[...]</span> for 6 months"During the <b>surveillance period</b> following removal of a <u>hydatidiform mole</u>, patients must take <span class=cloze>contraceptives</span> for 6 months<br> <i>pregnancy during this time period would make it difficult to determine the significance of a rising beta-hCG&nbsp;</i><div><i><br /></i><div><i><img src=""mollemole.png"" /></i></div></div>"
What is the <i>underlying cause</i>&nbsp;of <b>early decelerations</b>&nbsp;on fetal heart tracing?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>underlying cause</i>&nbsp;of <b>early decelerations</b>&nbsp;on fetal heart tracing?<div><br /></div><div><span class=cloze>Fetal head compression</span></div><br> <i>occurs as an <u>autonomic vagal response</u> to alterations in intracranial pressure</i><div><i><br /></i><div><i><img src=""beautiful.png"" /></i></div><div><i><img src=""veal chop.png"" /></i></div></div>"
"<b>Severe fetal anemia</b> typically presents with a <span class=cloze>[...]</span> <b>fetal</b> <b>heart</b> <b>tracing</b><div><br /></div><div><img src=""sinu.png"" /></div>""<b>Severe fetal anemia</b> typically presents with a <span class=cloze><u>sinusoidal</u></span> <b>fetal</b> <b>heart</b> <b>tracing</b><div><br /></div><div><img src=""sinu.png"" /></div><br> <i>e.g., 2/2 vasa previa; needs <b>urgent C-section</b></i>"
<b>Spontaneous abortion</b>&nbsp;is unprovoked pregnancy loss at &lt;&nbsp;<span class=cloze>[...]</span> weeks gestation and is a common cause of <u>first trimester</u>&nbsp;bleeding"<b>Spontaneous abortion</b>&nbsp;is unprovoked pregnancy loss at &lt;&nbsp;<span class=cloze>20</span> weeks gestation and is a common cause of <u>first trimester</u>&nbsp;bleeding<br> <img src=""spont abort.png"" />"
<b>Preeclampsia</b>&nbsp;is defined as hypertension&nbsp;with&nbsp;<span class=cloze>[...]</span> <i>or</i> <span class=cloze>[...]</span>&nbsp;<u>after</u>&nbsp;the 20th week of gestation&nbsp;"<b>Preeclampsia</b>&nbsp;is defined as hypertension&nbsp;with&nbsp;<span class=cloze>proteinuria</span> <i>or</i> <span class=cloze>end-organ dysfunction</span>&nbsp;<u>after</u>&nbsp;the 20th week of gestation&nbsp;<br> <div><br /></div><div><i><b><br /></b></i></div><img src=""precl.png"" />"
What level of&nbsp;<u>proteinuria</u>&nbsp;is required to make a diagnosis of&nbsp;<b>preeclampsia</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What level of&nbsp;<u>proteinuria</u>&nbsp;is required to make a diagnosis of&nbsp;<b>preeclampsia</b>?<div><br /></div><div><span class=cloze>≥ 300 mg/day (or a protein/creatinine ratio <u>&gt;</u>&nbsp;0.3)</span></div><br> <i><img src=""i found chart!.png"" /></i>"
What is the likely <i>diagnosis</i>&nbsp;in a pregnant patient that develops <b>encephalopathy</b>, <b>nystagmus</b>, and <b>gait</b> <b>ataxia</b> after several days of <u>hyperemesis gravidum</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a pregnant patient that develops <b>encephalopathy</b>, <b>nystagmus</b>, and <b>gait</b> <b>ataxia</b> after several days of <u>hyperemesis gravidum</u>?<div><br /></div><div><span class=cloze>Wernicke encephalopathy</span></div><br> <i>secondary to <b>thiamine</b> deficiency</i><div><i><br /></i><div><i><img src=""ha i got one.png"" /></i></div></div>"
<b>Placenta <span class=cloze>[...]</span></b>&nbsp;is the abnormal&nbsp;attachment&nbsp;of the placenta to the&nbsp;<u>myometrium</u>,&nbsp;without&nbsp;penetrating it"<b>Placenta <span class=cloze>accreta</span></b>&nbsp;is the abnormal&nbsp;attachment&nbsp;of the placenta to the&nbsp;<u>myometrium</u>,&nbsp;without&nbsp;penetrating it<br> <div><i>A-I-P (ABC order)</i></div><div><i>Accreta, Increta, Percreta</i></div><img src=""accreta i hardly kno wher.png"" />"
<i>Antenatally</i> diagnosed <b>placenta</b> <b>accreta</b> is delivered by planned&nbsp;<span class=cloze>[...]</span>&nbsp;<i>Antenatally</i> diagnosed <b>placenta</b> <b>accreta</b> is delivered by planned&nbsp;<span class=cloze>cesarean hysterectomy</span>&nbsp;<br> Risk factors for <u>placenta accreta</u>&nbsp;include history of <span class=cloze>[...]</span> delivery or <span class=cloze>[surgery]</span> and <b>advanced</b> <b>maternal age</b>&nbsp;"Risk factors for <u>placenta accreta</u>&nbsp;include history of <span class=cloze>cesarean</span> delivery or <span class=cloze>dilation &amp; curettage</span> and <b>advanced</b> <b>maternal age</b>&nbsp;<br> chorionic villi must go deeper into myometrium to get nutrients after scarred up or old<div><br /></div><div><img src=""19163.jpg"" /></div>"
<b>Fetal growth restriction</b> is an ultrasound-estimated fetal weight &lt; <span class=cloze>[...]</span> percentile for gestational age"<b>Fetal growth restriction</b> is an ultrasound-estimated fetal weight &lt; <span class=cloze>10th</span> percentile for gestational age<br> <img src=""fgr.png"" />"
<b><span class=cloze>[...]</span> fetal growth restriction</b>&nbsp;begins in the <u>first trimester</u>&nbsp;and is typically caused by <b>chromosomal</b> <b>abnormalities or intrauterine&nbsp;<u>infection</u>&nbsp;(TORCH).</b>"<b><span class=cloze>Symmetric</span> fetal growth restriction</b>&nbsp;begins in the <u>first trimester</u>&nbsp;and is typically caused by <b>chromosomal</b> <b>abnormalities or intrauterine&nbsp;<u>infection</u>&nbsp;(TORCH).</b><br> <i>global growth lag that affects fetal organs uniformly</i><div><i>imagine a symmetric TORCH burning<br /></i><div><i><img src=""fgr.png"" /></i></div></div><div><i><br /></i></div>"
<b>Symmetric fetal growth restriction</b>&nbsp;begins in the <u><span class=cloze>[...]</span> trimester</u>&nbsp;and is typically caused by <b>chromosomal</b> <b>abnormalities or intrauterine&nbsp;<u>infection</u>&nbsp;(TORCH).</b>"<b>Symmetric fetal growth restriction</b>&nbsp;begins in the <u><span class=cloze>first</span> trimester</u>&nbsp;and is typically caused by <b>chromosomal</b> <b>abnormalities or intrauterine&nbsp;<u>infection</u>&nbsp;(TORCH).</b><br> <i>global growth lag that affects fetal organs uniformly</i><div><i>imagine a symmetric TORCH burning<br /></i><div><i><img src=""fgr.png"" /></i></div></div><div><i><br /></i></div>"
"<b><span class=cloze>[...]</span> fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>second/third trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<b><font color=""#ff0000"">placental insufficiency</font></b>&nbsp;(e.g. hypertension, diabetes)""<b><span class=cloze>Asymmetric</span> fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>second/third trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<b><font color=""#ff0000"">placental insufficiency</font></b>&nbsp;(e.g. hypertension, diabetes)<br> <i>characterized by normal growth in <b>vital</b> organs (e.g. brain, heart, placenta) at the expense of <b>less</b> <b>vital</b> organs (e.g. abdominal viscera) due to <u>fetal hypoxia</u> and preferred shunting of blood to vital organs.&nbsp;</i><div><i><br /></i><div><i><img src=""fgr.png"" /></i></div></div>"
<b>Asymmetric fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>second/third trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<span class=cloze>[...]</span>"<b>Asymmetric fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>second/third trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<span class=cloze><b><font color=""#ff0000"">placental insufficiency</font></b>&nbsp;(e.g. hypertension, diabetes)</span><br> <i>characterized by normal growth in <b>vital</b> organs (e.g. brain, heart, placenta) at the expense of <b>less</b> <b>vital</b> organs (e.g. abdominal viscera) due to <u>fetal hypoxia</u> and preferred shunting of blood to vital organs.&nbsp;</i><div><i><br /></i><div><i><img src=""fgr.png"" /></i></div></div>"
<span class=cloze>[...]</span>&nbsp;is a blood pressure&nbsp;<b><u>&gt;</u>&nbsp;140/90 mmHg</b>&nbsp;<i>before</i>&nbsp;the&nbsp;20th week of gestation"<span class=cloze><b>Chronic</b><b>&nbsp;hypertension</b></span>&nbsp;is a blood pressure&nbsp;<b><u>&gt;</u>&nbsp;140/90 mmHg</b>&nbsp;<i>before</i>&nbsp;the&nbsp;20th week of gestation<br> <i>elevated blood pressure must be seen on <u>2 separate measurements</u> taken <b>at least 4 hours apart</b>&nbsp;</i><div><i><img src=""i found chart!.png"" /></i></div>"
<b>Chronic</b><b>&nbsp;hypertension</b>&nbsp;is a blood pressure&nbsp;<b><u>&gt;</u>&nbsp;140/90 mmHg</b>&nbsp;<i>before</i>&nbsp;the&nbsp;<span class=cloze>[...]</span> week of gestation"<b>Chronic</b><b>&nbsp;hypertension</b>&nbsp;is a blood pressure&nbsp;<b><u>&gt;</u>&nbsp;140/90 mmHg</b>&nbsp;<i>before</i>&nbsp;the&nbsp;<span class=cloze>20th</span> week of gestation<br> <i>elevated blood pressure must be seen on <u>2 separate measurements</u> taken <b>at least 4 hours apart</b>&nbsp;</i><div><i><img src=""i found chart!.png"" /></i></div>"
<u>Laboring</u> patients at <i>high risk</i> of <b>uterine</b> <b>rupture</b> require urgent <span class=cloze>[...]</span><u>Laboring</u> patients at <i>high risk</i> of <b>uterine</b> <b>rupture</b> require urgent <span class=cloze>laparotomy and delivery</span><br> <i>e.g. patients with a history of extensive myomectomy or classical cesarean delivery&nbsp;</i>
What is the likely <i>diagnosis</i>&nbsp;in a postpartum patient on post-operative day 5 with a <b>fever</b> that is <u>unreponsive</u> to broad-spectrum antibiotic therapy with a&nbsp;<u>negative</u> infectious workup (blood/urine cultures, urinalysis)?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a postpartum patient on post-operative day 5 with a <b>fever</b> that is <u>unreponsive</u> to broad-spectrum antibiotic therapy with a&nbsp;<u>negative</u> infectious workup (blood/urine cultures, urinalysis)?&nbsp;<div><br /></div><div><span class=cloze>Septic pelvic thrombophlebitis</span></div><br> <i><b>diagnosis of exclusion</b>; due to an infected thrombosis of the deep pelvic or ovarian veins&nbsp;</i><div><i><br /></i><div><i><img src=""spt.png"" /></i></div></div>"
What is the <i>recommended treatment</i>&nbsp;for <b>septic pelvic thrombophlebitis</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended treatment</i>&nbsp;for <b>septic pelvic thrombophlebitis</b>?&nbsp;<div><br /></div><div><span class=cloze>anticoagulation and broad-spectrum antibiotics</span></div><br> <img src=""spt.png"" />"
What is the <i>most likely cause</i> of <u>postpartum hemorrhage</u>&nbsp;in a patient that presents with profuse vaginal bleeding with a <b>soft</b>, <b>boggy,</b>&nbsp;<b>enlarged</b> <b>uterus</b> on pelvic examination? Ultrasound reveals a<u> thin</u> endometrial stripe.<div><br /></div><div><span class=cloze>[...]</span></div>What is the <i>most likely cause</i> of <u>postpartum hemorrhage</u>&nbsp;in a patient that presents with profuse vaginal bleeding with a <b>soft</b>, <b>boggy,</b>&nbsp;<b>enlarged</b> <b>uterus</b> on pelvic examination? Ultrasound reveals a<u> thin</u> endometrial stripe.<div><br /></div><div><span class=cloze>Uterine atony</span></div><br> <i>- lack of contraction --&gt; cannot compress placental blood vessels.</i><div><i>- risk factors include <b>prolonged</b> labor, <b>large</b> fetal weight &gt; 4000g, <u>induction</u> of labor, and <u>operative</u> vaginal delivery (think about uterus getting tired b/c of all this force or not needing to do anything at all)</i></div><div><i></i><i>- <b>thin stripe </b>suggests empty endometrial cavity (i.e., not retained placenta)</i></div>
What is the <i>most common </i>site of implantation for <b>ectopic</b> <b>pregnancy</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>most common </i>site of implantation for <b>ectopic</b> <b>pregnancy</b>?<div><br /></div><div><span class=cloze>Fallopian tube (ampulla)</span></div><br> <div><br /></div><img src=""okie (4).png"" />"
Examination findings consistent with&nbsp;<span class=cloze>[...]</span>&nbsp;include the presence of&nbsp;<b>abdominally</b> <b>palpable</b> <b>fetal</b> <b>parts</b>&nbsp;and/or the<b> loss of&nbsp;</b><b>fetal</b> <b>station</b>"Examination findings consistent with&nbsp;<span class=cloze><u>uterine rupture</u></span>&nbsp;include the presence of&nbsp;<b>abdominally</b> <b>palpable</b> <b>fetal</b> <b>parts</b>&nbsp;and/or the<b> loss of&nbsp;</b><b>fetal</b> <b>station</b><br> <i>loss of fetal station may be described as <b>no presenting fetal parts vaginally</b> or <b>abdominally palpable fetal parts</b> and is pathognomonic; other symptoms include <b>abdominal</b> <b>pain</b> and <b>bleeding</b> (vaginal or intra-abdominal)&nbsp;</i><div><i>&nbsp;<br /></i><div><i><img src=""finally.png"" /></i></div><div><i><img src=""Uterine rupture.png"" /></i></div></div>"
Which&nbsp;<u>TORCH infections</u> are <i>routinely screened</i>&nbsp;for in <b>pregnant</b> <b>women</b>&nbsp;during their first prenatal visit?<div><br /></div><div><span class=cloze>[...]</span></div>"Which&nbsp;<u>TORCH infections</u> are <i>routinely screened</i>&nbsp;for in <b>pregnant</b> <b>women</b>&nbsp;during their first prenatal visit?<div><br /></div><div><span class=cloze>rubella and syphilis</span></div><br> <div><i>other routinely screened infections include <b>HIV</b>, <b>hepatitis B</b>, and <b>Chlamydia trachomatis</b></i></div><div><i><b><br /></b></i></div><img src=""biiitch.png"" />"
What is the <i>recommended management</i>&nbsp;for a <u>pregnant woman</u>&nbsp;that is <b>rubella-nonimmune</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended management</i>&nbsp;for a <u>pregnant woman</u>&nbsp;that is <b>rubella-nonimmune</b>?<div><br /></div><div><span class=cloze>Immediate <i>postpartum</i> vaccination (e.g. MMR)</span></div><br> <i>contraindicated during pregnancy but safe during breastfeeding</i><div><i><br /></i><div><i><img src=""vaccines prego.png"" /></i></div></div>"
What is the likely <i>diagnosis</i>&nbsp;in an <u>afebrile</u> postpartum woman that presents with <b>bilateral</b>, <b>symmetric</b> <b>warmth </b>and <b>tenderness</b> <b>of the breasts</b> 3 days after delivery?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in an <u>afebrile</u> postpartum woman that presents with <b>bilateral</b>, <b>symmetric</b> <b>warmth </b>and <b>tenderness</b> <b>of the breasts</b> 3 days after delivery?&nbsp;<div><br /></div><div><span class=cloze>Breast engorgement</span></div><br> <i>common 3-5 days after delivery when <b>colostrum is replaced by milk</b>; improves with breastfeeding</i><div><i><br /></i><div><i><img src=""hmm (2).png"" /></i></div></div>"
<span class=cloze>[...]</span> refers to <u>normal</u>&nbsp;<b>vaginal</b> <b>discharge</b> containing blood and/or mucus in the <i>postpartum</i> period&nbsp;<span class=cloze>Lochia</span> refers to <u>normal</u>&nbsp;<b>vaginal</b> <b>discharge</b> containing blood and/or mucus in the <i>postpartum</i> period&nbsp;<br> <i>can occur for up to 2-3 months</i>
What is the <i>strongest risk factor</i> for <b>preterm delivery</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>strongest risk factor</i> for <b>preterm delivery</b>?<div><br /></div><div><span class=cloze><u>prior</u>&nbsp;preterm delivery</span></div><br> <img src=""ya got me (4).png"" />"
What is the <i>first step</i>&nbsp;in evaluating <u>risk of preterm delivery</u>&nbsp;in a patient with a <b>history of cervical surgery</b>&nbsp;(e.g. cold knife conization)?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>first step</i>&nbsp;in evaluating <u>risk of preterm delivery</u>&nbsp;in a patient with a <b>history of cervical surgery</b>&nbsp;(e.g. cold knife conization)?<div><br /></div><div><span class=cloze>transvaginal <b>ultrasound</b> measurement of <u>cervical length</u> in the 2nd trimester</span></div><br> <i>cervical surgery → scarring/incompetence; finding a&nbsp;<b>short cervical length</b> is a strong predictor of preterm labor</i><div><i><br /></i><div><i><img src=""cone bx.png"" /><img src=""paste-425519589883905.jpg"" /></i></div></div><div><i><br /></i></div>"
What is the <i>recommended management</i>&nbsp;for a pregnant patient with <u>no history of preterm labor</u>&nbsp;and a <b>short cervix </b>(<u>&lt;</u>&nbsp;2 cm)&nbsp;on TVUS?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended management</i>&nbsp;for a pregnant patient with <u>no history of preterm labor</u>&nbsp;and a <b>short cervix </b>(<u>&lt;</u>&nbsp;2 cm)&nbsp;on TVUS?<div><br /></div><div><span class=cloze>Vaginal progesterone</span></div><br> <i></i><i>- progesterone quiets the uterus and protects against premature rupture</i>&nbsp;<div><i>-&nbsp;<b>short</b> cervix = <b>local</b> progesterone (vs. systemic progesterone for history of preterm)</i></div><div><div><i><br /></i><div><i><img src=""preterm.png"" /></i></div></div></div>"
What is the <i>next step</i>&nbsp;in management for a healthy pregnant woman at <u>37 weeks gestation</u> that <b>desires a</b> <b>vaginal</b> <b>delivery</b>? Ultrasound reveals the fetus is in a <b>frank&nbsp;breech</b> <b>presentation</b>.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step</i>&nbsp;in management for a healthy pregnant woman at <u>37 weeks gestation</u> that <b>desires a</b> <b>vaginal</b> <b>delivery</b>? Ultrasound reveals the fetus is in a <b>frank&nbsp;breech</b> <b>presentation</b>.&nbsp;<div><br /></div><div><span class=cloze>External cephalic version</span></div><br> <i>can be attempted in women with breech pregnancies at<b> <u>&gt;</u>&nbsp;37 weeks of gestational age </b>if there's no contraindications to vaginal delivery and the fetus is in good health&nbsp;</i><div><i><br /></i><div><i><img src=""ecv2.png"" /></i></div><div><i><img src=""ECV.png"" /></i></div><div><i><img src=""breech.png"" /></i></div></div>"
What is the <i>next step</i>&nbsp;in management for a pregnant woman at 32 weeks gestation that presents with <b>decreased</b> <b>fetal</b> <b>movement</b>? Heart tones are heard by Doppler.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>What is the <i>next step</i>&nbsp;in management for a pregnant woman at 32 weeks gestation that presents with <b>decreased</b> <b>fetal</b> <b>movement</b>? Heart tones are heard by Doppler.&nbsp;<div><br /></div><div><span class=cloze>Non-stress test</span></div><br> <i>i.e. recording the fetal heart rate while monitoring for spontaneous perceived fetal movements</i>
What is the <i>most common cause</i>&nbsp;of a <u>non-reactive</u>&nbsp;<b>non-stress test</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>most common cause</i>&nbsp;of a <u>non-reactive</u>&nbsp;<b>non-stress test</b>?<div><br /></div><div><span class=cloze>Fetal sleep cycle</span></div><br> <i>non-reactive meaning no accelerations; vibroacoustic stimulation may be used to awaken the fetus; sleep cycles can last as long as 40 minutes therefore a non-reactive test should be extended to <b>40 - 120 minutes</b></i><div><i><b><br /></b></i></div><div><i><b><img src=""afp20091215p1388-of4.gif"" /></b></i></div>"
What is the <i>first-line intervention</i>&nbsp;for a woman in the first stage of labor with <b><u>recurrent</u> variable decelerations</b>&nbsp;and <b>moderate</b> <b>variability</b> on fetal heart tracing?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>first-line intervention</i>&nbsp;for a woman in the first stage of labor with <b><u>recurrent</u> variable decelerations</b>&nbsp;and <b>moderate</b> <b>variability</b> on fetal heart tracing?&nbsp;<div><br /></div><div><span class=cloze>Maternal repositioning (e.g. left lateral decubitus)</span></div><br> <i><b>- recurrent </b>= &gt; 50% of contractions have variable decels.</i><div><i><b>- amnioinfusion</b> is a possible second-line intervention; assisted vaginal delivery could be indicated if the patient was <b>fully dilated ( &gt; 10 cm)</b></i><div><i><br /></i><div><i><img src=""rec.png"" /><img src=""paste-3088094370725889.jpg"" /></i></div></div></div><div><i><br /></i></div><div><i><br /></i></div>"
What is the <i>recommended management</i>&nbsp;for a pregnant woman at <u>37 weeks gestation</u> that presents with <b>placenta previa</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended management</i>&nbsp;for a pregnant woman at <u>37 weeks gestation</u> that presents with <b>placenta previa</b>?<div><br /></div><div><span class=cloze>Cesarean delivery</span></div><br> <i>patients diagnosed antenatally should have <b>C-section delivery at 36-37 weeks</b>; vaginal delivery is <u>contraindicated</u>&nbsp;(baby will hit the placenta on the way out causing bleeding!)</i><div><i><br /></i><div><i><img src=""previa.png"" /><br /></i><div><i><img src=""placenta previa.png"" /></i></div></div></div>"
What is the <i>most common cause</i>&nbsp;of <b>second stage arrest of labor</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>most common cause</i>&nbsp;of <b>second stage arrest of labor</b>?<div><br /></div><div><span class=cloze>Fetal malposition (e.g. occiput transverse)</span></div><br> <i>position is relation of fetal presenting part to maternal pelvis; the optimal fetal position is <b>occiput anterior</b>&nbsp;</i><div><i><br /></i><div><i><img src=""paste-1068789726707713.jpg"" /></i><br /><div><i><img src=""Screenshot 2018-02-28_13-58-20.png"" /><img src=""darn (2).png"" /></i></div><div><i><br /></i></div></div></div>"
<b>Chorionic villus sampling</b>&nbsp;may be performed between <span class=cloze>[...]</span> to <span class=cloze>[...]</span> weeks"<b>Chorionic villus sampling</b>&nbsp;may be performed between <span class=cloze>10</span> to <span class=cloze>13</span> weeks<br> <i><b>earlier</b> than amniocentesis, but higher risk of fetal loss; diagnostic for aneuploidies&nbsp;</i><div><i><br /></i><div><i><img src=""prenatal testing.png"" /></i></div><div><i><img src=""cvs (1).png"" /></i></div></div>"
Complications of <u>inadequate weight gain</u>&nbsp;during pregnancy include&nbsp;<span class=cloze>[...]</span> and <b>preterm delivery</b>&nbsp;"Complications of <u>inadequate weight gain</u>&nbsp;during pregnancy include&nbsp;<span class=cloze>fetal growth restriction</span> and <b>preterm delivery</b>&nbsp;<br> <div><br /></div><img src=""ez (3).png"" />"
Can a <u>reactive</u> <b>non-stress test</b> effectively rule <i>out</i>&nbsp;<b>fetal</b> <b>acidemia</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"Can a <u>reactive</u> <b>non-stress test</b> effectively rule <i>out</i>&nbsp;<b>fetal</b> <b>acidemia</b>?<div><br /></div><div><span class=cloze>Yes</span></div><br> <i>a reactive NST has a <u>high</u> negative predictive value for fetal acidemia</i><div><i><img src=""reactive.png"" /></i></div>"
<b>Oligohydramnios</b>&nbsp;is characterized by an amniotic fluid index <u>&lt;</u>&nbsp;<span class=cloze>[...]</span> cm or a single deepest pocket <u>&lt;</u> 2 cm&nbsp;"<b>Oligohydramnios</b>&nbsp;is characterized by an amniotic fluid index <u>&lt;</u>&nbsp;<span class=cloze>5</span> cm or a single deepest pocket <u>&lt;</u> 2 cm&nbsp;<br> <div><i><br /></i></div><div><i><img src=""bpp.png"" /></i></div>"
<b>Magnesium </b>is solely <u>excreted</u>&nbsp;by the&nbsp;<span class=cloze>[...]</span>"<b>Magnesium </b>is solely <u>excreted</u>&nbsp;by the&nbsp;<span class=cloze>kidneys</span><br> <i>thus patients with <b>renal insufficiency</b> are at increased risk for <b>toxicity</b></i><div><b><i><br /></i></b><div><i><img src=""mg tox.png"" /></i></div></div>"
Symptoms of <u>magnesium toxicity</u>&nbsp;include somnolence, respiratory <span class=cloze>[...]</span>, and <span class=cloze>[...]</span>-reflexia"Symptoms of <u>magnesium toxicity</u>&nbsp;include somnolence, respiratory <span class=cloze>depression</span>, and <span class=cloze>hypo</span>-reflexia<br> <div><i>more mild symptoms include nausea, flushing, and headache</i></div><img src=""mg tox.png"" />"
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What is the <i>recommended treatment</i>&nbsp;for <u>symptomatic</u> postpartum <b>pubic symphysis diastasis</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended treatment</i>&nbsp;for <u>symptomatic</u> postpartum <b>pubic symphysis diastasis</b>?<div><br /></div><div><span class=cloze><b>Supportive</b> (e.g. NSAIDs, physical therapy)</span></div><br> <i>typically resolves witin the first 4 weeks postpartum</i><div><i><br /></i><div><i><img src=""gotit.png"" /></i></div></div>"
What is the likely <i>diagnosis</i>&nbsp;in a pregnant woman with <u>preeclampsia</u>&nbsp;that develops sudden-onset <b>dyspnea</b>, <b>hypoxia</b>, and <b>crackles</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a pregnant woman with <u>preeclampsia</u>&nbsp;that develops sudden-onset <b>dyspnea</b>, <b>hypoxia</b>, and <b>crackles</b>?<div><br /></div><div><span class=cloze>Pulmonary edema</span></div><br> <i>rare but life-threatening complication of severe preeclampsia</i><div><i><img src=""why (4).png"" /></i></div>"
What is the likely <i>diagnosis</i>&nbsp;in a patient that presents one week after an elective abortion with <b>fever</b>, <b>vaginal</b> <b>bleeding</b>, <b>abdominal</b> <b>pain</b>, and <b>purulent</b> <b>vaginal</b> <b>discharge</b>? Pelvic ultrasound reveals a <u>thickened</u> endometrial stripe.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a patient that presents one week after an elective abortion with <b>fever</b>, <b>vaginal</b> <b>bleeding</b>, <b>abdominal</b> <b>pain</b>, and <b>purulent</b> <b>vaginal</b> <b>discharge</b>? Pelvic ultrasound reveals a <u>thickened</u> endometrial stripe.&nbsp;<div><br /></div><div><span class=cloze>Septic abortion</span></div><br> <i>pelvic examination typically reveals an <b>enlarged</b>, <b>boggy</b>, <b>tender</b> <b>uterus; </b>thicekened endometrial stripe due to the POC left behind.</i><div><i>&nbsp;</i><div><i><img src=""help (2).png"" /></i></div></div><div><i><br /></i></div><div><i><img src=""paste-3072623898525697.jpg"" /></i></div>"
What is the <i>recommended treatment</i>&nbsp;for patients with&nbsp;<b>septic abortion</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended treatment</i>&nbsp;for patients with&nbsp;<b>septic abortion</b>?<div><br /></div><div><span class=cloze><u>broad</u>-spectrum antibiotics and suction curettage</span></div><br> <i>medical emergency; urgent treatment required to reduce risk of sepsis (<b>surgery</b>!)</i><div><i><br /></i><div><i><img src=""help (2).png"" /></i></div></div>"
<u>Normal</u> postpartum changes include shivering, lochia, and a <span class=cloze>[...]</span> uterus (relaxed or contracted)"<u>Normal</u> postpartum changes include shivering, lochia, and a <span class=cloze>contracted</span> uterus (relaxed or contracted)<br> <div><i>the uterus should be <b>palpable at or below the level of the umbilicus; lochia </b>is due to normal shedding of uterine decidua</i></div><div><i><b><br /></b></i></div><i><img src=""got one right finally.png"" /></i>"
Late- and post-term pregnancies require <u>antenatal fetal surveillance</u> beginning at <b>41 weeks</b> with a <span class=cloze>[...]</span> to screen for <b>fetal</b> <b>hypoxia</b>&nbsp;"Late- and post-term pregnancies require <u>antenatal fetal surveillance</u> beginning at <b>41 weeks</b> with a <span class=cloze>biophysical profile</span> to screen for <b>fetal</b> <b>hypoxia</b>&nbsp;<br> <i>late- and post-term pregnancies are at risk for <b>uteroplacental insufficiency</b>&nbsp;due to ""old placenta"" (e.g. <u>oligohydramnios</u>, late decelerations)</i><div><i><img src=""bpp is back.png"" /></i></div>"
Evaluation of a newborn with <u>fetal growth restriction</u> at delivery includes <i>histopathologic examination</i> of the <span class=cloze>[...]</span> to assess for <b>infection</b> and&nbsp;<b>infarction</b>"Evaluation of a newborn with <u>fetal growth restriction</u> at delivery includes <i>histopathologic examination</i> of the <span class=cloze>placenta</span> to assess for <b>infection</b> and&nbsp;<b>infarction</b><br> <i>since the cause of IUGR is usually 2/2<b> uteroplacental insufficiency;</b>&nbsp;baby urine toxicology, serology, and karyotype should be considered; additional management is dependent on symptoms (e.g. antibiotics for suspected sepsis, surfactant therapy for suspected NRDS, etc.)</i><div><i><br /></i><div><i><img src=""damn dude.png"" /></i></div></div>"
Patients with <b>placenta previa</b>&nbsp;should be advised to <u>avoid</u> <span class=cloze>[...]</span>"Patients with <b>placenta previa</b>&nbsp;should be advised to <u>avoid</u> <span class=cloze>sexual intercourse</span><br> <i><b>digital vaginal examination</b> is also <u>contraindicated</u>; both can cause trauma to the placenta and trigger massive hemorrhage</i><div><i><img src=""previa.png"" /></i></div>"
What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a pregnant patient that presents with&nbsp;<b>painless third-trimester bleeding</b>&nbsp;with <u><b>bradycardia</b></u>&nbsp;on&nbsp;fetal heart tracing?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a pregnant patient that presents with&nbsp;<b>painless third-trimester bleeding</b>&nbsp;with <u><b>bradycardia</b></u>&nbsp;on&nbsp;fetal heart tracing?<div><br /></div><div><span class=cloze>Vasa previa</span></div><br> <i>fetal <u>bradycardia</u> is an important distinguishing feature from placenta previa; occurs because the hemorrhage is of fetal origin (versus maternal origin in placenta previa - mom's placenta)</i><div><i><br /></i><div><i><img src=""vasa previa.png"" /></i></div></div>"
Complications of <u>oxytocin</u>&nbsp;include <b><span class=cloze>[...]</span>-natremia</b>, <b><span class=cloze>[...]</span>-tension</b>, and <b>uterine <span class=cloze>[...]</span></b>&nbsp;"Complications of <u>oxytocin</u>&nbsp;include <b><span class=cloze>hypo</span>-natremia</b>, <b><span class=cloze>hypo</span>-tension</b>, and <b>uterine <span class=cloze>tachysystole</span></b>&nbsp;<br> <i>uterine tachysystole is defined as &gt; 5 contractions in 10 minutes; <b>hypo</b>natremia may occur due to structural similarities between oxytocin and <b>ADH</b>&nbsp;(suck in H2O) - imagine an ox drinking lots of water.</i><div><i><br /></i><div><i><img src=""hrm.png"" /></i></div></div>"
What&nbsp;<i>type(s) of fibroids</i>&nbsp;are most associated with&nbsp;<b>heavy menstrual bleeding</b>&nbsp;and/or <b>recurrent pregnancy loss</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What&nbsp;<i>type(s) of fibroids</i>&nbsp;are most associated with&nbsp;<b>heavy menstrual bleeding</b>&nbsp;and/or <b>recurrent pregnancy loss</b>?<div><br /></div><div><span class=cloze>submucosal and intracavitary fibroids (leiomyomata)</span></div><br> <div><i>i.e., the ones that are directly connected to the outside so blood can come out and those that can mechanically obstruct/disrupt implantation.&nbsp;</i></div><div><i><img src=""paste-2969175316234241.jpg"" /></i></div><img src=""Uterine fibroid.png"" />"
What&nbsp;<i>type(s) of fibroids</i>&nbsp;are most associated with&nbsp;<u>bulk-related symptoms</u>&nbsp;and&nbsp;<b><i>irregular</i> uterine enlargement</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What&nbsp;<i>type(s) of fibroids</i>&nbsp;are most associated with&nbsp;<u>bulk-related symptoms</u>&nbsp;and&nbsp;<b><i>irregular</i> uterine enlargement</b>?<div><br /></div><div><span class=cloze>subserosal and pedunculated<b> fibroids</b> (leiomyomata)</span></div><br> <div><i>e.g. constipation, incomplete voiding, pelvic pressure</i></div><div><i><br /></i></div><img src=""fibroids.png"" />"
<b>Late-</b> and <b>post-term pregnancies</b> are commonly <i>complicated</i> by <b><span class=cloze>[...]</span>-hydramnios</b>"<b>Late-</b> and <b>post-term pregnancies</b> are commonly <i>complicated</i> by <b><span class=cloze>oligo</span>-hydramnios</b><br> <i>the presence of oligohydramnios is an<b> indication for delivery</b>; aging placentas may have <u>decreased fetal perfusion</u>, which causes decreased renal perfusion and urinary output</i><div><i><img src=""late .png"" /></i></div>"
<b>Polyhydramnios</b>&nbsp;is characterized by an amniotic fluid index&nbsp;<u>&gt;</u>&nbsp;<span class=cloze>[...]</span> cm or a single deepest pocket&nbsp;<u>&gt;</u>&nbsp;8&nbsp;cm&nbsp;<b>Polyhydramnios</b>&nbsp;is characterized by an amniotic fluid index&nbsp;<u>&gt;</u>&nbsp;<span class=cloze>24</span> cm or a single deepest pocket&nbsp;<u>&gt;</u>&nbsp;8&nbsp;cm&nbsp;<br> 8 x 3 = 24
The major <i>risk factor</i> for <u>shoulder dystocia</u> is <b>fetal</b> <b><span class=cloze>[...]</span></b>"The major <i>risk factor</i> for <u>shoulder dystocia</u> is <b>fetal</b> <b><span class=cloze>macrosomia</span></b><br> <i>i.e. fetal weight &gt; 4.5 kg (<b>9.9 lb</b>); conditions that predispose to macrosomia include <b>post</b>-term pregnancy, maternal <b>obesity</b>, gestational <b>diabetes</b>, and excessive weight gain during pregnancy</i><div><img src=""dyst.png"" /></div><div><img src=""dystocia.png"" /></div>"
<b>External cephalic version</b>&nbsp;can be attempted for <u>breech presentations</u> at <u>&gt;</u>&nbsp;<span class=cloze>[...]</span> weeks gestation"<b>External cephalic version</b>&nbsp;can be attempted for <u>breech presentations</u> at <u>&gt;</u>&nbsp;<span class=cloze>37</span> weeks gestation<br> <i>- done at 37 weeks or later due to risk of preterm delivery</i><div><i>- if the patient refuses ECV, cesarean delivery is typically performed at 39 weeks gestation</i></div><div><i><br /></i><div><i><img src=""ecv2.png"" /></i></div><div><i><img src=""ECV.png"" /></i></div></div>"
What is the <i>recommended treatment</i>&nbsp;for a <u>pregnant woman</u> with <b>antiphospholipid syndrome</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended treatment</i>&nbsp;for a <u>pregnant woman</u> with <b>antiphospholipid syndrome</b>?<div><br /></div><div><span class=cloze>aspirin and LMW heparin</span></div><br> <i>warfarin is contraindicated during pregnancy</i><div><i><img src=""aps (1).png"" /></i></div>"
What is the <i>typical prognosis</i>&nbsp;for newborns with <b>Erb-Duchenne </b>or <b>Klumpke&nbsp;palsy</b> secondary to shoulder dystocia?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>typical prognosis</i>&nbsp;for newborns with <b>Erb-Duchenne </b>or <b>Klumpke&nbsp;palsy</b> secondary to shoulder dystocia?<div><br /></div><div><span class=cloze>Spontaneous resolution within 3 months (80%)</span></div><br> <i><b>conservative&nbsp;</b>gentle massages and physical therapy can prevent contractures; rarely surgical intervention is considered for infants with no improvement by age 3 - 6 months</i><div><i><img src=""brachial plexus injury.png"" /></i></div>"
What is the <i>next step</i>&nbsp;in management for a pregnant woman at 38 weeks gestation with <u>chorioamnionitis</u>&nbsp;after <b>administration</b> <b>of antibiotics</b>? Fetal heart tracing reveals tachycardia but is otherwise reassuring.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step</i>&nbsp;in management for a pregnant woman at 38 weeks gestation with <u>chorioamnionitis</u>&nbsp;after <b>administration</b> <b>of antibiotics</b>? Fetal heart tracing reveals tachycardia but is otherwise reassuring.&nbsp;<div><br /></div><div><span class=cloze>Induction of labor</span></div><br> <i>cesarean delivery is reserved for <u>standard obstetric indications</u> (e.g. <b>prior</b> <b>uterine</b> <b>surgeries</b>, <b>breech</b> <b>presentation</b>, <b>non-reassuring fetal heart tracing</b>)&nbsp;</i><div><i><br /></i><div><i><img src=""whoop (2).png"" /></i></div></div>"
What <i>screening test</i> is used to determine if an&nbsp;<u>Rh(D)- pregnant woman</u> has&nbsp;<b>already</b> <b>alloimmunized</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What <i>screening test</i> is used to determine if an&nbsp;<u>Rh(D)- pregnant woman</u> has&nbsp;<b>already</b> <b>alloimmunized</b>?&nbsp;<div><br /></div><div><span class=cloze>Antibody screen (indirect Coombs test)</span></div><br> <i>detects the presence of any RBC antibodies; Rh(D)- women with a <u>negative antibody screen</u> should receive anti-D immune globulin at <b>28 - 32 weeks </b>gestation</i><div><i><br /></i><div><i><img src=""paste-156323924672948.jpg"" /><br /></i><div><i><img src=""okaaaay....png"" /></i></div></div></div>"
<b>Hyperemesis gravidarum</b>&nbsp;is more common in patients with <span class=cloze>[...]</span>, hydatidiform mole, or history of GERD&nbsp;"<b>Hyperemesis gravidarum</b>&nbsp;is more common in patients with <span class=cloze>multiple gestation</span>, hydatidiform mole, or history of GERD&nbsp;<br> <div><i>multiple gestation/mole = ↑ hCG and progesterone → ↑ <b>nausea</b>; ↑ relaxation of LES → ↑<b> vomiting</b></i></div><div><i><br /></i></div><img src=""hg.png"" />"
What is the <i>initial management</i>&nbsp;for a hemodynamically <u>unstable</u>&nbsp;pregnant patient that presents with <b>abruptio</b> <b>placentae</b>&nbsp;following a motor vehicle accident?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>What is the <i>initial management</i>&nbsp;for a hemodynamically <u>unstable</u>&nbsp;pregnant patient that presents with <b>abruptio</b> <b>placentae</b>&nbsp;following a motor vehicle accident?&nbsp;<div><br /></div><div><span class=cloze>IV fluid resuscitation and left lateral decubitus positioning</span></div><br> <i>left lateral decubitus position displaces the uterus off the aortocaval vessels and maximizes cardiac output</i>
<b>Gestational diabetes</b> is a result of pancreatic beta-cell <u>hyperplasia</u> and <u>increased</u>&nbsp;<span class=cloze>[...]</span> secondary to <i>elevated</i> levels of <b>human placental lactogen</b> during the third trimester of pregnancy&nbsp;<b>Gestational diabetes</b> is a result of pancreatic beta-cell <u>hyperplasia</u> and <u>increased</u>&nbsp;<span class=cloze>insulin resistance</span> secondary to <i>elevated</i> levels of <b>human placental lactogen</b> during the third trimester of pregnancy&nbsp;<br> <i>hPL (a type of <u>placental</u> somatomammotropin) production ceases after delivery resulting in resolution of GDM</i>
<b>Gestational diabetes</b> is a result of pancreatic beta-cell <u>hyperplasia</u> and <u>increased</u>&nbsp;insulin resistance secondary to <i>elevated</i> levels of <b><span class=cloze>[...]</span></b> during the third trimester of pregnancy&nbsp;<b>Gestational diabetes</b> is a result of pancreatic beta-cell <u>hyperplasia</u> and <u>increased</u>&nbsp;insulin resistance secondary to <i>elevated</i> levels of <b><span class=cloze>human placental lactogen</span></b> during the third trimester of pregnancy&nbsp;<br> <i>hPL (a type of <u>placental</u> somatomammotropin) production ceases after delivery resulting in resolution of GDM</i>
What is the <i>underlying pathophysiology</i>&nbsp;of <u>hypotension</u> after administration of <b>epidural</b> <b>anesthesia</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>underlying pathophysiology</i>&nbsp;of <u>hypotension</u> after administration of <b>epidural</b> <b>anesthesia</b>?<div><br /></div><div><span class=cloze>vasodilation and venous pooling</span></div><br> <i><b>sympathetic</b> nerve fibers responsible for vascular tone may be <b>blocked</b> by the anesthesia resulting in <b>vasodilation and venous pooling → ↓ cardiac return</b></i><div><b><i><br /></i></b><div><i><img src=""crazy!.png"" /></i></div></div>"
Leakage of CSF after epidural placement may result in <b>postural headaches</b>, which are <u>worse</u>&nbsp;with <span class=cloze>[...]</span> and <u>better</u>&nbsp;with <span class=cloze>[...]</span>&nbsp;"Leakage of CSF after epidural placement may result in <b>postural headaches</b>, which are <u>worse</u>&nbsp;with <span class=cloze>sitting up</span> and <u>better</u>&nbsp;with <span class=cloze>lying down</span>&nbsp;<br> <i>occurs if the <b>dura is mistakenly punctured</b> during epidural placement</i><div><i><img src=""crazy!.png"" /></i></div>"
What is the likely <i>diagnosis</i>&nbsp;in a <u>stillborn fetus</u>&nbsp;with <b>multiple limb fractures</b> and a <b>hypoplastic thoracic cavity</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a <u>stillborn fetus</u>&nbsp;with <b>multiple limb fractures</b> and a <b>hypoplastic thoracic cavity</b>?<div><br /></div><div><span class=cloze>Type II osteogenesis imperfecta</span></div><br> <i>due to mutations in <b>type 1 collagen (bONE);</b> type II OI is the <b>most</b> <b>severe</b> type and often manifests as fatal perinatal disease</i><div><i><br /></i><div><i><img src=""typeIIoi.png"" /></i></div></div>"
What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a laboring patient with&nbsp;<b><u>&gt;</u>&nbsp;6 cm dilation</b>&nbsp;that experiences&nbsp;<u>no further dilation</u>&nbsp;for <b>4 hours</b>&nbsp;despite <b>adequate</b> <b>contractions</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a laboring patient with&nbsp;<b><u>&gt;</u>&nbsp;6 cm dilation</b>&nbsp;that experiences&nbsp;<u>no further dilation</u>&nbsp;for <b>4 hours</b>&nbsp;despite <b>adequate</b> <b>contractions</b>?<div><br /></div><div><span class=cloze><u>Arrest</u> of active labor</span></div><br> <i>arrest of active labor is also diagnosed if there is <b>no cervical change for <u>&gt;</u>&nbsp;6 hours </b>with <u>inadequate</u> contractions (&lt; 200 MVUs in a 10-minute period)</i><div><i><img src=""mvu.png"" /></i></div>"
What is the&nbsp;<i>recommended management</i>&nbsp;for a patient with&nbsp;<b>arrest of active labor</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the&nbsp;<i>recommended management</i>&nbsp;for a patient with&nbsp;<b>arrest of active labor</b>?<div><br /></div><div><span class=cloze>Cesarean delivery</span></div><br> <i>differentiated from&nbsp;<u>protraction</u>&nbsp;of active labor by the absence of cervical dilation (versus abnormally slow cervical dilation)</i><div><i><img src=""wtf (3).png"" /></i></div>"
What is the <i>recommended management</i>&nbsp;for a laboring patient with&nbsp;<b><u>&gt;</u>&nbsp;6 cm dilation</b>&nbsp;that experiences&nbsp;<u>no further dilation</u>&nbsp;for&nbsp;<b>4 hours</b>&nbsp;and&nbsp;<b>in</b><b>adequate</b>&nbsp;<b>contractions</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended management</i>&nbsp;for a laboring patient with&nbsp;<b><u>&gt;</u>&nbsp;6 cm dilation</b>&nbsp;that experiences&nbsp;<u>no further dilation</u>&nbsp;for&nbsp;<b>4 hours</b>&nbsp;and&nbsp;<b>in</b><b>adequate</b>&nbsp;<b>contractions</b>?<div><br /></div><div><span class=cloze>Cervical examination in 2 hours</span></div><br> <i>arrest of active labor is not diagnosed with <u>inadequate contractions</u> until there is <b><u>&gt;</u>&nbsp;6 hours of no cervical change</b>&nbsp;</i><div><i><img src=""wtf (3).png"" /></i></div>"
What is the <i>recommended management</i>&nbsp;for a woman in the third trimester of pregnancy that presents with <b>lower back pain </b>that radiates down the legs, especially with activity? Physical exam is benign.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended management</i>&nbsp;for a woman in the third trimester of pregnancy that presents with <b>lower back pain </b>that radiates down the legs, especially with activity? Physical exam is benign.&nbsp;<div><br /></div><div><span class=cloze>reassurance and conservative management</span></div><br> <i>e.g. behavioral modifications, analgesics; back pain occurs due to postural changes, weakened abdominal muscles, and joint/ligament laxity</i><div><i><br /></i><div><i><img src=""hmmmm (2).png"" /></i></div></div>"
<b>Maternal adaptations</b> to pregnancy include a(n) <span class=cloze>[...]</span> <b>cardiac output</b>"<b>Maternal adaptations</b> to pregnancy include a(n) <span class=cloze><u>increased</u></span> <b>cardiac output</b><br> <i>due to increased stroke volume (early pregnancy) or increased heart rate (late pregnancy); may be accompanied by a <b>systolic</b> <b>ejection</b> <b>murmur</b>&nbsp;</i><div><i><img src=""mater.png"" /></i></div>"
What <i>exercise regimen</i> is recommended for <u>healthy</u> women with <b>uncomplicated</b> <b>pregnancies</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What <i>exercise regimen</i> is recommended for <u>healthy</u> women with <b>uncomplicated</b> <b>pregnancies</b>?<div><br /></div><div><span class=cloze>20 - 30 minutes of <b>moderate</b>-intensity exercise on <u>most or all</u> days of the week</span></div><br> <i><b>contact sports</b> and activities with <b>high</b> <b>fall</b>&nbsp;<b>risk</b> should be <u>avoided (e.g., gymnastics, skiing)</u>&nbsp;due to risk of blunt trauma; women with risk for preterm delivery, preeclampsia, or severe cardiopulmonary disease should also avoid exercise &nbsp;</i><div><i><br /></i><div><i><img src=""LAME.png"" /></i></div></div>"
<b>Systemic lupus erythematosus flare</b> during pregnancy is distinguished from <u>preeclampsia</u> by the presence of <span class=cloze>[...]</span> <b>on</b> <b>urinalysis</b> and <b>classic symptoms of SLE</b> (e.g. joint pain, malar rash)"<b>Systemic lupus erythematosus flare</b> during pregnancy is distinguished from <u>preeclampsia</u> by the presence of <span class=cloze>RBC casts</span> <b>on</b> <b>urinalysis</b> and <b>classic symptoms of SLE</b> (e.g. joint pain, malar rash)<br> <div><i>other findings consistent with SLE flare include <b>decreased complement levels and increased ANA titers</b></i></div><div><i><b><br /></b></i></div><img src=""seemed obvi.png"" />"
<b>Hypopituitarism</b>&nbsp;may be caused by&nbsp;<b>Sheehan syndrome</b>, which is a&nbsp;pregnancy-related <span class=cloze>[...]</span>&nbsp;of the pituitary gland&nbsp;"<b>Hypopituitarism</b>&nbsp;may be caused by&nbsp;<b>Sheehan syndrome</b>, which is a&nbsp;pregnancy-related <span class=cloze><u>infarction</u></span>&nbsp;of the pituitary gland&nbsp;<br> <i>occurs as a complication of massive obstetric hemorrhage and hypovolemic shock</i><div><i><img src=""ed sheehan.png"" /></i></div>"
What is the likely <i>diagnosis</i>&nbsp;in a postpartum woman that presents with <b>lactation</b> <b>failure</b>, <b>amenorrhea</b>, <b>fatigue</b>, and <b>hypotension</b>&nbsp;for months after a spontaneous vaginal delivery complicated by <u>uterine atony</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a postpartum woman that presents with <b>lactation</b> <b>failure</b>, <b>amenorrhea</b>, <b>fatigue</b>, and <b>hypotension</b>&nbsp;for months after a spontaneous vaginal delivery complicated by <u>uterine atony</u>?<div><br /></div><div><span class=cloze>Sheehan syndrome</span></div><br> <i>symptoms are due to <u>hypopituitarism</u>&nbsp;secondary to ischemic infarction and necrosis of the pituitary gland following massive obstetric hemorrhage</i><div><i><br /></i><div><i><img src=""ed sheehan.png"" /></i></div></div>"
"What complication of <u>shoulder dystocia</u>&nbsp;manifests as a ""<b>claw</b> <b>hand</b>"", an <b>impaired</b> <b>grasp</b> <b>reflex</b>, and&nbsp;<b>Horner</b> <b>syndrome</b> in a newborn?<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""paste-472961798635521.jpg"" /></div>""What complication of <u>shoulder dystocia</u>&nbsp;manifests as a ""<b>claw</b> <b>hand</b>"", an <b>impaired</b> <b>grasp</b> <b>reflex</b>, and&nbsp;<b>Horner</b> <b>syndrome</b> in a newborn?<div><br /></div><div><span class=cloze>Klumpke palsy (due to lower trunk injury involving C8 and T1)</span></div><div><br /></div><div><img src=""paste-472961798635521.jpg"" /></div><br> <i><div></div></i><i>Klumpke Klaw; Horner syndrome 2/2 damage to SNS fibers (miosis + ptosis)</i><img src=""brachial plexus injury.png"" /><img src=""paste-471630358773761.jpg"" /><div><i><img src=""big chart.png"" /></i></div>"
What is the <i>recommended management</i>&nbsp;for an <u>asymptomatic</u> patient with incidentally discovered <b>endometriosis</b> during an unrelated surgery?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended management</i>&nbsp;for an <u>asymptomatic</u> patient with incidentally discovered <b>endometriosis</b> during an unrelated surgery?<div><br /></div><div><span class=cloze>Observation</span></div><br> <i>intraoperative findings may include <b>adhesions</b>, <b>powder-burn lesions</b>, and ""<b>chocolate cysts</b>""; asymptomatic patients do <u>not</u> require any treatment</i><div><i><img src=""endo_1358629116483.png"" /></i></div>"
What is the <i>likely</i> <i>diagnosis</i>&nbsp;in an adolescent girl at <u>15 weeks gestation</u> that presents with symptoms of <b>preeclampsia with severe features</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>likely</i> <i>diagnosis</i>&nbsp;in an adolescent girl at <u>15 weeks gestation</u> that presents with symptoms of <b>preeclampsia with severe features</b>?<div><br /></div><div><span class=cloze>Hydatidiform molar pregnancy</span></div><br> <i>the presence of preeclampsia with severe features at <b>&lt; 20 weeks gestation</b> can be a complication of hydatidiform moles; typically resolves after mole removal&nbsp;</i><div><i><br /></i><div><i><img src=""interestin' last question.png"" /></i></div></div>"
What is the likely <i>diagnosis</i>&nbsp;in a patient that presents with sudden-onset <u>unilateral pelvic pain</u> with <b>free fluid in the pelvis</b> on ultrasound after <b>strenuous</b> exercise (sex)? Pregnancy test is negative.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a patient that presents with sudden-onset <u>unilateral pelvic pain</u> with <b>free fluid in the pelvis</b> on ultrasound after <b>strenuous</b> exercise (sex)? Pregnancy test is negative.&nbsp;<div><br /></div><div><span class=cloze>Ruptured ovarian cyst</span></div><br> <i>free pelvic fluid helps differentiate a ruptured cyst from ovarian torsion (enlarged, edematous ovaries on ultrasound)&nbsp;</i><div><i><br /></i><div><i><img src=""gonna be a rough one.png"" /></i></div></div>"
What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a patient that presents with sudden-onset&nbsp;<u>unilateral pelvic pain</u>&nbsp;with&nbsp;an&nbsp;<b>enlarged</b>, <b>edematous ovary</b>&nbsp;on ultrasound? Pregnancy test is negative.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a patient that presents with sudden-onset&nbsp;<u>unilateral pelvic pain</u>&nbsp;with&nbsp;an&nbsp;<b>enlarged</b>, <b>edematous ovary</b>&nbsp;on ultrasound? Pregnancy test is negative.&nbsp;<div><br /></div><div><span class=cloze>Ovarian torsion</span></div><br> <i>absence of free pelvic fluid helps differentiate ovarian torsion from a ruptured cyst&nbsp;</i><div><i><br /></i><div><i><img src=""paste-911267506159617.jpg"" /><br /></i><div><i><img src=""gonna be a rough one.png"" /></i></div></div></div>"
<b><span class=cloze>[...]</span></b>&nbsp;is transient <u>mid-cycle</u>&nbsp;ovulatory pain that may mimic appendicitis&nbsp;"<b><span class=cloze>Mittelschmerz</span></b>&nbsp;is transient <u>mid-cycle</u>&nbsp;ovulatory pain that may mimic appendicitis&nbsp;<br> <div><i>e.g. on day 10-14 (corresponding with the <b>time of ovulation, 2 weeks prior to menses); </b>due to rupture of follicle releasing the egg.</i></div><div><i><b><br /></b></i></div><div><i><img src=""gonna be a rough one.png"" /></i></div>"
What is the first-line <i>pharmacologic treatment</i>&nbsp;for <u>infertility</u>&nbsp;due to <b>polycystic ovarian syndrome</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the first-line <i>pharmacologic treatment</i>&nbsp;for <u>infertility</u>&nbsp;due to <b>polycystic ovarian syndrome</b>?<div><br /></div><div><span class=cloze>Clomiphene citrate</span></div><br> <div><i>primarily <b>blocks estrogen receptors </b>at the hypothalamus, inhibiting the negative feedback mechanism and <b>restoring pulsatile release of GnRH</b></i></div><div><i><br /></i></div><img src=""pcos (1).png"" />"
What is the likely <i>diagnosis</i>&nbsp;in a woman that presents with <b>infertility</b>&nbsp;and <b>chronic pelvic pain</b>&nbsp;with a <u>fixed</u>, <u>immobile uterus</u> on physical exam?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a woman that presents with <b>infertility</b>&nbsp;and <b>chronic pelvic pain</b>&nbsp;with a <u>fixed</u>, <u>immobile uterus</u> on physical exam?&nbsp;<div><br /></div><div><span class=cloze>Endometriosis</span></div><br> <div><i>pelvic adhesions may interfere with oocyte release and/or block sperm entry, thus causing infertility; resection of lesions improves conception rates</i></div><img src=""endometriosis.png"" />"
What is the likely <i>diagnosis</i>&nbsp;in a post-menopausal woman that presents with <u>chronic pelvic pain</u> and a&nbsp;<b>solid ovarian mass with</b>&nbsp;<b>thick</b> <b>septations</b>&nbsp;and <b>ascites</b>&nbsp;on ultrasound?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a post-menopausal woman that presents with <u>chronic pelvic pain</u> and a&nbsp;<b>solid ovarian mass with</b>&nbsp;<b>thick</b> <b>septations</b>&nbsp;and <b>ascites</b>&nbsp;on ultrasound?&nbsp;<div><br /></div><div><span class=cloze>Epithelial ovarian carcinoma</span></div><br> <i>due to abnormal proliferation of <u>ovarian or tubal epithelium or peritoneum</u>; may also present with <b>bloating</b> and/or <b>early</b> <b>satiety </b>2/2 ascites.</i><div><b><i><br /></i></b><div><i><img src=""epithel ovarian carc.png"" /></i></div></div>"
Ultrasound findings consistent with <u>epithelial ovarian carcinoma</u> include a <b>solid</b> <b>mass</b> with <b>thick</b> <b>septations</b> and the presence of <span class=cloze>[...]</span>"Ultrasound findings consistent with <u>epithelial ovarian carcinoma</u> include a <b>solid</b> <b>mass</b> with <b>thick</b> <b>septations</b> and the presence of <span class=cloze>ascites</span><br> <div><i><b>ascites </b>causes bloating, pain, early satiety, abdominal distension.</i></div><div><i><br /></i></div><img src=""epithel ovarian carc.png"" />"
<span class=cloze>[...]</span> consumption is a <u>dose-dependent</u>&nbsp;risk factor for <b>breast cancer</b>&nbsp;"<span class=cloze>Alcohol</span> consumption is a <u>dose-dependent</u>&nbsp;risk factor for <b>breast cancer</b>&nbsp;<br> <img src=""dang (3).png"" />"
What <i>cause of vaginitis</i>&nbsp;is characterized by a <b>thin</b>, <b>white</b> <b>discharge</b> with a <b>fishy</b> <b>odor</b> and <u>no</u>&nbsp;vaginal inflammation?<div><br /></div><div><span class=cloze>[...]</span></div>"What <i>cause of vaginitis</i>&nbsp;is characterized by a <b>thin</b>, <b>white</b> <b>discharge</b> with a <b>fishy</b> <b>odor</b> and <u>no</u>&nbsp;vaginal inflammation?<div><br /></div><div><span class=cloze>Bacterial vaginosis (<i>Gardnerella vaginalis</i>&nbsp;infection)</span></div><br> <div><i>think thin and white, not inflamed (i.e., no itching, erythema)</i></div><div><i><br /></i></div><i><img src=""dammit.png"" /></i>"
The pathophysiology of <u>bacterial vaginosis</u> involves decreased colonization of the vagina with <span class=cloze>[...]</span>, leading to increased pH and <b>overgrowth of anaerobic bacteria</b>"The pathophysiology of <u>bacterial vaginosis</u> involves decreased colonization of the vagina with <span class=cloze><i>lactobacilli</i></span>, leading to increased pH and <b>overgrowth of anaerobic bacteria</b><br> <i>e.g. Gardnerella vaginalis</i><div><i><img src=""dammit.png"" /></i></div>"
What&nbsp;is the&nbsp;<i>recommended treatment</i>&nbsp;for&nbsp;<b>bacterial vaginosis</b>&nbsp;(<i>Gardnerella</i>&nbsp;infection)?<div><br /></div><div><span class=cloze>[...]</span></div>"What&nbsp;is the&nbsp;<i>recommended treatment</i>&nbsp;for&nbsp;<b>bacterial vaginosis</b>&nbsp;(<i>Gardnerella</i>&nbsp;infection)?<div><br /></div><div><span class=cloze>metronidazole or clindamycin</span></div><br> <img src=""dammit.png"" />"
<b>Oral contraceptives</b>&nbsp;are associated with <u>decreased</u>&nbsp;risk for <span class=cloze>[...]</span> and <span class=cloze>[...]</span> cancer"<b>Oral contraceptives</b>&nbsp;are associated with <u>decreased</u>&nbsp;risk for <span class=cloze>ovarian</span> and <span class=cloze>endometrial</span> cancer<br> <i>due to chronic suppression of <b>ovulation</b>&nbsp;(decreased LH/FSH) and suppressed <b>endometrial</b> <b>proliferation </b>(d/t progestin), respectively</i><div><i><br /></i><div><i><img src=""this is painful.png"" /></i></div></div>"
<b>Oral contraceptives</b> are associated with&nbsp;<span class=cloze>[...]</span> (blood pressure)"<b>Oral contraceptives</b> are associated with&nbsp;<span class=cloze>hypertension</span> (blood pressure)<br> <i>due to <b>increased angiotensinogen synthesis</b> by estrogen during first-pass metabolism; discontinuing use can correct the hypertension in most patients</i><div><i><br /></i><div><i><img src=""this is painful.png"" /></i></div></div>"
What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a premenopausal woman with&nbsp;<u>heavy menstrual bleeding,</u>&nbsp;<u>dys</u>menorrhea, and&nbsp;a&nbsp;<b>uniformly enlarged</b>,<b>&nbsp;boggy,</b>&nbsp;<b>tender</b>,&nbsp;<b>globular uterus</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a premenopausal woman with&nbsp;<u>heavy menstrual bleeding,</u>&nbsp;<u>dys</u>menorrhea, and&nbsp;a&nbsp;<b>uniformly enlarged</b>,<b>&nbsp;boggy,</b>&nbsp;<b>tender</b>,&nbsp;<b>globular uterus</b>?<div><br /></div><div><span class=cloze>Adenomyosis</span></div><br> <i>i.e. the presence of endometrial tissue in the uterine myometrium; typically presents in a women &gt; 40 years old with new-onset <b>dys</b>menorrheal; think boggy endometrial glands softening the myometrium and the increased surface area = increased bleeding.</i><div><i><br /></i><div><img src=""AUB.png"" /><br /><div><i><img src=""adenomyosis.png"" /></i></div></div></div>"
What is the likely <i>diagnosis</i>&nbsp;in a breastfeeding woman that presents with <b>fever</b>&nbsp;and&nbsp;<b>localized breast</b> <b>erythema</b>/<b>tenderness</b> with a palpable, <u>fluctuant</u> mass on physical exam?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a breastfeeding woman that presents with <b>fever</b>&nbsp;and&nbsp;<b>localized breast</b> <b>erythema</b>/<b>tenderness</b> with a palpable, <u>fluctuant</u> mass on physical exam?<div><br /></div><div><span class=cloze>Breast abscess</span></div><br> <i>persistent mastitis can result in a collection of pus, thus causing an abscess</i><div><i><img src=""argh!.png"" /></i></div>"
What is the likely <i>diagnosis</i>&nbsp;in a young woman that presents with a <b>soft</b>, <b>mobile</b>, <b>well-circumscribed mass</b> at the <u>base of the labia majora</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a young woman that presents with a <b>soft</b>, <b>mobile</b>, <b>well-circumscribed mass</b> at the <u>base of the labia majora</u>?<div><br /></div><div><span class=cloze>Bartholin duct cysts</span></div><br> <div><i>common in women age <u>&lt;</u>&nbsp;30; at the <b>4 and 8 o'clock </b>positions.</i></div><div><i><br /></i></div><img src=""paste-919123001646.jpg"" />"
What is the <i>recommended treatment</i> for an <u>asymptomatic</u>&nbsp;<b>Bartholin duct cyst</b>?<div><br /></div><div><span class=cloze>[...]</span></div>What is the <i>recommended treatment</i> for an <u>asymptomatic</u>&nbsp;<b>Bartholin duct cyst</b>?<div><br /></div><div><span class=cloze>Observation</span></div><br> <i>spontaneous drainage and resolution may occur; <u>symptomatic</u>&nbsp;cysts require <b>incision &amp; drainage</b>, followed by placement of a Word catheter</i><div><i><br /></i></div>
What is the likely <i>diagnosis</i>&nbsp;in a 6-month postpartum woman that presents with <b>irregular</b> <b>vaginal</b> <b>bleeding</b>, an&nbsp;<b>enlarged</b> <b>uterus</b>, and <b>dyspnea</b> with <u>multiple infiltrates</u> on CXR?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a 6-month postpartum woman that presents with <b>irregular</b> <b>vaginal</b> <b>bleeding</b>, an&nbsp;<b>enlarged</b> <b>uterus</b>, and <b>dyspnea</b> with <u>multiple infiltrates</u> on CXR?<div><br /></div><div><span class=cloze>Choriocarcinoma</span></div><br> <i>classically occurs after a complete hydatidiform mole, but can occur after <u>normal</u>&nbsp;pregnancy or spontaneous abortion</i><div><i><img src=""chorio.png"" /></i></div>"
<b>Choriocarcinoma</b>&nbsp;is a tumor with&nbsp;early, diffuse <u>hematogenous</u> spread, especially to the <span class=cloze>[...]</span>"<b>Choriocarcinoma</b>&nbsp;is a tumor with&nbsp;early, diffuse <u>hematogenous</u> spread, especially to the <span class=cloze>lungs</span><br> <div><i>presents as hemoptysis, shortness of breath, and/or chest pain; other common sites of metastasis include the <b>vagina</b>&nbsp;and <b>brain; diagnose with hCG.</b></i></div><img src=""chorio.png"" />"
<div>What <i>serum marker</i> is characteristically <u>elevated</u> in&nbsp;<b>choriocarcinoma</b>?</div><div><br /></div><div><span class=cloze>[...]</span>&nbsp;</div>"<div>What <i>serum marker</i> is characteristically <u>elevated</u> in&nbsp;<b>choriocarcinoma</b>?</div><div><br /></div><div><span class=cloze>beta-hCG</span>&nbsp;</div><br> <img src=""chorio.png"" />"
What is the likely <i>diagnosis</i>&nbsp;in a young, sexually active woman that presents with <b>fever</b>, <b>sore</b> <b>throat</b>, and <b>lower abdominal pain</b>? Physical exam reveals erythematous tonsils <u>without</u> exudates and <u>non-tender</u> cervical lymphadenopathy.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>What is the likely <i>diagnosis</i>&nbsp;in a young, sexually active woman that presents with <b>fever</b>, <b>sore</b> <b>throat</b>, and <b>lower abdominal pain</b>? Physical exam reveals erythematous tonsils <u>without</u> exudates and <u>non-tender</u> cervical lymphadenopathy.&nbsp;<div><br /></div><div><span class=cloze>Gonococcal pharyngitis with pelvic inflammatory disease</span></div><br> <i>- oral sex → pharyngitis!&nbsp;</i><div><i>- versus Epstein-Barr virus, which typically causes <u>tender</u>&nbsp;cervical lymphadenopathy and <u>exudative</u>&nbsp;pharyngitis</i><div><i><br /></i></div><div><i><br /></i></div></div>
"The ""three D's"" of <u>endometriosis</u> are <b>dysmenorrhea</b>,&nbsp;<span class=cloze>[...]</span>, and <b>dyschezia</b>""The ""three D's"" of <u>endometriosis</u> are <b>dysmenorrhea</b>,&nbsp;<span class=cloze><b>deep</b> <b>dyspareunia</b></span>, and <b>dyschezia</b><br> <i>other possible symptoms include <b>chronic</b>&nbsp;<b>pelvic</b> <b>pain</b> and <b>infertility</b>&nbsp;(resection of endometriosis improves conception rates)</i><div><i><img src=""endometriosis.png"" /></i></div><div><i><img src=""endo_1358629116483.png"" /></i></div>"
"The ""three D's"" of <u>endometriosis</u> are <b>dysmenorrhea</b>,&nbsp;<b>deep</b> <b>dyspareunia</b>, and <b><span class=cloze>[...]</span></b>""The ""three D's"" of <u>endometriosis</u> are <b>dysmenorrhea</b>,&nbsp;<b>deep</b> <b>dyspareunia</b>, and <b><span class=cloze>dyschezia</span></b><br> <i>other possible symptoms include <b>chronic</b>&nbsp;<b>pelvic</b> <b>pain</b> and <b>infertility</b>&nbsp;(resection of endometriosis improves conception rates)</i><div><i><img src=""endometriosis.png"" /></i></div><div><i><img src=""endo_1358629116483.png"" /></i></div>"
Empiric treatment for <b>endometriosis</b>&nbsp;consists of <span class=cloze>[...]</span> and/or <span class=cloze>[...]</span>"Empiric treatment for <b>endometriosis</b>&nbsp;consists of <span class=cloze>NSAIDs</span> and/or <span class=cloze>OCPs</span><br> <div><i><b>- NSAIDs</b> for to reduce prostaglandins for pelvic pain and <b>OCPs </b>cause (-) feedback to&nbsp;reduce estrogen stimulation of endometrial tissue.&nbsp;</i></div><div><i>- laparoscopy is reserved for <b>treatment failure</b>, <b>adnexal mass</b>, or <b>infertility</b></i></div><div><i><b><br /></b></i></div><img src=""a rarity.png"" />"
What is the likely <i>diagnosis</i>&nbsp;in an adolescent girl with <b>delayed</b> <b>puberty</b>, <b>clitoromegaly</b>, and <b>osteoporosis</b>? Laboratory exam reveals <u>undetectable estrogen</u> and <u>elevated testosterone</u> levels.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in an adolescent girl with <b>delayed</b> <b>puberty</b>, <b>clitoromegaly</b>, and <b>osteoporosis</b>? Laboratory exam reveals <u>undetectable estrogen</u> and <u>elevated testosterone</u> levels.&nbsp;<div><br /></div><div><span class=cloze>Aromatase deficiency</span></div><br> <div><i>cannot convert T → E (aroma of a woman); normal internal genitalia with ambiguous external due to ↑ androgens.&nbsp;</i></div><div><i><br /></i></div><div><img src=""fycj.png"" /></div>"
<b>Aromatase deficiency</b>&nbsp;is associated with&nbsp;<u><span class=cloze>[...]</span> ovaries</u> on ultrasound due to high concentrations of gonadotropins&nbsp;"<b>Aromatase deficiency</b>&nbsp;is associated with&nbsp;<u><span class=cloze>polycystic</span> ovaries</u> on ultrasound due to high concentrations of gonadotropins&nbsp;<br> <img src=""fycj.png"" />"
What is the likely <i>diagnosis</i>&nbsp;in a women <u>age &lt; 30</u> with a <b>well-circumscribed</b>, <b>firm</b>, <b>mobile breast mass</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a women <u>age &lt; 30</u> with a <b>well-circumscribed</b>, <b>firm</b>, <b>mobile breast mass</b>?<div><br /></div><div><span class=cloze>Fibroadenoma (benign)</span></div><br> <div><i>fibroadenoma is firm and most common before age 30, versus a <u>breast cyst</u>, which is soft and most common after age 30</i></div><div><i><br /></i></div><img src=""gg.png"" />"
What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a women&nbsp;<u>age &gt; 30</u>&nbsp;with a&nbsp;<b>well-circumscribed</b>,&nbsp;<b>soft</b>,&nbsp;<b>mobile breast mass</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a women&nbsp;<u>age &gt; 30</u>&nbsp;with a&nbsp;<b>well-circumscribed</b>,&nbsp;<b>soft</b>,&nbsp;<b>mobile breast mass</b>?<div><br /></div><div><span class=cloze>Breast cyst (benign)</span></div><br> <div><i>breast cysts are soft and most common after age 30, versus a&nbsp;<u>fibroadenoma</u>, which is hard and most common before age 30</i></div><img src=""gg.png"" />"
The&nbsp;<u>size/</u><u>tenderness</u>&nbsp;of&nbsp;<b>fibroadenomas</b>&nbsp;and <b>breast cysts</b>&nbsp;<i>increase</i> with exposure to&nbsp;<b><span class=cloze>[...]</span></b>"The&nbsp;<u>size/</u><u>tenderness</u>&nbsp;of&nbsp;<b>fibroadenomas</b>&nbsp;and <b>breast cysts</b>&nbsp;<i>increase</i> with exposure to&nbsp;<b><span class=cloze>estrogen</span></b><br> <div><i>e.g. with pregnancy, prior to menstruation</i></div><img src=""gg.png"" />"
What is the <i>initial test/imaging study</i>&nbsp;for a <u>women age &lt; 30</u> with a <u>persistent</u>&nbsp;<b>palpable</b> <b>breast</b> <b>mass</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>initial test/imaging study</i>&nbsp;for a <u>women age &lt; 30</u> with a <u>persistent</u>&nbsp;<b>palpable</b> <b>breast</b> <b>mass</b>?<div><br /></div><div><span class=cloze>Ultrasound</span></div><br> <i>reassurance first, then do U/S to help differentiate a cystic lesion versus a solid lesion; mammogram is not as useful due to increased breast tissue density in younger women</i><div><i><br /></i><div><i></i><i><img src=""paste-9285719294638.jpg"" /></i><br /><div><i><img src=""okaay...png"" /></i></div></div></div>"
What is the gold standard <i>diagnostic test</i>&nbsp;for <b>acute cervicitis</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the gold standard <i>diagnostic test</i>&nbsp;for <b>acute cervicitis</b>?<div><br /></div><div><span class=cloze>Nucleic acid amplification testing (NAAT)</span></div><br> <i>has a high sensitivity/specificity for <b>Chlamydia</b> trachomatis and Neisseria <b>gonorrhoeae</b>, which are the most common causes of acute cervicitis; microscopy is <u>not</u>&nbsp;used as you can't see Chlamydia and seeing gram (-) diplococci is low yield.</i><div><i><br /></i><div><i><img src=""cervicitis.png"" /></i></div></div>"
What is the likely <i>diagnosis</i>&nbsp;in a woman with a history of a <u>dermoid cyst</u>&nbsp;that presents with <u>colicky&nbsp;</u><b>LLQ</b> <b>pain</b>, <b>nausea</b>, and <b>voluntary</b> <b>guarding</b>? Pregnancy test is negative.<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a woman with a history of a <u>dermoid cyst</u>&nbsp;that presents with <u>colicky&nbsp;</u><b>LLQ</b> <b>pain</b>, <b>nausea</b>, and <b>voluntary</b> <b>guarding</b>? Pregnancy test is negative.<div><br /></div><div><span class=cloze>Ovarian torsion</span></div><br> <i>pain due to <u>ischemia</u>/<u>necrosis</u> of the affected ovary; ovarian torsion is more common in patients with a <b>pelvic mass&nbsp;</b></i><div><i><br /></i><div><i><img src=""OT.png"" /><br /></i><div><i><img src=""wow (4).png"" /></i></div></div></div>"
What is the <i>recommended treatment</i>&nbsp;for a patient with <b>ovarian torsion</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended treatment</i>&nbsp;for a patient with <b>ovarian torsion</b>?<div><br /></div><div><span class=cloze>Urgent surgical detorsion and ovarian cystectomy</span></div><br> <div>ovarian cystectomy is a surgery to remove a cyst/tumor from ovary.</div><div><br /></div><div><img src=""paste-911267506159617.jpg"" /></div><div><br /></div><img src=""gonna be a rough one.png"" />"
What is the <i>definitive treatment</i>&nbsp;for pregnant patients with <b>HELLP syndrome</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>definitive treatment</i>&nbsp;for pregnant patients with <b>HELLP syndrome</b>?<div><br /></div><div><span class=cloze>Delivery</span></div><br> <i>delivery should occur at<b> <u>&gt;</u>&nbsp;34 weeks gestation</b> or with&nbsp;<b>deteriorating</b> <b>maternal</b>/<b>fetal status</b>;&nbsp;</i><i>antihypertensive medications&nbsp;and/or&nbsp;magnesium&nbsp;may be needed for&nbsp;stabilization</i><div><i><br /></i><div><i><img src=""hellp.png"" /></i></div></div>"
What is the likely <i>diagnosis</i>&nbsp;in a postmenopausal woman that presents with <b>breast</b> <b>tenderness</b> and <b>vaginal</b> <b>bleeding</b> with a <u>large adnexal mass</u> on ultrasound?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a postmenopausal woman that presents with <b>breast</b> <b>tenderness</b> and <b>vaginal</b> <b>bleeding</b> with a <u>large adnexal mass</u> on ultrasound?&nbsp;<div><br /></div><div><span class=cloze>Granulosa cell tumor</span></div><br> <i>symptoms are due to <b>estrogen secretion</b>; may cause prococious puberty in <u>children</u>&nbsp;</i><div><i><br /></i><div><i><img src=""didnt see that comin.png"" /></i></div></div>"
What <u>ovarian tumor</u>&nbsp;is associated with <b>estrogen secretion</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What <u>ovarian tumor</u>&nbsp;is associated with <b>estrogen secretion</b>?<div><br /></div><div><span class=cloze>Granulosa cell tumor</span></div><br> <img src=""didnt see that comin.png"" />"
What is the <i>next step</i>&nbsp;in management for a postmenopausal woman with a suspected <u>granulosa cell tumor</u> that presents with&nbsp;<b>vaginal</b> <b>bleeding</b> and a <b>thickened</b> <b>endometrial</b> <b>stripe</b> on ultrasound?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step</i>&nbsp;in management for a postmenopausal woman with a suspected <u>granulosa cell tumor</u> that presents with&nbsp;<b>vaginal</b> <b>bleeding</b> and a <b>thickened</b> <b>endometrial</b> <b>stripe</b> on ultrasound?&nbsp;<div><br /></div><div><span class=cloze>Endometrial biopsy</span></div><br> <i>granulosa tumor → ↑ estrogen → endometrial hyperplasia; postmenopausal bleeding and thickened endometrium are concerning for <b>endometrial</b> <b>hyperplasia</b>/<b>cancer</b>; must be evaluated with endometrial biopsy, which is the gold standard test to rule out endometrial malignancy; thicekened stripe is <b>&gt; 4 mm</b></i><div><i><br /></i><div><i><img src=""didnt see that comin.png"" /></i></div></div>"
What is the preferred <i>method of contraception</i>&nbsp;for patients with <b>breast cancer</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the preferred <i>method of contraception</i>&nbsp;for patients with <b>breast cancer</b>?<div><br /></div><div><span class=cloze>Copper IUD</span></div><br> <i><b>all hormone-containing contraceptives</b>&nbsp;are&nbsp;<u>contraindicated</u>&nbsp;in patients with breast cancer (both estrogen and progesterone may have a <u>proliferative</u> effect on breast tissue)</i><div><i><br /></i><div><i><img src=""womp (4).png"" /><img src=""paste-3053893546147841.jpg"" /></i></div></div>"
What is the likely <i>diagnosis</i>&nbsp;in a postmenopausal woman that presents with <b>vaginal</b> <b>pruritus</b>/<b>dryness</b>, <b>dysuria/dyspareunia</b><b>,</b> and <b>increased</b> <b>urinary</b> <b>frequency and urgency</b>? Urinalysis is <u>normal</u>.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a postmenopausal woman that presents with <b>vaginal</b> <b>pruritus</b>/<b>dryness</b>, <b>dysuria/dyspareunia</b><b>,</b> and <b>increased</b> <b>urinary</b> <b>frequency and urgency</b>? Urinalysis is <u>normal</u>.&nbsp;<div><br /></div><div><span class=cloze>Atrophic vaginitis (genitourinary syndrome of menopause)</span></div><br> <i>due to <u>reduced estrogen support</u> after menopause causing <b>loss of epithelial elasticity</b>; in the urethra/trigone, this loss of support → urge incontinence; can also see <b>petechiae/fissures/bleeding </b>due to thin tissue; <b>dyspareunia</b> due to narrowed vagina and dryness from less lubrication.</i><div><i><br /></i><div><i><img src=""howd everyone know.png"" /></i></div></div><div><i><br /></i></div>"
What is the <i>recommended treatment</i>&nbsp;for non-pregnant women age &gt; 25 with <b>grade 3</b> cervical intraepithelial neoplasia (CIN)?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended treatment</i>&nbsp;for non-pregnant women age &gt; 25 with <b>grade 3</b> cervical intraepithelial neoplasia (CIN)?<div><br /></div><div><span class=cloze>Ablate&nbsp;(conization, LEEP)</span></div><br> <i><b>cold</b> <b>knife</b> <b>conization</b> or loop electrosurgical excision procedure (<b>LEEP</b>)</i><div><i><br /></i><div><i><img src=""CIN3.png"" /><br /></i><div><i><img src=""cone bx (1).png"" /></i></div><div><i><img src=""leeep.png"" /></i></div></div></div>"
Just prior to&nbsp;<u>ovulation</u>, cervical mucus&nbsp;<i>increases</i>&nbsp;in quantity and becomes <b>more</b>&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;and penetrable by sperm"Just prior to&nbsp;<u>ovulation</u>, cervical mucus&nbsp;<i>increases</i>&nbsp;in quantity and becomes <b>more</b>&nbsp;<b><span class=cloze>watery</span></b>&nbsp;and penetrable by sperm<br> <i>this change corresponds with the </i><b style=""font-style: italic; "">LH surge; </b><span style=""font-style: italic"">facilitates sperm transport.</span><div><img src=""ovulation.png"" /></div>"
Just prior to&nbsp;<u><span class=cloze>[...]</span></u>, cervical mucus&nbsp;<i>increases</i>&nbsp;in quantity and becomes <b>more</b>&nbsp;<b>watery</b>&nbsp;and penetrable by sperm"Just prior to&nbsp;<u><span class=cloze>ovulation</span></u>, cervical mucus&nbsp;<i>increases</i>&nbsp;in quantity and becomes <b>more</b>&nbsp;<b>watery</b>&nbsp;and penetrable by sperm<br> <i>this change corresponds with the </i><b style=""font-style: italic; "">LH surge; </b><span style=""font-style: italic"">facilitates sperm transport.</span><div><img src=""ovulation.png"" /></div>"
During the&nbsp;<u>luteal phase</u>&nbsp;of menstruation, cervical mucus&nbsp;becomes more&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;and less penetrable by sperm&nbsp;"During the&nbsp;<u>luteal phase</u>&nbsp;of menstruation, cervical mucus&nbsp;becomes more&nbsp;<b><span class=cloze>thick</b>&nbsp;(less watery)<b></span></b>&nbsp;and less penetrable by sperm&nbsp;<br> <img src=""ovulation.png"" />"
Pap testing may be <i>discontinued</i> in patients <b>age <u>&gt;</u>&nbsp;65</b> with <u>no history of CIN 2 or higher</u> and <span class=cloze>[...]</span> consective negative Pap tests or <span class=cloze>[...]</span> consecutive negative co-testing results&nbsp;"Pap testing may be <i>discontinued</i> in patients <b>age <u>&gt;</u>&nbsp;65</b> with <u>no history of CIN 2 or higher</u> and <span class=cloze>3</span> consective negative Pap tests or <span class=cloze>2</span> consecutive negative co-testing results&nbsp;<br> <i>patients with <b>cervical cancer risk factors</b> (e.g. immunosuppression, tobacco use, DES exposure, high-risk sexual activity) may need continued Pap testing</i><div><i><br /></i><div><i><img src=""no more paps.png"" /></i></div></div>"
Pap testing may be <i>discontinued</i> in patients <b>age <u>&gt;</u>&nbsp;<span class=cloze>[...]</span></b> with <u>no history of CIN 2 or higher</u> and 3 consective negative Pap tests or 2 consecutive negative co-testing results&nbsp;"Pap testing may be <i>discontinued</i> in patients <b>age <u>&gt;</u>&nbsp;<span class=cloze>65</span></b> with <u>no history of CIN 2 or higher</u> and 3 consective negative Pap tests or 2 consecutive negative co-testing results&nbsp;<br> <i>patients with <b>cervical cancer risk factors</b> (e.g. immunosuppression, tobacco use, DES exposure, high-risk sexual activity) may need continued Pap testing</i><div><i><br /></i><div><i><img src=""no more paps.png"" /></i></div></div>"
What is the <i>recommended management</i>&nbsp;for an adolescent that presents with <u>fever</u> and <u>leukocytosis</u> secondary to <b>pelvic</b> <b>inflammatory</b> <b>disease</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended management</i>&nbsp;for an adolescent that presents with <u>fever</u> and <u>leukocytosis</u> secondary to <b>pelvic</b> <b>inflammatory</b> <b>disease</b>?<div><br /></div><div><span class=cloze><u>Inpatient</u> broad-spectrum antibiotic therapy</span></div><br> <i>hospitalization is recommended for those with <b>severe</b> presentation (e.g. fever, leukocytosis) and those with a higher risk of noncompliance (e.g. adolescents)</i><div><i><br /></i><div><i><img src=""lock em up.png"" /></i></div></div>"
"What is the <i>next step</i>&nbsp;in diagnosis for a middle-aged woman that presents with ""<b>night</b> <b>sweats</b>"", <b>insomnia</b>, and <b>irregular</b> <b>menses</b>? Pregnancy test is negative.<div><br></div><div><span class=cloze>[...]</span></div>""What is the <i>next step</i>&nbsp;in diagnosis for a middle-aged woman that presents with ""<b>night</b> <b>sweats</b>"", <b>insomnia</b>, and <b>irregular</b> <b>menses</b>? Pregnancy test is negative.<div><br></div><div><span class=cloze>Measure serum TSH and FSH</span></div><br> <i>these symptoms could be due to menopause or <b>hyperthyroidism</b>, thus both should be evaluated</i><div><i><br /></i><div><i><img src=""menopaws.png"" /></i></div></div>"
<b>Menopause</b>&nbsp;<i>before</i>&nbsp;age&nbsp;<b>40</b>&nbsp;suggests <span class=cloze>[...]</span> insufficiency"<b>Menopause</b>&nbsp;<i>before</i>&nbsp;age&nbsp;<b>40</b>&nbsp;suggests <span class=cloze>primary ovarian</span> insufficiency<br> <i>also known as&nbsp;premature ovarian failure&nbsp;or <u>hyper</u>gonadotropic hypogonadism 2/2 ↓ ovarian follicles; more common in women who&nbsp;<b>smoke</b>&nbsp;or those receiving&nbsp;<b><u><font color=""#ff0000"">chemotherapy</font></u></b>/<b>radiation</b>&nbsp;</i><div><i><br /></i><div><i><img src=""paste-1367689385738243.jpg"" /><br /></i><div><i><img src=""premature ovarian.png"" /></i></div></div></div>"
<b>Premature ovarian failure</b> is characterized by <span class=cloze>[...]</span> <b>FSH</b> and&nbsp;<b>LH</b> levels&nbsp;"<b>Premature ovarian failure</b> is characterized by <span class=cloze><u>increased</u></span> <b>FSH</b> and&nbsp;<b>LH</b> levels&nbsp;<br> <i>due to <u>lack</u>&nbsp;of feedback inhibition from estrogen</i><div><i><img src=""premature ovarian.png"" /></i></div>"
<b>Condylomata acuminata</b>&nbsp;(genital warts) is associated with HPV strains&nbsp;<span class=cloze>[...]</span> and&nbsp;<span class=cloze>[...]</span>"<b>Condylomata acuminata</b>&nbsp;(genital warts) is associated with HPV strains&nbsp;<span class=cloze>6</span> and&nbsp;<span class=cloze>11</span><br> <img src=""whoop (3).png"" /><img src=""Screen Shot 2017-03-01 at 6.07.01 PM.jpg"" />"
Treatment of <i>small</i> <b>genital</b> <b>warts</b> includes <u>topical medications</u>, such as <b>t</b>ri<b>c</b>hloroacetic <b>a</b>cid or <span class=cloze>[...]</span>"Treatment of <i>small</i> <b>genital</b> <b>warts</b> includes <u>topical medications</u>, such as <b>t</b>ri<b>c</b>hloroacetic <b>a</b>cid or <span class=cloze>podophyllin resin</span><br> <i>- larger lesions may require <b>surgical removal</b>; imiquimod and podophyillin resin are&nbsp;<b><u>contraindicated</u></b> during pregnancy&nbsp;</i><div><i>- imagine cauliflower warts inside the TCA cycle.</i></div><div><i><br /></i><div><i><img src=""whoop (3).png"" /></i></div></div>"
What is the <i>next step</i>&nbsp;in management for a 14-year-old girl that presents with <b>lack of menses</b>? Breast and pubic hair are <u>tanner stage 3</u>.<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step</i>&nbsp;in management for a 14-year-old girl that presents with <b>lack of menses</b>? Breast and pubic hair are <u>tanner stage 3</u>.<div><br /></div><div><span class=cloze>Reassurance and re-evaluation</span></div><br> <i>primary amenorrhea is not diagnosed until <b>age <u>&gt;</u>&nbsp;15</b> with normal secondary sex characteristics (age <u>&gt;</u>&nbsp;13 without); menarche is typically preceded by a<b> growth spurt. &nbsp;</b></i><div><i><br /></i><div><i><img src=""puberty girls.png"" /></i></div></div>"
The <b>HPV vaccine</b>&nbsp;is typically administered beginning at age 11 - 12 and can be received until <b>age&nbsp;<span class=cloze>[...]</span></b>"The <b>HPV vaccine</b>&nbsp;is typically administered beginning at age 11 - 12 and can be received until <b>age&nbsp;<span class=cloze>26</span></b><br> <i>recommended for <u>all</u>&nbsp;girls and women age 11-26, regardless of HPV status; boys &amp; men can receive the vaccine between ages 9 - 21 (up to 26 for HIV+ patients)&nbsp;</i><div><i><br /></i><div><i><img src=""hpv reccs.png"" /></i></div></div>"
Which<i> genital infection</i> is characterized by <b>tender</b>, <b>small</b> <b>ulcers</b> with an erythematous base and <u>mild</u> <b>lymphadenopathy</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"Which<i> genital infection</i> is characterized by <b>tender</b>, <b>small</b> <b>ulcers</b> with an erythematous base and <u>mild</u> <b>lymphadenopathy</b>?&nbsp;<div><br /></div><div><span class=cloze>Herpes simplex virus</span></div><br> <div><i>may also have <b>painful</b> <b>urination</b> (pee flows over raw area) and <b>sterile</b> <b>pyruria</b> (WBCs due to inflammation with negative urine culture)</i></div><div><i><br /></i></div><img src=""way better chart dafuq.png"" />"
"Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b><u>painful</u></b>,&nbsp;<b>deep</b>&nbsp;<b>ulcers</b>&nbsp;with a <u>gray/yellow</u>&nbsp;exudate and&nbsp;<u>severe</u>&nbsp;<b>lymphadenopathy with pus</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""paste-2775356327067649.jpg"" /></div>""Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b><u>painful</u></b>,&nbsp;<b>deep</b>&nbsp;<b>ulcers</b>&nbsp;with a <u>gray/yellow</u>&nbsp;exudate and&nbsp;<u>severe</u>&nbsp;<b>lymphadenopathy with pus</b>?&nbsp;<div><br /></div><div><span class=cloze><i>Haemophilus ducreyi</i>&nbsp;(chancroid)</span></div><div><br /></div><div><img src=""paste-2775356327067649.jpg"" /></div><br> <div><i>Crying gray and yellow tears</i></div><div><i>So painful you do cry</i></div><i><img src=""way better chart dafuq.png"" /><img src=""paste-2762982526287873.jpg"" /></i>"
Which<i>&nbsp;genital infection</i>&nbsp;is characterized by a&nbsp;<b>single painless ulcer</b>&nbsp;(chancre) often with <u>painless</u>&nbsp;bilateral lymphadenopathy?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"Which<i>&nbsp;genital infection</i>&nbsp;is characterized by a&nbsp;<b>single painless ulcer</b>&nbsp;(chancre) often with <u>painless</u>&nbsp;bilateral lymphadenopathy?&nbsp;<div><br /></div><div><span class=cloze><i>Treponema pallidum</i>&nbsp;(primary syphilis)</span></div><br> <div><i>single papule turns into painless, nonexudative ulcer (syphilis is all painless - nodes and lesion)</i></div><div><img src=""way better chart dafuq.png"" /></div>"
Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b>small</b>,&nbsp;<b>painless</b>&nbsp;<b>ulcers</b>&nbsp;that can progress to <u>painful&nbsp;inguinal lymphadenopathy</u> (buboes)?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b>small</b>,&nbsp;<b>painless</b>&nbsp;<b>ulcers</b>&nbsp;that can progress to <u>painful&nbsp;inguinal lymphadenopathy</u> (buboes)?&nbsp;<div><br /></div><div><span class=cloze><i>Chlamydia trachomatis</i>&nbsp;L1-L3 (lymphogranuloma venereum)</span></div><br> <img src=""hmmmmm (1).png"" />"
"What is the <i>preferred test</i>&nbsp;to diagnose <i style=""font-weight: bold; "">Haemophilus ducreyi</i>&nbsp;infection (chancroid)?<div><br /></div><div><span class=cloze>[...]</span></div>""What is the <i>preferred test</i>&nbsp;to diagnose <i style=""font-weight: bold; "">Haemophilus ducreyi</i>&nbsp;infection (chancroid)?<div><br /></div><div><span class=cloze>Bacterial culture</span></div><br> <img src=""hmmmmm (1).png"" />"
"What is the likely <i>diagnosis</i>&nbsp;in an <u>afebrile</u> middle-aged woman that presents with <b>unilateral</b> <b>breast</b> <b>warmth</b>, <b>erythema</b>, and <b>swelling</b> refractory to antibiotics?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""paste-18245021073409_1358629116483.jpg"" /></div>""What is the likely <i>diagnosis</i>&nbsp;in an <u>afebrile</u> middle-aged woman that presents with <b>unilateral</b> <b>breast</b> <b>warmth</b>, <b>erythema</b>, and <b>swelling</b> refractory to antibiotics?&nbsp;<div><br /></div><div><span class=cloze>Inflammatory breast carcinoma</span></div><div><br /></div><div><img src=""paste-18245021073409_1358629116483.jpg"" /></div><br> <i><u>lack</u> of fever and <u>no response</u> to antibiotics help distinguish inflammatory breast cancer from mastitis; other distinguishing features include <b>axillary</b> <b>lymphadenopathy</b> and a <b>peau</b> <b>d'orange appearance</b>&nbsp;</i><div><i><br /></i><div><i><img src=""inflammatory breast cancer.png"" /></i></div></div>"
<div>The&nbsp;<i>gross appearance</i>&nbsp;of&nbsp;<b>inflammatory breast cancer</b>&nbsp;is often described as resembling an <span class=cloze>[...]</span></div>"<div>The&nbsp;<i>gross appearance</i>&nbsp;of&nbsp;<b>inflammatory breast cancer</b>&nbsp;is often described as resembling an <span class=cloze>orange peel (Peau d'orange)</span></div><br> <i>- i.e., dimpling, pitting, edematous, <font color=""#ff0000"">erythematous</font>, painful.</i><div><i>- due to&nbsp;</i><u style=""font-style: italic; "">invasion of lymphatic spaces</u><div>&nbsp;<div><img src=""inflammatory breast cancer.png"" /></div></div></div>"
What is the likely <i>diagnosis</i>&nbsp;in a patient that presents with <u>pelvic pressure</u> and <u>voiding dysfunction</u> one year after a hysterectomy? Pelvic examination reveals a <b>protruding</b> <b>vaginal</b> <b>mass</b>, especially with the Valsalva maneuver. &nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a patient that presents with <u>pelvic pressure</u> and <u>voiding dysfunction</u> one year after a hysterectomy? Pelvic examination reveals a <b>protruding</b> <b>vaginal</b> <b>mass</b>, especially with the Valsalva maneuver. &nbsp;<div><br /></div><div><span class=cloze>Pelvic organ prolapse</span></div><br> <i>due to herniation of pelvic organs (e.g. bladder, uterus, rectum) through the vagina; risk factors include obesity, multiparity, and hysterectomy</i><div><i><img src=""POP.png"" /></i></div><div><i><img src=""weird.png"" /></i></div>"
What is the&nbsp;<i>initial test/imaging study</i>&nbsp;for a&nbsp;<u>women age &gt; 30</u>&nbsp;with a&nbsp;<b>palpable</b>&nbsp;<b>breast</b>&nbsp;<b>mass</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the&nbsp;<i>initial test/imaging study</i>&nbsp;for a&nbsp;<u>women age &gt; 30</u>&nbsp;with a&nbsp;<b>palpable</b>&nbsp;<b>breast</b>&nbsp;<b>mass</b>?<div><br /></div><div><span class=cloze>Mammogram</span></div><br> <i>ultrasound may be added for better characterization of the mass; tissue biopsy is needed to <u>confirm</u>&nbsp;the diagnosis</i><div><i><img src=""okaay...png"" /></i></div>"
What is the likely <i>diagnosis</i>&nbsp;in an adolescent girl that presents with <b>amenorrhea</b> and <b>cyclic</b> <b>lower</b> <b>abdominal</b> <b>pain</b> with a <u>bulging vaginal mass</u> on physical exam?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in an adolescent girl that presents with <b>amenorrhea</b> and <b>cyclic</b> <b>lower</b> <b>abdominal</b> <b>pain</b> with a <u>bulging vaginal mass</u> on physical exam?<div><br /></div><div><span class=cloze>Imperforate hymen</span></div><br> <div><i>the bulging vaginal mass is a&nbsp;<b>hematocolpos; </b>can compress nearby organs causing back pain, pelvic pressure, defecatory pain;&nbsp;treat with surgery.</i></div><div><i><br /></i></div><img src=""im dumb (1).png"" />"
What is the <i>recommended treatment</i>&nbsp;for <b>imperforate hymen</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended treatment</i>&nbsp;for <b>imperforate hymen</b>?<div><br /></div><div><span class=cloze>Incision and drainage</span></div><br> <img src=""im dumb (1).png"" />"
Evaluation of <u>atypical glandular cells</u>&nbsp;on Pap test in women <u>&gt;</u>&nbsp;35 years old includes <b>colposcopy</b>,&nbsp;<b><u>endo</u>cervical</b> <b>curettage</b>, and&nbsp;<span class=cloze>[...]</span>"Evaluation of <u>atypical glandular cells</u>&nbsp;on Pap test in women <u>&gt;</u>&nbsp;35 years old includes <b>colposcopy</b>,&nbsp;<b><u>endo</u>cervical</b> <b>curettage</b>, and&nbsp;<span class=cloze><b>endometrial</b> <b>biopsy</b></span><br> <div>colposcopy → ectocervix</div><div>curettage → endocervix</div><div>biopsy → endometrium</div><div><br /></div><img src=""didnt see that heh.png"" />"
Indications for <u>endometrial biopsy</u>&nbsp;include <b>abnormal</b> <b>uterine</b> or <b>postmenopausal</b> <b>bleeding</b> in women age <u>&gt;</u>&nbsp;<span class=cloze>[...]</span>&nbsp;"Indications for <u>endometrial biopsy</u>&nbsp;include <b>abnormal</b> <b>uterine</b> or <b>postmenopausal</b> <b>bleeding</b> in women age <u>&gt;</u>&nbsp;<span class=cloze>45</span>&nbsp;<br> <img src=""didnt see that heh.png"" />"
Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b>extensive</b>,&nbsp;<b><u>painless</u> ulcers</b>&nbsp;<u>without</u>&nbsp;<b>lymphadenopathy</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b>extensive</b>,&nbsp;<b><u>painless</u> ulcers</b>&nbsp;<u>without</u>&nbsp;<b>lymphadenopathy</b>?&nbsp;<div><br /></div><div><span class=cloze><i>Klebsiella granulomatis</i>&nbsp;(granuloma inguinale)</span></div><br> <div><i>primarily seen in India, Guyana, and New Guinea (rare in the U.S); having fun with no pain while you're in the club.</i></div><div><i><br /></i></div><div><img src=""way better chart dafuq.png"" /></div>"
What is the <i>recommended treatment</i>&nbsp;for a patient with a <b>painless genital ulcer</b> and&nbsp;bilateral&nbsp;inguinal&nbsp;lymphadenopathy? Serum RPR is <u>negative</u>.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended treatment</i>&nbsp;for a patient with a <b>painless genital ulcer</b> and&nbsp;bilateral&nbsp;inguinal&nbsp;lymphadenopathy? Serum RPR is <u>negative</u>.&nbsp;<div><br /></div><div><span class=cloze>Empiric penicillin treatment</span></div><br> <i>patients with negative initial serologies and strong clinical evidence of primary syphilis should be treated empirically (non-treponemal testing has a <u>high false negative rate</u> in <u>early</u> infection)</i><div><i><br /></i><div><i><img src=""okkkk.png"" /></i></div></div>"
What is the likely<i>&nbsp;diagnosis</i>&nbsp;in a woman that experiences <b>mood</b> <b>swings</b>, <b>fatigue</b>, <b>bloating</b>, and <b>hot</b> <b>flashes</b> one week <b><u>prior to menstruation</u></b>? The symptoms <u>resolve</u> with menses.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely<i>&nbsp;diagnosis</i>&nbsp;in a woman that experiences <b>mood</b> <b>swings</b>, <b>fatigue</b>, <b>bloating</b>, and <b>hot</b> <b>flashes</b> one week <b><u>prior to menstruation</u></b>? The symptoms <u>resolve</u> with menses.&nbsp;<div><br /></div><div><span class=cloze>Premenstrual syndrome (PMS)</span></div><br> <div><i>symptoms must cause <u>impairment of function</u> (e.g. missed work); other possible symptoms include irritability and breast tenderness</i></div><div><i><br /></i></div><div><img src=""this guy fucks.png"" /></div>"
Patients with suspected <b>premenstrual</b> <b>syndrome</b>&nbsp;(PMS) should record a <span class=cloze>[...]</span> to aid in diagnosis&nbsp;"Patients with suspected <b>premenstrual</b> <b>syndrome</b>&nbsp;(PMS) should record a <span class=cloze>symptom/menstrual diary</span> to aid in diagnosis&nbsp;<br> <i>symptoms typically occur 1-2 weeks before menses (<b>luteal</b> <b>phase</b>) and resolve after menses (follicular phase); see if there's a cyclic change in the bad mood (if constant, may be 2/2 medical condition like hypothyroidism)</i><div><i><br /></i><div><i><img src=""this guy fucks.png"" /></i></div></div>"
What is the <i>first-line treatment</i>&nbsp;for <b>premenstrual syndrome</b>&nbsp;(PMS)?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>first-line treatment</i>&nbsp;for <b>premenstrual syndrome</b>&nbsp;(PMS)?<div><br /></div><div><span class=cloze>SSRIs</span></div><br> <i><div></div></i><i><b>OCPs </b>also help -&nbsp;suppressing ovulation reduces symptoms of PMS; <b>milder</b> symptoms may be treated with lifestyle changes/NSAIDs. &nbsp;</i><div><br /></div><div><img src=""this guy fucks.png"" /></div>"
What is the <i>gold standard test</i>&nbsp;for <b>male factor infertility</b>?<div><br /></div><div><span class=cloze>[...]</span></div>What is the <i>gold standard test</i>&nbsp;for <b>male factor infertility</b>?<div><br /></div><div><span class=cloze>Semen analysis</span></div><br> <i>evaluates sperm concentration, motility, and morphology; male infertility occurs in as many as 25% of cases</i>
What is the <i>first-line</i><i>&nbsp;test/imaging study</i>&nbsp;to evaluate <u>infertility</u> in a patient with a history of&nbsp;<b>pelvic inflammatory disease</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>first-line</i><i>&nbsp;test/imaging study</i>&nbsp;to evaluate <u>infertility</u> in a patient with a history of&nbsp;<b>pelvic inflammatory disease</b>?<div><br /></div><div><span class=cloze>hysterosalpingogram</span></div><br> <i>minimally invasive way to detect fallopian tube patency and/or uterine cavity anomalies</i><div><i><img src=""paste-2798987237130241.jpg"" /><br /></i><div><i><img src=""i suk.png"" /></i></div></div>"
What is the <i>recommended management</i>&nbsp;for a patient with <b>suspected</b> <b>endometriosis</b> refractory to NSAIDs and OCPs?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended management</i>&nbsp;for a patient with <b>suspected</b> <b>endometriosis</b> refractory to NSAIDs and OCPs?<div><br /></div><div><span class=cloze>Laparoscopy</span></div><br> <i>allows for direct visualization, biopsy, and removal of endometriotic lesions</i><div><i><img src=""a rarity.png"" /><br /></i><div><i><img src=""endo_1358629116483.png"" /></i></div></div>"
What is the <u>definitive treatment</u>&nbsp;for <b>endometriosis</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <u>definitive treatment</u>&nbsp;for <b>endometriosis</b>?<div><br /></div><div><span class=cloze>Hysterectomy and bilateral salpingo-oohorectomy</span></div><br> <i>typically done in symptomatic women who have completed childbearing&nbsp;</i><div><i><br /></i><div><i><img src=""endometriosis.png"" /></i></div></div>"
What is the likely <i>diagnosis</i>&nbsp;in a premenopausal woman that presents with <b>dyspareunia</b> and <b>dry vaginal</b> <b>mucosa</b>? The patient's history is significant for <u>chronic dry eyes</u>/<u>mouth</u>.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a premenopausal woman that presents with <b>dyspareunia</b> and <b>dry vaginal</b> <b>mucosa</b>? The patient's history is significant for <u>chronic dry eyes</u>/<u>mouth</u>.&nbsp;<div><br /></div><div><span class=cloze>Sjogren syndrome</span></div><br> <i>""dry everywhere"" - extraglandular features include arthritis, Raynaud phenomenon, cutaneous vasculitis, and non-Hodgkin lymphoma</i><div><i><br /></i><div><i><img src=""im off today.png"" /></i></div></div>"
The gold standard for<i> diagnosis</i> of <b>ovarian torsion</b> is <u>ultrasound</u>, which typically reveals an <b>ovarian</b> <b>mass</b> with <b>absent <span class=cloze>[...]</span></b>"The gold standard for<i> diagnosis</i> of <b>ovarian torsion</b> is <u>ultrasound</u>, which typically reveals an <b>ovarian</b> <b>mass</b> with <b>absent <span class=cloze>Doppler flow</span></b><br> <img src=""OT.png"" /><div><img src=""wow (4).png"" /></div>"
How does <u>bone density</u> change in patients with <b>hypothalamic</b> <b>amenorrhea</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"How does <u>bone density</u> change in patients with <b>hypothalamic</b> <b>amenorrhea</b>?<div><br /></div><div><span class=cloze>Decreased (e.g. osteopenia)</span></div><br> <div><i>due to <b>estrogen</b> deficiency secondary to loss of pulsatile GnRH secretion&nbsp;</i></div><img src=""zzzzz.png"" />"
The risk of <b>endometrial</b> <b>hyperplasia</b>/<b>cancer</b>&nbsp;is directly related to <u>unopposed</u>&nbsp;<span class=cloze>[...]</span> exposure"The risk of <b>endometrial</b> <b>hyperplasia</b>/<b>cancer</b>&nbsp;is directly related to <u>unopposed</u>&nbsp;<span class=cloze>estrogen</span> exposure<br> <i><br /></i><div><i><br /></i><div><i><img src=""endometrial hyperplasia.png"" /></i></div></div>"
What is the <i>next step </i>in management for an elderly woman that presents with <b>bloody</b>, <b>malodorous</b> <b>discharge</b> and an <b>irregular</b> <b>vaginal</b> <b>lesion</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step </i>in management for an elderly woman that presents with <b>bloody</b>, <b>malodorous</b> <b>discharge</b> and an <b>irregular</b> <b>vaginal</b> <b>lesion</b>?&nbsp;<div><br /></div><div><span class=cloze>Biopsy of the lesion</span></div><br> <i>this patient likely has <b>vaginal squamous cell carcinoma</b></i><div><i><br /></i><div><i><img src=""im afraid to pick anything!.png"" /></i></div></div>"
The most significant <u>risk factors</u> for <b><u>vaginal</u> squamous cell carcinoma</b> are <span class=cloze>[...]</span> and <span class=cloze>[...]</span>"The most significant <u>risk factors</u> for <b><u>vaginal</u> squamous cell carcinoma</b> are <span class=cloze>smoking</span> and <span class=cloze>HPV infection</span><br> <i>similar to the risk factors for <b>cervical cancer</b></i><div><i><img src=""im afraid to pick anything!.png"" /></i></div>"
What is the likely <i>diagnosis</i>&nbsp;in a postmenopausal woman that presents with <u>vulvar itching</u> and <b>thin</b>, <b>dry</b>, <b>white</b> <b>plaque-like vulvar skin</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a postmenopausal woman that presents with <u>vulvar itching</u> and <b>thin</b>, <b>dry</b>, <b>white</b> <b>plaque-like vulvar skin</b>?<div><br /></div><div><span class=cloze>Lichen sclerosus</span></div><br> <i>skin is classically described as ""<b>cigarette paper</b>"" quality and patient's may have retraction of normal anatomical landmarks (e.g. clitoral retraction); think about a <b>thin&nbsp;white skull.</b></i><div><i><br /></i><div><i><img src=""LS.png"" /><br /></i><div><i><img src=""lichen sclerosis.png"" /></i></div></div></div>"
What is the <i>next step </i>in management for a woman that presents with a <u>thin, white plaque</u> suspicious for <b>lichen</b> <b>sclerosus</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step </i>in management for a woman that presents with a <u>thin, white plaque</u> suspicious for <b>lichen</b> <b>sclerosus</b>?<div><br /></div><div><span class=cloze>Vulvar punch biopsy</span></div><br> <i>necessary to confirm the diagnosis and rule out vulvar squamous cell carcinoma</i><div><i><br /></i></div><div><i><img src=""paste-3708150209314817.jpg"" /><br /></i><div><i><img src=""LS.png"" /><br /></i><div><i><img src=""lichen sclerosis.png"" /></i></div></div></div>"
What is the <i>next step </i>in management for an afebrile woman that experiences relief of symptoms following <b>aspiration</b> of <u>clear fluid</u> from a <b>simple</b>&nbsp;<b>breast</b> <b>cyst</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step </i>in management for an afebrile woman that experiences relief of symptoms following <b>aspiration</b> of <u>clear fluid</u> from a <b>simple</b>&nbsp;<b>breast</b> <b>cyst</b>?&nbsp;<div><br /></div><div><span class=cloze>Repeat breast examination in 2 - 4 months</span></div><br> <i>cystic fluid can reaccumulate; if no signs of recurrence, annual screening can be resumed</i><div><img src=""okaay...png"" /></div>"
What is the <i>recommended contraceptive</i>&nbsp;for a woman with a history of <b>anemia</b> and <b>medication non-compliance</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended contraceptive</i>&nbsp;for a woman with a history of <b>anemia</b> and <b>medication non-compliance</b>?<div><br /></div><div><span class=cloze>Levonorgestrel IUD</span></div><br> <i>typically causes <b>amenorrhea</b>, which is beneficial in patients with anemia (versus the copper IUD, which can cause heavy menstrual bleeding); <u>less common</u> side effects include <b>mood</b> <b>changes</b>, <b>breast</b> <b>tenderness</b>, and <b>headache</b></i><div><b><i><br /></i></b><div><b><i><img src=""IUD.png"" /><br /></i></b><div><b><i><img src=""poop (3).png"" /></i></b></div></div></div>"
Common <i>side effects</i> of the injectable <u>medroxyprogesterone</u> contraceptive are breast tenderness, fatigue,&nbsp;<b>vaginal</b> <b>bleeding</b>/<b>spotting</b> and <b>weight</b> <b><span class=cloze>[...]</span></b>&nbsp;"Common <i>side effects</i> of the injectable <u>medroxyprogesterone</u> contraceptive are breast tenderness, fatigue,&nbsp;<b>vaginal</b> <b>bleeding</b>/<b>spotting</b> and <b>weight</b> <b><span class=cloze>gain</span></b>&nbsp;<br> <i>may be similar to pregnancy symptoms</i><div><i><br /></i></div><div><img src=""http://www.ncregister.com/images/uploads/Depo-Provera-Injection.jpg"" /><i><br /></i></div>"
What is the likely <i>diagnosis</i>&nbsp;in a patient that presents with <b>foul-smelling brown discharge</b> from the <u><b>posterior</b> vaginal wall</u> two weeks after a vaginal delivery complicated by <b>third-degree laceration?</b><div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a patient that presents with <b>foul-smelling brown discharge</b> from the <u><b>posterior</b> vaginal wall</u> two weeks after a vaginal delivery complicated by <b>third-degree laceration?</b><div><br /></div><div><span class=cloze>Rectovaginal fistula</span></div><br> <i><font color=""#ff0000"">red, velvety rectal mucosa</font> may be visualized on the posterior vaginal wall</i><div><i><br /></i></div>"
What is the best <i>long-term management</i>&nbsp;for <b>stress urinary incontinence</b>&nbsp;due to urethral hypermobility?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the best <i>long-term management</i>&nbsp;for <b>stress urinary incontinence</b>&nbsp;due to urethral hypermobility?<div><br /></div><div><span class=cloze>Urethral sling surgery</span></div><br> <div><i>A sling (e.g., synthetic mesh, autologous or xenogeneic tissue) is placed <b>under the urethra and bladder neck</b> to lift, support, and exert pressure on the urethra to aid urine retention. The end of the sling is attached to pelvic fascia or the abdominal wall.</i></div><div><br /></div><div><img src=""80584.jpg"" /><img src=""paste-1251630779465731.jpg"" /></div><img src=""good start.png"" />"
Which <i>selective estrogen receptor modulator</i>&nbsp;(SERM) is preferred for treatment of&nbsp;<b>postmenopausal osteoporosis </b>(especially those with&nbsp;<b>breast cancer </b>risk)?<div><br /></div><div><span class=cloze>[...]</span></div>"Which <i>selective estrogen receptor modulator</i>&nbsp;(SERM) is preferred for treatment of&nbsp;<b>postmenopausal osteoporosis </b>(especially those with&nbsp;<b>breast cancer </b>risk)?<div><br /></div><div><span class=cloze>Raloxifene</span></div><br> <div><i>antagonist of estrogen in <u>both</u>&nbsp;breast and endometrium therefore no associated cancer risk; however&nbsp;<strong>it will still increase DVT risk </strong>(like all SERMs)&nbsp;<br /><br /></i></div><i><img src=""SERM_1358629116483.png"" /></i>"
What is the likely <i>diagnosis</i>&nbsp;in a young woman that presents with <b>chronic</b> <b>pelvic</b> <b>pain</b>, especially with <u>exercise</u>, and a <b>homogenous</b> <b>cystic</b> <b>ovarian</b> <b>mass</b> on ultrasound?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a young woman that presents with <b>chronic</b> <b>pelvic</b> <b>pain</b>, especially with <u>exercise</u>, and a <b>homogenous</b> <b>cystic</b> <b>ovarian</b> <b>mass</b> on ultrasound?<div><br /></div><div><span class=cloze>Ovarian <b>endometrioma</b> (secondary to endometriosis)</span></div><br> <div><i>i.e., chocolate cyst in ovary; endometriomas are also associated with <u>infertility</u>, which improves with surgical resection of the endometrioma</i></div><div><i><br /></i></div><div><i><img src=""paste-372446679007233.jpg"" /></i></div><img src=""endometriosis.png"" /><div><img src=""endo_1358629116483.png"" /></div>"
What <u>ultrasound finding</u>&nbsp;is typical for an <b>ovarian endometrioma</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What <u>ultrasound finding</u>&nbsp;is typical for an <b>ovarian endometrioma</b>?<div><br /></div><div><span class=cloze>Homogenous cystic mass</span></div><br> <img src=""endo_1358629116483.png"" /><div><img src=""paste-372442384039937.jpg"" /></div>"
<b>Uterine <span class=cloze>[...]</span></b> is a form of <u>pelvic organ prolapse</u> in which the <b>entire uterus herniates</b> through the vagina along with the anterior and posterior vaginal walls"<b>Uterine <span class=cloze>procidentia</span></b> is a form of <u>pelvic organ prolapse</u> in which the <b>entire uterus herniates</b> through the vagina along with the anterior and posterior vaginal walls<br> <div><i>treat with <b>pessaries </b>or <b>surgery.&nbsp;</b></i></div><img src=""sigh.png"" />"
What is the <i>recommended treatment</i>&nbsp;for <u>symptomatic</u>&nbsp;<b>pelvic organ prolapse</b>&nbsp;refractory to lifestyle modifications?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended treatment</i>&nbsp;for <u>symptomatic</u>&nbsp;<b>pelvic organ prolapse</b>&nbsp;refractory to lifestyle modifications?<div><br /></div><div><span class=cloze>pessary or surgical management</span></div><br> <i>pessaries support the prolapsed organ; conservative, non-invasive management with pessary placement is appropriate for poor surgical candidates; note kegels only works for <u>mild</u>&nbsp;prolapse.&nbsp;</i><div><i><br /></i></div><div><i><img src=""paste-7125350744589.jpg"" /><br /></i></div><div><div><i><img src=""POPP.png"" /></i></div></div>"
"What is the likely <i>diagnosis</i>&nbsp;in a premenopausal woman that presents with <b>unilateral</b> <b><font color=""#ff0000"">bloody</font></b> <b>nipple</b> <b>discharge</b> with <u>no palpable breast mass</u> or lymphadenopathy?<div><br /></div><div><span class=cloze>[...]</span></div>""What is the likely <i>diagnosis</i>&nbsp;in a premenopausal woman that presents with <b>unilateral</b> <b><font color=""#ff0000"">bloody</font></b> <b>nipple</b> <b>discharge</b> with <u>no palpable breast mass</u> or lymphadenopathy?<div><br /></div><div><span class=cloze>Intraductal papilloma</span></div><br> <i>papillary tumor affecting a <u>single</u>&nbsp;lactiferous duct;&nbsp;most common cause of bloody nipple discharge; no mass/lymphadenopathy distinguishes from other malignant breast conditions.</i><div><i><br /></i><div><i><img src=""eee zzz.png"" /></i></div><div><i><img src=""donee.png"" /><u><img src=""paste-290034846531585.jpg"" /></u></i></div></div>"
What is the&nbsp;<i>recommended treatment</i>&nbsp;for a&nbsp;<u>symptomatic</u>&nbsp;<b>Bartholin duct cyst</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the&nbsp;<i>recommended treatment</i>&nbsp;for a&nbsp;<u>symptomatic</u>&nbsp;<b>Bartholin duct cyst</b>?<div><br /></div><div><span class=cloze>Incision and drainage, followed by Word catheter placement</span></div><br> <img src=""word son.jpg"" />"
What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a patient with&nbsp;<b>crampy abdominal</b>/<b>back pain</b>&nbsp;during the&nbsp;<u>first few days of menses</u>&nbsp;with a&nbsp;<b><u>normal</u> physical examination?&nbsp;</b><div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a patient with&nbsp;<b>crampy abdominal</b>/<b>back pain</b>&nbsp;during the&nbsp;<u>first few days of menses</u>&nbsp;with a&nbsp;<b><u>normal</u> physical examination?&nbsp;</b><div><br /></div><div><span class=cloze>Primary dysmenorrhea</span></div><br> <div><i>due to ↑&nbsp;<b>release of prostaglandins causing painful uterine muscle activity </b>during menses; other<b> GI</b> symptoms (n/v) can occur due to prostaglandin stimulation. &nbsp;</i></div><div><i><br /></i></div><div><i><img src=""paste-440440306270209.jpg"" /></i></div><div><i><br /></i></div><img src=""whateva.png"" />"
What is the&nbsp;<i>first-line treatment</i>&nbsp;for&nbsp;<b>primary dysmenorrhea</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the&nbsp;<i>first-line treatment</i>&nbsp;for&nbsp;<b>primary dysmenorrhea</b>?<div><br /></div><div><span class=cloze>NSAIDs and/or hormonal contraception</span></div><br> <div><i><u>NSAIDs</u>&nbsp;directly inhibit <b>prostaglandins </b>= ↓&nbsp;uterine smooth muscle activity; <u>OCPs</u> thin the endometrial lining → ↓ source of uterine <b>prostaglandins</b> → ↓ uterine contraction; distinguish between <b>PMS </b>which has more symptoms&nbsp;</i></div><div><i><br /></i></div><img src=""whateva.png"" />"
Adolescents with <u>irregular menstrual bleeding</u> due to <b>anovulatory</b> <b>cycles</b> may benefit from <span class=cloze>[...]</span> therapy"Adolescents with <u>irregular menstrual bleeding</u> due to <b>anovulatory</b> <b>cycles</b> may benefit from <span class=cloze>progesterone</span> therapy<br> <i>progesterone, which is normally secreted by the corpus luteum during ovulatory cycles, causes <b>differentiation</b> of the proliferative endometrium into <b>secretory</b> <b>endometrium</b>; <u>withdrawal</u> causes <b>menstruation</b></i><div><i><br /></i><div><i><br /></i><div><img src=""nasty.png"" /></div></div></div>"
<b>Lactational amenorrhea</b>&nbsp;occurs due to high levels of <u>prolactin</u>, which has an <i>inhibitory</i> effect on the production of <b><span class=cloze>[...]</span></b>"<b>Lactational amenorrhea</b>&nbsp;occurs due to high levels of <u>prolactin</u>, which has an <i>inhibitory</i> effect on the production of <b><span class=cloze>GnRH</span></b><br> <i>thus LH and FSH production is also suppressed and ovulation does not occur</i><div><i><img src=""conceptz.png"" /></i></div>"
What is the effect of <u>low estrogen levels</u>&nbsp;on <b>vaginal</b> <b>pH</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the effect of <u>low estrogen levels</u>&nbsp;on <b>vaginal</b> <b>pH</b>?<div><br /></div><div><span class=cloze>Increased pH (<u>&gt;</u>&nbsp;5)</span></div><br> <i>menopause = ↓ estrogen = reduced glycogen production = ↓ vaginal lactobacilli activity = increased pH</i><div><i><br /></i><div><i><img src=""howd everyone know.png"" /></i></div></div>"
What is the <i>recommended screening</i>&nbsp;for asymptomatic patients at average-risk of <b>ovarian</b> <b>cancer</b>?<div><br /></div><div><span class=cloze>[...]</span></div>What is the <i>recommended screening</i>&nbsp;for asymptomatic patients at average-risk of <b>ovarian</b> <b>cancer</b>?<div><br /></div><div><span class=cloze>No screening recommended</span></div><br> What <i>pharmacologic agent</i>&nbsp;may be used in the treatment of <b>urgency incontinence</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What <i>pharmacologic agent</i>&nbsp;may be used in the treatment of <b>urgency incontinence</b>?<div><br /></div><div><span class=cloze>Anti-muscarinic agents (e.g. oxybutynin)</span></div><br> <div><i><u>first-line</u> treatment should consist of lifestyle modifications and/or <b>bladder</b> <b>training</b>; a newer agent, <b>mirabegron</b> (beta₃-adrenergic agonist) may be offered to patients who cannot take antimuscarinic drugs (e.g., <b>narrow angle glaucoma</b>)</i></div><div><i><br /></i></div><img src=""good start.png"" />"
What is the likely <i>diagnosis</i>&nbsp;in a 38-year-old woman that presents with <b>infertility</b> despite a&nbsp;<u>regular</u> menstrual cycle and normal physical exam?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a 38-year-old woman that presents with <b>infertility</b> despite a&nbsp;<u>regular</u> menstrual cycle and normal physical exam?&nbsp;<div><br /></div><div><span class=cloze>Decreased ovarian reserve</span></div><br> <i>characterized by decreased <u>oocyte number and quality</u>;&nbsp;sharp decline in conception is notable after age 35 (ddx. with <b>primary ovarian insufficiency </b>which is menopause &lt; 40 y.o.)&nbsp;</i><div><i><br /></i><div><i><img src=""boohoo.png"" /></i></div></div>"
<b>Mammary</b> <b>Paget's disease</b>&nbsp;is typically associated with an <u>underlying</u> <span class=cloze>[...]</span> and therefore must be biopsed"<b>Mammary</b> <b>Paget's disease</b>&nbsp;is typically associated with an <u>underlying</u> <span class=cloze>adenocarcinoma (e.g. DCIS)</span> and therefore must be biopsed<br> <div><i>adenocarcinoma = cancer that starts in <b>glandular</b> tissue; migration of cancer cells&nbsp;<b>into the ducts</b>&nbsp;causes the characteristic skin changes.</i></div><div><i><img src=""more PG.png"" /></i></div>"
<b>Mammary</b> <b>Paget's disease</b>&nbsp;is typically associated with an <u>underlying</u> adenocarcinoma (e.g. DCIS) and therefore must be <span class=cloze>[next step]</span>"<b>Mammary</b> <b>Paget's disease</b>&nbsp;is typically associated with an <u>underlying</u> adenocarcinoma (e.g. DCIS) and therefore must be <span class=cloze>biopsed</span><br> <div><i>adenocarcinoma = cancer that starts in <b>glandular</b> tissue; migration of cancer cells&nbsp;<b>into the ducts</b>&nbsp;causes the characteristic skin changes.</i></div><div><i><img src=""more PG.png"" /></i></div>"
What is the likely <i>diagnosis</i>&nbsp;in a patient with <u>primary amenorrhea</u>&nbsp;and the following physical exam: <b>absent uterus</b>/<b>upper</b> <b>vagina</b>, <b><u>minimal pubic hair</u></b>, and&nbsp;<b>normal lower vagina</b>,&nbsp;<b>breast</b> <b>development</b><div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a patient with <u>primary amenorrhea</u>&nbsp;and the following physical exam: <b>absent uterus</b>/<b>upper</b> <b>vagina</b>, <b><u>minimal pubic hair</u></b>, and&nbsp;<b>normal lower vagina</b>,&nbsp;<b>breast</b> <b>development</b><div><br /></div><div><span class=cloze>Androgen insensitivity syndrome</span></div><br> <i>patient's are 46,XY and have <u>normal testicular secretion</u> of <b>anti-Mullerian hormone</b> (absent cervix, uterus, upper vagina) and <b>testosterone</b> (converted to estrogen for breast development) - <u>minimal hair </u>distinguishes AIS from Mullerian agenesis.</i><div><i><br /></i></div><div><i></i><i><img src=""paste-277042570461185.jpg"" /></i><br /></div><div><div><i><img src=""chart (1).png"" /></i></div></div>"
<b>Androgen insensitivity syndrome</b>&nbsp;is characterized by an <u>absent</u>&nbsp;<b>uterus</b>, <b>cervix</b>, and <b>upper</b> <b>vagina</b> due to <i>normal</i>&nbsp;production of&nbsp;<span class=cloze>[...]</span>"<b>Androgen insensitivity syndrome</b>&nbsp;is characterized by an <u>absent</u>&nbsp;<b>uterus</b>, <b>cervix</b>, and <b>upper</b> <b>vagina</b> due to <i>normal</i>&nbsp;production of&nbsp;<span class=cloze>anti-Mullerian hormone (MIF)</span><br> <div><i><img src=""paste-277042570461185.jpg"" /></i></div><div><div><i><img src=""chart (1).png"" /></i></div></div>"
What is the <i>next step</i>&nbsp;in management for a <u>pregnant</u> patient with <b>high-grade</b> <b>squamous intraepithelial lesion </b>discovered on Pap testing?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step</i>&nbsp;in management for a <u>pregnant</u> patient with <b>high-grade</b> <b>squamous intraepithelial lesion </b>discovered on Pap testing?<div><br /></div><div><span class=cloze>Immediate <b><font color=""#ff0000"">colposcopy</font></b> +/- biopsy (<u>safe</u> during pregnancy)</span></div><br> <i>colposcopy helps&nbsp;<b>visualize</b> possible neoplastic changes (e.g., CIN2, CIN3);&nbsp;<b>don't do more invasive things (LEEP/curettage) unless it's INVASIVE!</b></i><div><b><i><br /></i></b><div><i><img src=""paste-77610059038721.jpg"" /><br /></i><div><i><img src=""gonna be along one.png"" /></i></div></div></div>"
What is the <i>most common</i>&nbsp;<u>side effect</u>&nbsp;of <b>tamoxifen</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>most common</i>&nbsp;<u>side effect</u>&nbsp;of <b>tamoxifen</b>?<div><br /></div><div><span class=cloze>Hot flashes (80%)</span></div><br> <i>due to <u>anti-estrogenic activity</u> in the CNS which causes <b>thermoregulatory dysfunction</b>&nbsp;in the anterior hypothalamus ~ analogous to hot flashes. (Tammy is HOT!)</i><div><i><br /></i><div><i><img src=""SERM_1358629116483.png"" /></i></div></div>"
What is the likely <i>diagnosis</i>&nbsp;in a woman with suspected <u>pelvic inflammatory disease</u>&nbsp;that presents with severe<b> RUQ pain</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a woman with suspected <u>pelvic inflammatory disease</u>&nbsp;that presents with severe<b> RUQ pain</b>?<div><br /></div><div><span class=cloze>Fits-Hugh-Curtis disease (perihepatitis)</span></div><br> <div><i>may also have <b>intermenstrual spotting </b>due to cervicitis&nbsp;</i></div><div><i><br /></i></div><img src=""i suk.png"" />"
Indications for&nbsp;<u>endometrial biopsy</u>&nbsp;include&nbsp;<b>abnormal</b>&nbsp;<b>uterine</b>&nbsp;<b>bleeding</b>&nbsp;in women <b>age&nbsp;&lt;&nbsp;45</b> with <span class=cloze>[...]</span> and/or <span class=cloze>[menstrual cycle abnormality]</span>"Indications for&nbsp;<u>endometrial biopsy</u>&nbsp;include&nbsp;<b>abnormal</b>&nbsp;<b>uterine</b>&nbsp;<b>bleeding</b>&nbsp;in women <b>age&nbsp;&lt;&nbsp;45</b> with <span class=cloze>obesity</span> and/or <span class=cloze>anovulation</span><br> <div><i>due to increased risk for endometrial hyperplasia/cancer from <b>unopposed</b> <b>estrogen</b>; other indications in women &lt; 45 include <b>Lynch syndrome</b>&nbsp;and <b>failed medical management</b></i></div><div><i><b><br /></b></i></div><img src=""didnt see that heh.png"" />"
What is the <i>next step</i>&nbsp;in management for a <u>postmenopausal</u> woman with an incidentally discovered <b>ovarian</b> <b>cyst</b> on ultrasound?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step</i>&nbsp;in management for a <u>postmenopausal</u> woman with an incidentally discovered <b>ovarian</b> <b>cyst</b> on ultrasound?<div><br /></div><div><span class=cloze>Measure CA-125 levels</span></div><br> <i>an elevated CA-125 level in a <u>postmenopausal</u> patient is suspicious for malignancy, even if the ultrasound findings seem benign - t</i><i>he other conditions that cause elevated CA-125 are&nbsp;<b>pre</b>-menopausal conditions (endometriosis, fibroids)</i><div><i><br /></i><div><i><img src=""epithel ovarian carc.png"" /></i></div></div>"
Postmenopausal women with ultrasound findings suspicious for ovarian cancer and/or elevated CA-125 should undergo <span class=cloze>[...]</span><i> prior</i> to surgical exploration&nbsp;Postmenopausal women with ultrasound findings suspicious for ovarian cancer and/or elevated CA-125 should undergo <span class=cloze>further imaging (e.g. CT, MRI)</span><i> prior</i> to surgical exploration&nbsp;<br> <i>helps assess for the presence of metastatic disease which can guide surgical exploration; don't do a needle aspiration b/c you can spread the cancer!</i><div><i><br /></i></div>
What is the likely <i>diagnosis</i>&nbsp;in a 35-year-old woman that presents with <b>infertility</b>, <b>irregular menses</b>, and <b>hot flashes</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a 35-year-old woman that presents with <b>infertility</b>, <b>irregular menses</b>, and <b>hot flashes</b>?<div><br /></div><div><span class=cloze>Primary ovarian insufficiency</span></div><br> <i>i.e. cessation of ovarian function before 40 years of age → <b>menopausal</b> symptoms due to decreased estrogen.</i><div><i><img src=""paste-1367689385738243.jpg"" /><br /></i><div><i><img src=""premature ovarian.png"" /></i></div></div>"
What is the likely <i>diagnosis</i>&nbsp;in a patient with&nbsp;<b>fever</b>, <b>hypotension</b>&nbsp;2/2 vomiting/diarrhea<b>,</b>&nbsp;and a <b>macular</b> <b>rash</b> involving the <u>palms/soles</u>? The patient's last menstrual period was 3 days ago.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a patient with&nbsp;<b>fever</b>, <b>hypotension</b>&nbsp;2/2 vomiting/diarrhea<b>,</b>&nbsp;and a <b>macular</b> <b>rash</b> involving the <u>palms/soles</u>? The patient's last menstrual period was 3 days ago.&nbsp;<div><br /></div><div><span class=cloze>Staphylococcal toxic shock syndrome</span></div><br> <i>likely due to <b>prolonged tampon use</b>, which causes a systemic inflammatory response to toxic shock syndrome toxin-1, an exotoxin that acts as a <u>superantigen</u>&nbsp;</i><div><i><br /></i><div><i><img src=""dsfdsfgsdgfdfdbdgfgdf.png"" /><img src=""paste-2879865766281217.jpg"" /></i></div></div>"
How do the following laboratory values change during <u>pregnancy</u>?<div><br /></div><div><b>Total T3</b>/<b>T4</b>:&nbsp;<span class=cloze>[...]</span></div><div><b>Free T3</b>/<b>T4</b>:&nbsp;<span class=cloze>[...]</span></div><div><b>TSH</b>:&nbsp;<span class=cloze>[...]</span></div>"How do the following laboratory values change during <u>pregnancy</u>?<div><br /></div><div><b>Total T3</b>/<b>T4</b>:&nbsp;<span class=cloze>Increased</span></div><div><b>Free T3</b>/<b>T4</b>:&nbsp;<span class=cloze>Unchanged</span></div><div><b>TSH</b>:&nbsp;<span class=cloze>Decreased</span></div><br> <i><div>2/2 increased <b>estrogen</b> causing increased TBG and <b>hCG</b> causing stimulation of TSH receptors&nbsp;</div><div><br /></div><u><img src=""potay.png"" /></u></i>"
<b>Secondary amenorrhea</b>&nbsp;is defined as the <i>absence of menses</i>&nbsp;for <u>&gt;</u>&nbsp;3 cycles or <u>&gt;</u>&nbsp;<span class=cloze>[...]</span> months in women who menstruated previously&nbsp;<b>Secondary amenorrhea</b>&nbsp;is defined as the <i>absence of menses</i>&nbsp;for <u>&gt;</u>&nbsp;3 cycles or <u>&gt;</u>&nbsp;<span class=cloze>6</span> months in women who menstruated previously&nbsp;<br> What is the <i>next step </i>in diagnosis for a patient with <b>secondary amenorrhea</b>&nbsp;and a <u>negative</u>&nbsp;pregnancy test?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>next step </i>in diagnosis for a patient with <b>secondary amenorrhea</b>&nbsp;and a <u>negative</u>&nbsp;pregnancy test?<div><br /></div><div><span class=cloze>Measure serum prolactin, TSH, and FSH</span></div><br> <i>assesses for the most common causes of secondary amenorrhea (hyperprolactinemia, hypothyroidism, premature ovarian failure)</i><div><i><br /></i><div><i><img src=""yeehaw.png"" /></i></div></div>"
<b>Postpartum thyroiditis</b> is often characterized by an <i>initial</i>&nbsp;brief <b><span class=cloze>[...]</span>-thyroid</b> phase followed by a <b><span class=cloze>[...]</span>-thyroid</b> phase"<b>Postpartum thyroiditis</b> is often characterized by an <i>initial</i>&nbsp;brief <b><span class=cloze>hyper</span>-thyroid</b> phase followed by a <b><span class=cloze>hypo</span>-thyroid</b> phase<br> <i>e.g. anxiety, palpitations followed by fatigue, weight gain, constipation, <b>hypercholesterolemia</b>, <b>hyponatremia</b>&nbsp;&nbsp;</i><div><i><br /></i><div><i><img src=""interesstin.png"" /></i></div></div>"
<b>Postpartum thyroiditis</b>&nbsp;is associated with&nbsp;<span class=cloze>[...]</span> antibodies"<b>Postpartum thyroiditis</b>&nbsp;is associated with&nbsp;<span class=cloze>anti-thyroid peroxidase</span> antibodies<br> <i>considered a variant of Hashimoto thyroidits</i><div><i><img src=""interesstin.png"" /><img src=""paste-4269193197256705.jpg"" /></i></div>"
What is the likely <i>diagnosis</i>&nbsp;in a newborn born to a <u>mother with Grave's disease</u> that presents with <b>irritability</b>, <b>tachycardia</b>, and <b>low birth</b> <b>weight</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a newborn born to a <u>mother with Grave's disease</u> that presents with <b>irritability</b>, <b>tachycardia</b>, and <b>low birth</b> <b>weight</b>?<div><br /></div><div><span class=cloze>Neonatal thyrotoxicosis</span></div><br> <i>due to <b>passage of maternal TSH receptor antibodies</b> across the placenta</i><div><i><br /></i><div><i><img src=""paste-4550333166518273.jpg"" /><br /></i><div><i><img src=""not bad.png"" /></i></div></div></div>"
What is the <i>recommended treatment</i>&nbsp;for a <u><b>newborn</b></u>&nbsp;with <b>neonatal thyrotoxicosis</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <i>recommended treatment</i>&nbsp;for a <u><b>newborn</b></u>&nbsp;with <b>neonatal thyrotoxicosis</b>?<div><br /></div><div><span class=cloze>Methimazole + beta-blocker until condition self-resolves</span></div><br> <i>typically self-resolves over the first few weeks to months of life (as maternal antibodies disappear from circulation)</i><div><i><br /></i><div><i><img src=""not bad.png"" /></i></div></div>"
Does <u>levothyroxine</u> significantly <i>increase</i> the risk for <b>neonatal thyrotoxicosis</b>?<div><br /></div><div><span class=cloze>[...]</span></div>Does <u>levothyroxine</u> significantly <i>increase</i> the risk for <b>neonatal thyrotoxicosis</b>?<div><br /></div><div><span class=cloze>No (doesn't cross placenta to a significant degree)</span></div><br> What is the likely <i>diagnosis</i>&nbsp;in a <u>newborn</u>&nbsp;with <b><u>micro</u>cephaly</b>,&nbsp;<b></b><b>cleft lip/palate</b>, and&nbsp;<b>distal phalange</b>&nbsp;<b><u>hypo</u>plasia?</b><div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a <u>newborn</u>&nbsp;with <b><u>micro</u>cephaly</b>,&nbsp;<b></b><b>cleft lip/palate</b>, and&nbsp;<b>distal phalange</b>&nbsp;<b><u>hypo</u>plasia?</b><div><br /></div><div><span class=cloze>Fetal hydantoin syndrome</span></div><br> <i>classically seen with <b>phenytoin</b>&nbsp;or <b>carbamazepine</b>&nbsp;use</i><div><i><br /></i><div><i><img src=""paste-534886637109719.jpg"" /></i></div><div><i><br /></i></div></div>"
<b>False pregnancy</b>, or&nbsp;<b><span class=cloze>[...]</span></b>, is the belief that one is pregnant when they aren't really<b>False pregnancy</b>, or&nbsp;<b><span class=cloze>pseudocyesis</span></b>, is the belief that one is pregnant when they aren't really<br> <i>may present with clinical signs of pregnancy (e.g. morning sickness, amenorrhea, abdominal distention) with a negative&nbsp;pregnancy test;</i><div><i><br /></i></div>
What is the <i>preferred imaging modality</i>&nbsp;for diagnosis of&nbsp;<b>acute appendicitis</b>&nbsp;during <u>pregnancy</u>?<div><br /></div><div><span class=cloze>[...]</span></div>What is the <i>preferred imaging modality</i>&nbsp;for diagnosis of&nbsp;<b>acute appendicitis</b>&nbsp;during <u>pregnancy</u>?<div><br /></div><div><span class=cloze>Ultrasound (graded compression technique)</span></div><br> <i>u/s shows <b>noncompression and dilation of appendix;</b>&nbsp;if ultrasound is non-diagnostic, MRI can be performed for further assessment</i><div><i><br /></i></div>
What is the likely <i>diagnosis</i>&nbsp;in a pregnant woman that presents with <b>intense generalized pruritus</b>, especially at <u>night</u>, and <b>elevated</b> <b>aminotransferases</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the likely <i>diagnosis</i>&nbsp;in a pregnant woman that presents with <b>intense generalized pruritus</b>, especially at <u>night</u>, and <b>elevated</b> <b>aminotransferases</b>?<div><br /></div><div><span class=cloze>Intrahepatic cholestasis of pregnancy</span></div><br> <i>2/2 estrogen/progesterone causing bile tract stasis; typically resolves within weeks following delivery</i><div><i><br /></i></div><div><i><br /></i><div><i><img src=""heh.png"" /></i></div></div>"
In patients with <b>osteoporosis</b>, the risk for <u>fragility fracture</u>&nbsp;is <i>highest</i>&nbsp;in those with a history of&nbsp;<span class=cloze>[...]</span>"In patients with <b>osteoporosis</b>, the risk for <u>fragility fracture</u>&nbsp;is <i>highest</i>&nbsp;in those with a history of&nbsp;<span class=cloze>prior fragility fracture</span><br> <div><br /></div><img src=""ok mate.png"" />"
What is the&nbsp;<i>preferred imaging modality</i>&nbsp;for diagnosis of <b>nephrolithiasis</b>&nbsp;during&nbsp;<u>pregnancy</u>?<div><br /></div><div><span class=cloze>[...]</span></div>What is the&nbsp;<i>preferred imaging modality</i>&nbsp;for diagnosis of <b>nephrolithiasis</b>&nbsp;during&nbsp;<u>pregnancy</u>?<div><br /></div><div><span class=cloze>Pelvic and renal ultrasound</span></div><br> <i>low-dose CT urography can be considered in the 2nd or 3rd trimester if ultrasound is not helpful</i><div><i><br /></i></div>
<div>All women are screened during the <u>first prenatal visit</u> for <b>asymptomatic bacteriuria</b>&nbsp;due to risk of <span class=cloze>[...]</span>, <u>pre</u>term birth, and <u>low</u> birth weight</div>"<div>All women are screened during the <u>first prenatal visit</u> for <b>asymptomatic bacteriuria</b>&nbsp;due to risk of <span class=cloze>pyelonephritis</span>, <u>pre</u>term birth, and <u>low</u> birth weight</div><br> <div><i>defined as an asymptomatic patient that grows <u>&gt;</u>&nbsp;100,000 colony-forming units/mL of a single organism on urinalysis (typically E. coli); due to progesterone causing&nbsp;<b>ureteral dilation</b> allowing bacteria to go backwards and causing <b>pyelo.</b></i></div><div><i><br /></i></div><img src=""daaangit.png"" />"
Newborns with&nbsp;<b>ABO incompatibility</b>&nbsp;are typically asymptomatic at birth or have <span class=cloze>[...]</span>"Newborns with&nbsp;<b>ABO incompatibility</b>&nbsp;are typically asymptomatic at birth or have <span class=cloze><u>mild</u> anemia</span><br> <i>maternal <b><u>IgG</u></b> antibodies against blood groups A and B develop from exposure to antigens in food, bacteria, viruses, etc can cross the placenta and can cause <u>mild</u>&nbsp;disease in a newborn - e.g., <b>jaundice</b> (attacks not only RBCs, but other tissues of the body that have ABO antigens, ""neutralizing"" the antibodies)</i><div><i><br /></i><div><i><img src=""i did not know ABO.png"" /></i></div></div>"
Post-menopausal <b>hormonal therapy</b> is associated with&nbsp;<span class=cloze>[...]</span> <b>HDL</b>&nbsp;and&nbsp;<span class=cloze>[...]</span> <b>LDL</b>&nbsp;Post-menopausal <b>hormonal therapy</b> is associated with&nbsp;<span class=cloze><u>increased</u></span> <b>HDL</b>&nbsp;and&nbsp;<span class=cloze><u>decreased</u></span> <b>LDL</b>&nbsp;<br> <i>however hormone therapy is <u>not</u>&nbsp;recommended for prevention of heart disease</i>
What is the <i>recommended treatment</i>&nbsp;for <b>lichen simplex chronicus</b>?<div><br /></div><div><span class=cloze>[...]</span></div>What is the <i>recommended treatment</i>&nbsp;for <b>lichen simplex chronicus</b>?<div><br /></div><div><span class=cloze>high-potency topical corticosteroids +/- antihistamines</span></div><br> Diagnosis of <b>adrenal tumor</b>&nbsp;is supported by an <u>elevated</u> level of <span class=cloze>[...]</span>"Diagnosis of <b>adrenal tumor</b>&nbsp;is supported by an <u>elevated</u> level of <span class=cloze>dehydroepiandrosterone sulfate (DHEAS)</span><br> <i>manifests as <b>rapidly progressive hirsutism or precocious adrenarche (pubic hair)</b></i><div><br /></div><div><img src=""paste-9661516047450113.jpg"" /></div>"
Do maternal <u>Lewis antibodies</u> during <i>pregnancy</i> pose significant risk for <b>hemolytic disease of the newborn</b>?<div><br /></div><div><span class=cloze>[...]</span></div>Do maternal <u>Lewis antibodies</u> during <i>pregnancy</i> pose significant risk for <b>hemolytic disease of the newborn</b>?<div><br /></div><div><span class=cloze>No</span></div><br> <i>these are <b>IgM antibodies</b>&nbsp;and thus do not cross the placenta (<b>Lewis</b> <b>Lives</b>, Duffy Dies, Kell Kills)</i>
Optimal daily <b>calcium</b> <b>supplementation</b> in <u>postmenopausal</u>&nbsp;women is&nbsp;<span class=cloze>[...]</span> mgOptimal daily <b>calcium</b> <b>supplementation</b> in <u>postmenopausal</u>&nbsp;women is&nbsp;<span class=cloze>1200</span> mg<br> What is the <i>next step</i>&nbsp;in management for a woman that presents in <u>active labor</u>&nbsp;with the fetus in <b>transverse lie</b>&nbsp;position?<div><br /></div><div><span class=cloze>[...]</span></div>What is the <i>next step</i>&nbsp;in management for a woman that presents in <u>active labor</u>&nbsp;with the fetus in <b>transverse lie</b>&nbsp;position?<div><br /></div><div><span class=cloze>Cesarean delivery</span></div><br> <i>external cephalic version <b>should</b> <b>not</b> be attempted if the patient is in active labor</i>
<b>Intrapartum penicillin</b>&nbsp;should be administered to those with <u>unknown GBS status</u>&nbsp;if they are <b>&lt; 37 weeks gestation</b>, have <b>intrapartum</b> <b>fever</b>, or have <b>ROM for <u>&gt;</u>&nbsp;<span class=cloze>[...]</span> hours</b>&nbsp;"<b>Intrapartum penicillin</b>&nbsp;should be administered to those with <u>unknown GBS status</u>&nbsp;if they are <b>&lt; 37 weeks gestation</b>, have <b>intrapartum</b> <b>fever</b>, or have <b>ROM for <u>&gt;</u>&nbsp;<span class=cloze>18</span> hours</b>&nbsp;<br> <img src=""gbs (1).png"" /><img src=""paste-2703338315448321.jpg"" />"
<b>Intrapartum penicillin</b>&nbsp;should be administered to those with <u>unknown GBS status</u>&nbsp;if they are <b>&lt; <span class=cloze>[...]</span> weeks gestation</b>, have <b>intrapartum</b> <b>fever</b>, or have <b>ROM for <u>&gt;</u>&nbsp;18 hours</b>&nbsp;"<b>Intrapartum penicillin</b>&nbsp;should be administered to those with <u>unknown GBS status</u>&nbsp;if they are <b>&lt; <span class=cloze>37</span> weeks gestation</b>, have <b>intrapartum</b> <b>fever</b>, or have <b>ROM for <u>&gt;</u>&nbsp;18 hours</b>&nbsp;<br> <img src=""gbs (1).png"" /><img src=""paste-2703338315448321.jpg"" />"
"<div class=card>ASCUS. HPV (+), next step?<div><br /><div><span class=cloze>[...]</span></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>ASCUS. HPV (+), next step?<div><br /><div><span class=cloze>Colposcopy</span></div></div></div><br><br> <div class=extra><div><i>Atypical squamous cells of undetermined significance</i></div></div> <div class=tags></div>
"<div class=card>ASCUS. Next step?<div><br /><div><span class=cloze>[...]</span></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>ASCUS. Next step?<div><br /><div><span class=cloze>HPV DNA or q6m pap</span></div></div></div><br><br> <div class=extra><div><i>Atypical squamous cells of undetermined significance</i></div><div><i>If HPV is (-), then resume normal testing q3y</i></div><div><i><br /></i></div><div><i><img src=""paste-8525510083262.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>Woman present with <b>HSIL</b> lesion on Pap. Next step?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Woman present with <b>HSIL</b> lesion on Pap. Next step?<div><br /></div><div><span class=cloze>Immediate colposcopy or LEEP</span></div></div><br><br> <div class=extra><div><span style=""color: rgb(34, 34, 34);font-family: Roboto, arial, sans-serif;font-size: 16px"">high grade squamous intraepithelial lesion</span><i><br /></i></div><div><span style=""color: rgb(34, 34, 34);font-family: Roboto, arial, sans-serif;font-size: 16px""><br /></span></div><div><span style=""font-size: 16px; font-family: Roboto, arial, sans-serif; color: rgb(34, 34, 34); ""><br /></span></div></div> <div class=tags></div>"
"<div class=card>What are most <b>postpartum endometritis </b>cases in term of their bacterial flora?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What are most <b>postpartum endometritis </b>cases in term of their bacterial flora?<div><br /></div><div><span class=cloze>Polymicrobial (aerobes and anaerobes)</span></div></div><br><br> <div class=extra><div><i></i><i><img src=""wats a lochia.png"" /></i></div><div><i></i><i><br /></i></div><div><i></i><i><img src=""paste-973922489073665.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>Most significant risk factor for <b>postpartum depression</b> is <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Most significant risk factor for <b>postpartum depression</b> is <span class=cloze>prior depression</span></div><br><br> <div class=extra></div> <div class=tags></div>
"<div class=card>What is the safest way to prevent lactation in a postpartum woman?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>What is the safest way to prevent lactation in a postpartum woman?<div><br /></div><div><span class=cloze><b>Conservative</b>: Supportive bra, ice packs, analgesics</span></div></div><br><br> <div class=extra><i>Engorgement itself creates a chain of events that lead to cessation of the lactation process due to negative inhibition of prolactin release. &nbsp;<b>Lactation suppression is accomplished by wearing a comfortable, supportive bra, avoidance of nipple stimulation and manipulation, application of ice packs to the breasts, and nonsteroidal anti-inflammatory drugs to reduce inflammation and pain</b>. &nbsp;Breast binding is not recommended for lactation suppression due to the risk of mastitis, plugged ducts, and increased pain. &nbsp;In addition, a tight bra or binder may lead to inadvertent nipple stimulation.</i></div> <div class=tags></div>
"<div class=card><b><span class=cloze>[...]</span> </b>are contraindicated up to 4 weeks after pregnancy because of increased risk of DVTs.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b><span class=cloze>OCPs</span> </b>are contraindicated up to 4 weeks after pregnancy because of increased risk of DVTs.</div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card>Frequent nursing, warm shower/compresses, massaging breast to express milk are ways to &nbsp;manage breast <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Frequent nursing, warm shower/compresses, massaging breast to express milk are ways to &nbsp;manage breast <span class=cloze>engorgement</span></div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card><span class=cloze>[hormone]</span> stimulates milk ejection after suckling&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><span class=cloze>Oxytocin</span> stimulates milk ejection after suckling&nbsp;</div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card>Oxytocin stimulates milk ejection after <span class=cloze>[action]</span>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Oxytocin stimulates milk ejection after <span class=cloze>suckling</span>&nbsp;</div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card>infants born to moms with <b>chorioamniotitis</b> will appear <font color=""#0000ff"">pale</font>, lethargic, and <span class=cloze>[febrile/afebrile]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>infants born to moms with <b>chorioamniotitis</b> will appear <font color=""#0000ff"">pale</font>, lethargic, and <span class=cloze>febrile</span></div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>"
"<div class=card>in twin-twin transfusion syndrome:<div><br></div><div><span class=cloze>[donor/recipient]</span> twin &nbsp;= <b>poly</b>cythemia, <b>poly</b>hydramnios</div><div><span class=cloze>[...]</span> twin = anemia, growth retardation, <b>oligo</b>hydramnios</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>in twin-twin transfusion syndrome:<div><br></div><div><span class=cloze>recipient</span> twin &nbsp;= <b>poly</b>cythemia, <b>poly</b>hydramnios</div><div><span class=cloze>donor</span> twin = anemia, growth retardation, <b>oligo</b>hydramnios</div></div><br><br> <div class=extra><i></i><i><img src=""paste-152814936391681.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>What&nbsp;<u>neonatal complications</u>&nbsp;are associated with&nbsp;<b>diabetes in pregnancy</b>?<div><br /></div><div><span class=cloze>[due to hyperinsulinemia]</span>,&nbsp;polycythemia,&nbsp;<span class=""clozed c1"">hyperbilirubinemia</span>,&nbsp;<span class=""clozed c1"">respiratory distress</span>,&nbsp;<b>hypo</b>calcemia</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What&nbsp;<u>neonatal complications</u>&nbsp;are associated with&nbsp;<b>diabetes in pregnancy</b>?<div><br /></div><div><span class=cloze>Hypoglycemia</span>,&nbsp;polycythemia,&nbsp;<span class=""clozed c1"">hyperbilirubinemia</span>,&nbsp;<span class=""clozed c1"">respiratory distress</span>,&nbsp;<b>hypo</b>calcemia</div></div><br><br> <div class=extra><img src=""paste-3191890845368321.jpg"" /></div> <div class=tags></div>"
"<div class=card>What&nbsp;<u>neonatal complications</u>&nbsp;are associated with&nbsp;<b>diabetes in pregnancy</b>?<div><br /></div><div>Hypoglycemia,&nbsp;<span class=cloze>[due to relative intrauterine hypoxia]</span>,&nbsp;<span class=""clozed c1"">hyperbilirubinemia</span>,&nbsp;<span class=""clozed c1"">respiratory distress</span>,&nbsp;<b>hypo</b>calcemia</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What&nbsp;<u>neonatal complications</u>&nbsp;are associated with&nbsp;<b>diabetes in pregnancy</b>?<div><br /></div><div>Hypoglycemia,&nbsp;<span class=cloze>polycythemia</span>,&nbsp;<span class=""clozed c1"">hyperbilirubinemia</span>,&nbsp;<span class=""clozed c1"">respiratory distress</span>,&nbsp;<b>hypo</b>calcemia</div></div><br><br> <div class=extra><img src=""paste-3191890845368321.jpg"" /></div> <div class=tags></div>"
"<div class=card>What&nbsp;<u>neonatal complications</u>&nbsp;are associated with&nbsp;<b>diabetes in pregnancy</b>?<div><br /></div><div>Hypoglycemia,&nbsp;polycythemia,&nbsp;<span class=""clozed c1""><span class=cloze>[due to immmature liver enzymes]</span></span>,&nbsp;<span class=""clozed c1"">respiratory distress</span>,&nbsp;<b>hypo</b>calcemia</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What&nbsp;<u>neonatal complications</u>&nbsp;are associated with&nbsp;<b>diabetes in pregnancy</b>?<div><br /></div><div>Hypoglycemia,&nbsp;polycythemia,&nbsp;<span class=""clozed c1""><span class=cloze>hyperbilirubinemia</span></span>,&nbsp;<span class=""clozed c1"">respiratory distress</span>,&nbsp;<b>hypo</b>calcemia</div></div><br><br> <div class=extra><img src=""paste-3191890845368321.jpg"" /></div> <div class=tags></div>"
"<div class=card>What&nbsp;<u>neonatal complications</u>&nbsp;are associated with&nbsp;<b>diabetes in pregnancy</b>?<div><br /></div><div>Hypoglycemia,&nbsp;polycythemia,&nbsp;<span class=""clozed c1"">hyperbilirubinemia</span>,&nbsp;<span class=""clozed c1""><span class=cloze>[due to immature surfactant]</span></span>,&nbsp;<b>hypo</b>calcemia</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What&nbsp;<u>neonatal complications</u>&nbsp;are associated with&nbsp;<b>diabetes in pregnancy</b>?<div><br /></div><div>Hypoglycemia,&nbsp;polycythemia,&nbsp;<span class=""clozed c1"">hyperbilirubinemia</span>,&nbsp;<span class=""clozed c1""><span class=cloze>respiratory distress</span></span>,&nbsp;<b>hypo</b>calcemia</div></div><br><br> <div class=extra><img src=""paste-3191890845368321.jpg"" /></div> <div class=tags></div>"
"<div class=card>What&nbsp;<u>neonatal complications</u>&nbsp;are associated with&nbsp;<b>diabetes in pregnancy</b>?<div><br /></div><div>Hypoglycemia,&nbsp;polycythemia,&nbsp;<span class=""clozed c1"">hyperbilirubinemia</span>,&nbsp;<span class=""clozed c1"">respiratory distress</span>,&nbsp;<span class=cloze>[due to immature parathyroids]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What&nbsp;<u>neonatal complications</u>&nbsp;are associated with&nbsp;<b>diabetes in pregnancy</b>?<div><br /></div><div>Hypoglycemia,&nbsp;polycythemia,&nbsp;<span class=""clozed c1"">hyperbilirubinemia</span>,&nbsp;<span class=""clozed c1"">respiratory distress</span>,&nbsp;<span class=cloze><b>hypo</b>calcemia</span></div></div><br><br> <div class=extra><img src=""paste-3191890845368321.jpg"" /></div> <div class=tags></div>"
"<div class=card>What is the correct head position for a neonate on<b> positive pressure ventilation?</b><div><br /></div><div>""<span class=cloze>[...]</span>"" position</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the correct head position for a neonate on<b> positive pressure ventilation?</b><div><br /></div><div>""<span class=cloze>sniffing</span>"" position</div></div><br><br> <div class=extra>Sniffing position (head-tilt, chin-lift)<div>10L/min</div><div>Chest rise</div><div><br /></div><div><img src=""fe63e553bd3a1e1efb718e3fbaf9b6b2.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>Clues in a vignette that an Apgar score is (slightly) abnormal?<div><br /><div><span class=cloze>[...]</span></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Clues in a vignette that an Apgar score is (slightly) abnormal?<div><br /><div><span class=cloze><div><div><b>1 point</b>&nbsp;each:</div>&nbsp;-&nbsp;<u>acro</u>cyanosis<div>&nbsp;- HR &lt;100</div><div>&nbsp;- irregular respirations</div></div></span></div></div></div><br><br> <div class=extra><div>Commonly used as descriptions in vignettes → more obvious extremes would be scored as 0 or 2.</div><img src=""paste-88592290414593_1522849603677.jpg"" /></div> <div class=tags></div>"
"<div class=card>Immediately after delivery of a vigorous infant, initiate <span class=cloze>[...]</span> with mom</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Immediately after delivery of a vigorous infant, initiate <span class=cloze>skin-skin contact</span> with mom</div><br><br> <div class=extra><i>then, suction airway if needed and dry off baby with towel.</i><div><i>30-60 seconds later clamp and cut cord.</i></div></div> <div class=tags></div>
"<div class=card>Treatment of <b>prolonged vs. arrested</b> <u>active</u> phase of labor?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Treatment of <b>prolonged vs. arrested</b> <u>active</u> phase of labor?<div><br /></div><div><span class=cloze>Oxytocin vs. C-section</span></div></div><br><br> <div class=extra><img src=""paste-135261405052931.jpg"" /><img src=""paste-1415191724032001.jpg"" /></div> <div class=tags></div>"
"<div class=card><b>Postpartum <span class=cloze>[...]</span></b>&nbsp;is characterized by&nbsp;<u>depressed affect</u>, anxiety, and poor concentration for&nbsp;<b><u>&gt;</u>&nbsp;2 weeks</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Postpartum <span class=cloze>depression</span></b>&nbsp;is characterized by&nbsp;<u>depressed affect</u>, anxiety, and poor concentration for&nbsp;<b><u>&gt;</u>&nbsp;2 weeks</b>&nbsp;</div><br><br> <div class=extra><i></i><i><img src=""paste-3262448568107009.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><b>Postpartum depression</b>&nbsp;is characterized by&nbsp;<u>depressed affect</u>, anxiety, and poor concentration for&nbsp;<b><u><span class=cloze>[...]</span></u>&nbsp;2 weeks</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Postpartum depression</b>&nbsp;is characterized by&nbsp;<u>depressed affect</u>, anxiety, and poor concentration for&nbsp;<b><u><span class=cloze>&gt;</span></u>&nbsp;2 weeks</b>&nbsp;</div><br><br> <div class=extra><i></i><i><img src=""paste-3262448568107009.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>Are SSRIs safe during breastfeeding? <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Are SSRIs safe during breastfeeding? <span class=cloze>Yes</span></div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card><b>Postpartum <span class=cloze>[...]</span></b>&nbsp;is characterized by&nbsp;<u>depressed affect</u>, tearfulness, and fatigue starting 2-3 days after delivery for&nbsp;<b>&lt; 2 weeks</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Postpartum <span class=cloze>blues</span></b>&nbsp;is characterized by&nbsp;<u>depressed affect</u>, tearfulness, and fatigue starting 2-3 days after delivery for&nbsp;<b>&lt; 2 weeks</b></div><br><br> <div class=extra><i></i><i>50 - 85% incidence rate; usually resolves within 10 days</i><div><i>Increased risk of postpartum depression</i></div><div><i><br /></i></div><div><i><img src=""paste-3262448568107009.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What should be given to women with <b>unknown GBS status&nbsp;</b>who go into <b>preterm</b> <b>labor</b>?<div><br></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What should be given to women with <b>unknown GBS status&nbsp;</b>who go into <b>preterm</b> <b>labor</b>?<div><br></div><div><span class=cloze>penicillin or ampicillin</span></div></div><br><br> <div class=extra><i><img src=""paste-1598780101099521.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><b>IUGR</b> is fetal weight below <span class=cloze>[...]</span>% and is most commonly caused by <b>placental insufficiency</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>IUGR</b> is fetal weight below <span class=cloze>10</span>% and is most commonly caused by <b>placental insufficiency</b></div><br><br> <div class=extra><i><div></div><img src=""paste-1696971643420673.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><b>IUGR</b> is fetal weight below 10% and is most commonly caused by <b><span class=cloze>[...]</span></b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>IUGR</b> is fetal weight below 10% and is most commonly caused by <b><span class=cloze>placental insufficiency</span></b></div><br><br> <div class=extra><i><div></div><img src=""paste-1696971643420673.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>When in delivery indicated in an <b>IUGR</b> <b>fetus</b> with <b>oligohydramnios</b> or abnormal umbilical artery doppler studies?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>When in delivery indicated in an <b>IUGR</b> <b>fetus</b> with <b>oligohydramnios</b> or abnormal umbilical artery doppler studies?<div><br /></div><div><span class=cloze>36 weeks</span></div></div><br><br> <div class=extra></div> <div class=tags></div>
"<div class=card><b>IUGR fetuses</b> should be monitored <b>1-2 times <span class=cloze>[daily/weekly/monthly]</span> </b>with non-stress tests (<b>NST</b>), biophysical profile, amniotic fluid index (<b>AFI</b>), and umbilical artery doppler.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>IUGR fetuses</b> should be monitored <b>1-2 times <span class=cloze>weekly</span> </b>with non-stress tests (<b>NST</b>), biophysical profile, amniotic fluid index (<b>AFI</b>), and umbilical artery doppler.</div><br><br> <div class=extra></div> <div class=tags></div>
"<div class=card>third trimester bleeding mnemonic for questions to ask? <b>PPQRST</b>.<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>third trimester bleeding mnemonic for questions to ask? <b>PPQRST</b>.<div><br /></div><div><span class=cloze><img src=""paste-64888365907969.jpg"" /></span></div></div><br><br> <div class=extra></div> <div class=tags></div>"
"<div class=card>What kind of&nbsp;<u>vaginal exam</u>&nbsp;is indicated in&nbsp;<b>placenta previa</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What kind of&nbsp;<u>vaginal exam</u>&nbsp;is indicated in&nbsp;<b>placenta previa</b>?<div><br /></div><div><span class=cloze>Speculum examination (involves no risk of cervical penetration)</span></div></div><br><br> <div class=extra><ol type=""1"" start=""1""><li>Therefore, it is safe and can be used to verify and quantify vaginal bleeding in patients with placenta previa. &nbsp;</li><li><b>Digital cervical examination is contraindicated as it can lead to cervical penetration, placental disruption, and hemorrhage.</b></li></ol></div> <div class=tags></div>"
"<div class=card>Pt will <b>polyhydramnios</b> with rapid decompression of uterine cavity due to oxytocin use begins to bleed. Likely dx?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Pt will <b>polyhydramnios</b> with rapid decompression of uterine cavity due to oxytocin use begins to bleed. Likely dx?&nbsp;<div><br /></div><div><span class=cloze>Placental abruption</span></div></div><br><br> <div class=extra></div> <div class=tags></div>
"<div class=card>The <span class=cloze>[GYN region]</span> becomes <font color=""#ff0000"">hypervascular</font> in pregnancy.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The <span class=cloze>cervix</span> becomes <font color=""#ff0000"">hypervascular</font> in pregnancy.</div><br><br> <div class=extra><i>Thus, infections like cervicitis can lead to vaginal bleeding</i></div> <div class=tags></div>"
"<div class=card><b>Tocolysis</b> is used in PROM to delay delivery up to <span class=cloze>[...]</span> hours in order to administer <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>Tocolysis</b> is used in PROM to delay delivery up to <span class=cloze>48</span> hours in order to administer <span class=cloze>steroids</span></div><br><br> <div class=extra><i>to help with lung maturity, don't use more than 48 hours for possibility of chorio.</i></div> <div class=tags></div>
"<div class=card><b>variable decelerations</b> can be 2/2 <span class=cloze>[↑/↓]</span> amniotic fluid</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>variable decelerations</b> can be 2/2 <span class=cloze>↓</span> amniotic fluid</div><br><br> <div class=extra><i>after rupture of membranes → ↓ fluid → cord compression</i></div> <div class=tags></div>
"<div class=card><u>post</u>-term pregnancy → <span class=cloze>[...]</span>hydramnios</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>post</u>-term pregnancy → <span class=cloze>oligo</span>hydramnios</div><br><br> <div class=extra><i>later pregnancy &nbsp;→ crappy old placenta → uteroplacental insufficiency → redistribute blood to brain rather than peripheral tissues (e.g., <u>kidney</u> for amniotic fluid) → ↓ amniotic fluid volume</i><div><i><br /></i></div><div><i><img src=""paste-179671366893571.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>pregnancy dating </b>in women with <b>irregular</b> periods should be confirmed with <span class=cloze>[imaging]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>pregnancy dating </b>in women with <b>irregular</b> periods should be confirmed with <span class=cloze>first trimester ultrasound</span></div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card>post-term pregnancy &gt; 42 weeks with a <u>favorable</u> cervix = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>post-term pregnancy &gt; 42 weeks with a <u>favorable</u> cervix = <span class=cloze>induce labor</span></div><br><br> <div class=extra><i><u>unfavorable</u> cervix → antepartum fetal testing (twice weekly NST and AFI)</i></div> <div class=tags></div>
"<div class=card>Newborn is withered, meconium stained, long-nailed, fragile, and has small associated placenta.&nbsp;<div><br /></div><div>1) Likely dx?&nbsp;</div><div>2) What is the greatest risk factor for this?<div><br /></div><div><br /></div><div><span class=cloze>[...]</span><br /><br /></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Newborn is withered, meconium stained, long-nailed, fragile, and has small associated placenta.&nbsp;<div><br /></div><div>1) Likely dx?&nbsp;</div><div>2) What is the greatest risk factor for this?<div><br /></div><div><br /></div><div><span class=cloze>1) Fetal dysmaturity<div>2) Post-term birth</div></span><br /><br /></div></div></div><br><br> <div class=extra><i>due to age-related placental changes and resultant &nbsp;uteroplacental insufficiency.&nbsp;</i></div> <div class=tags></div>
"<div class=card>What is the first step in <u>induction</u> in pt with<b> closed cervix?</b><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the first step in <u>induction</u> in pt with<b> closed cervix?</b><div><br /></div><div><span class=cloze>Prostaglandin E1 tablet (misoprostol)</span></div></div><br><br> <div class=extra><i>followed by <b>oxytocin</b> when cervix is ripened</i><div><br /></div><div><img src=""paste-263758236614657.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>What GA is <b>vacuum aspiration</b> recommended by?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>What GA is <b>vacuum aspiration</b> recommended by?<div><br /></div><div><span class=cloze>8 weeks</span></div></div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card><font color=""#ff0000"">heavy bleeding</font> with retained product of conception (<b>POC</b>) post-termination of pregnancy = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">heavy bleeding</font> with retained product of conception (<b>POC</b>) post-termination of pregnancy = <span class=cloze>D&amp;C</span></div><br><br> <div class=extra><i>If tissue remains in the uterus (incomplete abortion), a repeat suction curettage is necessary</i></div> <div class=tags></div>"
"<div class=card><b>surgical abortion</b> should be accompanied with <span class=cloze>[...]</span> to <b>prevent infection.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>surgical abortion</b> should be accompanied with <span class=cloze>antibiotics</span> to <b>prevent infection.</b></div><br><br> <div class=extra><i>e.g, doxycycline</i></div> <div class=tags></div>
"<div class=card>Before abortion, do a <b>urine pregnancy test</b> and <span class=cloze>[imaging]</span> to verify <u>location and age</u> of gestation.&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Before abortion, do a <b>urine pregnancy test</b> and <span class=cloze>ultrasound</span> to verify <u>location and age</u> of gestation.&nbsp;</div><br><br> <div class=extra><i>determines best method of termination.</i></div> <div class=tags></div>
"<div class=card>Uncontrolled maternal diabetes = <span class=cloze>[...]</span>hydramnios</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Uncontrolled maternal diabetes = <span class=cloze>poly</span>hydramnios</div><br><br> <div class=extra><i>macrosomia, big, lots of fluid.&nbsp;</i></div> <div class=tags></div>
"<div class=card><b>painless cervical dilation</b>, in the absence of uterine contractions and/or labor, in the <b>second trimester</b> of pregnancy = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>painless cervical dilation</b>, in the absence of uterine contractions and/or labor, in the <b>second trimester</b> of pregnancy = <span class=cloze>cervical incompetence</span></div><br><br> <div class=extra><i><div></div></i><i>&lt; 25 cm cervical length + &gt; 3 preterm births.</i><div><i><br /></i><img src=""paste-339057603248129.jpg"" /><img src=""paste-2491776816381953.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b>breast engorgement </b>can cause a low-grade <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>breast engorgement </b>can cause a low-grade <span class=cloze>fever</span></div><br><br> <div class=extra><i><img src=""paste-42807939039233.jpg"" /></i></div> <div class=tags></div>"
Fetal complications of&nbsp;<b>maternal hypertension</b>&nbsp;include oligohydramnios, <span class=cloze>[...]</span>term delivery, and fetal growth restriction (size)"Fetal complications of&nbsp;<b>maternal hypertension</b>&nbsp;include oligohydramnios, <span class=cloze>pre</span>term delivery, and fetal growth restriction (size)<br> <div><i>- <b>small size </b>due to <u>uteroplacental insufficiency&nbsp;</u></i></div><div><i>- maternal complications include superimposed preeclampsia and placental abruption</i></div><div><i><br /></i></div><img src=""zzz (2).png"" />"
"<div class=card><b>Increased creatinine or LFTs </b>classifies pre-eclampsia as <span class=cloze>[category]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Increased creatinine or LFTs </b>classifies pre-eclampsia as <span class=cloze>severe</span></div><br><br> <div class=extra><img src=""precl.png"" /></div> <div class=tags></div>"
"<div class=card><b>Severe headache or visual changes&nbsp;</b>classifies pre-eclampsia as <span class=cloze>[category]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Severe headache or visual changes&nbsp;</b>classifies pre-eclampsia as <span class=cloze>severe</span></div><br><br> <div class=extra><img src=""precl.png"" /></div> <div class=tags></div>"
"<div class=card>methyldopa = <span class=cloze>[acute/chronic]</span> hypertension in pregnancy</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>methyldopa = <span class=cloze>chronic</span> hypertension in pregnancy</div><br><br> <div class=extra></div> <div class=tags></div>
"<div class=card><b>Category III</b> fetal heart tracing = intrauterine resuscitative intervention; if refractory do <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Category III</b> fetal heart tracing = intrauterine resuscitative intervention; if refractory do <span class=cloze>C-section</span></div><br><br> <div class=extra><b>IRI</b> = oxygen, repositioning, stop uterotonics.<div><br /></div><div><img src=""paste-393878565814275.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b>Category III</b> fetal heart tracing = <span class=cloze>[initial step]</span>; if refractory do C-section</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Category III</b> fetal heart tracing = <span class=cloze>intrauterine resuscitative intervention</span>; if refractory do C-section</div><br><br> <div class=extra><b>IRI</b> = oxygen, repositioning, stop uterotonics.<div><br /></div><div><img src=""paste-393878565814275.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b>Asherman syndrome (intrauterine synechiae)&nbsp;</b>&nbsp;is often the result of <b>intrauterine</b> <b>surgery</b> (e.g., myomectomy or&nbsp;<b>overaggressive</b>&nbsp;<span class=cloze>[...]</span>).</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Asherman syndrome (intrauterine synechiae)&nbsp;</b>&nbsp;is often the result of <b>intrauterine</b> <b>surgery</b> (e.g., myomectomy or&nbsp;<b>overaggressive</b>&nbsp;<span class=cloze>dilation and curettage (D&amp;C)</span>).</div><br><br> <div class=extra>scrape away basalis during uterine surgery (e.g., after abortion)<br /><div>synechiae is a term which means ""adhesions""&nbsp;</div><div><br /></div><div><img src=""CDR680398-571.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>oxytocin toxicity leading to hyponatremia can cause <span class=cloze>[neuro]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>oxytocin toxicity leading to hyponatremia can cause <span class=cloze>seizures</span></div><br><br> <div class=extra><b><div></div></b><b>oxytocin ~ ADH --&gt; hyponatremia</b><div><b><br /></b></div><img src=""hrm.png"" /></div> <div class=tags></div>"
"<div class=card>a <b>thin</b>&nbsp;endometrial stripe suggests an <span class=cloze>[...]</span> uterine cavity</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>a <b>thin</b>&nbsp;endometrial stripe suggests an <span class=cloze>empty</span> uterine cavity</div><br><br> <div class=extra><i>thus ruling out <b>retained placenta</b></i></div> <div class=tags></div>
"<div class=card>hCG = <span class=cloze>[↑↓↔]</span> thyroid function</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>hCG = <span class=cloze>↑</span> thyroid function</div><br><br> <div class=extra><i>- hCG is similar to TSH</i><div><i>- i.e.<b> hydatidiform mole </b>or choriocarcinoma (leads to <b>hyperthyroidism</b>)</i></div></div> <div class=tags></div>
"<div class=card><b>Twin pregnancies </b>increase the risk for <u>spontaneous</u> <span class=cloze>[...]</span> labor because of uterine <u>crowding</u> and <u>overdistension</u>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>Twin pregnancies </b>increase the risk for <u>spontaneous</u> <span class=cloze>preterm</span> labor because of uterine <u>crowding</u> and <u>overdistension</u>.</div><br><br> <div class=extra><i>- overdistension --&gt; stretch --&gt; increased <b>prostaglandins and oxytocin receptors </b>--&gt; increased contractility.&nbsp;</i><div><i>- also <u>medically required</u>&nbsp;for maternal (preeclampsia) and fetal (growth restriction) abnormalities.&nbsp;</i></div></div> <div class=tags></div>
"<div class=card>Delivery method of nonviable fetuses?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Delivery method of nonviable fetuses?<div><br /></div><div><span class=cloze>Vaginal delivery</span></div></div><br><br> <div class=extra><i>minimizes damage to mom</i><div><i><br /></i><div><i><img src=""paste-490717193437187.jpg"" /></i></div><div><i><br /></i></div></div></div> <div class=tags></div>"
"<div class=card>How do you manage <b>virilization</b> during pregnancy?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>How do you manage <b>virilization</b> during pregnancy?<div><br /></div><div><span class=cloze>Conservative</span></div></div><br><br> <div class=extra><div><div><i>symptoms and masses often spontaneously regress after delivery.</i></div><div><i><br /></i></div><div><i><img src=""this is gonna suck.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>Vaccinations recommended for&nbsp;<u>all</u>&nbsp;pregnant women during each pregnancy include&nbsp;<u>inactivated</u>&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;and <b>Tdap</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Vaccinations recommended for&nbsp;<u>all</u>&nbsp;pregnant women during each pregnancy include&nbsp;<u>inactivated</u>&nbsp;<b><span class=cloze>influenzae</span></b>&nbsp;and <b>Tdap</b>&nbsp;</div><br><br> <div class=extra><div><i>vaccination during the third trimester protects the mother against pertussis and provides passive immunity to the infant; live vaccines are contraindicated.</i></div><div><i><br /></i></div><img src=""hm (5).png"" /></div> <div class=tags></div>"
"<div class=card><u>Recurrent</u> pregnancy loss may be investigated with maternal <span class=cloze>[...]</span> studies.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>Recurrent</u> pregnancy loss may be investigated with maternal <span class=cloze>coagulation</span> studies.</div><br><br> <div class=extra><div><div><i>e.g., antiphospholipid antibody syndrome</i></div><div><i><img src=""paste-58140972285955_1529603012320.jpg"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>hydatidiform mole = <span class=cloze>[treatment]</span> to evacuate the uterus</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>hydatidiform mole = <span class=cloze>suction curettage</span> to evacuate the uterus</div><br><br> <div class=extra><div><div><i>- need <b>surgery</b> to <u>completely </u>evacuate the uterus (imagine sucking up a mole from the ground)</i></div><div><i>- follow with <b>hCG</b> levels.</i></div></div><div><i><br /></i></div><div><i><img src=""Suction+Curettage+Abortion.jpg"" /></i></div><div><i><img src=""paste-580404700512259.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[vitamin]</span>&nbsp;deficiency = Wernicke-Korsakoff syndrome</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>thiamine (B₁)</span>&nbsp;deficiency = Wernicke-Korsakoff syndrome</div><br><br> <div class=extra><img src=""paste-403482112688129.jpg"" /></div> <div class=tags></div>"
"<div class=card><u>When</u>&nbsp;during pregnancy does&nbsp;<b>acute fatty liver of pregnancy</b>&nbsp;occur?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>When</u>&nbsp;during pregnancy does&nbsp;<b>acute fatty liver of pregnancy</b>&nbsp;occur?<div><br /></div><div><span class=cloze>Third trimester&nbsp;<u>or early postpartum period</u></span></div></div><br><br> <div class=extra><img src=""paste-23553600651267_1496784870471.jpg"" /></div> <div class=tags></div>"
"<div class=card><b>Pre-eclampsia</b> at <b>&lt; 20 weeks</b> <b>gestation</b> with an <b>enlarged uterus </b>be a complication of <span class=cloze>[trophoblastic disease]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Pre-eclampsia</b> at <b>&lt; 20 weeks</b> <b>gestation</b> with an <b>enlarged uterus </b>be a complication of <span class=cloze>hydatidiform mole</span></div><br><br> <div class=extra><div><i>- abnormal placental spiral artery development →<b> maternal hypertension.</b></i></div><div><i>-<b> enlarged uterus </b>can present as a pelvic mass.</i></div><div><i><br /></i></div><img src=""interestin' last question.png"" /></div> <div class=tags></div>"
"<div class=card>T/F: Placental abruption can cause a variable amount of vaginal bleeding<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>T/F: Placental abruption can cause a variable amount of vaginal bleeding<div><br /></div><div><span class=cloze>T</span></div></div><br><br> <div class=extra>May be concealed<div><br /></div><div><img src=""paste-83580063580163.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b>ACE inhibitors and ARBs</b>&nbsp;are&nbsp;<u>contraindicated</u>&nbsp;during <span class=cloze>[...]</span> due to possible <span class=cloze>[...]</span> effects</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>ACE inhibitors and ARBs</b>&nbsp;are&nbsp;<u>contraindicated</u>&nbsp;during <span class=cloze>pregnancy</span> due to possible <span class=cloze>teratogenic</span> effects</div><br><br> <div class=extra><div><i><b>renal</b>&nbsp;malformations&nbsp;→ can't pee →&nbsp;<b>oligo</b>hydramnios → pulmonary <b>hypo</b>plasia + skeletal deformities (potter syndrome)&nbsp;**</i></div><div><i><br /></i></div><div><i><img src=""paste-345680442819054.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>HSV&nbsp;<b>lesions</b> during labor = <span class=cloze>[delivery method]</span><div><b>No lesions</b> during labor = <span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>HSV&nbsp;<b>lesions</b> during labor = <span class=cloze>C-section</span><div><b>No lesions</b> during labor = <span class=cloze>vaginal delivery</span></div></div><br><br> <div class=extra><div><b><i><img src=""paste-251968551387137 (1).jpg"" /></i></b></div></div> <div class=tags></div>"
"<div class=card><img src=""paste-345839356608513.jpg"" />&nbsp;<div><br /></div><div>Category <span class=cloze>[...]</span> heart tracing</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><img src=""paste-345839356608513.jpg"" />&nbsp;<div><br /></div><div>Category <span class=cloze>3</span> heart tracing</div></div><br><br> <div class=extra><div><i>intrauterine resuscitative intervention (oxygen, repositioning, stop uterotonics) → C-section</i></div><div><i><br /></i></div><div><b><i><img src=""paste-393878565814275.jpg"" /></i></b></div></div> <div class=tags></div>"
Complications of <u>inadequate weight gain</u>&nbsp;during pregnancy include&nbsp;fetal growth restriction and <b><span class=cloze>[...]</span>term delivery</b>&nbsp;"Complications of <u>inadequate weight gain</u>&nbsp;during pregnancy include&nbsp;fetal growth restriction and <b><span class=cloze>pre</span>term delivery</b>&nbsp;<br> <div><br /></div><img src=""ez (3).png"" />"
"<div class=card>T/F: Follow up abnormal first-trimester <u>combined</u> screen with <u>quadruple</u> screen.<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>T/F: Follow up abnormal first-trimester <u>combined</u> screen with <u>quadruple</u> screen.<div><br /></div><div><span class=cloze>F</span></div></div><br><br> <div class=extra><div><i>These are both <u>screening</u>&nbsp;tests but cannot <u>confirm</u>&nbsp;(need villus sampling / amniocentesis for that)</i></div><i><img src=""paste-454609403379713.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><div><span class=cloze>[...]</span>&nbsp;is a&nbsp;<u>mask-like</u>&nbsp;<b>hyperpigmentation of the cheeks</b>&nbsp;associated with&nbsp;<b>pregnancy</b>&nbsp;and&nbsp;<b>OCPs</b>&nbsp;</div><div><br /></div><div><img src=""paste-633460431520060.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div><span class=cloze><b>Melasma</b>&nbsp;(chloasma)</span>&nbsp;is a&nbsp;<u>mask-like</u>&nbsp;<b>hyperpigmentation of the cheeks</b>&nbsp;associated with&nbsp;<b>pregnancy</b>&nbsp;and&nbsp;<b>OCPs</b>&nbsp;</div><div><br /></div><div><img src=""paste-633460431520060.jpg"" /></div></div><br><br> <div class=extra><div><i>""melasma mask of pregnancy""&nbsp;- 2/2 ↑ estrogen/progesterone; this is <b>benign.</b></i></div><div><br /></div><div><img src=""paste-461064739225601.jpg"" /></div></div> <div class=tags></div>"
Patients in&nbsp;<u>preterm labor</u>&nbsp;at &lt; <span class=cloze>[...]</span> weeks should receive&nbsp;<b>corticosteroids</b> to <i>reduce</i> <i>risk</i> of <b>neonatal respiratory distress syndrome</b>&nbsp;"Patients in&nbsp;<u>preterm labor</u>&nbsp;at &lt; <span class=cloze>37</span> weeks should receive&nbsp;<b>corticosteroids</b> to <i>reduce</i> <i>risk</i> of <b>neonatal respiratory distress syndrome</b>&nbsp;<br> <div><i>e.g. </i><b style=""font-style: italic; "">betamethasone</b>&nbsp;</div><div><br /></div><img src=""ptl.png"" />"
"<div class=card><span class=cloze>[hormone]</span> is responsible for ↑ DVT risk</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>Estrogen</span> is responsible for ↑ DVT risk</div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i>Risk of clots increases substantially with combination of 3 things:</i><div><i><b>Estrogen</b> based contraception</i></div><div><i>Age &gt;<b> 35</b></i></div><div><i><b>Smoking</b></i></div><div><i><br /></i></div><img src=""paste-2682683817721857.jpg"" /></div> <div class=tags></div>"
"<div class=card><div>levonorgestrel (Plan B) = <span class=cloze>[drug class]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>levonorgestrel (Plan B) = <span class=cloze>progestin (<b>emergency</b> contraception)</span></div></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><div><i>stops ovulation.</i></div><i><img src=""dangit.png"" /><img src=""paste-996922038943745.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><div><img src=""https://ankiuser.net/study/media/paste-2834781494575105.jpg""><br></div><div><br></div><div>These are contraindications to <span class=cloze>[...]</span>-containing <b>contraeptives</b>.</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div><img src=""https://ankiuser.net/study/media/paste-2834781494575105.jpg""><br></div><div><br></div><div>These are contraindications to <span class=cloze>estrogen</span>-containing <b>contraeptives</b>.</div></div><br><br> <div class=extra><i><div></div></i><i><div></div></i></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>clinical use</u>&nbsp;of&nbsp;<b>ulipristal</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>clinical use</u>&nbsp;of&nbsp;<b>ulipristal</b>?<div><br /></div><div><span class=cloze>Emergency contraception (progesterone receptor modulator)</span></div></div><br><br> <div class=extra><i><div></div></i><i><div></div><div></div></i><i>prevents ovulation</i><div><i><br /></i></div><div><i><img src=""paste-2938565084315649.jpg"" /></i></div><div><i><br /></i></div><img src=""paste-996917743976449.jpg"" /><img src=""paste-425042848514051.jpg"" /></div> <div class=tags></div>"
"<div class=card>uterine fibroids in lower uterine segment during pregnancy &nbsp;--&gt; <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>uterine fibroids in lower uterine segment during pregnancy &nbsp;--&gt; <span class=cloze>C-section</span></div><br><br> <div class=extra><i>due to possibility of obstructing fetal head from entering pelvis</i></div> <div class=tags></div>
"<div class=card>itching + thick&nbsp;<font color=""#ff0000"">white</font>&nbsp;""<font color=""#ff0000"">cottage cheese</font>"" vaginal discharge&nbsp;= <span class=cloze>[infection]</span><div><br /></div><div><img src=""paste-1058142502780929.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>itching + thick&nbsp;<font color=""#ff0000"">white</font>&nbsp;""<font color=""#ff0000"">cottage cheese</font>"" vaginal discharge&nbsp;= <span class=cloze>candida albicans</span><div><br /></div><div><img src=""paste-1058142502780929.jpg"" /></div></div><br><br> <div class=extra><img src=""paste-1062012268314627.jpg"" /></div> <div class=tags></div>"
"<div class=card><b>pseudohyphae</b>&nbsp;on <u>KOH prep</u> in the cold = <span class=cloze>[fungus]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>pseudohyphae</b>&nbsp;on <u>KOH prep</u> in the cold = <span class=cloze>candida</span></div><br><br> <div class=extra><div><div>bottom right&nbsp;vs. germ tubes at 37 (top right)</div><div><img src=""paste-224004019322883.jpg"" /></div></div><div><br /></div><img src=""paste-1062012268314627.jpg"" /></div> <div class=tags></div>"
"<div class=card>Candida albicans&nbsp;<span class=cloze>[does/does not]</span> change the&nbsp;<u>vaginal pH</u></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Candida albicans&nbsp;<span class=cloze><b>does not</b></span> change the&nbsp;<u>vaginal pH</u></div><br><br> <div class=extra><div><b>normal vaginal pH: </b>4</div><div><br /></div><img src=""paste-17742509900195.jpg"" /><img src=""paste-18266495910306.jpg"" /></div> <div class=tags></div>"
"<div class=card>Drug of choice for candidal infections of&nbsp;<b>all&nbsp;</b>types?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Drug of choice for candidal infections of&nbsp;<b>all&nbsp;</b>types?<div><br /></div><div><span class=cloze>Fluconazole</span></div></div><br><br> <div class=extra><div>esophageal, oropharyngeal, vulvovaginal, urinary candidiasis, candidemia</div><img src=""Screen Shot 2017-03-25 at 2.53.43 PM.jpg"" /><img src=""Screen Shot 2017-03-25 at 3.12.53 PM.jpg"" /></div> <div class=tags></div>"
"<div class=card><b>Gardnerella Vaginalis</b>&nbsp;is characterized by a <b>fishy</b> smelling, <span class=cloze>[...]</span> (color)&nbsp;<i>discharge</i>&nbsp;<u>from the vagina</u></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Gardnerella Vaginalis</b>&nbsp;is characterized by a <b>fishy</b> smelling, <span class=cloze><i>grayish</i>-<i>white</i></span> (color)&nbsp;<i>discharge</i>&nbsp;<u>from the vagina</u></div><br><br> <div class=extra><img src=""paste-9088150798580.jpg"" /><img src=""dammit.png"" /></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span></b>&nbsp;is characterized by a <b>fishy</b> smelling, <i>grayish</i>-<i>white</i> (color)&nbsp;<i>discharge</i>&nbsp;<u>from the vagina</u></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Gardnerella Vaginalis</span></b>&nbsp;is characterized by a <b>fishy</b> smelling, <i>grayish</i>-<i>white</i> (color)&nbsp;<i>discharge</i>&nbsp;<u>from the vagina</u></div><br><br> <div class=extra><img src=""paste-9088150798580.jpg"" /><img src=""dammit.png"" /></div> <div class=tags></div>"
"<div class=card><i>Gardnerella vaginalis</i>&nbsp;<span class=cloze>[does/does not]</span> change the&nbsp;<u>vaginal pH</u></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><i>Gardnerella vaginalis</i>&nbsp;<span class=cloze><b>does</b></span> change the&nbsp;<u>vaginal pH</u></div><br><br> <div class=extra><div>normal vaginal pH: acidic, ~3.8-4.2 (avg: 4 pH)</div><div>in women, candida infections do not occur after 4 pH</div><img src=""paste-17742509900195.jpg"" /><img src=""paste-18270790877602.jpg"" /></div> <div class=tags></div>"
"<div class=card><span class=cloze>[<i>Candida albicans</i>&nbsp;or&nbsp;<i>Gardnerella vaginalis</i>]</span>&nbsp;<b>does</b> change the&nbsp;<u>vaginal pH</u></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze><i>Gardnerella vaginalis</i></span>&nbsp;<b>does</b> change the&nbsp;<u>vaginal pH</u></div><br><br> <div class=extra><div>normal vaginal pH: acidic, ~3.8-4.2 (avg: 4 pH)</div><div>in women, candida infections do not occur after 4 pH</div><img src=""paste-17742509900195.jpg"" /><img src=""paste-18270790877602.jpg"" /></div> <div class=tags></div>"
"<div class=card><b>Trichomonas Vaginalis</b>&nbsp;infection occurs in a&nbsp;<u>pH</u>&nbsp;of <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Trichomonas Vaginalis</b>&nbsp;infection occurs in a&nbsp;<u>pH</u>&nbsp;of <span class=cloze>&gt;4.5</span></div><br><br> <div class=extra><img src=""paste-20658792694149.jpg"" /></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>treatment</u>&nbsp;of&nbsp;<i>Trichomonas vaginalis</i>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>treatment</u>&nbsp;of&nbsp;<i>Trichomonas vaginalis</i>?<div><br /></div><div><span class=cloze>Metronidazole for <b><u>both partners</u></b></span></div></div><br><br> <div class=extra><div><br /></div><img src=""paste-66477503807961.jpg"" /><div><br /></div></div> <div class=tags></div>"
"<div class=card>candida, gardnerella, and trichomonas cause infections of the <span class=cloze>[vagina/cervix]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>candida, gardnerella, and trichomonas cause infections of the <span class=cloze>vagina</span></div><br><br> <div class=extra><b>cervix</b> = cervicitis, PID 2/2 gonorrhea or chlamydia<div><br /></div><div><img src=""90420767-vaginitis-is-an-inflammation-of-the-vagina-vaginal-infection-and-causative-agents-of-vulvovaginitis-.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>Cervical motion tenderness + mucopurulent/<font color=""#ff0000"">bloody </font>discharge without PID symptoms = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Cervical motion tenderness + mucopurulent/<font color=""#ff0000"">bloody </font>discharge without PID symptoms = <span class=cloze>cervicitis</span></div><br><br> <div class=extra><img src=""paste-346088464711681.jpg"" /><div><img src=""paste-3045819007631361.jpg"" /></div><div><br /></div></div> <div class=tags></div>"
"<div class=card><b>Cervicitis</b>&nbsp;is mainly caused by&nbsp;<u>which organisms</u>?<div><br /></div><div><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Cervicitis</b>&nbsp;is mainly caused by&nbsp;<u>which organisms</u>?<div><br /></div><div><div><span class=""clozed c1""><span class=cloze>Chlaymdia trachomatis</span></span></div><div><span class=""clozed c1""><span class=cloze>Neisseria gonorrhea</span></span></div></div></div><br><br> <div class=extra><img src=""paste-348077034569729.jpg"" /></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a woman that presents with&nbsp;<b>fever</b>,&nbsp;<b>lower abdominal pain</b>, and&nbsp;<b>purulent cervical discharge</b>? Physical exam reveals cervical motion tenderness.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a woman that presents with&nbsp;<b>fever</b>,&nbsp;<b>lower abdominal pain</b>, and&nbsp;<b>purulent cervical discharge</b>? Physical exam reveals cervical motion tenderness.&nbsp;<div><br /></div><div><span class=cloze>Pelvic inflammatory disease</span></div></div><br><br> <div class=extra><i>typically preceded by Neisseria gonorrhoeae or Chlamydia trachomatis cervicitis</i><div><div><i><b>cervicitis + fever/leukocytosis </b>due to ascending infection.</i><div><b><i><br /></i></b><div><i><img src=""acute-pid-pathology.jpg"" /><br /></i><div><i><img src=""i suk.png"" /></i></div></div></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>treatment</u>&nbsp;for&nbsp;<b>pelvic inflammatory disease</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>treatment</u>&nbsp;for&nbsp;<b>pelvic inflammatory disease</b>?<div><br /></div><div><span class=cloze>Ceftriaxone + azithromycin/doxycycline</span></div></div><br><br> <div class=extra><div><i>for&nbsp;<u>both</u>&nbsp;<b>Neisseria gonorrhea&nbsp;</b>and&nbsp;<b>Chlamydia trachomatis</b>&nbsp;coverage</i></div><div><i><br /></i></div><img src=""i suk.png"" /></div> <div class=tags></div>"
"<div class=card>Inpatient<font color=""#ff0000"">&nbsp;PID</font>&nbsp;therapy:<div><br /></div><div>1. cefoxitin/cefotetan</div><div>2. doxycycline</div><div><br /></div><div>OR&nbsp;</div><div><br /></div><div>1. <span class=cloze>[drug]</span></div><div>2. <span class=cloze>[drug]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Inpatient<font color=""#ff0000"">&nbsp;PID</font>&nbsp;therapy:<div><br /></div><div>1. cefoxitin/cefotetan</div><div>2. doxycycline</div><div><br /></div><div>OR&nbsp;</div><div><br /></div><div>1. <span class=cloze>clindamycin</span></div><div>2. <span class=cloze>gentamicin</span></div></div><br><br> <div class=extra><div>- cephalosporin (gonorrhea chandelier) + doxycycline (chlamydia) - ""foxy doxy""</div><div>- gently clean the uterus</div><div>- <b>inpatient</b> (vs. outpatient) treatment preferred in teenagers (lack of f/o) or severe symptoms (see below for example)</div><div><br /></div><div><br /></div><div><img src=""paste-3067598786789377.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>Outpatient&nbsp;<font color=""#ff0000"">PID</font>&nbsp;therapy:<div><br /></div><div>1. <span class=cloze>[drug]</span></div><div>2. <span class=cloze>[drug]</span></div><div>3.&nbsp;<span class=cloze>[drug]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Outpatient&nbsp;<font color=""#ff0000"">PID</font>&nbsp;therapy:<div><br /></div><div>1. <span class=cloze>ceftriaxone (or other ceph.)</span></div><div>2. <span class=cloze>doxycycline</span></div><div>3.&nbsp;<span class=cloze>metronidazole</span></div></div><br><br> <div class=extra>ceftriaxone for gonorrhea, doxycycline for chlamydia, metronidazole for other anaerobic vaginal flora</div> <div class=tags></div>"
"<div class=card><span class=cloze>[Anatomical location]</span> consists of&nbsp;<div><br /></div><div>labia majora, minora, vestibule of vagina, clitoris, and perineum.</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>Vulva</span> consists of&nbsp;<div><br /></div><div>labia majora, minora, vestibule of vagina, clitoris, and perineum.</div></div><br><br> <div class=extra><i></i><i><div><img src=""vulva_inside_article_contenful_2x.png"" /></div><div><img src=""paste-78623671320577.jpg"" /></div></i></div> <div class=tags></div>"
"<div class=card>thin, white vulvar lesions with parchment-like skin = <span class=cloze>[...]</span><div><br /></div><div><img src=""paste-13543161460686851.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>thin, white vulvar lesions with parchment-like skin = <span class=cloze>lichen sclerosis</span><div><br /></div><div><img src=""paste-13543161460686851.jpg"" /></div></div><br><br> <div class=extra><i></i><i><div></div></i><i><div></div></i><i>itchy → scratch → inflammation → ↑ risk of SCC</i><div><i>necessary to confirm the diagnosis and rule out vulvar squamous cell carcinoma</i></div><div><i><br /></i></div><div><i><img src=""LS.png"" /></i></div><div><i><br /></i></div><div><i><br /></i></div><div><img src=""paste-13542040474222593.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>next step&nbsp;</i>in management for a woman that presents with a&nbsp;<u>thin, white plaque</u>&nbsp;suspicious for&nbsp;<b>lichen</b>&nbsp;<b>sclerosus (itchy!)?</b><div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""paste-13543161460686851.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>next step&nbsp;</i>in management for a woman that presents with a&nbsp;<u>thin, white plaque</u>&nbsp;suspicious for&nbsp;<b>lichen</b>&nbsp;<b>sclerosus (itchy!)?</b><div><br /></div><div><span class=cloze>Vulvar punch biopsy</span></div><div><br /></div><div><img src=""paste-13543161460686851.jpg"" /></div></div><br><br> <div class=extra><i></i><i><div></div></i><i><div></div></i><i>itchy → scratch → inflammation → ↑ risk of SCC</i><div><i>necessary to confirm the diagnosis and rule out vulvar squamous cell carcinoma</i></div><div><i><br /></i></div><div><i><img src=""LS.png"" /></i></div><div><i><br /></i></div><div><i><br /></i></div><div><img src=""paste-13542040474222593.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>Patient presents with pruritic, purple, polygonal planar papules, and plaques<div><br /></div><div><img src=""paste-6980786439847937.jpg"" /><img src=""paste-176192443383811.jpg"" /></div><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Patient presents with pruritic, purple, polygonal planar papules, and plaques<div><br /></div><div><img src=""paste-6980786439847937.jpg"" /><img src=""paste-176192443383811.jpg"" /></div><div><br /></div><div><span class=cloze>Lichen planus</span></div></div><br><br> <div class=extra><span style=""font-weight: bold""><div><b>P of Planus</b></div><div><b><br /></b></div><div><b><img src=""dpg140006fa.png"" /></b></div><div><b><br /></b></div><div><b><img src=""paste-726669811777537.jpg"" /><br /><div><img src=""msd.PNG"" /></div><div><img src=""paste-2325600236732417.jpg"" /></div><div><br /></div></b></div></span></div> <div class=tags></div>"
"<div class=card><b>Lichen simplex chronicus</b>&nbsp;presents as&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;with&nbsp;<b>thick</b>, leathery&nbsp;vulvar skin</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Lichen simplex chronicus</b>&nbsp;presents as&nbsp;<b><span class=cloze>leukoplakia</span></b>&nbsp;with&nbsp;<b>thick</b>, leathery&nbsp;vulvar skin</div><br><br> <div class=extra><i>""chronic"" scratching → hyperplasia</i><div><i>contrast with lichen sclerosus (<b>thin, white</b>)</i></div><div><img src=""paste-8837762794913793.jpg"" /><img src=""paste-989899767414785.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b>Lichen simplex chronicus</b>&nbsp;presents as&nbsp;<b>leukoplakia</b>&nbsp;with&nbsp;<span class=cloze>[...]</span>&nbsp;vulvar skin</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Lichen simplex chronicus</b>&nbsp;presents as&nbsp;<b>leukoplakia</b>&nbsp;with&nbsp;<span class=cloze><b>thick</b>, leathery</span>&nbsp;vulvar skin</div><br><br> <div class=extra><i>""chronic"" scratching → hyperplasia</i><div><i>contrast with lichen sclerosus (<b>thin, white</b>)</i></div><div><img src=""paste-8837762794913793.jpg"" /><img src=""paste-989899767414785.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b>Lichen <span class=cloze>[...]</span></b>&nbsp;presents as&nbsp;<b>leukoplakia</b>&nbsp;with&nbsp;<b>thick</b>, leathery&nbsp;vulvar skin</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Lichen <span class=cloze>simplex chronicus</span></b>&nbsp;presents as&nbsp;<b>leukoplakia</b>&nbsp;with&nbsp;<b>thick</b>, leathery&nbsp;vulvar skin</div><br><br> <div class=extra><i>""chronic"" scratching → hyperplasia</i><div><i>contrast with lichen sclerosus (<b>thin, white</b>)</i></div><div><img src=""paste-8837762794913793.jpg"" /><img src=""paste-989899767414785.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>chronic vulvar ""burning"" or soreness that is triggered by touch/pressure (e.g., sex) = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>chronic vulvar ""burning"" or soreness that is triggered by touch/pressure (e.g., sex) = <span class=cloze>vulvodynia</span></div><br><br> <div class=extra><div><i><b>conservative </b>treeatment -&nbsp;pelvic floor therapy, topical anesthetics.&nbsp;</i></div><div><i><br /></i></div><img src=""vulvar_anatomy.jpg"" /></div> <div class=tags></div>"
"<div class=card><b>primary</b> herpes infections are usually preceded by <span class=cloze>[...]</span>-like symptoms preceding genital lesions.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>primary</b> herpes infections are usually preceded by <span class=cloze>viral</span>-like symptoms preceding genital lesions.</div><br><br> <div class=extra><i>and <b>tender</b> inguinal lymph nodes.</i></div> <div class=tags></div>
"<div class=card>HbSAg (+) post-exposure prophylaxis = <span class=cloze>[...]</span><div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>HbSAg (+) post-exposure prophylaxis = <span class=cloze>HbIg + vaccination</span><div><br /></div></div><br><br> <div class=extra></div> <div class=tags></div>
On pap smear, how do you describe <b>squamous epithelial cell abnormalities</b> that are <u>atypical</u>, but <u>not adequate</u> to determine significance?<div><br /></div><div><span class=cloze>[...]</span></div>"On pap smear, how do you describe <b>squamous epithelial cell abnormalities</b> that are <u>atypical</u>, but <u>not adequate</u> to determine significance?<div><br /></div><div><span class=cloze>ASCUS</span></div><hr> <div class=mystyle1><img src=""paste-213094802391041.jpg"" /></div> "
What is the <u>next best step</u> in management if you have a <b>positive <u>endo</u>cervix finding</b> upon colposcopy?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <u>next best step</u> in management if you have a <b>positive <u>endo</u>cervix finding</b> upon colposcopy?<div><br /></div><div><span class=cloze>Cone biopsy</span></div><hr> <div class=mystyle1><div><i>Cone goes deeper to endocervix</i></div><i><img src=""paste-8529805050558.jpg"" /><br /></i><div><i><br /></i></div><div><i>Positive curettage findings: do cone biopsy</i></div><div><i>Positive biopsy findings: do local ablation therapy (cryotherapy or LEEP)</i></div></div> "
What is the&nbsp;<u>next best step</u>&nbsp;in management if you have a&nbsp;<b>positive ectocervix finding</b>&nbsp;and <u>negative endocervix finding</u>&nbsp;upon colposcopy?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the&nbsp;<u>next best step</u>&nbsp;in management if you have a&nbsp;<b>positive ectocervix finding</b>&nbsp;and <u>negative endocervix finding</u>&nbsp;upon colposcopy?<div><br /></div><div><span class=cloze>local destruction (LEEP/Cryo)</span></div><hr> <div class=mystyle1><div><i>only on outside, so can destroy (vs. cone biopsy for endo)</i></div><i><img src=""paste-8525510083262.jpg"" /><br /></i><div><i><br /></i></div><div><i>Positive curettage findings: cone biopsy</i></div><div><i>Positive biopsy findings: local ablation therapy (cryotherapy or LEEP)</i></div></div> "
"What is the&nbsp;<u>next best step</u>&nbsp;in management if you have an abnormal&nbsp;<b>pap smear</b>? (not ASCUS)<div><br></div><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div>""What is the&nbsp;<u>next best step</u>&nbsp;in management if you have an abnormal&nbsp;<b>pap smear</b>? (not ASCUS)<div><br></div><div><span class=""clozed c1""><span class=cloze><b>colposcopy</b> to get <u>ecto</u>cervical <i>biopsy</i> and <u>endo</u>cervical <i>curettage</i></span></span></div><hr> <div class=mystyle1><img src=""paste-8525510083262.jpg""><br><div><br></div><div><i>General rule of thumb with ASCUS:&nbsp;</i></div><div><i>IF your next step of management yields normal result, you can go back to doing pap smear every 3 years.&nbsp;</i></div><div><i>IF your next step of management yields abnormal results, do colposcopy.</i></div></div> "
"<div class=card><div>What is the&nbsp;<b>#1</b>&nbsp;<b>risk factor</b>&nbsp;for&nbsp;<b>cervical&nbsp;</b><b>carcinoma</b>?&nbsp;</div><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>What is the&nbsp;<b>#1</b>&nbsp;<b>risk factor</b>&nbsp;for&nbsp;<b>cervical&nbsp;</b><b>carcinoma</b>?&nbsp;</div><div><br /></div><div><span class=cloze>multiple sexual partners (→ high risk HPV 16/18/31/33)</span></div></div><br><br> <div class=extra><i>other:</i><div><i><br /></i><div><i><b>smoking</b></i></div><div><i>starting&nbsp;<b>sexual</b>&nbsp;intercourse at a&nbsp;<b>young</b>&nbsp;age</i></div><div><i><b>immunodeficiency</b>&nbsp;(e.g.&nbsp;HIV infection)</i></div><div><br /></div><div><img src=""Screen Shot 2017-03-01 at 6.05.14 PM.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card>The quadrivalent vaccine&nbsp;Gardasil protects against&nbsp;<font color=""#ff0000"">HPV</font>&nbsp;types <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The quadrivalent vaccine&nbsp;Gardasil protects against&nbsp;<font color=""#ff0000"">HPV</font>&nbsp;types <span class=cloze>6,11,16,18</span></div><br><br> <div class=extra><div>the ones outside the fence (31,33) and 1-4 are not protected</div><div><br /></div><img src=""Screen Shot 2017-03-01 at 5.58.46 PM.jpg"" /></div> <div class=tags></div>"
"<div class=card><div>What is the extent of&nbsp;<b>epithelial involvement</b>&nbsp;by&nbsp;<b>immature&nbsp;<i>dysplastic cells</i>&nbsp;</b>in&nbsp;<b>cervical&nbsp;carcinoma in situ</b>?&nbsp;</div><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>What is the extent of&nbsp;<b>epithelial involvement</b>&nbsp;by&nbsp;<b>immature&nbsp;<i>dysplastic cells</i>&nbsp;</b>in&nbsp;<b>cervical&nbsp;carcinoma in situ</b>?&nbsp;</div><div><br /></div><div><span class=cloze>the&nbsp;<u>entire</u>&nbsp;thickness of the epithelium</span></div></div><br><br> <div class=extra><div><div><i><div style=""display: inline !important; ""><img src=""paste-4768839627702275.jpg"" /></div></i></div></div></div> <div class=tags></div>"
"<div class=card>what bad habit can increase the risk of <b>cervical cancer?</b><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>what bad habit can increase the risk of <b>cervical cancer?</b><div><br /></div><div><span class=cloze>smoking</span></div></div><br><br> <div class=extra><i>HPV is necessary but not sufficient; other factors like smoking/immunosuppression speed things up by allowing <b>persistent HPV infection.</b></i><div><br /></div></div> <div class=tags></div>
"<div class=card><b>Endometrial hyperplasia</b>&nbsp;is usually caused by&nbsp;<b>unopposed</b>&nbsp;<span class=cloze>[...]</span>, seen in obese women</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Endometrial hyperplasia</b>&nbsp;is usually caused by&nbsp;<b>unopposed</b>&nbsp;<span class=cloze>estrogen</span>, seen in obese women</div><br><br> <div class=extra><i></i><i>unopposed estrogen without progesterone = proliferate!</i><div><i><br /></i></div><div><i><img src=""paste-10979220603797505.jpg"" /><br /><div></div></i><i><br /></i></div><div><i><b>obesity (↑ fat)&nbsp;</b>= ↑ androgen → estrogen conversion (aromatase)</i></div><div><i><br /></i></div><div><i></i><i><b>PCOS (also fat)&nbsp;</b>=&nbsp;&nbsp;↑↑ estrone production from adipose tissue (proliferative phase)</i>&nbsp;and lack of progesterone (due to ↓ FSH → no luteal phase): overall, continual&nbsp;<u>proliferation</u>&nbsp;without shedding!</div><div><br /><div><img src=""paste-9953371960115203.jpg"" /></div></div><div><br /></div><div><div><img src=""paste-10774767275606017.jpg"" /></div><div><br /></div><img src=""paste-10775987046318083.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>granulosa cell tumor = ↑ <span class=cloze>[hormone]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>granulosa cell tumor = ↑ <span class=cloze>estrogen</span></div><br><br> <div class=extra><div>↑ risk of endometrial hyperplasia</div><br /></div> <div class=tags></div>
"<div class=card>The three types of <b>ovarian</b> <b>cancers</b> can be classified into the three cell types, which are <span class=cloze>[...]</span>, stromal, and germ cell.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The three types of <b>ovarian</b> <b>cancers</b> can be classified into the three cell types, which are <span class=cloze>epithelial</span>, stromal, and germ cell.</div><br><br> <div class=extra><div><br /></div><img src=""paste-220666829733889.jpg"" /><div><img src=""paste-220684009603073.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>The three types of <b>ovarian</b> <b>cancers</b> can be classified into the three cell types, which are epithelial, <span class=cloze>[...]</span>, and germ cell.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The three types of <b>ovarian</b> <b>cancers</b> can be classified into the three cell types, which are epithelial, <span class=cloze>stromal</span>, and germ cell.</div><br><br> <div class=extra><div><br /></div><img src=""paste-220666829733889.jpg"" /><div><img src=""paste-220684009603073.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><div>What serum tumor marker is useful for monitoring&nbsp;<b>treatment response</b>&nbsp;and&nbsp;<b>recurrence</b>&nbsp;of&nbsp;<b><u>epithelial</u>&nbsp;ovarian cancer</b>?&nbsp;</div><div><b><br /></b></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>What serum tumor marker is useful for monitoring&nbsp;<b>treatment response</b>&nbsp;and&nbsp;<b>recurrence</b>&nbsp;of&nbsp;<b><u>epithelial</u>&nbsp;ovarian cancer</b>?&nbsp;</div><div><b><br /></b></div><div><span class=cloze>CA-125</span></div></div><br><br> <div class=extra><i></i><i>may also be used as part of the initial workup for&nbsp;<u><b>post</b>menopausal</u>&nbsp;women with suspected ovarian cancer because the other conditions that cause elevated CA-125 are <b>pre</b>-menopausal conditions (endometriosis, fibroids)</i><div><i><br /></i></div><div><i></i><i><img src=""epithel ovarian carc.png"" /></i><br /><div><br /></div><div><img src=""paste-748810368188417.jpg"" /><img src=""paste-8392366096385.jpg"" /><img src=""paste-1038261099167745.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card>T/F: <u>Simple</u> ovarian cysts are usually <u>not</u> treated.<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>T/F: <u>Simple</u> ovarian cysts are usually <u>not</u> treated.<div><br /></div><div><span class=cloze>T</span></div></div><br><br> <div class=extra><i>mostly <b>asymptomatic</b>; complex cysts are usually removed; OCPs may help prevent formation of new cysts by inhibiting ovulation.</i><div><br /></div><div><img src=""paste-2873320236122113.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>Diagnosis of a <b>mole or choriocarcinoma</b> is with b-HCG levels and <span class=cloze>[imaging]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Diagnosis of a <b>mole or choriocarcinoma</b> is with b-HCG levels and <span class=cloze>TVUS</span></div><br><br> <div class=extra><i><b>- b-HCG</b> levels higher than expected ( &gt; 100,000) with ""<b>snowstorm</b>"" pattern for complete mole or <b>fetal parts </b>with partial mole; <u>only</u> <b>b-hCG</b> is required for diagnosis.</i><div><i><br /></i></div><div><i><img src=""paste-129141076656129.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>Diagnosis of a <b>mole or choriocarcinoma</b> is with <span class=cloze>[...]</span> levels and TVUS</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Diagnosis of a <b>mole or choriocarcinoma</b> is with <span class=cloze>b-HCG</span> levels and TVUS</div><br><br> <div class=extra><i><b>- b-HCG</b> levels higher than expected ( &gt; 100,000) with ""<b>snowstorm</b>"" pattern for complete mole or <b>fetal parts </b>with partial mole; <u>only</u> <b>b-hCG</b> is required for diagnosis.</i><div><i><br /></i></div><div><i><img src=""paste-129141076656129.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[Complete/partial]</span> mole has fetal parts</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>Partial</span> mole has fetal parts</div><br><br> <div class=extra><div><i>Partial/Part</i></div><div><i>This means that there may be a fetus (although abnormal looking)</i></div><i><img src=""paste-1620697319211009.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">46 XX</font><font color=""#ff0000"">&nbsp;or XY</font>&nbsp;mole = <span class=cloze>[partial/complete]</span> hydatidiform mole<div><font color=""#ff0000"">69 XXY</font>&nbsp;mole = <span class=cloze>[partial/complete]</span> hydatidiform mole</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">46 XX</font><font color=""#ff0000"">&nbsp;or XY</font>&nbsp;mole = <span class=cloze>complete</span> hydatidiform mole<div><font color=""#ff0000"">69 XXY</font>&nbsp;mole = <span class=cloze>partial</span> hydatidiform mole</div></div><br><br> <div class=extra><div><div>two sperm fertilizes empty egg - “<b>completely</b>” from dad (46 chromosomes)</div><div><div><img src=""Molar pregnancy.png"" /></div><div><img src=""paste-1366035823329281.jpg"" /></div></div></div><img src=""paste-1620697319211009.jpg"" /></div> <div class=tags></div>"
"<div class=card>In areas with&nbsp;<u>no prenatal care</u>, a&nbsp;<b>hydatidiform mole</b>&nbsp;presents in the 2nd trimester with&nbsp;<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In areas with&nbsp;<u>no prenatal care</u>, a&nbsp;<b>hydatidiform mole</b>&nbsp;presents in the 2nd trimester with&nbsp;<span class=cloze>passage of&nbsp;<b>grape-like masses</b>&nbsp;(large, edematous villi) through the vaginal canal</span></div><br><br> <div class=extra><div><i>also called ""honeycombed"" uterus</i></div><div><img src=""paste-114963389612622.jpg"" /></div><div><br /></div></div> <div class=tags></div>"
"<div class=card>""<font color=""#ff0000"">snowstorm</font>"" on uterine ultrasound = <span class=cloze>[condition]</span><div><br /></div><div><img src=""paste-115672059216293.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>""<font color=""#ff0000"">snowstorm</font>"" on uterine ultrasound = <span class=cloze><u>complete</u> hydatidiform mole</span><div><br /></div><div><img src=""paste-115672059216293.jpg"" /></div></div><br><br> <div class=extra><div>snowstorm</div><div><br /></div><div><img src=""paste-413695544918017.jpg"" /></div><img src=""paste-1366035823329281.jpg"" /></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">DES</font>&nbsp;exposure in utero = <span class=cloze>[neoplasm]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">DES</font>&nbsp;exposure in utero = <span class=cloze>clear cell adenocarcinoma (vagina)</span></div><br><br> <div class=extra>DES =&nbsp;diethylstilbestrol (synthetic estrogen)</div> <div class=tags></div>"
"<div class=card><b>Vulvar cancer </b>(squamous, melanoma) are treated with <span class=cloze>[first line treatment]</span> +/- LN dissection</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>Vulvar cancer </b>(squamous, melanoma) are treated with <span class=cloze>vulvectomy</span> +/- LN dissection</div><br><br> <div class=extra></div> <div class=tags></div>
"<div class=card>↑↑↑&nbsp;<font color=""#ff0000"">hCG</font>&nbsp;= <span class=cloze>[partial/complete]</span> hydatidiform mole</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>↑↑↑&nbsp;<font color=""#ff0000"">hCG</font>&nbsp;= <span class=cloze>complete</span> hydatidiform mole</div><br><br> <div class=extra><div>Complete, more, high</div><div><img src=""paste-1620697319211009.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><u>persistent</u> molar pregnancy is more likely in <span class=cloze>[complete/partial]</span> moles</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>persistent</u> molar pregnancy is more likely in <span class=cloze>complete</span> moles</div><br><br> <div class=extra><div><i>i.e., persistent after curettage due to retained tissue or mets; complete, more, high</i></div><div><i><img src=""paste-1620697319211009.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the likely <u>diagnosis</u> in this patient with <b>vulvar itchiness, intermittent <font color=""#ff0000"">bleeding</font>, and a <u>unifocal, friable</u> mass?</b><div><div><br /></div><div><span class=cloze>[...]</span><br /><div><br /></div><div><img src=""paste-237180978987009.jpg"" /></div></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely <u>diagnosis</u> in this patient with <b>vulvar itchiness, intermittent <font color=""#ff0000"">bleeding</font>, and a <u>unifocal, friable</u> mass?</b><div><div><br /></div><div><span class=cloze>Vulvar cancer</span><br /><div><br /></div><div><img src=""paste-237180978987009.jpg"" /></div></div></div></div><br><br> <div class=extra><div><i><br /></i></div><div><i><img src=""paste-2735215562719233.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>Infection with <span class=cloze>[virus]</span> increases risk of vulvar cancer.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Infection with <span class=cloze>HPV</span> increases risk of vulvar cancer.</div><br><br> <div class=extra><div><i>same as cervical cancer risk factors (e.g.,&nbsp;<b>smoking</b>)</i></div><div><i><br /></i></div><div><i><img src=""paste-247102353440769.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">anterior</font>&nbsp;vaginal wall prolapse = <span class=cloze>[condition]</span><div><br /></div><div><img src=""paste-1697508514332673.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">anterior</font>&nbsp;vaginal wall prolapse = <span class=cloze>cystocele</span><div><br /></div><div><img src=""paste-1697508514332673.jpg"" /></div></div><br><br> <div class=extra>due to&nbsp;<b>pelvic floor dysfunction</b></div> <div class=tags></div>"
<b>Stress urinary incontinence</b>&nbsp;is often associated with <b>urethral hyper-mobility </b>or <span class=cloze>[...]</span> <b>urethral sphincter</b> tone."<b>Stress urinary incontinence</b>&nbsp;is often associated with <b>urethral hyper-mobility </b>or <span class=cloze>decreased</span> <b>urethral sphincter</b> tone.<br> <i>push more pee out due to too much movement or less blockage on the way out</i><div><i><br></i><div><i><img src=""afdgdhj.png""></i></div><div><i><img src=""paste-1251626484498435.jpg""></i></div></div>"
<div><b><span class=cloze>[...]</span> incontinence</b>&nbsp;is characterized by&nbsp;<u>leakage</u>&nbsp;when there is an&nbsp;<i>increased</i>&nbsp;<b>intra-abdominal pressure</b>&nbsp;(e.g. sneezing, lifting)</div> "<div><b><span class=cloze>Stress</span> incontinence</b>&nbsp;is characterized by&nbsp;<u>leakage</u>&nbsp;when there is an&nbsp;<i>increased</i>&nbsp;<b>intra-abdominal pressure</b>&nbsp;(e.g. sneezing, lifting)</div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><div><div><b>Stress </b>= think of things that put “stress” and force pee out</div></div><div><img src=""paste-1251626484498435.jpg"" /></div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3075909548507139.jpg"" /><div><br /></div></div> "
<div><b>Stress incontinence</b>&nbsp;is characterized by&nbsp;<u>leakage</u>&nbsp;when there is an&nbsp;<i>increased</i>&nbsp;<b><span class=cloze>[...]</span> pressure</b>&nbsp;(e.g. sneezing, lifting)</div> "<div><b>Stress incontinence</b>&nbsp;is characterized by&nbsp;<u>leakage</u>&nbsp;when there is an&nbsp;<i>increased</i>&nbsp;<b><span class=cloze>intra-abdominal</span> pressure</b>&nbsp;(e.g. sneezing, lifting)</div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><div><div><b>Stress </b>= think of things that put “stress” and force pee out</div></div><div><img src=""paste-1251626484498435.jpg"" /></div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3075909548507139.jpg"" /><div><br /></div></div> "
<div>Vaginal delivery, prostate surgery, and obesity&nbsp;<u>increase</u>&nbsp;risk for&nbsp;<b><span class=cloze>[...]</span> incontinence</b>&nbsp;&nbsp;</div> "<div>Vaginal delivery, prostate surgery, and obesity&nbsp;<u>increase</u>&nbsp;risk for&nbsp;<b><span class=cloze>stress</span> incontinence</b>&nbsp;&nbsp;</div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><div><div><b>Stress </b>= think of things that put “stress” and force pee out</div></div><div><br /></div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3075909548507139.jpg"" /></div> "
<div><b><span class=cloze>[...]</span> incontinence</b>&nbsp;is due to&nbsp;<u>outlet&nbsp;incompetence</u>&nbsp;(e.g. urethral hypermobility or intrinsic sphincteric deficiency)&nbsp;</div> "<div><b><span class=cloze>Stress</span> incontinence</b>&nbsp;is due to&nbsp;<u>outlet&nbsp;incompetence</u>&nbsp;(e.g. urethral hypermobility or intrinsic sphincteric deficiency)&nbsp;</div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><i>e.g., when intraabdominal pressure &gt; sphincter pressure (<b>urethral</b> <b>hypermobility</b> means the urethra itself moves a lot due to weakened pelvic floor muscles, leading to inability to properly compress and close the urethra)</i><div><div><div><br /></div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3075909548507139.jpg"" /></div></div></div> "
<div><b><span class=cloze>[...]</span> incontinence</b>&nbsp;is associated with a&nbsp;<u>positive</u>&nbsp;<b>bladder stress test</b>&nbsp;</div> "<div><b><span class=cloze>Stress</span> incontinence</b>&nbsp;is associated with a&nbsp;<u>positive</u>&nbsp;<b>bladder stress test</b>&nbsp;</div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><i>i.e. leakage from urethra upon&nbsp;</i><u style=""font-style: italic; "">coughing</u><i>&nbsp;or&nbsp;</i><u style=""font-style: italic; "">Valsalva maneuver</u>&nbsp;<div><br /></div><div><div><div><b>Stress&nbsp;</b>= think of things that put “stress” and force pee out</div></div><div><br /></div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3075909548507139.jpg"" /></div></div> "
<div><b>Stress incontinence</b>&nbsp;is associated with a&nbsp;<u>positive</u>&nbsp;<b><span class=cloze>[...]</span> stress test</b>&nbsp;</div> "<div><b>Stress incontinence</b>&nbsp;is associated with a&nbsp;<u>positive</u>&nbsp;<b><span class=cloze>bladder</span> stress test</b>&nbsp;</div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><i>i.e. leakage from urethra upon&nbsp;</i><u style=""font-style: italic; "">coughing</u><i>&nbsp;or&nbsp;</i><u style=""font-style: italic; "">Valsalva maneuver</u>&nbsp;<div><br /></div><div><div><div><b>Stress&nbsp;</b>= think of things that put “stress” and force pee out</div></div><div><br /></div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3075909548507139.jpg"" /></div></div> "
<div>Treatment for&nbsp;<b>stress incontinence</b>&nbsp;includes&nbsp;<i>strengthening</i></div><div>&nbsp;<span class=cloze>[...]</span>&nbsp;<b>muscles</b>&nbsp;(e.g. Kegels)&nbsp;</div><div><br /></div><div><br /></div> "<div>Treatment for&nbsp;<b>stress incontinence</b>&nbsp;includes&nbsp;<i>strengthening</i></div><div>&nbsp;<span class=cloze><b>pelvic</b>&nbsp;<b>floor/external sphincter</b></span>&nbsp;<b>muscles</b>&nbsp;(e.g. Kegels)&nbsp;</div><div><br /></div><div><br /></div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><div><div><b>Stress&nbsp;</b>= think of things that put “stress” and force pee out</div></div><div><br /></div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3075909548507139.jpg"" /></div> "
<div>Treatment for&nbsp;<b>stress incontinence</b>&nbsp;may include <span class=cloze>[lifestyle modification]</span> and&nbsp;<u>pessaries</u>&nbsp;</div> "<div>Treatment for&nbsp;<b>stress incontinence</b>&nbsp;may include <span class=cloze>weight loss</span> and&nbsp;<u>pessaries</u>&nbsp;</div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><i>a pessary is a&nbsp;device that is inserted into the vagina to support the uterus</i>&nbsp;<div><br /></div><div><div><div><i><b>Stress&nbsp;</b>= think of things that put “stress” and force pee out</i></div></div><div><br /></div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3075909548507139.jpg"" /></div></div> "
<div><b><span class=cloze>[...]</span> incontinence</b>&nbsp;is due to an&nbsp;<u>overactive bladder</u>&nbsp;due to&nbsp;<b>detrusor muscle</b>&nbsp;<b>hyperactivity.</b></div> "<div><b><span class=cloze>Urge</span> incontinence</b>&nbsp;is due to an&nbsp;<u>overactive bladder</u>&nbsp;due to&nbsp;<b>detrusor muscle</b>&nbsp;<b>hyperactivity.</b></div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><i>thus, also known as ""overactive bladder syndrome""</i>&nbsp;<div><br /></div><div><div><i>“Urgent and Overactive Detrusor”&nbsp;</i></div><div><br /></div><div><img src=""Urinary incontinence differential.png"" /></div><div><br /></div><div><img src=""paste-3077060599742467.jpg"" /></div></div></div> "
<div>Treatment for&nbsp;<b>urgency incontinence&nbsp;</b>includes <u>anti-muscarinics</u>&nbsp;and&nbsp;<span class=cloze>[...]</span><u>&nbsp;training</u>&nbsp;(timed voiding, distraction, or relaxation techniques)&nbsp;</div> "<div>Treatment for&nbsp;<b>urgency incontinence&nbsp;</b>includes <u>anti-muscarinics</u>&nbsp;and&nbsp;<span class=cloze><u>bladder</u></span><u>&nbsp;training</u>&nbsp;(timed voiding, distraction, or relaxation techniques)&nbsp;</div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><div>“Urgent and Overactive Detrusor;"" timed voiding involves scheduled bathroom breaks to prevent peeing all over the place!</div><div><br /></div><div><img src=""paste-1268836418453507.jpg"" /></div><div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3077060599742467.jpg"" /></div></div> "
<div><b>Urge incontinence</b>&nbsp;may be treated with&nbsp;<u>anti-muscarinics</u>, such as&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;</div> "<div><b>Urge incontinence</b>&nbsp;may be treated with&nbsp;<u>anti-muscarinics</u>, such as&nbsp;<b><span class=cloze>oxybutynin</span></b>&nbsp;</div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><i>decreases parasympathetic tone of the detrusor muscle so it's not as overactive.</i><div><i>“Urgent and Overactive Detrusor”</i><br /><div><img src=""paste-65953517797962.jpg"" /><img src=""paste-1268836418453507.jpg"" /></div><div><div><br /></div><div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3077060599742467.jpg"" /></div></div></div></div> "
<div><b><span class=cloze>[...]</span> incontinence</b>&nbsp;is due to&nbsp;<u>incomplete emptying</u>, due to detrusor <u>under</u>activity or outlet obstruction&nbsp;</div> "<div><b><span class=cloze>Overflow</span> incontinence</b>&nbsp;is due to&nbsp;<u>incomplete emptying</u>, due to detrusor <u>under</u>activity or outlet obstruction&nbsp;</div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><div><div><i><b>overflow</b> = think of things that stop outflow and cause overflow; e.g., due to MS, <b>diabetes</b>, BPH.&nbsp;</i></div></div><div><i><br /></i></div><i><img src=""Urinary incontinence differential.png"" /><img src=""paste-3091538934497283.jpg"" /></i></div> "
<div><b>Overflow incontinence</b>&nbsp;is associated with&nbsp;<u>increased</u>&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;on catheterization or ultrasound&nbsp;</div> "<div><b>Overflow incontinence</b>&nbsp;is associated with&nbsp;<u>increased</u>&nbsp;<b><span class=cloze>post-void residual (urinary retention)</span></b>&nbsp;on catheterization or ultrasound&nbsp;</div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><div><div><b>Overflow</b>&nbsp;= think of things that stop outflow and cause overflow - therefore there's more urine leftover</div></div><div><br /></div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3091538934497283.jpg"" /></div> "
<div><b><span class=cloze>[...]</span> incontinence</b>&nbsp;is associated with&nbsp;<u>increased</u>&nbsp;<b>post-void residual (urinary retention)</b>&nbsp;on catheterization or ultrasound&nbsp;</div> "<div><b><span class=cloze>Overflow</span> incontinence</b>&nbsp;is associated with&nbsp;<u>increased</u>&nbsp;<b>post-void residual (urinary retention)</b>&nbsp;on catheterization or ultrasound&nbsp;</div><br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><div><div><b>Overflow</b>&nbsp;= think of things that stop outflow and cause overflow - therefore there's more urine leftover</div></div><div><br /></div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3091538934497283.jpg"" /></div> "
Treatment for&nbsp;<b>overflow incontinence</b>&nbsp;includes <span class=cloze>[...]</span> and/or&nbsp;<u>relief of obstruction</u>&nbsp;(e.g.&nbsp;α-blockers for BPH) "Treatment for&nbsp;<b>overflow incontinence</b>&nbsp;includes <span class=cloze><u>catheterization</u></span> and/or&nbsp;<u>relief of obstruction</u>&nbsp;(e.g.&nbsp;α-blockers for BPH)<br> <br> <div style='font-family: Arial;font-style: italic; font-size: 20px;'><div><div><b>Overflow</b>&nbsp;= think of things that stop outflow and cause overflow - since outflow is blocked we must get a vacuum to suck the pee out!</div></div><div><br /></div><img src=""Urinary incontinence differential.png"" /><img src=""paste-3091538934497283.jpg"" /></div> "
"<div class=card><span class=cloze>[...]</span> bladder is&nbsp;<b>inflammation of the bladder</b>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>Irritative</span> bladder is&nbsp;<b>inflammation of the bladder</b>.</div><br><br> <div class=extra><i>Think of stones, cancers, or UTIs. In other words, cystitis!</i><div><i><br /></i></div><div><i><img src=""paste-1011791215722497.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What&nbsp;<u>pelvic surgery complication</u>&nbsp;is characterized by&nbsp;<b><u>continuous</u> involuntary loss of urine</b>&nbsp;through the vagina in the absence of other urinary symptoms?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What&nbsp;<u>pelvic surgery complication</u>&nbsp;is characterized by&nbsp;<b><u>continuous</u> involuntary loss of urine</b>&nbsp;through the vagina in the absence of other urinary symptoms?<div><br /></div><div><span class=cloze>Vesicovaginal fistula</span></div></div><br><br> <div class=extra><div><i>may present within a month after surgery;&nbsp;<b>dye</b>&nbsp;<b>tests</b>&nbsp;and/or&nbsp;<b>cystourethroscopy</b>&nbsp;can help identify small fistulas not seen on visual inspection</i></div><div><i><br /></i></div><div><img src=""vvf.png"" /></div><img src=""that would suck -.png"" /></div> <div class=tags></div>"
"<div class=card>What&nbsp;<i>pharmacologic agent</i>&nbsp;may be used in the treatment of&nbsp;<b>overflow incontinence</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What&nbsp;<i>pharmacologic agent</i>&nbsp;may be used in the treatment of&nbsp;<b>overflow incontinence</b>?<div><br /></div><div><span class=cloze>Cholinergic agonists (e.g. bethanecol)</span></div></div><br><br> <div class=extra><div><i>more PNS squeezing out pee.</i></div><div><i><br /></i></div><img src=""paste-497155349414377.jpg"" /><img src=""good start.png"" /></div> <div class=tags></div>"
"<div class=card>mirabegron =&nbsp;<span class=cloze>[drug class]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>mirabegron =&nbsp;<span class=cloze>β₃&nbsp;agonist (overactive bladder)</span></div><br><br> <div class=extra><div><i>in those who cannot tolerate anti-muscarinics (e.g., narrow angle glaucoma)</i></div><i><br /></i><div><i><img src=""paste-60511794233345.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>uterosacral nodularity = <span class=cloze>[diagnosis&nbsp;]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>uterosacral nodularity = <span class=cloze>endometriosis</span></div><br><br> <div class=extra><div><img src=""afp19991015p1753-f1.jpg"" /></div><img src=""afp19991015p1753-f4.jpg"" /><div><br /></div><div><br /></div></div> <div class=tags></div>"
"<div class=card>endometriosis = <span class=cloze>[increased/decreased]</span> fertility</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>endometriosis = <span class=cloze>decreased</span> fertility</div><br><br> <div class=extra><i>2/2 adhesions&nbsp;</i></div> <div class=tags></div>
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a&nbsp;<u>female</u>&nbsp;with&nbsp;<b>bladder pain</b>&nbsp;that is&nbsp;<b><u>relieved</u> with voiding</b>, as well as<b>&nbsp;</b>dyspareunia,&nbsp;urinary frequency/urgency, and&nbsp;<b>normal urinalysis</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a&nbsp;<u>female</u>&nbsp;with&nbsp;<b>bladder pain</b>&nbsp;that is&nbsp;<b><u>relieved</u> with voiding</b>, as well as<b>&nbsp;</b>dyspareunia,&nbsp;urinary frequency/urgency, and&nbsp;<b>normal urinalysis</b>?<div><br /></div><div><span class=cloze>Interstitial cystitis (painful bladder syndrome)</span></div></div><br><br> <div class=extra><i>treatment is&nbsp;<u>palliative</u>&nbsp;and includes trigger avoidance, amitriptyline, and analgesics</i><div><i><br /></i><div><i><img src=""uwot (1).png"" /></i></div></div><div><i><br /></i></div><div><i><img src=""paste-2986698782801921.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>post-operative pelvic pain = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>post-operative pelvic pain = <span class=cloze>pelvic adhesive disease</span></div><br><br> <div class=extra><i>2/2 postoperative infection / adhesions / tubal damage</i></div> <div class=tags></div>
"<div class=card>(+)&nbsp;<font color=""#ff0000"">Carnett</font>&nbsp;sign (pain with abdominal contraction) = <span class=cloze>[condition]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>(+)&nbsp;<font color=""#ff0000"">Carnett</font>&nbsp;sign (pain with abdominal contraction) = <span class=cloze>abdominal wall pain</span></div><br><br> <div class=extra><u>MSK</u> vs. visceral pain; treat <u>MSK</u> pain with <b>physical therapy / exercise;</b>&nbsp;imagine a&nbsp;<b>car</b>&nbsp;ramming straight into your&nbsp;<b>abdomen</b><div><b><br /></b></div><div><b><img src=""technique-n.jpg"" /></b></div></div> <div class=tags></div>"
"<div class=card>irregular enlargement of uterus = <span class=cloze>[diagnosis]</span><div>enlarged boggy uterus = <span class=cloze>[diagnosis]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>irregular enlargement of uterus = <span class=cloze>fibroids</span><div>enlarged boggy uterus = <span class=cloze>adenomyosis</span></div></div><br><br> <div class=extra><img src=""paste-443932114681857.jpg"" /></div> <div class=tags></div>"
"<div class=card>How do OCPs decrease dysmenorrhea?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>How do OCPs decrease dysmenorrhea?<div><br /></div><div><span class=cloze>The progestin causes<b> endometrial atrophy </b>causing fewer <b>prostaglandins</b> to be produced by endometrium</span></div></div><br><br> <div class=extra><i><img src=""paste-440440306270209.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><span class=cloze>[...]</span> dysmenorrhea is menstrual pain secondary to conditions like endometriosis, adenomyosis, fibroids, or PID.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><span class=cloze>secondary</span> dysmenorrhea is menstrual pain secondary to conditions like endometriosis, adenomyosis, fibroids, or PID.</div><br><br> <div class=extra><i>vs. <u>primary</u> dysmenorrhea - normal physical exam.</i></div> <div class=tags></div>
"<div class=card>The risk of developing&nbsp;<u>breast cancer</u>&nbsp;is directly correlated with&nbsp;<i>lifetime exposure</i>&nbsp;to&nbsp;<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The risk of developing&nbsp;<u>breast cancer</u>&nbsp;is directly correlated with&nbsp;<i>lifetime exposure</i>&nbsp;to&nbsp;<span class=cloze>estrogen</span></div><br><br> <div class=extra><div><i>e.g.&nbsp;<u>increased</u>&nbsp;risk with&nbsp;<b>nulliparity</b>,&nbsp;<b>early</b>&nbsp;<b>menarche</b>,&nbsp;<b>late</b>&nbsp;<b>menopause</b>,&nbsp;<b>obesity</b>, <b>HRT (<u>not</u>&nbsp;OCPs)</b></i></div><div><b><i><br /></i></b><div><i><img src=""dang (3).png"" /></i></div></div><div><i><br /></i></div><img src=""120133_Breast Cancer_091317-edit.png"" /></div> <div class=tags></div>"
"<div class=card>screening&nbsp;modality for<font color=""#ff0000"">&nbsp;</font>breast cancer for pt w/&nbsp;<b>normal risk<font color=""#ff0000"">&nbsp;</font></b>= <span class=cloze>[...]</span><div><br /><div>screening modality for breast cancer for pt w/&nbsp;<b>high risk</b>&nbsp;(family hx, radiation)&nbsp;= <span class=cloze>[...]</span></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>screening&nbsp;modality for<font color=""#ff0000"">&nbsp;</font>breast cancer for pt w/&nbsp;<b>normal risk<font color=""#ff0000"">&nbsp;</font></b>= <span class=cloze><b>mammography</b></span><div><br /><div>screening modality for breast cancer for pt w/&nbsp;<b>high risk</b>&nbsp;(family hx, radiation)&nbsp;= <span class=cloze>MRI</span></div></div></div><br><br> <div class=extra></div> <div class=tags></div>"
"<div class=card><u>&lt;30 y.o.</u> with with breast lump, initially <b>reassurance (watch/wait);</b>&nbsp;if it persists, then get an <span class=cloze>[Imaging]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>&lt;30 y.o.</u> with with breast lump, initially <b>reassurance (watch/wait);</b>&nbsp;if it persists, then get an <span class=cloze>ultrasound</span></div><br><br> <div class=extra><div>- IF <b>cyst</b>&nbsp;→ needle aspiration</div><div>- IF<b> mass or blood or recurrance or &gt; 30</b>&nbsp;→ mammogram / core biopsy route</div><div><br /></div><div><i><img src=""okaay...png"" /></i></div><img src=""120133_Breast Cancer_091317-edit.png"" /></div> <div class=tags></div>"
"<div class=card>a <b>sentinel</b> lymph node biopsy should be done <span class=cloze>[before/after]</span> an <b>axillary</b> lymph node biopsy to determine <b>stage </b>of cancer.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>a <b>sentinel</b> lymph node biopsy should be done <span class=cloze>before</span> an <b>axillary</b> lymph node biopsy to determine <b>stage </b>of cancer.</div><br><br> <div class=extra><div>less risk of lymphedema</div><div>if sentinel is (-) then others likely (-) too</div><img src=""120133_Breast Cancer_091317-edit.png"" /></div> <div class=tags></div>"
"<div class=card>Best&nbsp;<u>initial</u>&nbsp;treatment for breast cancer is&nbsp;<span class=cloze>[...]</span> + <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Best&nbsp;<u>initial</u>&nbsp;treatment for breast cancer is&nbsp;<span class=cloze>lumpectomy</span> + <span class=cloze>radiation</span></div><br><br> <div class=extra><div>- Get lymph node <b>biopsy</b> <b>first</b> (sentinel LN → axillary LN)</div><div>- Much less deforming than modified radical <b>mastectomy</b> with equal efficacy.&nbsp;<b>Radiation is essential in preventing recurrence at the breast.</b></div><img src=""120133_Breast Cancer_091317-edit.png"" /></div> <div class=tags></div>"
"<div class=card><b>HER2/neu (+) </b>breast cancer treatment and side effect?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>HER2/neu (+) </b>breast cancer treatment and side effect?<div><br /></div><div><span class=cloze>Trastuzumab (herceptin); <u>reversible&nbsp;</u>cardiotoxicity</span></div></div><br><br> <div class=extra><div><br /></div><img src=""paste-29407641076204.jpg"" /><img src=""paste-268748988612609.jpg"" /></div> <div class=tags></div>"
"<div class=card>late,&nbsp;<b><u>dose</u>-</b>dependent,&nbsp;<u>irreversible&nbsp;</u><b>dilated cardiomyopathy</b>?&nbsp;<span class=cloze>[doxorubicin or trastuzumab]</span><div>early,&nbsp;<b><u>dose</u>-</b>independent,&nbsp;<u>reversible&nbsp;</u><b>dilated cardiomyopathy</b>?&nbsp;<span class=cloze>[doxorubicin or trastuzumab]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>late,&nbsp;<b><u>dose</u>-</b>dependent,&nbsp;<u>irreversible&nbsp;</u><b>dilated cardiomyopathy</b>?&nbsp;<span class=cloze>Doxorubicin</span><div>early,&nbsp;<b><u>dose</u>-</b>independent,&nbsp;<u>reversible&nbsp;</u><b>dilated cardiomyopathy</b>?&nbsp;<span class=cloze>trastuzumab</span></div></div><br><br> <div class=extra><div>- Once you jump off the dock, it's irreversible death.</div><div>-&nbsp;<b>Dexrazoxane</b>&nbsp;is an iron chelator that prevents cardiotoxicity from rubicin</div><div><br /></div><img src=""paste-93102006075875.jpg"" /><div><img src=""paste-95288144429532.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>All <u><b>ER+ and/or PR+</b></u> breast cancers should receive&nbsp;<span class=cloze>[<u>pre</u>-menopause]</span> or&nbsp;<b>aromatase inhibitors</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>All <u><b>ER+ and/or PR+</b></u> breast cancers should receive&nbsp;<span class=cloze>tamoxifen/raloxifen <b>(SERMs)</b></span> or&nbsp;<b>aromatase inhibitors</b></div><br><br> <div class=extra><div>aromatase inhibitors&nbsp;<div style=""display: inline !important; "">block&nbsp;<u style=""font-weight: bold; "">peripheral</u>&nbsp;conversion of T --&gt; E</div></div><div><div style=""display: inline !important; "">only works if your ovaries aren't producing E</div></div><div><br /></div><div><img src=""paste-504572757934081.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>All <u><b>ER+ and/or PR+</b></u> breast cancers should receive&nbsp;tamoxifen/raloxifen <b>(SERMs)</b> or&nbsp;<span class=cloze>[<u>post</u>-menopause &nbsp;]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>All <u><b>ER+ and/or PR+</b></u> breast cancers should receive&nbsp;tamoxifen/raloxifen <b>(SERMs)</b> or&nbsp;<span class=cloze><b>aromatase inhibitors</b></span></div><br><br> <div class=extra><div>aromatase inhibitors&nbsp;<div style=""display: inline !important; "">block&nbsp;<u style=""font-weight: bold; "">peripheral</u>&nbsp;conversion of T --&gt; E</div></div><div><div style=""display: inline !important; "">only works if your ovaries aren't producing E</div></div><div><br /></div><div><img src=""paste-504572757934081.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[Tamoxifen/Raloxifen]</span></b>&nbsp;is an&nbsp;<u>antagonist</u>&nbsp;at&nbsp;<b>breast&nbsp;</b>and an&nbsp;<u>agonist</u>&nbsp;at&nbsp;<b>bone and uterus</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Tamoxifen</span></b>&nbsp;is an&nbsp;<u>antagonist</u>&nbsp;at&nbsp;<b>breast&nbsp;</b>and an&nbsp;<u>agonist</u>&nbsp;at&nbsp;<b>bone and uterus</b>&nbsp;</div><br><br> <div class=extra><div>↑ risk of <b>endometrial</b> <b>cancer</b> and<b> DVT</b> vs. raloxifene</div><img src=""paste-280555853709313.jpg"" /></div> <div class=tags></div>"
"<div class=card><b><i>BRCA</i>-positive individuals</b>&nbsp;are recommended to have a <span class=cloze>[...]</span> to&nbsp;<u>decrease incidence</u>&nbsp;of&nbsp;<b>ovarian</b>&nbsp;<b>cancer and breast cancer</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><i>BRCA</i>-positive individuals</b>&nbsp;are recommended to have a <span class=cloze>prophylactic <b>bi</b>lateral <u>mastectomy</u> + <u>salpingo-oophorectomy</u></span> to&nbsp;<u>decrease incidence</u>&nbsp;of&nbsp;<b>ovarian</b>&nbsp;<b>cancer and breast cancer</b></div><br><br> <div class=extra><i>recommended as soon as childbearing is complete; may cause side effects from&nbsp;<b>surgical</b>&nbsp;<b>menopause</b></i><div><i><img src=""ovarian cancer wow.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>In the patient with a&nbsp;<b>breast lump</b>; if the <b>ultrasound</b> shows a(n) <span class=cloze>[...]</span>, the aspirate is <span class=cloze>[...]</span>, the&nbsp;<u>cyst recurs</u>, or she’s older than <span class=cloze>[...]</span> years old; go to the&nbsp;<u>mammogram</u>&nbsp;and&nbsp;<u>core needle&nbsp;biopsy</u> route</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In the patient with a&nbsp;<b>breast lump</b>; if the <b>ultrasound</b> shows a(n) <span class=cloze><u>mass</u></span>, the aspirate is <span class=cloze><u>bloody</u></span>, the&nbsp;<u>cyst recurs</u>, or she’s older than <span class=cloze><u>30</u></span> years old; go to the&nbsp;<u>mammogram</u>&nbsp;and&nbsp;<u>core needle&nbsp;biopsy</u> route</div><br><br> <div class=extra><div><br /></div><img src=""paste-9285719294638.jpg"" /></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>breast lump</b>&nbsp;in a patient under 30?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>breast lump</b>&nbsp;in a patient under 30?<div><br /></div><div><span class=cloze>Reassurance</span></div></div><br><br> <div class=extra><div>Watch and wait to see if the lump goes away</div><img src=""paste-9285719294638.jpg"" /></div> <div class=tags></div>"
"<div class=card><u><b>&lt; 30 y.o.</b></u>&nbsp;woman&nbsp;with with breast lump, initially&nbsp;<b>reassurance (watch/wait);</b>&nbsp;if it persists, then get an <span class=cloze>[Imaging]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u><b>&lt; 30 y.o.</b></u>&nbsp;woman&nbsp;with with breast lump, initially&nbsp;<b>reassurance (watch/wait);</b>&nbsp;if it persists, then get an <span class=cloze>ultrasound</span></div><br><br> <div class=extra><i><div></div></i><i><img src=""paste-9285719294638.jpg"" /></i><br /></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>persistent</b>&nbsp;<b>breast lump</b>&nbsp;that&nbsp;<u>resembles a cyst</u>&nbsp;on ultrasound in a patient under 30?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in working up a&nbsp;<b>persistent</b>&nbsp;<b>breast lump</b>&nbsp;that&nbsp;<u>resembles a cyst</u>&nbsp;on ultrasound in a patient under 30?<div><br /></div><div><span class=cloze>Aspirate</span></div></div><br><br> <div class=extra><i><div></div></i><i><img src=""paste-9285719294638.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>Which gynecological cancer presents with&nbsp;<b>bloating,</b>&nbsp;<b>lower abdominal pain/pressure, and urinary frequency/urgency?</b><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which gynecological cancer presents with&nbsp;<b>bloating,</b>&nbsp;<b>lower abdominal pain/pressure, and urinary frequency/urgency?</b><div><br /></div><div><span class=cloze>Ovarian cancer</span></div></div><br><br> <div class=extra><i>pain/pressure 2/2 ascites; other symptoms include <b>early satiety, indigestion, back pain, dysparenuia, constipation, menstrual irregularities.&nbsp;</b></i><div><i><b><br /></b></i></div><div><i><b></b></i><i><img src=""epithel ovarian carc.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>OCPs </b>are contraindicated up to 4 weeks after pregnancy because of increased risk of <span class=cloze>[...]</span>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>OCPs </b>are contraindicated up to 4 weeks after pregnancy because of increased risk of <span class=cloze>DVTs</span>.</div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
<b>Female puberty</b> occurs through the <u>following stages</u>:<div><br /></div><div><span class=cloze>[...]</span> at 8 years</div><div><span class=cloze>[...]</span> at 9 years</div><div><span class=cloze>[...]</span> at 10 years</div><div><span class=cloze>[...]</span> at 11 years</div>"<b>Female puberty</b> occurs through the <u>following stages</u>:<div><br /></div><div><span class=cloze>Breasts (<u>The</u>larche)</span> at 8 years</div><div><span class=cloze><u>A</u>xillary hair (<u>A</u>drenarche)</span> at 9 years</div><div><span class=cloze>Growth spurt</span> at 10 years</div><div><span class=cloze><font color=""#ff0000"">Menarche</font></span> at 11 years</div><hr> <div class=mystyle1><i>8 = ""The"" two breasts</i><div><i>Hairy Cat</i></div><div><i>Imagine 10 toes growing toenails</i></div><div><i>Skiis poking vagina (also 11/51 for puberty/menopause)<br /></i><div><i><br /></i></div></div></div> "
<span class=cloze>[...]</span> is when patient presents with <u>secondary sex characteristics</u> <b>before age 8</b> in girls (or 9 in boys)."<span class=cloze>Precocious puberty</span> is when patient presents with <u>secondary sex characteristics</u> <b>before age 8</b> in girls (or 9 in boys).<hr> <div class=mystyle1><img src=""paste-37873021616964.jpg"" /></div> "
The <u>first test</u> to order for <b>precocious puberty</b> is <span class=cloze>[...]</span>."The <u>first test</u> to order for <b>precocious puberty</b> is <span class=cloze>wrist X-ray</span>.<hr> <div class=mystyle1><div><i>IF the <b>bone age &gt; patient's age </b>by at least 2 years, move on to second test, which is <b>measuring LH level / GnRH stimulation test.&nbsp;</b></i></div><div><i><br /></i></div><div><i>IF the bone age is at the appropriate age, diagnosis is simply either premature thelarche or premature adrenarche depending on your physical exam findings.&nbsp;</i></div><div><i><br /></i></div><img src=""paste-65854733549569.jpg"" /><img src=""big_5939744306ae0.jpg"" /></div> "
<b><span class=cloze>[...]</span> precocious puberty</b> is diagnosed when <b>leuprolide (GnRH stimulation)</b> causes an <u>increase in LH production</u>."<b><span class=cloze>Central</span> precocious puberty</b> is diagnosed when <b>leuprolide (GnRH stimulation)</b> causes an <u>increase in LH production</u>.<hr> <div class=mystyle1><div><i>Here, it implies that there's a premature activation of the hypothalamic pituitary axis. You might have to suspect cancer as a possible cause of this, and thus order an MRI.</i></div><div><i><br /></i></div><img src=""paste-65850438582273.jpg"" /><img src=""paste-37873021616964.jpg"" /></div> "
What is the <u>next step in management</u> for <b>precocious puberty</b> if the&nbsp;pulsatile&nbsp;<u>GnRH</u> stimulation test <u>increases LH levels</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"What is the <u>next step in management</u> for <b>precocious puberty</b> if the&nbsp;pulsatile&nbsp;<u>GnRH</u> stimulation test <u>increases LH levels</u>?<div><br /></div><div><span class=cloze>Brain MRI</span></div><hr> <div class=mystyle1><i>You suspect a tumor. So find the tumor, and resect it.</i><div><i><br /></i></div><div><i>If you DON'T find any tumor, diagnosis is constitutional precocious puberty and treat with continuous use of leuprolide.</i></div><div><i><br /></i></div><div><i><img src=""paste-65850438582273.jpg"" /><img src=""paste-37873021616964.jpg"" /></i></div></div> "
What is the&nbsp;<u>next step in management</u>&nbsp;for&nbsp;<b>precocious puberty</b>&nbsp;if the&nbsp;pulsatile&nbsp;<u>GnRH</u> stimulation test&nbsp;<u>increases LH levels</u>, but the <u>MRI is negative</u>?<div><br /></div><div><div>Treat with&nbsp;<span class=cloze>[...]</span></div></div>"What is the&nbsp;<u>next step in management</u>&nbsp;for&nbsp;<b>precocious puberty</b>&nbsp;if the&nbsp;pulsatile&nbsp;<u>GnRH</u> stimulation test&nbsp;<u>increases LH levels</u>, but the <u>MRI is negative</u>?<div><br /></div><div><div>Treat with&nbsp;<span class=cloze>continuous leuprolide</span></div></div><hr> <div class=mystyle1><div><i><b>constitutional</b> precocious puberty to turn off the axis.</i></div><div><i><br /></i></div><i><img src=""paste-65850438582273.jpg"" /><img src=""paste-37873021616964.jpg"" /></i></div> "
<b><span class=cloze>[...]</span> precocious puberty</b>&nbsp;is diagnosed when&nbsp;<b>leuprolide (GnRH stimulation)</b>&nbsp;causes&nbsp;<u>no change in&nbsp;LH production</u>."<b><span class=cloze>Peripheral</span> precocious puberty</b>&nbsp;is diagnosed when&nbsp;<b>leuprolide (GnRH stimulation)</b>&nbsp;causes&nbsp;<u>no change in&nbsp;LH production</u>.<hr> <div class=mystyle1><div><i>There will be low FSH/LH levels due to <b>negative</b> <b>feedback</b> from peripherally produced high estrogen/testosterone levels.&nbsp;</i></div><div><i><br /></i></div><img src=""paste-65850438582273.jpg"" /><div><br /></div><div><img src=""big_5939744306ae0.jpg"" /></div></div> "
<b>Delayed puberty</b> is the <u>lack of secondary sex characteristics</u> by age <span class=cloze>[...]</span> or <u>lack of menses</u> by age <span class=cloze>[...]</span>."<b>Delayed puberty</b> is the <u>lack of secondary sex characteristics</u> by age <span class=cloze>13</span> or <u>lack of menses</u> by age <span class=cloze>15</span>.<hr> <div class=mystyle1><i>Dx is with wrist x-ray and a biochemical profile of FSH/LH, just like <b>precocious</b> <b>puberty</b>!</i><div><i><br /></i></div><div><i><img src=""paste-39625368273560.jpg"" /></i></div></div> "
"<div class=card>In&nbsp;<b>gonadotropin-</b><b>independent</b>&nbsp;(<b>peripheral</b>)&nbsp;<b>precocious puberty</b>, LH levels are <span class=cloze>[<i>high or low</i>]</span> at baseline and <span class=cloze>[...]</span> increase with a&nbsp;<b>GnRH</b>&nbsp;<b>agonist.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In&nbsp;<b>gonadotropin-</b><b>independent</b>&nbsp;(<b>peripheral</b>)&nbsp;<b>precocious puberty</b>, LH levels are <span class=cloze><u>low</u></span> at baseline and <span class=cloze><u>do NOT</u></span> increase with a&nbsp;<b>GnRH</b>&nbsp;<b>agonist.</b></div><br><br> <div class=extra><div><i>caused by <b>gonadal or adrenal </b>release of excess estrogen and testosterone, resulting in low LH due to negative feedback; diagnose this with lab testing and abdominal-pelvic ultrasound looking for the source of sex hormones (e.g., adrenals, ovary).</i></div><div><br /></div><div><img src=""paste-1412296916074497.jpg"" /></div><div><i><br /></i></div>/<img src=""big_5939744306ae0.jpg"" /><img src=""hmmmm.png"" /><div><br /></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>most likely</i>&nbsp;<i>diagnosis</i>&nbsp;in for&nbsp;<b>precocious puberty</b>&nbsp;in patient with....<div><br /><div><b><span class=cloze>[Normal/Advanced]</span> bone age</b>: Premature thelarche or adrenarche</div><div><br /></div><div><b><span class=cloze>[...]</span> bone age</b>: Peripheral PC (<i><u>low</u>&nbsp;LH</i>), Central PC (<i><u>high</u>&nbsp;LH</i>)</div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>most likely</i>&nbsp;<i>diagnosis</i>&nbsp;in for&nbsp;<b>precocious puberty</b>&nbsp;in patient with....<div><br /><div><b><span class=cloze>Normal</span> bone age</b>: Premature thelarche or adrenarche</div><div><br /></div><div><b><span class=cloze>Advanced</span> bone age</b>: Peripheral PC (<i><u>low</u>&nbsp;LH</i>), Central PC (<i><u>high</u>&nbsp;LH</i>)</div></div></div><br><br> <div class=extra><div><i>excess androgens → ↑ bone age</i></div><i><img src=""PrecociousPuberty.png"" /></i></div> <div class=tags></div>"
"<div class=card>Treatment of&nbsp;<u>congenital adrenal hyperplasia</u>&nbsp;= <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Treatment of&nbsp;<u>congenital adrenal hyperplasia</u>&nbsp;= <span class=cloze>low dose exogenous corticosteroids</span></div><br><br> <div class=extra>low dose steroids → (-) feedback → ↓ ACTH → ↓ stimulation of adrenal cortex → ↓ androgen production by cortex (e.g., in 21-hydroxylase deficiency)<div><br /></div><div><img src=""paste-15410712025235457.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a healthy&nbsp;12-year-old male that presents with&nbsp;<b>delayed</b>&nbsp;<b>growth</b>&nbsp;<b>spurt</b>,&nbsp;<b>delayed puberty</b>, and&nbsp;<b><u>delayed</u>&nbsp;bone age</b>?<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""asdsfs.png"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a healthy&nbsp;12-year-old male that presents with&nbsp;<b>delayed</b>&nbsp;<b>growth</b>&nbsp;<b>spurt</b>,&nbsp;<b>delayed puberty</b>, and&nbsp;<b><u>delayed</u>&nbsp;bone age</b>?<div><br /></div><div><span class=cloze>Reassurance and follow-up</span></div><div><br /></div><div><img src=""asdsfs.png"" /></div></div><br><br> <div class=extra><i><div></div></i><i>bone age &lt; real age;&nbsp;</i><i>this patient has&nbsp;<b>constitutional growth delay</b>&nbsp;and is expected to have a normal growth spurt and reach a normal adult height; growth chart typically shows the child dropping percentiles on the growth curve between 6 months to 3 years of age before regaining normal growth velocity&nbsp;</i><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card><div>Which&nbsp;<u>sex chromosome disorder</u>&nbsp;is associated with&nbsp;<b>short stature</b>,&nbsp;<b>shield chest</b>, and<b>&nbsp;webbed neck</b>&nbsp;in a&nbsp;<b>female</b>?&nbsp;</div><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>Which&nbsp;<u>sex chromosome disorder</u>&nbsp;is associated with&nbsp;<b>short stature</b>,&nbsp;<b>shield chest</b>, and<b>&nbsp;webbed neck</b>&nbsp;in a&nbsp;<b>female</b>?&nbsp;</div><div><br /></div><div><span class=cloze>Turner syndrome</span></div></div><br><br> <div class=extra><div><i>also have lymphatic defects (<b>cystic hygroma</b>: ""soft, compressible mass that transilluminates""), horseshoe kidney, bicuspid aortic valve, and streak ovary</i></div><img src=""paste-266528490520998.jpg"" /><div><br /><div><img src=""paste-2747241471148033.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card><b>Kallmann syndrome</b>&nbsp;is characterized by a defective&nbsp;<u>migration</u>&nbsp;of <span class=cloze>[...]</span> cells and defective formation of the olfactory bulb.<div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Kallmann syndrome</b>&nbsp;is characterized by a defective&nbsp;<u>migration</u>&nbsp;of <span class=cloze>GnRH</span> cells and defective formation of the olfactory bulb.<div><br /></div></div><br><br> <div class=extra><div><i></i><i>results in delayed/absent puberty and anosmia with a normal karyotype</i></div><div><i></i><i><br /></i></div><div><i></i><i><div>↓ GnRH on pituitary = ↓ FSH/LH = ↓ testosterone</div><div><br /></div></i></div><div><i><img src=""ks (2).PNG"" /><img src=""paste-2627154185551875.jpg"" /><br /><div></div></i><i><img src=""kallman.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span> syndrome</b>&nbsp;is characterized by a defective&nbsp;<u>migration</u>&nbsp;of GnRH cells and defective formation of the olfactory bulb.<div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Kallmann</span> syndrome</b>&nbsp;is characterized by a defective&nbsp;<u>migration</u>&nbsp;of GnRH cells and defective formation of the olfactory bulb.<div><br /></div></div><br><br> <div class=extra><div><i></i><i>results in delayed/absent puberty and anosmia with a normal karyotype</i></div><div><i></i><i><br /></i></div><div><i></i><i><div>↓ GnRH on pituitary = ↓ FSH/LH = ↓ testosterone</div><div><br /></div></i></div><div><i><img src=""ks (2).PNG"" /><img src=""paste-2627154185551875.jpg"" /><br /><div></div></i><i><img src=""kallman.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Anorexia nervosa/↑↑ exercise</b>&nbsp;is associated with <span class=cloze>[...]</span> due to&nbsp;<b>loss</b>&nbsp;of pulsatile&nbsp;<b>GnRH</b>&nbsp;secretion from the hypothalamus&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Anorexia nervosa/↑↑ exercise</b>&nbsp;is associated with <span class=cloze>amenorrhea</span> due to&nbsp;<b>loss</b>&nbsp;of pulsatile&nbsp;<b>GnRH</b>&nbsp;secretion from the hypothalamus&nbsp;</div><br><br> <div class=extra><div>""functional hypothalamic amenorrhea""</div><div><br /></div><img src=""Anorexia amenorrhea.png"" /><img src=""paste-15304110936948737.jpg"" /><div><br /></div><div><img src=""paste-2910140990750721.jpg"" /><img src=""paste-14178838095331329.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>anosmia + ↓ GnRH = <span class=cloze>[condition]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>anosmia + ↓ GnRH = <span class=cloze>Kallmann syndrome</span></div><br><br> <div class=extra><div><i>↓ GnRH from hypothalamus on pituitary = ↓ FSH/LH</i></div><div><i>results in delayed/absent puberty and anosmia with a normal karyotype</i></div><div><br /></div><div><img src=""ks (2).PNG"" /><img src=""kallman.png"" /></div></div> <div class=tags></div>"
"<div class=card>tumor of anterior pituitary + ↓ FSH/LH + bitemporal hemianopsia = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>tumor of anterior pituitary + ↓ FSH/LH + bitemporal hemianopsia = <span class=cloze>Craniopharyngioma</span></div><br><br> <div class=extra>get <b>MRI </b>to see the mass and distinguish between craniopharyngioma and kallman (no mass in kallman)<div><br /></div><div><img src=""paste-244555437834241.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>Patient presents with<b> streak ovaries</b>, congenital <b>heart</b> disease, horseshoe kidney, cystic hygroma at birth, <b>short statue</b>, <b>webbed neck</b>, and lymphedema = <span class=cloze>[diagnosis]</span><div><br /></div><div><img src=""X2604-T-53.png"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Patient presents with<b> streak ovaries</b>, congenital <b>heart</b> disease, horseshoe kidney, cystic hygroma at birth, <b>short statue</b>, <b>webbed neck</b>, and lymphedema = <span class=cloze>Turner syndrome</span><div><br /></div><div><img src=""X2604-T-53.png"" /></div></div><br><br> <div class=extra><img src=""paste-387947215978497.jpg"" /><img src=""paste-390665930276867.jpg"" /></div> <div class=tags></div>"
"<div class=card><b>Turner syndrome&nbsp;</b>↑ risk of what two&nbsp;<b>cardiovascular</b>&nbsp;conditions?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Turner syndrome&nbsp;</b>↑ risk of what two&nbsp;<b>cardiovascular</b>&nbsp;conditions?&nbsp;<div><br /></div><div><span class=cloze>↑ risk of&nbsp;<font color=""#ff0000"">bicuspid</font>&nbsp;aortic valve + (infantile)&nbsp;<font color=""#ff0000"">coarctation</font>&nbsp;of aorta</span></div></div><br><br> <div class=extra><div><b>Get an echocardiogram.</b></div>Turnt the aorta and right next to it is the valve!&nbsp;<div>also turnt the horseshoe kidney</div><div><br /></div><div><img src=""paste-1718545264148481.jpg"" /><img src=""paste-929233354358785.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>What is the next step in management of a&nbsp;patient with<b>&nbsp;primary amenorrhea</b>&nbsp;has&nbsp;<u>intact endocrine axis</u>&nbsp;but&nbsp;<u>no uterus</u>.<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the next step in management of a&nbsp;patient with<b>&nbsp;primary amenorrhea</b>&nbsp;has&nbsp;<u>intact endocrine axis</u>&nbsp;but&nbsp;<u>no uterus</u>.<div><br /></div><div><span class=cloze>Karyotyping</span></div></div><br><br> <div class=extra><i><div></div></i><i>these two look exactly the same on the <u>outside</u> (secondary sex characteristics, female external genitalia; the only difference is no internal female stuff)</i><div><i><br /></i></div>1) XX →&nbsp;<b>Mullerian agenesis (idiopathic loss of <font color=""#ff0000"">mullerian ducts</font>)</b><div><i><br /></i></div><div><i>2) XY → <b>Androgen insensitivity syndrome (MIF from testes inhibit <font color=""#ff0000"">mullerian ducts</font> so no uterus)</b></i></div><div><i><img src=""paste-261816911396865.jpg"" /></i></div><div><i><img src=""paste-258720239976449_1505754167063.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>In&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b>XY</b>&nbsp;but has female&nbsp;<i>external&nbsp;</i>genitalia with presence of testes</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In&nbsp;<b><span class=cloze>androgen insensitivity</span></b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b>XY</b>&nbsp;but has female&nbsp;<i>external&nbsp;</i>genitalia with presence of testes</div><br><br> <div class=extra><i><div>- testes secrete <b>MIF</b> which inhibit formation of mullerian duct → no uterus → primary amenorrhea&nbsp;</div><div>- breasts form due to conversion of T → <b>estrogen</b></div><div><b><br /></b></div><div></div></i><img src=""paste-277042570461185.jpg"" /><img src=""paste-258720239976449_1505754167063.jpg"" /></div> <div class=tags></div>"
"<div class=card>In&nbsp;<b>androgen insensitivity</b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b>XY</b>&nbsp;but has <span class=cloze>[...]</span>&nbsp;<i>external&nbsp;</i>genitalia with presence of testes</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In&nbsp;<b>androgen insensitivity</b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b>XY</b>&nbsp;but has <span class=cloze>female</span>&nbsp;<i>external&nbsp;</i>genitalia with presence of testes</div><br><br> <div class=extra><i><div>- testes secrete <b>MIF</b> which inhibit formation of mullerian duct → no uterus → primary amenorrhea&nbsp;</div><div>- breasts form due to conversion of T → <b>estrogen</b></div><div><b><br /></b></div><div></div></i><img src=""paste-277042570461185.jpg"" /><img src=""paste-258720239976449_1505754167063.jpg"" /></div> <div class=tags></div>"
"<div class=card>In&nbsp;<b>androgen insensitivity</b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b>XY</b>&nbsp;but has female&nbsp;<i>external&nbsp;</i>genitalia with presence of <span class=cloze>[male organ]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In&nbsp;<b>androgen insensitivity</b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b>XY</b>&nbsp;but has female&nbsp;<i>external&nbsp;</i>genitalia with presence of <span class=cloze>testes</span></div><br><br> <div class=extra><i><div>- testes secrete <b>MIF</b> which inhibit formation of mullerian duct → no uterus → primary amenorrhea&nbsp;</div><div>- breasts form due to conversion of T → <b>estrogen</b></div><div><b><br /></b></div><div></div></i><img src=""paste-277042570461185.jpg"" /><img src=""paste-258720239976449_1505754167063.jpg"" /></div> <div class=tags></div>"
"<div class=card>In&nbsp;<b>androgen insensitivity</b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;but has female&nbsp;<i>external&nbsp;</i>genitalia with presence of testes</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In&nbsp;<b>androgen insensitivity</b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b><span class=cloze>XY</span></b>&nbsp;but has female&nbsp;<i>external&nbsp;</i>genitalia with presence of testes</div><br><br> <div class=extra><i><div>- testes secrete <b>MIF</b> which inhibit formation of mullerian duct → no uterus → primary amenorrhea&nbsp;</div><div>- breasts form due to conversion of T → <b>estrogen</b></div><div><b><br /></b></div><div></div></i><img src=""paste-277042570461185.jpg"" /><img src=""paste-258720239976449_1505754167063.jpg"" /></div> <div class=tags></div>"
"<div class=card><div style=""text-align: left; "">What is the&nbsp;<i>treatment</i>&nbsp;of&nbsp;<b>androgen insensitivity syndrome&nbsp;</b>(<i>phenotypic female with 46-XY</i>)?&nbsp;</div><div style=""text-align: left; ""><br /></div><div style=""text-align: left; ""><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div style=""text-align: left; "">What is the&nbsp;<i>treatment</i>&nbsp;of&nbsp;<b>androgen insensitivity syndrome&nbsp;</b>(<i>phenotypic female with 46-XY</i>)?&nbsp;</div><div style=""text-align: left; ""><br /></div><div style=""text-align: left; ""><span class=cloze><font color=""#ff0000""><b>Bilateral gonadectomy&nbsp;<u>after</u>&nbsp;puberty</b></font></span></div></div><br><br> <div class=extra><div><i><span style=""font-style: italic"">Decreases the risk of&nbsp;<b>testicular</b>&nbsp;<b>malignancy</b>&nbsp;but allows for completion of puberty (<b>testosterone</b> for attainment of&nbsp;adult height)</span></i></div><div><i><span style=""font-style: italic;""><br /></span></i></div></div> <div class=tags></div>"
"<div class=card>Karyotype of <b>Mullerian Agenesis</b> = <span class=cloze>[...]</span> + ↔ testosterone levels<div>Karyotype of <b>Androgen Insensitivity Syndrome </b>= <span class=cloze>[...]</span> + ↑ testosterone levels</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Karyotype of <b>Mullerian Agenesis</b> = <span class=cloze>XX</span> + ↔ testosterone levels<div>Karyotype of <b>Androgen Insensitivity Syndrome </b>= <span class=cloze>XY</span> + ↑ testosterone levels</div></div><br><br> <div class=extra>The presentation is the <u style=""font-weight: bold; "">same</u>&nbsp;except for karyotype and testosterone levels.&nbsp;<div><b>Testosterone</b> comes from <b>testes</b> in AIS.&nbsp;<br /><div><br /></div><div><img src=""paste-277042570461185.jpg"" /><img src=""paste-285546605707265.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card>Karyotype of <b>Mullerian Agenesis</b> = XX + <span class=cloze>[...]</span> testosterone levels<div>Karyotype of <b>Androgen Insensitivity Syndrome </b>= XY + <span class=cloze>[...]</span> testosterone levels</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Karyotype of <b>Mullerian Agenesis</b> = XX + <span class=cloze>↔</span> testosterone levels<div>Karyotype of <b>Androgen Insensitivity Syndrome </b>= XY + <span class=cloze>↑</span> testosterone levels</div></div><br><br> <div class=extra>The presentation is the <u style=""font-weight: bold; "">same</u>&nbsp;except for karyotype and testosterone levels.&nbsp;<div><b>Testosterone</b> comes from <b>testes</b> in AIS.&nbsp;<br /><div><br /></div><div><img src=""paste-277042570461185.jpg"" /><img src=""paste-285546605707265.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in an adolescent female that presents with&nbsp;<u>amenorrhea</u>&nbsp;with a&nbsp;<b>non-palpable uterus</b>&nbsp;and&nbsp;<b>normal-size ovaries</b>&nbsp;on ultrasound?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in an adolescent female that presents with&nbsp;<u>amenorrhea</u>&nbsp;with a&nbsp;<b>non-palpable uterus</b>&nbsp;and&nbsp;<b>normal-size ovaries</b>&nbsp;on ultrasound?<div><br /></div><div><span class=cloze>Mullerian agenesis (Mayer-Rokitanksy-Kuster-Hauser syndrome)</span></div></div><br><br> <div class=extra><i><div><b>↓ uterine development</b>&nbsp;(Mullerian ducts give rise to upper 1/3 vagina, uterus, fallopian tubes) =&nbsp;no lining to shed for menses! → primary amenorrhea</div><div><br /><div><b>ovaries&nbsp;are normal&nbsp;</b>= ↑ estrogen =&nbsp;normal secondary characteristics</div></div></i><div><i><br /></i></div><div><i><img src=""paste-327199198543875.jpg"" /></i></div><div><i><br /></i><div><i><img src=""shemolly.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><div><div>Which&nbsp;<b>embryologic structure</b>&nbsp;develops into the fallopian tubes, uterus, and&nbsp;<u>upper</u>&nbsp;portion of the vagina?</div></div><div><br /></div><div><span class=cloze>[...]</span>&nbsp;</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div><div>Which&nbsp;<b>embryologic structure</b>&nbsp;develops into the fallopian tubes, uterus, and&nbsp;<u>upper</u>&nbsp;portion of the vagina?</div></div><div><br /></div><div><span class=cloze>Paramesonephric (mullerian) duct</span>&nbsp;</div></div><br><br> <div class=extra><i><img src=""paste-327199198543875.jpg"" /></i><div><i><br /></i><div><i><br /></i></div></div></div> <div class=tags></div>"
"<div class=card>Patients with&nbsp;<u>Turner syndrome</u>&nbsp;typically have&nbsp;<span class=cloze>[...]</span> levels of&nbsp;<b>estrogen.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Patients with&nbsp;<u>Turner syndrome</u>&nbsp;typically have&nbsp;<span class=cloze>low</span> levels of&nbsp;<b>estrogen.</b></div><br><br> <div class=extra><div><div><i></i><i>due to ovarian dysgenesis; results in&nbsp;<b>high levels of FSH</b>/<b>LH</b>&nbsp;due to lack of negative feedback</i></div><div><i><br /><div></div></i><i><img src=""yikes (6).png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>In&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b>XY</b>&nbsp;but has female&nbsp;<i>external&nbsp;</i>genitalia with presence of testes</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In&nbsp;<b><span class=cloze>androgen insensitivity</span></b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b>XY</b>&nbsp;but has female&nbsp;<i>external&nbsp;</i>genitalia with presence of testes</div><br><br> <div class=extra><div><i><u>testes&nbsp;</u>(due to SRY gene on Y chromosome)&nbsp;and female&nbsp;<u>external</u>&nbsp;genitalia present (due to presence of testosterone → aromatase →&nbsp;<b>estrogen</b>), everything else gone.&nbsp;</i></div><div><i><br /></i></div><div><i><br /></i></div><div><div><div><i></i><img src=""paste-3338667057741825.jpg"" /><img src=""paste-361743620505601.jpg"" /><img src=""paste-2217775082766339.jpg"" /></div><div><img src=""paste-9144870136446977.jpg"" /><span><img src=""paste-9192716072124417.jpg"" /></span></div></div></div></div> <div class=tags></div>"
"<div class=card>In&nbsp;<b>androgen insensitivity</b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b>XY</b>&nbsp;but has <span class=cloze>[...]</span>&nbsp;<i>external&nbsp;</i>genitalia with presence of testes</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In&nbsp;<b>androgen insensitivity</b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b>XY</b>&nbsp;but has <span class=cloze>female</span>&nbsp;<i>external&nbsp;</i>genitalia with presence of testes</div><br><br> <div class=extra><div><i><u>testes&nbsp;</u>(due to SRY gene on Y chromosome)&nbsp;and female&nbsp;<u>external</u>&nbsp;genitalia present (due to presence of testosterone → aromatase →&nbsp;<b>estrogen</b>), everything else gone.&nbsp;</i></div><div><i><br /></i></div><div><i><br /></i></div><div><div><div><i></i><img src=""paste-3338667057741825.jpg"" /><img src=""paste-361743620505601.jpg"" /><img src=""paste-2217775082766339.jpg"" /></div><div><img src=""paste-9144870136446977.jpg"" /><span><img src=""paste-9192716072124417.jpg"" /></span></div></div></div></div> <div class=tags></div>"
"<div class=card>In&nbsp;<b>androgen insensitivity</b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b>XY</b>&nbsp;but has female&nbsp;<i>external&nbsp;</i>genitalia with presence of <span class=cloze>[male organ]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In&nbsp;<b>androgen insensitivity</b>&nbsp;<b>syndrome</b>&nbsp;a person is genotypically&nbsp;<b>XY</b>&nbsp;but has female&nbsp;<i>external&nbsp;</i>genitalia with presence of <span class=cloze>testes</span></div><br><br> <div class=extra><div><i><u>testes&nbsp;</u>(due to SRY gene on Y chromosome)&nbsp;and female&nbsp;<u>external</u>&nbsp;genitalia present (due to presence of testosterone → aromatase →&nbsp;<b>estrogen</b>), everything else gone.&nbsp;</i></div><div><i><br /></i></div><div><i><br /></i></div><div><div><div><i></i><img src=""paste-3338667057741825.jpg"" /><img src=""paste-361743620505601.jpg"" /><img src=""paste-2217775082766339.jpg"" /></div><div><img src=""paste-9144870136446977.jpg"" /><span><img src=""paste-9192716072124417.jpg"" /></span></div></div></div></div> <div class=tags></div>"
"When a woman presents with <b>secondary amenorrhea</b>, what are the <u>3 ""first-line"" differentials</u> you should have in your head?<div><br /></div><div><span class=cloze>[Most common cause]</span><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div></div>""When a woman presents with <b>secondary amenorrhea</b>, what are the <u>3 ""first-line"" differentials</u> you should have in your head?<div><br /></div><div><span class=cloze>Pregnancy</span><div><span class=""clozed c1""><span class=cloze>Hypothyroidism</span></span></div><div><span class=""clozed c1""><span class=cloze>Prolactinemia</span></span></div></div><hr> <div class=mystyle1><div><i><br /></i></div><img src=""paste-6262062317569.jpg"" /></div> "
"<div class=card>1° <span class=cloze>[hypo/hyper]</span>thyroidism = prolactinemia = ↓ GnRH</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>1° <span class=cloze>hypo</span>thyroidism = prolactinemia = ↓ GnRH</div><br><br> <div class=extra>↓ T₃/T₄&nbsp;= ↑ TRH = ↑ prolactin = ↓ GnRH = amenorrhea&nbsp;<div><br /></div><div><img src=""paste-34097745362945 (1).jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b>Antipsychotics</b>&nbsp;may cause symptoms of&nbsp;<b><span class=cloze>[...]</span> excess</b>&nbsp;(e.g. galactorrhea, <u>amenorrhea</u>, gynecomastia)&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Antipsychotics</b>&nbsp;may cause symptoms of&nbsp;<b><span class=cloze>prolactin</span> excess</b>&nbsp;(e.g. galactorrhea, <u>amenorrhea</u>, gynecomastia)&nbsp;</div><br><br> <div class=extra><div><i>due to inhibition of the tubuloinfundibular dopamine pathway&nbsp;→ ↓ prolactin → ↓ GnRH&nbsp;</i></div><div><i><img src=""paste-136906377527297 (1).jpg"" /><img src=""paste-4608499909070.jpg"" /><img src=""paste-585030380290558.jpg"" /></i></div><div></div></div> <div class=tags></div>"
"<div class=card>first line treatment in&nbsp;<b>prolactinoma</b>&nbsp;= <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>first line treatment in&nbsp;<b>prolactinoma</b>&nbsp;= <span class=cloze>medication (dopamine agonist)</span></div><br><br> <div class=extra><div><i>dopamine = ↓ prolactin</i></div><i><img src=""paste-136906377527297 (1).jpg"" /></i></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span> syndrome</b>&nbsp;is&nbsp;<i>secondary</i>&nbsp;<b>amenorrhea</b> due to loss and scarring of the&nbsp;<b>basalis</b>&nbsp;<b>layer</b>&nbsp;of the <b>endometrium</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Asherman</span> syndrome</b>&nbsp;is&nbsp;<i>secondary</i>&nbsp;<b>amenorrhea</b> due to loss and scarring of the&nbsp;<b>basalis</b>&nbsp;<b>layer</b>&nbsp;of the <b>endometrium</b>&nbsp;</div><br><br> <div class=extra><b>- basalis</b>&nbsp;is the&nbsp;regenerative layer; contains stem cells&nbsp;<i>(imagine stem cells turning to ASH)</i><div><i><b>- dys</b>menorrhea may also occur 2/2 blockages</i></div><div><i><br /></i></div><div><i></i><i><img src=""paste-2896113627561985.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Asherman syndrome</b>&nbsp;is&nbsp;<i>secondary</i>&nbsp;<span class=cloze>[...]</span> due to loss and scarring of the&nbsp;<b>basalis</b>&nbsp;<b>layer</b>&nbsp;of the <b>endometrium</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Asherman syndrome</b>&nbsp;is&nbsp;<i>secondary</i>&nbsp;<span class=cloze><b>amenorrhea</b></span> due to loss and scarring of the&nbsp;<b>basalis</b>&nbsp;<b>layer</b>&nbsp;of the <b>endometrium</b>&nbsp;</div><br><br> <div class=extra><b>- basalis</b>&nbsp;is the&nbsp;regenerative layer; contains stem cells&nbsp;<i>(imagine stem cells turning to ASH)</i><div><i><b>- dys</b>menorrhea may also occur 2/2 blockages</i></div><div><i><br /></i></div><div><i></i><i><img src=""paste-2896113627561985.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Savage syndrome</b>&nbsp;is caused by <span class=cloze>[...]</span> insensitivity (""resistant ovary syndrome"")</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Savage syndrome</b>&nbsp;is caused by <span class=cloze>FSH receptor</span> insensitivity (""resistant ovary syndrome"")</div><br><br> <div class=extra><img src=""paste-413639710343169.jpg"" /></div> <div class=tags></div>"
"<div class=card><b>Menopause</b>&nbsp;is associated with&nbsp;<u><span class=cloze>[...]</span></u>&nbsp;levels of <b>FSH</b>, LH, and GnRH with&nbsp;<u><span class=cloze>[...]</span></u>&nbsp;levels of estrogen</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Menopause</b>&nbsp;is associated with&nbsp;<u><span class=cloze>increased</span></u>&nbsp;levels of <b>FSH</b>, LH, and GnRH with&nbsp;<u><span class=cloze>decreased</span></u>&nbsp;levels of estrogen</div><br><br> <div class=extra><i>No negative feedback due to lack of estrogen; <b>↑ FSH is the best marker for menopause.</b><br /></i><img src=""paste-9851525400625153.jpg"" /><span><img src=""paste-9854501812961281.jpg"" /><i><span style=""font-style: normal; ""><img src=""paste-311556927652355.jpg"" /></span></i></span><div></div><div><span><i><span style=""font-style: normal; ""><br /></span></i></span></div></div> <div class=tags></div>"
"<div class=card>What is seen in a&nbsp;<b>positive</b>&nbsp;Progestin challenge in the workup of<b> secondary amenorrhea?</b><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is seen in a&nbsp;<b>positive</b>&nbsp;Progestin challenge in the workup of<b> secondary amenorrhea?</b><div><br /></div><div><span class=cloze>Withdrawal bleeding</span></div></div><br><br> <div class=extra><i>(+) test implies you had enough estrogen to build up the lining, you have an endometrium to bleed from, and you have a patent outflow tract.&nbsp;</i><div><i>e.g.,&nbsp;<b>anovulation 2/2&nbsp;PCOS</b>&nbsp;-&nbsp;there was estrogen from first part of cycle, but no progesterone from corpus luteum to shed lining until we gave it exogenously)&nbsp;</i></div><div><div><i><br /></i><div><i><img src=""paste-2225703592394753.jpg"" /><br /></i><div><img src=""paste-2189514197958657.jpg"" /></div><div><br /></div><div><img src=""paste-9754038232940545.jpg"" /><img src=""paste-9757542926254081.jpg"" /><i><img src=""paste-28308129449880.jpg"" /></i></div><div><img src=""paste-9758771286900739.jpg"" /></div></div></div></div></div> <div class=tags></div>"
"<div class=card>After weight loss, <b>PCOS</b> is treated with <span class=cloze>[drug]</span> to <b>regulate cycles and reduce androgenic symptoms.&nbsp;</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>After weight loss, <b>PCOS</b> is treated with <span class=cloze>OCPs</span> to <b>regulate cycles and reduce androgenic symptoms.&nbsp;</b></div><br><br> <div class=extra><i><div></div></i><i>OCPs = ↑ sex hormone binding globulin = ↓ free testosterone.&nbsp;</i><div><i><br /></i></div><img src=""paste-2263688283160577.jpg"" /></div> <div class=tags></div>"
"<div class=card>Before starting workup for <b>amenorrhea</b>, order a <span class=cloze>[test]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Before starting workup for <b>amenorrhea</b>, order a <span class=cloze>UPT</span></div><br><br> <div class=extra><i>to rule out pregnancy!</i></div> <div class=tags></div>
"<div class=card>Some patients with a history of <b>irregular periods</b> may have a period of <span class=cloze>[...]</span> following <b>discontinuation of OCPs.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Some patients with a history of <b>irregular periods</b> may have a period of <span class=cloze>amenorrhea</span> following <b>discontinuation of OCPs.</b></div><br><br> <div class=extra><i>""post pill amenorrhea""</i></div> <div class=tags></div>"
Which etiology of <b>hirsutism</b> presents with <u>elevated testosterone</u>, a <u>LH:FSH ≥ 3:1</u>, and typically affects <u>both ovaries</u>?<div><br /></div><div><span class=cloze>[...]</span></div>"Which etiology of <b>hirsutism</b> presents with <u>elevated testosterone</u>, a <u>LH:FSH ≥ 3:1</u>, and typically affects <u>both ovaries</u>?<div><br /></div><div><span class=cloze>PCOS</span></div><hr> <div class=mystyle1><img src=""paste-35854386987572.jpg"" /></div> "
"<div class=card><b>Polycystic ovarian syndrome</b>&nbsp;often presents in young,&nbsp;<u><b>obese</b></u>&nbsp;women with <span class=cloze>[...]</span> and symptoms of <span class=cloze>[...]</span>&nbsp;<b>excess</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Polycystic ovarian syndrome</b>&nbsp;often presents in young,&nbsp;<u><b>obese</b></u>&nbsp;women with <span class=cloze><b>oligo-</b>&nbsp;or&nbsp;<b>amenorrhea</b></span> and symptoms of <span class=cloze><b>androgen</b></span>&nbsp;<b>excess</b>&nbsp;</div><br><br> <div class=extra><div><i>laboratory findings include&nbsp;<u>normal</u>/<u>elevated</u>&nbsp;testosterone and estrogen levels with an imbalance of LH/FSH (<b>often&nbsp;<u>&gt;</u>&nbsp;2:1 ratio of LH:FSH</b>)</i></div><div><i><br /></i></div><img src=""pcos (1).png"" /></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span></b>&nbsp;often presents in young,&nbsp;<u><b>obese</b></u>&nbsp;women with <b>oligo-</b>&nbsp;or&nbsp;<b>amenorrhea</b> and symptoms of <b>androgen</b>&nbsp;<b>excess</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Polycystic ovarian syndrome</span></b>&nbsp;often presents in young,&nbsp;<u><b>obese</b></u>&nbsp;women with <b>oligo-</b>&nbsp;or&nbsp;<b>amenorrhea</b> and symptoms of <b>androgen</b>&nbsp;<b>excess</b>&nbsp;</div><br><br> <div class=extra><div><i>laboratory findings include&nbsp;<u>normal</u>/<u>elevated</u>&nbsp;testosterone and estrogen levels with an imbalance of LH/FSH (<b>often&nbsp;<u>&gt;</u>&nbsp;2:1 ratio of LH:FSH</b>)</i></div><div><i><br /></i></div><img src=""pcos (1).png"" /></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>first-line treatment</i>&nbsp;for&nbsp;<u>infertility</u>&nbsp;or&nbsp;<u>menstrual irregularities</u>&nbsp;due to&nbsp;<b>polycystic ovarian syndrome</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>first-line treatment</i>&nbsp;for&nbsp;<u>infertility</u>&nbsp;or&nbsp;<u>menstrual irregularities</u>&nbsp;due to&nbsp;<b>polycystic ovarian syndrome</b>?<div><br /></div><div><span class=cloze>Weight loss</span></div></div><br><br> <div class=extra><div><i>helps restore ovulatory cycles</i></div><div><i><img src=""pcos (1).png"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the<i>&nbsp;first line treatment</i>&nbsp;for&nbsp;<u>irregular menstrual cycles</u>&nbsp;in patients with&nbsp;<b>polycystic ovarian syndrome</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the<i>&nbsp;first line treatment</i>&nbsp;for&nbsp;<u>irregular menstrual cycles</u>&nbsp;in patients with&nbsp;<b>polycystic ovarian syndrome</b>?<div><br /></div><div><span class=cloze>Weight loss and <b>OCPs</b></span></div></div><br><br> <div class=extra><div><div><i>OCPs<b> reduce hyperandrogenism </b>with (-) feedback causing ↓ LH and ↓ androgen production and antagonism of androgen receptors.</i></div></div><div><i><br /></i></div><img src=""pcos.png"" /></div> <div class=tags></div>"
"<div class=card>What drug is used to&nbsp;<u>induce ovulation</u>&nbsp;in patients with&nbsp;<b>polycystic ovarian syndrome</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What drug is used to&nbsp;<u>induce ovulation</u>&nbsp;in patients with&nbsp;<b>polycystic ovarian syndrome</b>?&nbsp;<div><br /></div><div><span class=cloze>Clomiphene citrate</span></div></div><br><br> <div class=extra><div>↑ GnRH starts the cycle up.</div><div><br /></div><div><img src=""paste-475968275742721.jpg"" /></div><img src=""paste-291645459268232.jpg"" /><img src=""pcos.png"" /></div> <div class=tags></div>"
"<div class=card><div><b>Sertoli-Leydig tumors&nbsp;</b>produce androgens causing <u>rapid</u>-onset <span class=cloze>[feature]</span> in&nbsp;<b>women</b>&nbsp;&nbsp;</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div><b>Sertoli-Leydig tumors&nbsp;</b>produce androgens causing <u>rapid</u>-onset <span class=cloze>hirsutism/virilization</span> in&nbsp;<b>women</b>&nbsp;&nbsp;</div></div><br><br> <div class=extra><div>a ""Sir"" - along with signs of <b>estrogen </b>deficiency (breast atrophy, vulvovaginal atrophy)</div><div><br /></div><img src=""paste-1161561020301313.jpg"" /></div> <div class=tags></div>"
"<div class=card><div><b>Sertoli-Leydig tumors&nbsp;</b>produce <span class=cloze>[hormones]</span> causing <u>rapid</u>-onset hirsutism/virilization in&nbsp;<b>women</b>&nbsp;&nbsp;</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div><b>Sertoli-Leydig tumors&nbsp;</b>produce <span class=cloze>androgens</span> causing <u>rapid</u>-onset hirsutism/virilization in&nbsp;<b>women</b>&nbsp;&nbsp;</div></div><br><br> <div class=extra><div>a ""Sir"" - along with signs of <b>estrogen </b>deficiency (breast atrophy, vulvovaginal atrophy)</div><div><br /></div><img src=""paste-1161561020301313.jpg"" /></div> <div class=tags></div>"
"<div class=card><span class=cloze>[compound]</span> = elevated in the most common&nbsp;<u>CAH</u>,&nbsp;<b>21-hydroxylase deficiency&nbsp;</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>17-hydroxyprogesterone</span> = elevated in the most common&nbsp;<u>CAH</u>,&nbsp;<b>21-hydroxylase deficiency&nbsp;</b></div><br><br> <div class=extra><img src=""paste-11172558556626945.jpg"" /></div> <div class=tags></div>"
"<div class=card>Treatment of&nbsp;<u>congenital adrenal hyperplasia</u>&nbsp;= <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Treatment of&nbsp;<u>congenital adrenal hyperplasia</u>&nbsp;= <span class=cloze>low dose exogenous corticosteroids</span></div><br><br> <div class=extra>low dose steroids → (-) feedback → ↓ ACTH → ↓ stimulation of adrenal cortex → ↓ androgen production by cortex (e.g., in 21-hydroxylase deficiency)<div><br /><div><br /></div><div><img src=""paste-15410712025235457.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a newborn female that presents with&nbsp;<b>salt</b>&nbsp;<b>wasting</b>&nbsp;and&nbsp;<b>clitoromegaly</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a newborn female that presents with&nbsp;<b>salt</b>&nbsp;<b>wasting</b>&nbsp;and&nbsp;<b>clitoromegaly</b>?<div><br /></div><div><span class=cloze>Congenital adrenal hyperplasia (due to 21-hydroxylase deficiency)</span></div></div><br><br> <div class=extra><div><i>shunting from aldosterone toward androgens&nbsp;</i></div><div><i><br /></i></div><div><i><img src=""paste-11172558556626945.jpg"" /></i></div><div><i><img src=""salt waster.png"" /></i></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[hormone]</span> = endometrium&nbsp;<u>proliferation</u>&nbsp;phase<div><span class=cloze>[hormone]</span> = endometrium&nbsp;<u>secretory</u>&nbsp;phase</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>estrogen</span> = endometrium&nbsp;<u>proliferation</u>&nbsp;phase<div><span class=cloze>progesterone</span> = endometrium&nbsp;<u>secretory</u>&nbsp;phase</div></div><br><br> <div class=extra><u>estrogen</u>&nbsp;during proliferative d/t follicle,&nbsp;<u>progesterone</u>&nbsp;during luteal d/t corpus luteum<div><br /><div><img src=""paste-560557656637441.jpg"" /></div><div><img src=""paste-10550432543801347.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">Polycystic ovarian syndrome</font>&nbsp;(PCOS) must include&nbsp;<font color=""#ff0000"">2</font>/3 of:<div><br /></div><div>1. clinical or biochemical evidence of&nbsp;<span class=cloze>[condition]</span></div><div>2. <span class=cloze>[menstrual cycle abnormality]</span></div><div>3. <span class=cloze>[condition]</span> on ultrasound or histology</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">Polycystic ovarian syndrome</font>&nbsp;(PCOS) must include&nbsp;<font color=""#ff0000"">2</font>/3 of:<div><br /></div><div>1. clinical or biochemical evidence of&nbsp;<span class=cloze>↑ androgens (acne/hirsutism)</span></div><div>2. <span class=cloze>irregular menstruation (oligo/anovulatory)</span></div><div>3. <span class=cloze>polycystic ovaries</span> on ultrasound or histology</div></div><br><br> <div class=extra><img src=""paste-638236435152897.jpg"" /></div> <div class=tags></div>"
"<div class=card>Patients with&nbsp;<b>PCOS</b>&nbsp;may have <span class=cloze>[...]</span> due to&nbsp;<u>anovulation</u>&nbsp;from&nbsp;<b>failed follicular maturation</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Patients with&nbsp;<b>PCOS</b>&nbsp;may have <span class=cloze>infertility</span> due to&nbsp;<u>anovulation</u>&nbsp;from&nbsp;<b>failed follicular maturation</b>&nbsp;</div><br><br> <div class=extra><i>↑ LH:FSH ratio means follicle can't develop properly.&nbsp;</i><div><i>↓ ovulation = ↓ progesterone from corpus luteum =<b> no menses.</b><br /></i><div><i><br /></i><div><i><img src=""pcos (1).png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>Insulin resistance in PCOS = <span class=cloze>[treatment]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Insulin resistance in PCOS = <span class=cloze>metformin</span></div><br><br> <div class=extra><i>also helps with anovulation, but clomiphene is better.&nbsp;</i><div><i><br /></i></div><div><i></i><i><img src=""pcos (1).png"" /></i></div></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">Polycystic ovarian syndrome</font>&nbsp;(PCOS) must include&nbsp;<font color=""#ff0000"">2</font>/3 of:<div><br /></div><div>1. clinical or biochemical evidence of&nbsp;<span class=cloze>[condition]</span></div><div>2. <span class=cloze>[menstrual cycle abnormality]</span></div><div>3. <span class=cloze>[condition]</span> on ultrasound or histology</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">Polycystic ovarian syndrome</font>&nbsp;(PCOS) must include&nbsp;<font color=""#ff0000"">2</font>/3 of:<div><br /></div><div>1. clinical or biochemical evidence of&nbsp;<span class=cloze>↑ androgens (acne/hirsutism)</span></div><div>2. <span class=cloze>irregular menstruation (oligo/anovulatory)</span></div><div>3. <span class=cloze>polycystic ovaries</span> on ultrasound or histology</div></div><br><br> <div class=extra><div><i>note that if you already have 1 and 2, you don't need u/s!</i></div><div><i><br /></i></div><i><img src=""paste-638236435152897.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><b>Oral contraceptive pills</b>&nbsp;can be used to treat&nbsp;<b>hirsutism</b>&nbsp;(e.g., in PCOS). How?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Oral contraceptive pills</b>&nbsp;can be used to treat&nbsp;<b>hirsutism</b>&nbsp;(e.g., in PCOS). How?<div><br /></div><div><span class=cloze>Estrogen/Progesterone negative feedback to decrease anterior pituitary&nbsp;<b>LH</b>, which decreases ovarian androgen production from&nbsp;<b>Theca</b>&nbsp;cells</span></div></div><br><br> <div class=extra><img src=""paste-14147725352239107.jpg"" /><img src=""paste-14147794071715843.jpg"" /></div> <div class=tags></div>"
"<div class=card>Which etiology of&nbsp;<b>hirsutism</b>&nbsp;is considered the&nbsp;<u>diagnosis of exclusion</u> (i.e., hormone levels all <u>normal</u>)?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which etiology of&nbsp;<b>hirsutism</b>&nbsp;is considered the&nbsp;<u>diagnosis of exclusion</u> (i.e., hormone levels all <u>normal</u>)?<div><br /></div><div><span class=cloze>Hair follicle androgen sensitivity (<b>Familial hirsutism</b>)</span></div></div><br><br> <div class=extra><div><i>can check 5-alpha reductase activity (↑ reductase = ↑ DHT, which is <b>more</b> <b>potent = more hair</b>)</i></div><div><br /></div><img src=""paste-34866544508929.jpg"" /><img src=""paste-2932371741474817.jpg"" /></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>pathophysiologic cause</i>&nbsp;of&nbsp;<b>postpartum telogen effluvium</b>&nbsp;(hair loss)?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>pathophysiologic cause</i>&nbsp;of&nbsp;<b>postpartum telogen effluvium</b>&nbsp;(hair loss)?<div><br /></div><div><span class=cloze>High estrogen levels during pregnancy</span></div></div><br><br> <div class=extra><div><i></i><i>results in increased&nbsp;<u>synchronous</u>&nbsp;hair growth, thus hair is shed at the same time (typically ~3 months after delivery)</i></div><div><i><br /><div></div></i><i><img src=""telogen effl.png"" /></i></div></div> <div class=tags></div>"
How do you treat <b>menopausal hot flashes</b>?<div><br /></div><div><span class=cloze>[...]</span></div>"How do you treat <b>menopausal hot flashes</b>?<div><br /></div><div><span class=cloze>Venlafaxine</span></div><hr> <div class=mystyle1><div><br /></div><img src=""paste-3766686319202.jpg"" /></div> "
"What is the term for <b>menopause</b> that occurs <u>before age 40</u>?<div><br /></div><div><span class=""clozed c1""><span class=cloze>[...]</span></span></div>""What is the term for <b>menopause</b> that occurs <u>before age 40</u>?<div><br /></div><div><span class=""clozed c1""><span class=cloze>Primary ovarian insufficiency</span></span></div><hr> <div class=mystyle1><img src=""paste-1367693680705539.jpg"" /></div> "
"<div class=card>Vaginal atrophy = <span class=cloze>[treatment]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Vaginal atrophy = <span class=cloze>estrogen cream</span></div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card><b>Menopause</b>&nbsp;is diagnosed by&nbsp;<b>amenorrhea</b>&nbsp;for at least <span class=cloze>[...]</span> months</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Menopause</b>&nbsp;is diagnosed by&nbsp;<b>amenorrhea</b>&nbsp;for at least <span class=cloze>12</span> months</div><br><br> <div class=extra><div><i><img src=""paste-8504421793136641.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the recommended&nbsp;<u>screening</u>&nbsp;protocol for&nbsp;<b>osteoporosis</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the recommended&nbsp;<u>screening</u>&nbsp;protocol for&nbsp;<b>osteoporosis</b>?&nbsp;<div><br /></div><div><span class=cloze>One-time dual-energy x-ray absorptiometry (<b>DEXA</b>&nbsp;scan) for all women&nbsp;<u>&gt;</u>&nbsp;<b>65</b></span></div></div><br><br> <div class=extra><div><i><div></div></i><i>also recommended for&nbsp;<b>younger</b>&nbsp;<b>women</b>&nbsp;who have an equivalent risk of osteoporotic fracture</i></div><div><i><br /></i></div><div><i><img src=""dsofsg.png"" /></i></div><div><i><br /></i></div><div><i><br /></i></div><img src=""paste-11122178590244865.jpg"" /></div> <div class=tags></div>"
"<div class=card>What is the best initial therapy for&nbsp;<b>osteoporosis</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the best initial therapy for&nbsp;<b>osteoporosis</b>?<div><br /></div><div><span class=cloze>Vitamin D + Ca + <b>bisphosphonates</b></span></div></div><br><br> <div class=extra><div><i>bisphosphonates prevent reabsorption of bone (<b>dronate</b>)</i></div><div><i><img src=""paste-326486233973217.jpg"" /><img src=""paste-326464759136720.jpg"" /></i></div><div><i><br /></i></div><i><img src=""paste-11122178590244865.jpg"" /><img src=""paste-2336419259351041.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">luteal phase</font>&nbsp;(ovulation to menstruation) = <span class=cloze>[length]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">luteal phase</font>&nbsp;(ovulation to menstruation) = <span class=cloze>14 days</span></div><br><br> <div class=extra><div><i><div><u>constant;</u>&nbsp;think about programmed cell death of corpus luteum. follicular phase may vary (e.g., around menopause)&nbsp;</div><div><br /></div><div><img src=""paste-10550428248834051.jpg"" /></div></i></div></div> <div class=tags></div>"
"<div class=card><b>The Women's Health Initiative (WHI) Study</b>&nbsp;had poor <span class=cloze>[internal/external]</span> validity due to <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>The Women's Health Initiative (WHI) Study</b>&nbsp;had poor <span class=cloze>external</span> validity due to <span class=cloze>↑ age of participants (63 yo)</span></div><br><br> <div class=extra><div><b>overall takeaway:</b>&nbsp;use of HRT in older women or for long periods of time may&nbsp;<u>increase</u>&nbsp;risk of&nbsp;<b>breast cancer and CHD</b>&nbsp;→ using estrogen ""forever"" after menopause is&nbsp;<b>not recommended&nbsp;</b></div><div><b><br /></b></div><div><b><img src=""paste-2606954954358785.jpg"" /></b></div></div> <div class=tags></div>"
"<div class=card><b>Post</b>-menopausal ovaries continue to produce <span class=cloze>[...]</span>, which are converted in <b>fat</b> <b>cells</b> into<b> estrogen.&nbsp;</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>Post</b>-menopausal ovaries continue to produce <span class=cloze>androgens</span>, which are converted in <b>fat</b> <b>cells</b> into<b> estrogen.&nbsp;</b></div><br><br> <div class=extra><i>therefore, removal of ovaries can cause decrease in androgen and therefore estrogen → re-emergenc of menopausal symptoms</i><div><i><br /></i></div><div><i><div></div></i><i><b>obesity (↑ fat)&nbsp;</b>= ↑ androgen → estrogen conversion (aromatase)</i></div></div> <div class=tags></div>
"<div class=card>What do you look at to determine if an&nbsp;<b>infertile woman</b>&nbsp;is&nbsp;<u>ovulating</u>?<div><br /></div><div><div><b>Basal temperature </b><span class=cloze>[↑/↓]</span> with ovulation</div><div><b>Endometrial biopsy</b>&nbsp;to ensure <u>secretory</u> uterus during the luteal phase.</div><div><b>Serum progesterone levels</b>&nbsp;should be <span class=cloze>[↑/↓]</span> during the luteal phase.</div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What do you look at to determine if an&nbsp;<b>infertile woman</b>&nbsp;is&nbsp;<u>ovulating</u>?<div><br /></div><div><div><b>Basal temperature </b><span class=cloze>↑</span> with ovulation</div><div><b>Endometrial biopsy</b>&nbsp;to ensure <u>secretory</u> uterus during the luteal phase.</div><div><b>Serum progesterone levels</b>&nbsp;should be <span class=cloze>↑</span> during the luteal phase.</div></div></div><br><br> <div class=extra><i><div></div></i><i></i><i></i><i>luteal phase is <b>progesterone</b> predominant and corresponds to <b>secretory</b> uterus.&nbsp;</i><div><i></i><i></i><i><br /></i></div><div><i></i><i><img src=""paste-9682466897920003.jpg"" /></i></div><div><i><br /></i></div><img src=""paste-28548647616513_1529603012320.jpg"" /></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a woman that presents with&nbsp;<b>infertility</b>&nbsp;and&nbsp;<b>chronic pelvic pain</b>&nbsp;with a<b> fixed,&nbsp;<u>immobile uterus</u></b>&nbsp;on physical exam?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a woman that presents with&nbsp;<b>infertility</b>&nbsp;and&nbsp;<b>chronic pelvic pain</b>&nbsp;with a<b> fixed,&nbsp;<u>immobile uterus</u></b>&nbsp;on physical exam?&nbsp;<div><br /></div><div><span class=cloze>Endometriosis</span></div></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i>pelvic adhesions may interfere with oocyte release and/or block sperm entry, thus causing infertility; resection of lesions improves conception rates</i><div><i><br /></i></div><img src=""endometriosis.png"" /><div><i><br /></i></div><img src=""paste-31044023615489_1529603012320.jpg"" /></div> <div class=tags></div>"
"<div class=card>(+) nocturnal erection = <span class=cloze>[...]</span> cause of erectile dysfunction</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>(+) nocturnal erection = <span class=cloze>psychogenic</span> cause of erectile dysfunction</div><br><br> <div class=extra>intact neurovascular function<div><div><br /></div><div><img src=""ed_1358629116483.png"" /><img src=""paste-192088117346305.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card>Start off evaluating infertility by doing tests on the <span class=cloze>[male/female]</span> because it's cheaper/easier to do.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Start off evaluating infertility by doing tests on the <span class=cloze>male</span> because it's cheaper/easier to do.</div><br><br> <div class=extra><i></i><i>sperm test, erectile dysfunction ... easier to do and cheaper.</i></div> <div class=tags></div>
"<div class=card>Infertility + history of <u>irregular</u> menses = <span class=cloze>[cause of infertility]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Infertility + history of <u>irregular</u> menses = <span class=cloze>anovulation</span></div><br><br> <div class=extra><i>e.g., PCOS; use <b>clomiphene </b>for ovulation induction.</i><div><i><br /></i></div><div><i><img src=""paste-3537463914004481.jpg"" /><br /></i><div><i><img src=""pcos (1).png"" /></i></div><div><i><br /></i></div></div></div> <div class=tags></div>"
"<div class=card>↓ ovarian reserve = <span class=cloze>[...]</span> anti-mullerian hormone</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>↓ ovarian reserve = <span class=cloze>↓</span> anti-mullerian hormone</div><br><br> <div class=extra><i>AMH is produced by ovarian follicles</i><div><i><br /></i></div><div><i><img src=""paste-71876277698561 (1).jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>primary hypothyroidism = <span class=cloze>[...]</span> prolactin</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>primary hypothyroidism = <span class=cloze>↑</span> prolactin</div><br><br> <div class=extra><i><div></div></i><i>low T3/T4 = lost negative feedback → high TRH → high prolactin → ↓ GnRH → infertility.&nbsp;</i><div><i><br /></i></div><img src=""fc35947284ecc475e8bd31b5c868ff1acd86dd33_tmpmklrs9.png"" /></div> <div class=tags></div>"
"<div class=card>primary <span class=cloze>[...]</span>thyroidism = ↑ prolactin</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>primary <span class=cloze>hypo</span>thyroidism = ↑ prolactin</div><br><br> <div class=extra><i><div></div></i><i>low T3/T4 = lost negative feedback → high TRH → high prolactin → ↓ GnRH → infertility.&nbsp;</i><div><i><br /></i></div><img src=""fc35947284ecc475e8bd31b5c868ff1acd86dd33_tmpmklrs9.png"" /></div> <div class=tags></div>"
"<div class=card>Supplementation with [<span class=cloze>[...]</span>] has been shown to improve premenstrual syndrome.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Supplementation with [<span class=cloze>Ca</span>] has been shown to improve premenstrual syndrome.</div><br><br> <div class=extra><i><div></div><br /></i></div> <div class=tags></div>
"<div class=card>What is the treatment of symptomatic MVP in preg?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>What is the treatment of symptomatic MVP in preg?<div><br /></div><div><span class=cloze>beta-blockers</span></div></div><br><br> <div class=extra><i><div></div>decrease sympathetic tone to relieve chest pain and palpitations.&nbsp;</i></div> <div class=tags></div>
"<div class=card>How much fetal blood is neutralized by 300 mcg (one dose) of Rhogam?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>How much fetal blood is neutralized by 300 mcg (one dose) of Rhogam?<div><br /></div><div><span class=cloze>30mL</span></div></div><br><br> <div class=extra><i><div></div><br /></i></div> <div class=tags></div>
"<div class=card>Most fibroids are <span class=cloze>[symptomatic/asymptomatic]</span>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Most fibroids are <span class=cloze>asymptomatic</span>&nbsp;</div><br><br> <div class=extra><i><div></div>And therefore do NOT require treatment.</i></div> <div class=tags></div>
"<div class=card><b><span class=cloze>[characteristic]</span>&nbsp;</b>women usually have&nbsp;<b><u>regular</u>&nbsp;menses.</b><div><b></b><b><span class=cloze>[characteristic]</span>&nbsp;</b>women usually have&nbsp;<b><u>irregular</u>&nbsp;menses.</b></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Ovulatory</span>&nbsp;</b>women usually have&nbsp;<b><u>regular</u>&nbsp;menses.</b><div><b></b><b><span class=cloze>Anovulatory</span>&nbsp;</b>women usually have&nbsp;<b><u>irregular</u>&nbsp;menses.</b></div></div><br><br> <div class=extra><i><div></div><div></div></i><i><b>regular</b>&nbsp;bleeding = ovulatory<div><b>irregular</b>&nbsp;bleeding = anovulatory (e.g., PCOS)</div><div><br /></div></i><img src=""paste-346835789021185.jpg"" /></div> <div class=tags></div>"
"<div class=card>most common cause of&nbsp;<b><font color=""#ff0000"">heavy, regular menses</font></b>&nbsp;in adolescents = <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>most common cause of&nbsp;<b><font color=""#ff0000"">heavy, regular menses</font></b>&nbsp;in adolescents = <span class=cloze>von willebrand disease</span></div><br><br> <div class=extra><i><div></div><div></div></i><i><div>suspect if began at menarche, family history of coagulpathy, and other signs (bruising, prolonged bleeding)</div><div><br /></div><img src=""mpcd.PNG"" /></i></div> <div class=tags></div>"
"<div class=card><div>What structure is contained in the&nbsp;<b>suspensory ligament of the ovary</b>&nbsp;(infundibulopelvic ligament)?&nbsp;</div><div><br /></div><div><span class=cloze>[...]</span>&nbsp;</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>What structure is contained in the&nbsp;<b>suspensory ligament of the ovary</b>&nbsp;(infundibulopelvic ligament)?&nbsp;</div><div><br /></div><div><span class=cloze>Ovarian vessels</span>&nbsp;</div></div><br><br> <div class=extra><div><i></i><i>The suspense was unbearable as the surgeon carefully avoided cutting the suspensory ligament containing the ovarian artery.&nbsp;</i></div><div><img src=""paste-1619726656602113.jpg"" /><img src=""ch-27lecturepresentation-15-638.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b>Ovarian torsion</b>&nbsp;occurs due to twisting of the&nbsp;<b>ovary</b>&nbsp;around the <span class=cloze>[...]</span> ligament; biggest risk factor is ovarian enlargement (pregnancy, tumor, cyst).&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Ovarian torsion</b>&nbsp;occurs due to twisting of the&nbsp;<b>ovary</b>&nbsp;around the <span class=cloze>suspensory</span> ligament; biggest risk factor is ovarian enlargement (pregnancy, tumor, cyst).&nbsp;</div><br><br> <div class=extra><div><i></i><i>The suspense was unbearable as the surgeon carefully avoided cutting the suspensory ligament containing the ovarian artery.&nbsp;</i></div><div><br /></div><div><img src=""paste-91577292685313.jpg"" /></div><div><img src=""paste-1619726656602113.jpg"" /><img src=""ch-27lecturepresentation-15-638.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>the uterine artery is a branch of the <span class=cloze>[...]</span> artery</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>the uterine artery is a branch of the <span class=cloze>internal iliac</span> artery</div><br><br> <div class=extra><div><i><img src=""paste-20800526614531.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>(F) corresponds to the:<div><br /></div><div><img src=""paste-109401406963715.jpg"" /><br /><div><br /></div><div><span class=cloze>[...]</span></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>(F) corresponds to the:<div><br /></div><div><img src=""paste-109401406963715.jpg"" /><br /><div><br /></div><div><span class=cloze>Uterosacral ligament</span></div></div></div><br><br> <div class=extra><div><i>- extends from the&nbsp;<b>cervix</b>&nbsp;to the&nbsp;<b>posterior pelvic wall;&nbsp;</b>stabilizes the uterus in the pelvic cavity<div><br /></div><div><img src=""paste-109611860361219.jpg"" /></div><div><br /></div><div><img src=""paste-133092446568449.jpg"" /></div></i></div></div> <div class=tags></div>"
"<div class=card>The <span class=cloze>[ligament]</span>&nbsp;connects the cervix to the side wall of the pelvis&nbsp;and contains the&nbsp;<b>uterine vessels</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The <span class=cloze>Cardinal ligament</span>&nbsp;connects the cervix to the side wall of the pelvis&nbsp;and contains the&nbsp;<b>uterine vessels</b></div><br><br> <div class=extra><div><i>C for&nbsp;<b>C</b>ervix → contains&nbsp;<u>uterine</u>&nbsp;vessels (which are going to the cervix/uterus)<br /><div><br /></div><div><img src=""paste-151925878161409.jpg"" /></div><div><br /></div></i><img src=""paste-506393824067585.jpg"" /><i><div><img src=""paste-133092446568449.jpg"" /></div></i></div></div> <div class=tags></div>"
"<div class=card>The Cardinal ligament&nbsp;connects the cervix to the side wall of the pelvis&nbsp;and contains the&nbsp;<b><span class=cloze>[...]</span> vessels</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The Cardinal ligament&nbsp;connects the cervix to the side wall of the pelvis&nbsp;and contains the&nbsp;<b><span class=cloze>uterine</span> vessels</b></div><br><br> <div class=extra><div><i>C for&nbsp;<b>C</b>ervix → contains&nbsp;<u>uterine</u>&nbsp;vessels (which are going to the cervix/uterus)<br /><div><br /></div><div><img src=""paste-151925878161409.jpg"" /></div><div><br /></div></i><img src=""paste-506393824067585.jpg"" /><i><div><img src=""paste-133092446568449.jpg"" /></div></i></div></div> <div class=tags></div>"
"<div class=card>The&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;connects the&nbsp;<b>uterine fundus</b>&nbsp;to the&nbsp;<b>labia majora</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The&nbsp;<b><span class=cloze>round ligament of the uterus</span></b>&nbsp;connects the&nbsp;<b>uterine fundus</b>&nbsp;to the&nbsp;<b>labia majora</b>&nbsp;</div><br><br> <div class=extra><div><i>passes through the&nbsp;<b>""round""&nbsp;inguinal canal</b></i><b>&nbsp;</b></div><div><i>derivative of the&nbsp;<b>gubernaculum</b></i></div><div><img src=""paste-519931560984577.jpg"" /><img src=""paste-521512108949505.jpg"" /></div><div><br /></div><img src=""paste-263002322370889.jpg"" /></div> <div class=tags></div>"
"<div class=card>The&nbsp;<b>round ligament of the uterus</b>&nbsp;connects the&nbsp;<b>uterine fundus</b>&nbsp;to the&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The&nbsp;<b>round ligament of the uterus</b>&nbsp;connects the&nbsp;<b>uterine fundus</b>&nbsp;to the&nbsp;<b><span class=cloze>labia majora</span></b>&nbsp;</div><br><br> <div class=extra><div><i>passes through the&nbsp;<b>""round""&nbsp;inguinal canal</b></i><b>&nbsp;</b></div><div><i>derivative of the&nbsp;<b>gubernaculum</b></i></div><div><img src=""paste-519931560984577.jpg"" /><img src=""paste-521512108949505.jpg"" /></div><div><br /></div><img src=""paste-263002322370889.jpg"" /></div> <div class=tags></div>"
"<div class=card>What is the biggest predictor of the ""<b>patch</b>"" failing as contraception?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the biggest predictor of the ""<b>patch</b>"" failing as contraception?<div><br /></div><div><span class=cloze>Weight (&gt; 198 lbs)</span></div></div><br><br> <div class=extra>More diffusion barrier with more fat with a patch.</div> <div class=tags></div>"
"<div class=card><u>post</u>-term pregnancy (&gt; 41 weeks) + <u>oligo</u>hydramnios = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>post</u>-term pregnancy (&gt; 41 weeks) + <u>oligo</u>hydramnios = <span class=cloze>induce/deliver</span></div><br><br> <div class=extra><div><i>aging placentas may have&nbsp;<u>decreased fetal perfusion</u>, which causes decreased renal perfusion and urinary output --&gt; oligo; induce with <b>prostaglandins </b>to ripen cervix.</i></div><div><i><br /></i></div><img src=""late .png"" /><div><br /></div><div><img src=""paste-2420750942208001.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>Starting <span class=cloze>[drug]</span> may lead to<b> breakthrough bleeding.&nbsp;</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Starting <span class=cloze>OCPs</span> may lead to<b> breakthrough bleeding.&nbsp;</b></div><br><br> <div class=extra><div><i><div><br /></div><div><img src=""paste-300493091897345.jpg"" /></div></i></div></div> <div class=tags></div>"
"<div class=card>irregular mass post-trauma to breast = <span class=cloze>[...]</span> (diagnosis)</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>irregular mass post-trauma to breast = <span class=cloze>fat necrosis</span> (diagnosis)</div><br><br> <div class=extra><div><img src=""bandicam 2017-12-13 12-59-02-579.jpg"" /><i><div><img src=""bandicam 2017-12-13 12-59-01-713.jpg"" /></div></i></div></div> <div class=tags></div>"
"<div class=card>Fragile X syndrome premutation carriers = <span class=cloze>[...]</span> risk of primary ovarian insufficiency</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Fragile X syndrome premutation carriers = <span class=cloze>↑</span> risk of primary ovarian insufficiency</div><br><br> <div class=extra><i>- i.e,, secondary amenorrhea, elevated FSH, low estrogen.</i><div><i>- premutation means 50-200 CGG repeats.</i></div></div> <div class=tags></div>
"<div class=card>What is the likely&nbsp;<i>underlying etiology</i>&nbsp;of&nbsp;<b>painless</b>,&nbsp;<b>irregular</b>,&nbsp;<b>heavy</b>&nbsp;<b>menses</b>&nbsp;in an adolescent girl that started menstruation one year ago?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>underlying etiology</i>&nbsp;of&nbsp;<b>painless</b>,&nbsp;<b>irregular</b>,&nbsp;<b>heavy</b>&nbsp;<b>menses</b>&nbsp;in an adolescent girl that started menstruation one year ago?<div><br /></div><div><span class=cloze>Immaturity of the hypothalamic-pituitary-ovarian axis</span></div></div><br><br> <div class=extra><i></i><i>recent menarche → immature system (not enough GnRH/LH/FSH) → results in&nbsp;<b>anovulatory cycles →&nbsp;</b></i><i><b>persistent</b>&nbsp;<b>endometrial</b>&nbsp;<b>proliferation</b>&nbsp;that results in heavy menses when ovulation does occur. this is due to a&nbsp;<b>lack of progesterone</b>&nbsp;after ovulation from the absent corpus luteum.</i><div><i><br /></i><div><div><i><br /></i><div><i><img src=""nasty.png"" /></i></div></div></div></div></div> <div class=tags></div>"
"<div class=card><b>endometrial</b> <b>polyps</b> often present with <span class=cloze>[bleeding characteristic]</span> <u>without</u> uterine enlargement</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>endometrial</b> <b>polyps</b> often present with <span class=cloze>intermenstrual spotting</span> <u>without</u> uterine enlargement</div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a patient&nbsp;who develops&nbsp;<b>respiratory failure</b>,&nbsp;<b>hypotension,</b>&nbsp;and&nbsp;<b>DIC</b>&nbsp;<u>immediately post-partum</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a patient&nbsp;who develops&nbsp;<b>respiratory failure</b>,&nbsp;<b>hypotension,</b>&nbsp;and&nbsp;<b>DIC</b>&nbsp;<u>immediately post-partum</u>?<div><br /></div><div><span class=cloze>Amniotic fluid embolism</span></div></div><br><br> <div class=extra><div><i>hypoxia can lead to <b>seizures</b></i></div><div><i><b><br /></b></i></div><i><img src=""sesaw.png"" /><img src=""paste-3056753994366977.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>What is the recommended<i>&nbsp;management</i>&nbsp;for&nbsp;<b>amniotic fluid embolism syndrome</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the recommended<i>&nbsp;management</i>&nbsp;for&nbsp;<b>amniotic fluid embolism syndrome</b>?<div><br /></div><div><span class=cloze>Supportive (e.g. respiratory, hemodynamic support)</span></div></div><br><br> <div class=extra><i><div></div></i><i><br /></i><img src=""sesaw.png"" /></div> <div class=tags></div>"
"<div class=card>The pathogenesis of <b>HELLP</b> <b>syndrome</b> involves hepatic and systemic <span class=cloze>[process]</span>, activation of the <u>coagulation cascade</u>, and <u>platelet consumption.</u></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The pathogenesis of <b>HELLP</b> <b>syndrome</b> involves hepatic and systemic <span class=cloze>inflammation</span>, activation of the <u>coagulation cascade</u>, and <u>platelet consumption.</u></div><br><br> <div class=extra><i><div></div></i><i>The resulting hepatocellular necrosis and thrombi in the portal system cause elevated liver enzymes, liver swelling, and distension of the hepatic (Glisson) capsule. &nbsp;MAHA causes increased bilirubin production (indirect hyperbilirubinemia) and red blood cell fragments on blood smear.</i><div><i><br /></i></div><img src=""paste-79087527788547.jpg"" /></div> <div class=tags></div>"
"<div class=card>Treatment of postpartum urinary retention causing overflow incontinence = <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Treatment of postpartum urinary retention causing overflow incontinence = <span class=cloze>urethral cath</span></div><br><br> <div class=extra><div style=""font-style: italic; ""></div><div><i>decompresses bladder, preventing urine reflux damage</i></div><div><i><br /></i></div><i><img src=""ret.png"" /></i></div> <div class=tags></div>"
"<div class=card><b>Endometriosis</b> can lead to <span class=cloze>[...]</span> because of disruption of pelvic anatomy.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Endometriosis</b> can lead to <span class=cloze>infertility</span> because of disruption of pelvic anatomy.</div><br><br> <div class=extra><div style=""font-style: italic; ""></div><div><i>the ectopic glands can disrupt oocyte release, sperm entry, ovarian function (endometrioma); resection improves the infertility.&nbsp;</i></div></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[5a-reductase deficiency or complete androgen insensitivity]</span> =&nbsp;</b>female-appearing child with&nbsp;<font color=""#ff0000"">masculinization</font>&nbsp;at puberty, bilateral undescended testes, and <u>no</u> breasts.&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>5α-reductase deficiency</span> =&nbsp;</b>female-appearing child with&nbsp;<font color=""#ff0000"">masculinization</font>&nbsp;at puberty, bilateral undescended testes, and <u>no</u> breasts.&nbsp;</div><br><br> <div class=extra><div style=""font-style: italic; ""></div><div><i></i><i>due to lack of&nbsp;<u>dihydrotestosterone</u>, which is necessary for external genitalia development; androgens also <b>inhibit</b> <font color=""#0000ff"">breast development.&nbsp;</font></i><div><i><br /></i></div><div><i>female with <b>masculinzation at puberty</b> due to testes producing ↑↑ testosterone ""saturating"" limited 5a-reductase and making DHT.</i></div><div><i><br /></i></div><div><i>compare with CAIS where there's<font color=""#ff0000""> no masculinization</font> due to inability of androgens to function and there <b>is</b> <font color=""#0000ff"">breast development</font> since androgens can't inhibit breast tissue.</i></div><div><i><br /></i></div><img src=""paste-2732617107505155.jpg"" /></div><div><br /><img src=""paste-123961346097153.jpg"" /><i><div><br /></div></i></div><div><i><img src=""paste-9045308499558401.jpg"" /><img src=""paste-351160821088257.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-2673359443722241.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>Elevated <b>CA-125 </b>in a <span class=cloze>[...]</span>-menopausal woman is concerning for cancer.&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Elevated <b>CA-125 </b>in a <span class=cloze>post</span>-menopausal woman is concerning for cancer.&nbsp;</div><br><br> <div class=extra><div style=""font-style: italic; ""></div><div><i></i><i></i><i>t</i><i>he other conditions that cause elevated CA-125 are&nbsp;<b>pre</b>-menopausal conditions (endometriosis, fibroids); need f/o imaging/surgical exploration.&nbsp;</i></div><div><i></i><i><br /></i></div><div><i></i><i><img src=""epithel ovarian carc.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in an <b>obese</b> woman with an&nbsp;<b><font color=""#ff0000"">erythematous</font> <font color=""#ff0000"">plaques</font></b>&nbsp;involving the&nbsp;<u>skin folds</u>&nbsp;(e.g., breasts, inguinal, gluteal, axillary) along with <b>satellite lesions</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in an <b>obese</b> woman with an&nbsp;<b><font color=""#ff0000"">erythematous</font> <font color=""#ff0000"">plaques</font></b>&nbsp;involving the&nbsp;<u>skin folds</u>&nbsp;(e.g., breasts, inguinal, gluteal, axillary) along with <b>satellite lesions</b>?<div><br /></div><div><span class=cloze>Intertrigo (most commonly due to&nbsp;<i>Candida</i>)</span></div></div><br><br> <div class=extra><div style=""font-style: italic; ""></div><div><i></i><i><b>obesity/tight clothes (think friction) and steroid use/diabetes&nbsp;</b>worsens condition; treat with <b>antifungals (clotrimazole, ketoconazole)</b></i></div><div><i><br /><div></div></i><i><img src=""paste-961299580190723.jpg"" /><br /></i></div><div><div><i><img src=""boo (1).png"" /><img src=""paste-3219163887697921.jpg"" /></i></div><div></div><div></div></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card>In addition to <b>post</b>menopausal women, <b>lichen sclerosus</b> may also occur in <span class=cloze>[population]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In addition to <b>post</b>menopausal women, <b>lichen sclerosus</b> may also occur in <span class=cloze>premenarchal girls</span></div><br><br> <div class=extra><i>both are <b>hypoestrogenic states</b>&nbsp;<b>→ vulvar thinning.</b></i><div><br /></div><div><img src=""LS.png"" /></div></div> <div class=tags></div>"
"<div class=card>genitourinary syndrome of menopause (atrophic vaginitis) = <span class=cloze>[↑/↓]</span> UTIs + dysuria.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>genitourinary syndrome of menopause (atrophic vaginitis) = <span class=cloze>↑</span> UTIs + dysuria.</div><br><br> <div class=extra><i>↓ estrogen = ↓ glycogen content + ↑ elevated pH → ↑ risk of <b>UTIs</b>.</i><div><i><b>dysuria</b> due to thin, denuded vulvovaginal epithelium.</i></div><div><i><br /></i></div><div><i><br /></i></div><div><i><img src=""howd everyone know.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>lichen sclerosus</b> can have <u>perianal</u> involvement that results in painful <span class=cloze>[...]</span> and <b>anal fissures.&nbsp;</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>lichen sclerosus</b> can have <u>perianal</u> involvement that results in painful <span class=cloze>defecation</span> and <b>anal fissures.&nbsp;</b></div><br><br> <div class=extra><i><img src=""LS.png"" /></i></div> <div class=tags></div>"
"<div class=card><b>white, odorless mucoid cervical discharge</b> that increases <b>midcycle</b> due to ↑ <b>estrogen</b> levels and <u>without</u> inflammation/infection = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>white, odorless mucoid cervical discharge</b> that increases <b>midcycle</b> due to ↑ <b>estrogen</b> levels and <u>without</u> inflammation/infection = <span class=cloze>physiologic leukorrhea</span></div><br><br> <div class=extra><i><img src=""paste-1295241877389315.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><b>von Willebrand disease</b>&nbsp;presents&nbsp;with <span class=cloze>[...]</span>&nbsp;<b>platelet count&nbsp;</b>+ <span class=cloze>[...]</span> bleeding time + <span class=cloze>[...]</span> PTT</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>von Willebrand disease</b>&nbsp;presents&nbsp;with <span class=cloze><u>normal</u></span>&nbsp;<b>platelet count&nbsp;</b>+ <span class=cloze>increased</span> bleeding time + <span class=cloze>↔ or ↑</span> PTT</div><br><br> <div class=extra><div>- clinical scenario: <b>postpartum hemorrhage.</b></div>- platelets are around but cannot adhere → increased bleeding time<div><div>- vWF normally carries factor 8, but in mild disease PTT may not be increased.<i><br /></i><div><i><br /></i></div><div><i><img src=""paste-10982802606522369.jpg"" /><br /></i><div><img src=""paste-895938767880193.jpg"" /><img src=""paste-3523814507937793.jpg"" /><img src=""mpcd.PNG"" /></div></div></div></div><div><br /></div></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">Desmopressin</font>&nbsp;(DDAVP) is used to treat:<div><br /></div><div><span class=cloze>[hematologic condition]</span></div><div>von Willebrand disease (type 1)</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">Desmopressin</font>&nbsp;(DDAVP) is used to treat:<div><br /></div><div><span class=cloze>hemophilia&nbsp;<b>A</b></span></div><div>von Willebrand disease (type 1)</div></div><br><br> <div class=extra><div>desmopressin increases&nbsp;<b>factor 8</b>&nbsp;levels (for hemophilia A) and&nbsp;<b>vWF</b>&nbsp;from Weibel-Palade bodies in endothelial cells (for vWF disease)<div><br /><div><img src=""paste-394780508946909.jpg"" /><img src=""paste-394844933456343.jpg"" /></div></div><div><br /></div><div><img src=""paste-695282190778369.jpg"" /><img src=""paste-695320845484035.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card><b>elevated</b> DHEAS and normal testosterone = <span class=cloze>[ovarian/adrenal]</span> tumor<div><br /></div><div>normal DHEAS and <b>elevated</b> testosterone = <span class=cloze>[ovarian/adrenal]</span> tumor</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>elevated</b> DHEAS and normal testosterone = <span class=cloze>adrenal</span> tumor<div><br /></div><div>normal DHEAS and <b>elevated</b> testosterone = <span class=cloze>ovarian</span> tumor</div></div><br><br> <div class=extra><i>both cause <b>rapid</b>-onset virilization (&lt; 1 year)&nbsp;</i><div><i>contrast with PCOS which doesn't cause virilization</i></div></div> <div class=tags></div>
"<div class=card>diabetic neuropathy = <span class=cloze>[...]</span> incontinence</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>diabetic neuropathy = <span class=cloze>overflow</span> incontinence</div><br><br> <div class=extra><i>bladder overdistension due to inability to completely empty bladder.</i></div> <div class=tags></div>
"<div class=card>abnormal localized <u>outpouching</u>&nbsp;of the urethral mucosa leading to <b>dysuria</b>, postvoid <b>dribbling</b>, <b>dyspareunia</b>, and tender <u>anterior</u> vaginal wall mass with <b><font color=""#ff0000"">bloody</font>/purulent</b>&nbsp;<b>urethral</b> <b>discharge</b> = <span class=cloze>[diagnosis]</span>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>abnormal localized <u>outpouching</u>&nbsp;of the urethral mucosa leading to <b>dysuria</b>, postvoid <b>dribbling</b>, <b>dyspareunia</b>, and tender <u>anterior</u> vaginal wall mass with <b><font color=""#ff0000"">bloody</font>/purulent</b>&nbsp;<b>urethral</b> <b>discharge</b> = <span class=cloze>urethral diverticulum</span>&nbsp;</div><br><br> <div class=extra><i>the outpouching collects urine which can <b>dribble</b> out later or cause <b>infection</b>&nbsp;(causing dyspareunia, tender mass, bloody discharge).</i><div><i><br /></i></div><div><div><br /></div><div><img src=""paste-213614493433859.jpg"" /></div><div><br /></div><div><img src=""paste-213627378335747.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card>condyloma acuminata in children is concerning for <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>condyloma acuminata in children is concerning for <span class=cloze>sexual abuse</span></div><br><br> <div class=extra><i>since transmission is usually via direct contact.</i></div> <div class=tags></div>
"<div class=card>T/F: Raloxifene can increase <b>DVT</b> risk<div><br /><div><span class=cloze>[...]</span></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>T/F: Raloxifene can increase <b>DVT</b> risk<div><br /><div><span class=cloze>T</span></div></div></div><br><br> <div class=extra><i>anything that has <b>estrogen</b> <b>agonist</b> activity (even just at bone) can increase DVT risk by <b>increasing protein C resistance (aka like factor V leiden)</b></i><div><b><i><br /></i></b><div><i><img src=""paste-3038229800419331.jpg"" /></i></div></div></div> <div class=tags></div>"
<b>Candida vaginitis</b>&nbsp;is more common in patients with recent corticosteroid, antibiotic, or <span class=cloze>[...]</span> use"<b>Candida vaginitis</b>&nbsp;is more common in patients with recent corticosteroid, antibiotic, or <span class=cloze>OCP</span> use<br> <i>other risk factors include <b>pregnancy</b> and <b>diabetes mellitus </b>(pregnancy and OCPs increase estrogen)<b>&nbsp;</b></i><div><i><img src=""dammit.png"" /><img src=""paste-18318035517853.jpg"" /></i></div>"
"<div class=card>T/F: Asherman's syndrome causes no response to progesterone challenge.<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>T/F: Asherman's syndrome causes no response to progesterone challenge.<div><br /></div><div><span class=cloze>T</span></div></div><br><br> <div class=extra>No endometrial lining to bleed from when progesterone is withdrawn.<div><br /></div></div> <div class=tags></div>
"<div class=card><b>Mature cystic teratomas </b>have a higher risk of causing <span class=cloze>[...]</span> due to their <u>hetereogenous</u> composition.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>Mature cystic teratomas </b>have a higher risk of causing <span class=cloze>ovarian torsion</span> due to their <u>hetereogenous</u> composition.</div><br><br> <div class=extra><i>hetereogenous composition and variable density creates 'unstable' mass prone to rotation</i></div> <div class=tags></div>
"<div class=card><b>unilateral</b> (nonmidline) pelvic pain = <span class=cloze>[primary/secondary]</span> dysmenorrhea</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>unilateral</b> (nonmidline) pelvic pain = <span class=cloze>secondary</span> dysmenorrhea</div><br><br> <div class=extra><i>age &gt; 25 at onset, unilateral pelvic pain, <b>lack</b> of systemic symptoms (nausea, fatigue), abnormal uterine bleeding suggest <u>secondary</u>&nbsp;dysmenorrhea (e.g., endometriosis)</i></div> <div class=tags></div>
"<div class=card><div>soft, mobile, nontender cystic mass palpated behind the posterior labia majora = <span class=cloze>[diagnosis]</span></div><div><br /></div><div><img src=""paste-13426999775199233.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>soft, mobile, nontender cystic mass palpated behind the posterior labia majora = <span class=cloze>bartholin gland cyst</span></div><div><br /></div><div><img src=""paste-13426999775199233.jpg"" /></div></div><br><br> <div class=extra><div><i>can cause vaginal discomfort and pressure with sex, walking, sitting; treat with <b>incision and drainage.</b></i></div><div><i><b><br /></b></i></div><i><img src=""Bartholins-Cyst.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><b>Primary HSV</b> typically <span class=cloze>[outcome]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>Primary HSV</b> typically <span class=cloze>resolves spontaneously within a <b>week</b> of lesion development</span></div><br><br> <div class=extra><div><i><b>recurrent</b> disease, though becomes<u> less frequent</u> over time, helped by antivirals</i></div></div> <div class=tags></div>
"<div class=card><b>CA-125</b> is more useful in <span class=cloze>[...]</span>-menopausal women.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>CA-125</b> is more useful in <span class=cloze>post</span>-menopausal women.</div><br><br> <div class=extra><i>in <b>pre</b>-menopausal women, CA-125 can be elevated by many benign conditions (e.g., endometriosis, fibroids)</i></div> <div class=tags></div>
"<div class=card><b><span class=cloze>[...]</span> </b>can cause fetal compromise (hypoxemia, acidemia) due to <b>disruption of intervillous blood flow.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b><span class=cloze>Uterine tachysystole</span> </b>can cause fetal compromise (hypoxemia, acidemia) due to <b>disruption of intervillous blood flow.</b></div><br><br> <div class=extra><i><b>discontinue</b> <b>utertonic agents</b>&nbsp;to slow down contractions and give more time for blood flow.</i></div> <div class=tags></div>
"<div class=card><b>young girl </b>with<b> thin, fused</b> <u>labia minora</u> is due to <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>young girl </b>with<b> thin, fused</b> <u>labia minora</u> is due to <span class=cloze>labial adhesions.&nbsp;</span></div><br><br> <div class=extra><i>2/2 low estrogen + inflammation; if symptomatic treat with <b>topical estrogen.</b></i><div><i><br /></i></div><div><i><img src=""paste-1489202600476675.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>treatment of primary dysmenorrhea = <span class=cloze>[...]</span><div>treatment of PMS = <span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>treatment of primary dysmenorrhea = <span class=cloze>NSAIDs</span><div>treatment of PMS = <span class=cloze>SSRI</span></div></div><br><br> <div class=extra><i><div></div></i><i>PMS has more symptoms and impairs function; treat with prostaglandin blockers b/c that's the source of contractions/pain.</i><div><i><br /></i></div><img src=""this guy fucks.png"" /></div> <div class=tags></div>"
"<div class=card><b>endometrial cells</b> on pap smear in women &gt;<b> 45 </b>= <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>endometrial cells</b> on pap smear in women &gt;<b> 45 </b>= <span class=cloze>endometrial biopsy</span></div><br><br> <div class=extra><i>may be due to endometrial shedding from cancer; &lt; 45 is normal.</i><div><i><br /></i></div><div><i><img src=""paste-1566821249449987.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Rhogam</b> is administered at<b> 28</b> weeks and <span class=cloze>[before/after/either]</span> delivery.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>Rhogam</b> is administered at<b> 28</b> weeks and <span class=cloze>before or after</span> delivery.</div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card>loss of rugation = <span class=cloze>[...]</span> estrogen level</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>loss of rugation = <span class=cloze>↓</span> estrogen level</div><br><br> <div class=extra><i>aka vaginal atrophy</i></div> <div class=tags></div>
"<div class=card>(+) chlamydia and (-) gonorrhea with PCR testing = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>(+) chlamydia and (-) gonorrhea with PCR testing = <span class=cloze>treat chlamydia only</span></div><br><br> <div class=extra><i>PCR has great sensitivity/specificity so if it's just chlamydia give them the azithro/doxy; however if it were (+) gonorrhea then <b>give both </b>due to gonorrhea resistance to cephalos.</i><div><i><br /></i></div><div><i><img src=""paste-1595009119813635.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>Tamoxifen = ↑ risk of endometrial <span class=cloze>[...]</span> in<b> pre</b>menopausal women.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Tamoxifen = ↑ risk of endometrial <span class=cloze>polyps</span> in<b> pre</b>menopausal women.</div><br><br> <div class=extra><i>endometrial hyperplasia/cancer in <b>post</b>menopausal.</i></div> <div class=tags></div>
"<div class=card><b><span class=cloze>[state]</span> </b>can cause&nbsp;increased&nbsp;<b>aromatization</b>&nbsp;of&nbsp;<b>androgens</b>&nbsp;to&nbsp;<b>estrone </b>leading&nbsp;to <b>anovulation</b> and<b> abnormal uterine bleeding.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>obesity</span> </b>can cause&nbsp;increased&nbsp;<b>aromatization</b>&nbsp;of&nbsp;<b>androgens</b>&nbsp;to&nbsp;<b>estrone </b>leading&nbsp;to <b>anovulation</b> and<b> abnormal uterine bleeding.</b></div><br><br> <div class=extra><i>- <b>recall</b>: fat cells contain aromatase</i><div><i>- obesity causes <b>elevated</b> <b>androgen</b> levels due to <b>↓ sex hormone binding globulin</b></i></div><div><i>- estrone causes (-) feedback → ↓ GnRH, LH, FSH → no LH surge → anovulation; treat with <b>weight loss and OCPs.&nbsp;</b></i><div><i><br /></i></div><div><i><br /></i></div><div><i><img src=""paste-1610629915869187.jpg"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[intrahepatic cholestasis of pregnancy or acute fatty liver of pregnancy]</span> has <b>worse </b>symptoms (fulminant hepatic failure)</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>acute fatty liver of pregnancy</span> has <b>worse </b>symptoms (fulminant hepatic failure)</div><br><br> <div class=extra><div><i>i.e., scleral icterus, encephloatphy, leukocytosis, platelets &lt; 100,000</i></div><i><img src=""heh.png"" /></i></div> <div class=tags></div>"
"<div class=card><b>mitral stenosis </b>can worsen during <span class=cloze>[state]</span> due to ↑ transmitral gradient.</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>mitral stenosis </b>can worsen during <span class=cloze>pregnancy</span> due to ↑ transmitral gradient.</div><br><br> <div class=extra><i>increased blood flow in pregnancy causes increased LAP causing pulmonary edema; this causes symptoms of <b>pulmonary</b> <b>edema</b> (e.g., fatigue, exercise tolerance, dyspnea); further decompensation may occur if there's <b>new AF with RVR </b>(less filling time → ↑ LAP)</i></div> <div class=tags></div>
"<div class=card><div>Treatment for&nbsp;<b>acute (lactational) mastitis</b>&nbsp;is&nbsp;<span class=cloze>[...]</span> plus <span class=cloze>[...]</span>&nbsp;</div><div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>Treatment for&nbsp;<b>acute (lactational) mastitis</b>&nbsp;is&nbsp;<span class=cloze>continued drainage (e.g. feeding)</span> plus <span class=cloze>antibiotics (e.g. dicloxacillin)</span>&nbsp;</div><div><br /></div></div><br><br> <div class=extra><i></i><i><div></div></i><i></i><i>clogged milk ducts → flu-like symptoms, focal unilateral breast pain with<font color=""#ff0000""> erythema/induration</font> and axillary lymphadenopathy</i><div style=""font-weight: bold; ""><b><i></i><i><br /></i></b></div><b><img src=""bandicam 2017-12-13 12-58-09-537.jpg"" /></b><br class=""Apple-interchange-newline"" /><b><img src=""bandicam 2017-12-13 12-58-18-337.jpg"" /></b><br /><div style=""font-weight: bold; ""><i><img src=""bandicam 2017-12-13 12-57-27-523.jpg"" /><img src=""bandicam 2017-12-13 12-57-48-696.jpg"" /><img src=""bandicam 2017-12-13 12-58-05-186.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><u>serious</u> complication of <b>bartholin abscess</b> → <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>serious</u> complication of <b>bartholin abscess</b> → <span class=cloze>necrotizing fascitis</span></div><br><br> <div class=extra><img src=""paste-2316928697761793.jpg"" /><img src=""paste-2316967352467457.jpg"" /></div> <div class=tags></div>"
"<div class=card><b>clomiphene</b> is associated with <span class=cloze>[#]</span> pregnancies</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>clomiphene</b> is associated with <span class=cloze>twin</span> pregnancies</div><br><br> <div class=extra><i>lots of ovulation!</i></div> <div class=tags></div>
"<div class=card>Pregnant woman with elevated <b>AFP</b>. Next step?<div><br></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Pregnant woman with elevated <b>AFP</b>. Next step?<div><br></div><div><span class=cloze>U/S</span></div></div><br><br> <div class=extra><i><div></div></i>look for defects or multiple babies<div><br /><img src=""msafp.png"" /></div><div><br /></div><div><img src=""paste-2360518320848897.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[state]</span> = ↓ estrogen = ↑ incidence of &nbsp;urinary incontinence</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>menopause</span> = ↓ estrogen = ↑ incidence of &nbsp;urinary incontinence</div><br><br> <div class=extra><i><div></div></i><i><u>reduced estrogen support</u>&nbsp;→&nbsp;<b>loss of epithelial elasticity → </b>loss of support for urethra → urge incontinence.</i><div><i><br /><img src=""howd everyone know.png"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-2368073168322561.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><div>What is the&nbsp;<u>mode of inheritance</u>&nbsp;of&nbsp;<b>achondroplasia</b>?&nbsp;</div><div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>What is the&nbsp;<u>mode of inheritance</u>&nbsp;of&nbsp;<b>achondroplasia</b>?&nbsp;</div><div><br /></div><div><span class=cloze>Autosomal dominant</span></div><div><br /></div><div></div></div><br><br> <div class=extra><i><div></div><u>structural</u>&nbsp;= dominant</i><div><i><br /></i></div><div><i><img src=""paste-127770982088707.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-2371955818758145.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>prolapse of <u>urethra</u> into vagina causing incontinence = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>prolapse of <u>urethra</u> into vagina causing incontinence = <span class=cloze>urethrocele</span></div><br><br> <div class=extra><i><div style=""text-decoration: underline; ""></div><div style=""text-decoration: underline; ""></div><div></div></i><i><u style=""text-decoration: underline; "">- vs. cystocele</u>&nbsp;= bladder prolapse</i><div><i>- symptoms of urethrocele include<b> stress incontinence</b>, increased urinary frequency, and urinary retention</i></div><u><img src=""paste-2387035448934401.jpg"" /><img src=""paste-2387069808672769.jpg"" /></u></div> <div class=tags></div>"
"<div class=card><i><div></div></i><u>afebrile</u>&nbsp;postpartum patient with a <u>non-erythematous,&nbsp;fluctuant</u>&nbsp;breast mass &nbsp;= <span class=cloze>[diagnosis&nbsp;]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><i><div></div></i><u>afebrile</u>&nbsp;postpartum patient with a <u>non-erythematous,&nbsp;fluctuant</u>&nbsp;breast mass &nbsp;= <span class=cloze>galactocele</span></div><br><br> <div class=extra><i><div style=""text-decoration: underline; ""></div><div style=""text-decoration: underline; ""></div><div></div><div style=""text-decoration: underline; ""></div><div>- 2/2 blockage of milk duct.</div><div>- no fever, breast is not warm or erythematous so it rules out an abscess</div><div><br /></div><div style=""text-decoration: underline; ""></div></i><i><u><img src=""paste-2408239702474753.jpg"" /></u></i><u><img src=""paste-2408007774240769.jpg"" /></u></div> <div class=tags></div>"
"<div class=card>fluid-filled endometrial cavity with <u>no gestational sac</u> + lower than expected increase in b-hCG levels = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>fluid-filled endometrial cavity with <u>no gestational sac</u> + lower than expected increase in b-hCG levels = <span class=cloze>ectopic</span></div><br><br> <div class=extra><div style=""font-style: italic; text-decoration: underline; ""></div><div style=""font-style: italic; text-decoration: underline; ""></div><div style=""font-style: italic; ""></div><div style=""font-style: italic; text-decoration: underline; ""></div><div><i>the fluid may be due to ruptured ectopic, but there's no sac there so it's ectopic.</i></div><div style=""font-style: italic; ""><img src=""paste-2431196302671873.jpg"" /></div><div style=""font-style: italic; ""><br /></div></div> <div class=tags></div>"
"<div class=card><u>Fetal organomegaly</u>&nbsp;is a potential complication of&nbsp;<b>maternal gestational diabetes mellitus</b>&nbsp;and is a result of fetal&nbsp;<span class=cloze>[...]</span>.&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>Fetal organomegaly</u>&nbsp;is a potential complication of&nbsp;<b>maternal gestational diabetes mellitus</b>&nbsp;and is a result of fetal&nbsp;<span class=cloze>hyperinsulinemia</span>.&nbsp;</div><br><br> <div class=extra><div style=""font-style: italic; text-decoration: underline; ""></div><div style=""font-style: italic; text-decoration: underline; ""></div><div style=""font-style: italic; ""></div><div style=""font-style: italic; text-decoration: underline; ""></div><div><i><img src=""paste-2472243305119745.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>Why is&nbsp;<b>gestational diabetes</b>&nbsp;a risk factor for neonatal&nbsp;<b>Respiratory Distress Syndrome</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Why is&nbsp;<b>gestational diabetes</b>&nbsp;a risk factor for neonatal&nbsp;<b>Respiratory Distress Syndrome</b>?<div><br /></div><div><span class=cloze>Increased&nbsp;<u>insulin</u>&nbsp;<b>prevents</b>&nbsp;<b>surfactant</b>&nbsp;<b>synthesis</b>&nbsp;and lung maturation by interfering with&nbsp;<u>cortisol</u></span></div></div><br><br> <div class=extra><div style=""font-style: italic; text-decoration: underline; ""></div><div style=""font-style: italic; text-decoration: underline; ""></div><div style=""font-style: italic; ""></div><div style=""font-style: italic; text-decoration: underline; ""></div><div><i></i><i>insulin inhibits surfactant production</i></div><div><b><i><br /></i></b><i><div></div></i><i><img src=""paste-4731701045493761.jpg"" /></i></div><div><i><img src=""paste-4292712438169601.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-2472243305119745.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><div>True or false: If the patient has already had a&nbsp;<b><u>total</u> hysterectomy</b>&nbsp;and&nbsp;<u>no history of cervical neoplasia</u>, she can stop getting pap smears.<div><br /></div><div><span class=cloze>[...]</span></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><div>True or false: If the patient has already had a&nbsp;<b><u>total</u> hysterectomy</b>&nbsp;and&nbsp;<u>no history of cervical neoplasia</u>, she can stop getting pap smears.<div><br /></div><div><span class=cloze>True</span></div></div></div><br><br> <div class=extra>- ACOG, ACS and USPTF all recommend against pap smear post hysterectomy <b>UNLESS there is a hx of CIN 2 or greater.</b></div> <div class=tags></div>
"<div class=card><div>pain<b>FUL </b>contraction + cervix <b>DILATION</b> --&gt; <span class=cloze>[braxton hicks/labor]</span></div><div><br /></div><div>pain<b>LESS</b> contraction + <u><b>NO</b></u> cervical&nbsp;<b>DILATION</b> --&gt; <span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>pain<b>FUL </b>contraction + cervix <b>DILATION</b> --&gt; <span class=cloze>LABOR</span></div><div><br /></div><div>pain<b>LESS</b> contraction + <u><b>NO</b></u> cervical&nbsp;<b>DILATION</b> --&gt; <span class=cloze>BH contractions</span></div></div><br><br> <div class=extra><div><i>can't be BH below because there's cervical dilation</i></div><i><img src=""paste-2541538307473409.jpg"" /><img src=""fake news.png"" /></i></div> <div class=tags></div>"
"<div class=card><b>MS</b> can lead to <b><u>urge</u></b> <b>incontinence</b> due to <u>detrusor muscle</u> <span class=cloze>[...]</span>activity.<div><b>MS</b>&nbsp;can lead to&nbsp;<b><u>overflow</u></b>&nbsp;<b>incontinence</b>&nbsp;due to&nbsp;<u>detrusor muscle</u>&nbsp;<span class=cloze>[...]</span>activity.</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>MS</b> can lead to <b><u>urge</u></b> <b>incontinence</b> due to <u>detrusor muscle</u> <span class=cloze>hyper</span>activity.<div><b>MS</b>&nbsp;can lead to&nbsp;<b><u>overflow</u></b>&nbsp;<b>incontinence</b>&nbsp;due to&nbsp;<u>detrusor muscle</u>&nbsp;<span class=cloze>hypo</span>activity.</div></div><br><br> <div class=extra><div><i>- <b>UMN</b> demyelination&nbsp;→ <b>hyperactive</b> bladder and no storage (low PVR)</i></div><div><i>- <b>LMN</b> demyelination → <b>hypotonic</b> bladder and <b>overflow</b> incontinence (high PVR)</i></div><div><i><br /></i></div><div><i><img src=""paste-2549011550568449.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">upper posterior</font>&nbsp;vaginal wall prolapse&nbsp;= <span class=cloze>[condition]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">upper posterior</font>&nbsp;vaginal wall prolapse&nbsp;= <span class=cloze>enterocele</span></div><br><br> <div class=extra><div><i>often asymptomatic (vs. rectocele)</i></div><div><i><img src=""hLpPMl1D1mhmo5AUn8X9sg.jpg"" /><img src=""paste-2559375306653697.jpg"" /><img src=""paste-2559362421751809.jpg"" /></i></div><div></div></div> <div class=tags></div>"
"<div class=card>What is the protocol for an&nbsp;<b>HIV+</b>&nbsp;patient getting&nbsp;<u>pap smears</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>What is the protocol for an&nbsp;<b>HIV+</b>&nbsp;patient getting&nbsp;<u>pap smears</u>?<div><br /></div><div><span class=cloze>21q1</span></div></div><br><br> <div class=extra></div> <div class=tags></div>
"<div class=card>A&nbsp;<u>thick dividing membrane</u>&nbsp;and <b>two yolk sacs </b>on prenatal ultrasound is indicative of a&nbsp;<b><span class=cloze>[...]</span>-chorionic</b>,&nbsp;<b><span class=cloze>[...]</span>-amniotic</b>&nbsp;pregnancy</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>A&nbsp;<u>thick dividing membrane</u>&nbsp;and <b>two yolk sacs </b>on prenatal ultrasound is indicative of a&nbsp;<b><span class=cloze>di</span>-chorionic</b>,&nbsp;<b><span class=cloze>di</span>-amniotic</b>&nbsp;pregnancy</div><br><br> <div class=extra><div><i>two placentas, two amnioic sac</i></div><div><i><u>thin</u> dividing membrane = <b>mono</b>chorionic (think about the placenta being shared, so they must be close aka thinly divided)</i></div><div><i><br /></i></div><img src=""scan0001.jpg"" /><img src=""paste-24597277705268.jpg"" /></div> <div class=tags></div>"
"<div class=card>A&nbsp;<u>thin dividing membrane</u>&nbsp;and two yolk sacs on prenatal ultrasound is indicative of a&nbsp;<b><span class=cloze>[...]</span>-chorionic</b>,&nbsp;<b><span class=cloze>[...]</span>-amniotic</b>&nbsp;pregnancy</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>A&nbsp;<u>thin dividing membrane</u>&nbsp;and two yolk sacs on prenatal ultrasound is indicative of a&nbsp;<b><span class=cloze>mono</span>-chorionic</b>,&nbsp;<b><span class=cloze>di</span>-amniotic</b>&nbsp;pregnancy</div><br><br> <div class=extra><div><i>one placenta, two amnioic sac</i></div><div><i><u>thin</u> dividing membrane = <b>mono</b>chorionic (think about the placenta being shared, so they must be close aka thinly divided)</i></div><div><i><br /></i></div><img src=""image020.jpg"" /><div><img src=""paste-24601572672564.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">low</font>&nbsp;risk population&nbsp;<font color=""#ff0000"">(+) PPD</font>&nbsp;&gt; <span class=cloze>[mm]</span><div><font color=""#ff0000"">mid</font>&nbsp;risk population&nbsp;<font color=""#ff0000"">(+) PPD</font>&nbsp;&gt; <span class=cloze>[mm]</span></div><div><font color=""#ff0000"">high</font>&nbsp;risk population&nbsp;<font color=""#ff0000"">(+) PPD</font>&nbsp;&gt; <span class=cloze>[mm]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">low</font>&nbsp;risk population&nbsp;<font color=""#ff0000"">(+) PPD</font>&nbsp;&gt; <span class=cloze>15 mm</span><div><font color=""#ff0000"">mid</font>&nbsp;risk population&nbsp;<font color=""#ff0000"">(+) PPD</font>&nbsp;&gt; <span class=cloze>10 mm</span></div><div><font color=""#ff0000"">high</font>&nbsp;risk population&nbsp;<font color=""#ff0000"">(+) PPD</font>&nbsp;&gt; <span class=cloze>5 mm</span></div></div><br><br> <div class=extra><div><b>high risk:</b>&nbsp;HIV infections, immunosuppression</div><div><b>middle risk:&nbsp;</b>healthcare workers, homeless, country with high TB rates, IVDU.</div><div><br /></div><div><img src=""paste-2639231633588225.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>PPROM = <span class=cloze>[#]</span> of doses of corticosteroids</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>PPROM = <span class=cloze>2</span> of doses of corticosteroids</div><br><br> <div class=extra><div><i>critical for lung development</i></div><div><i><br /></i></div><div><img src=""paste-2666354352062465.jpg"" /><img src=""paste-5415953760258.jpg"" /><img src=""paste-2666319992324097.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b>5α-reductase deficiency = </b><span class=cloze>[genotype]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>5α-reductase deficiency = </b><span class=cloze>46XY</span></div><br><br> <div class=extra><div><i></i><i>due to lack of&nbsp;<u>dihydrotestosterone</u>, which is necessary for external genitalia development; androgens also&nbsp;<b>inhibit</b>&nbsp;<font color=""#0000ff"">breast development.&nbsp;</font></i><div><i><br /></i></div><div><i>female with&nbsp;<b>masculinzation at puberty</b>&nbsp;due to testes producing ↑↑ testosterone ""saturating"" limited 5a-reductase and making DHT.</i></div><div><i><br /></i></div><div><i>compare with CAIS where there's<font color=""#ff0000"">&nbsp;no masculinization</font>&nbsp;due to inability of androgens to function and there&nbsp;<b>is</b>&nbsp;<font color=""#0000ff"">breast development</font>&nbsp;since androgens can't inhibit breast tissue.</i></div><div><i><br /></i></div></div><div><i><img src=""paste-123961346097153.jpg"" /></i></div><div><i><img src=""paste-2732617107505155.jpg"" /></i><i><img src=""paste-351160821088257.jpg"" /></i></div><div><i><img src=""paste-2675906359328769.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Cervical cancer</b> can spread and cause <span class=cloze>[...]</span> due to compression of the ureters.<div><br /></div><div><img src=""paste-11605667353722881.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Cervical cancer</b> can spread and cause <span class=cloze>hydronephrosis</span> due to compression of the ureters.<div><br /></div><div><img src=""paste-11605667353722881.jpg"" /></div></div><br><br> <div class=extra><div><i><img src=""CDR0000670191.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-2686841346064385.jpg"" /><img src=""paste-2691724723879937.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>funneled lower uterine segment = <span class=cloze>[diagnosis]</span><div><br /></div><div><img src=""B9781416032649500227_f18-09-9781416032649.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>funneled lower uterine segment = <span class=cloze>cervical incompetence</span><div><br /></div><div><img src=""B9781416032649500227_f18-09-9781416032649.jpg"" /></div></div><br><br> <div class=extra><div><i>represents the <b>dilatation</b> of the internal part of the cervical canal and <b>reduction</b> of the cervical length; ↑ risk of preterm labor. &nbsp;</i></div><div><i><br /></i></div><div><i><img src=""paste-2737332981596161.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-2737371636301825.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>Maternal diabetes = <span class=cloze>[...]</span>hydramnios</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Maternal diabetes = <span class=cloze>poly</span>hydramnios</div><br><br> <div class=extra><div><i>- more insulin and more fluid</i></div><div><i>- leading to <b>fundus higher than dates.</b></i></div><div><i><br /></i></div><div><i><img src=""paste-2741765387845633.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Congenital adrenal hyperplasia</b>&nbsp;is a result of&nbsp;<u>decreased</u>&nbsp;levels of&nbsp;<b><span class=cloze>[...]</span></b>, causing&nbsp;<u>increased</u>&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;secretion via negative feedback&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Congenital adrenal hyperplasia</b>&nbsp;is a result of&nbsp;<u>decreased</u>&nbsp;levels of&nbsp;<b><span class=cloze>cortisol</span></b>, causing&nbsp;<u>increased</u>&nbsp;<b><span class=cloze>ACTH</span></b>&nbsp;secretion via negative feedback&nbsp;</div><br><br> <div class=extra><div><i><br /></i></div><div><i><img src=""paste-2753988864770049.jpg"" /><br /><div><br /></div><div><img src=""paste-15410712025235457.jpg"" /><img src=""paste-9843523876552707.jpg"" /><div></div></div></i><i><img src=""asfsdg.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>amniotic fluid embolism vs. PE time frame?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>amniotic fluid embolism vs. PE time frame?<div><br /></div><div><span class=cloze>during delivery / right afterwards vs. up to days afterwards</span></div></div><br><br> <div class=extra><div><i><br /></i></div><div><i><img src=""paste-2781730058534913.jpg"" /><img src=""paste-3056758289334273.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>In vitro fertilization + fundus higher than expected for dates = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In vitro fertilization + fundus higher than expected for dates = <span class=cloze>multiple gestation</span></div><br><br> <div class=extra><div>(D)</div><img src=""paste-2782361418727425.jpg"" /></div> <div class=tags></div>"
"<div class=card>breast mass &gt; <b>30</b> years old <u>after</u> mammogram = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>breast mass &gt; <b>30</b> years old <u>after</u> mammogram = <span class=cloze>biopsy</span></div><br><br> <div class=extra><div><i><img src=""okaay...png"" /><img src=""paste-2795830436167681.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>↑ FSH with absent breast development and no pubic hair = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>↑ FSH with absent breast development and no pubic hair = <span class=cloze>karyotype</span></div><br><br> <div class=extra><div><i>likely Turner's → primary ovarian insufficiency (streak ovaries)</i></div><div><i><br /></i></div><div><i><img src=""paste-2815552925990913.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><img src=""paste-2821372606676993.jpg"" /><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><img src=""paste-2821372606676993.jpg"" /><div><br /></div><div><span class=cloze>C</span></div></div><br><br> <div class=extra><i>weird looking herpes lesion ... but painful. also note the little vesicles&nbsp;</i><div><i>Paget disease would be itchy (vs. painful) and wouldn't be as acute.</i></div></div> <div class=tags></div>"
"<div class=card><img src=""paste-2829790742577153.jpg"" /><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><img src=""paste-2829790742577153.jpg"" /><div><span class=cloze>C</span></div></div><br><br> <div class=extra><i>ALWAYS RULE OUT PREGNANCY even in old people!!!</i></div> <div class=tags></div>"
"<div class=card><img src=""paste-2838277597954049.jpg"" /><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><img src=""paste-2838277597954049.jpg"" /><div><br /></div><div><span class=cloze>B</span></div></div><br><br> <div class=extra><i>fetal macrosomia &nbsp;→ future risk of gestational diabetes</i><div><br /></div><div><img src=""paste-2839720706965505.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>breast abscess = <span class=cloze>[fluctuant/non-fluctuant]</span> mass<div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>breast abscess = <span class=cloze>fluctuant</span> mass<div><br /></div></div><br><br> <div class=extra><div><i>mastitits doesn't have to be at the nipple</i></div><div><i><br /></i></div><i style=""font-style: italic; ""><img src=""ofQrRthWR6SK8UctpE9gLA.png"" /><img src=""paste-2845415833600001.jpg"" /><img src=""argh!.png"" /></i></div> <div class=tags></div>"
"<div class=card>A condition in which the <b>fetal head is too large</b> for the maternal pelvis, which can lead to <u>failure to progress during 2nd stage of labor</u> &nbsp;= <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>A condition in which the <b>fetal head is too large</b> for the maternal pelvis, which can lead to <u>failure to progress during 2nd stage of labor</u> &nbsp;= <span class=cloze>cephalopelvic disproportion</span></div><br><br> <div class=extra><div><i>commonly 2/2 <b>fetal</b> <b>macrosomia</b>, and can lead to prolonged/arrest of 2nd stage of labor (e.g., stuck at -4 station)</i></div><div><i><br /></i></div><img src=""paste-2852820357218305.jpg"" /><i><img src=""darn (2).png"" /></i></div> <div class=tags></div>"
"<div class=card>Treatment of&nbsp;<b>recurrent UTIs&nbsp;</b>associated with&nbsp;<u>sexual intercourse?</u><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Treatment of&nbsp;<b>recurrent UTIs&nbsp;</b>associated with&nbsp;<u>sexual intercourse?</u><div><br /></div><div><span class=cloze>Postcoital prophylaxis (TMP-SMX or nitrofurantoin)</span></div></div><br><br> <div class=extra><div><i><div><img src=""paste-559449555075073.jpg"" /></div><img src=""paste-559410900369409.jpg"" /><img src=""paste-559462439976961.jpg"" /><img src=""paste-2920801099579393.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>underlying cause</i>&nbsp;of&nbsp;<b>tinnitus</b>&nbsp;and a&nbsp;<b>metallic</b>&nbsp;<b>taste</b>&nbsp;in the mouth after administration of epidural anesthesia?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>underlying cause</i>&nbsp;of&nbsp;<b>tinnitus</b>&nbsp;and a&nbsp;<b>metallic</b>&nbsp;<b>taste</b>&nbsp;in the mouth after administration of epidural anesthesia?<div><br /></div><div><span class=cloze><b>Intravascular</b> injection of the anesthetic agent</span></div></div><br><br> <div class=extra><div><div><i>systemic toxicity&nbsp;</i></div><div style=""font-style: italic; ""><img src=""paste-2935627326685185.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card><img src=""paste-2953030534168577.jpg"" /><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><img src=""paste-2953030534168577.jpg"" /><div><br /></div><div><span class=cloze>E</span></div></div><br><br> <div class=extra><div><div><i><img src=""paste-2953146498285569.jpg"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>Lupus</b> can cause <b>uteroplacental <span class=cloze>[...]</span></b> and lead to<b> fetal growth&nbsp;<span class=cloze>[...]</span>.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Lupus</b> can cause <b>uteroplacental <span class=cloze>insufficiency</span></b> and lead to<b> fetal growth&nbsp;<span class=cloze>restriction</span>.</b></div><br><br> <div class=extra><div><div><i>similar to pre-eclampsia.</i></div><div><i><br /></i></div><div><i><img src=""seemed obvi.png"" /><img src=""paste-2955220967489537.jpg"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><div>What are the ""<b>4 P's</b>"" used to treat&nbsp;<b>thyroid storm</b>?</div><div><br /></div><div>&nbsp;1.&nbsp;<span class=cloze>[...]</span>&nbsp;(a beta-blocker)</div><div>&nbsp;2.&nbsp;<span class=cloze>[...]</span> (block TPO)</div><div>&nbsp;3.&nbsp;<b>P</b>rednisolone (↓ T4 to T3)&nbsp;(a corticosteroid)</div><div>&nbsp;4.&nbsp;<b>P</b>otassium iodide (Wolff-Chaikoff)&nbsp;(Lugol iodine) &nbsp;</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>What are the ""<b>4 P's</b>"" used to treat&nbsp;<b>thyroid storm</b>?</div><div><br /></div><div>&nbsp;1.&nbsp;<span class=cloze><b>P</b>ropranolol</span>&nbsp;(a beta-blocker)</div><div>&nbsp;2.&nbsp;<span class=cloze><b>P</b>ropylthiouracil (PTU) &gt; Methimazole</span> (block TPO)</div><div>&nbsp;3.&nbsp;<b>P</b>rednisolone (↓ T4 to T3)&nbsp;(a corticosteroid)</div><div>&nbsp;4.&nbsp;<b>P</b>otassium iodide (Wolff-Chaikoff)&nbsp;(Lugol iodine) &nbsp;</div></div><br><br> <div class=extra><div><div><i><div></div></i><i><b>recall:&nbsp;</b>with KI,&nbsp;</i><i>inhibition occurs via&nbsp;<u>transient</u>&nbsp;inhibition of&nbsp;<b>thyroid peroxidase (TPO)</b></i></div><div><b><i><img src=""paste-3141467929313281.jpg"" /></i></b></div><img src=""paste-2965279780896769.jpg"" /><i><div><b></b></div></i><i><img src=""paste-3143559578386433.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><div>What are the ""<b>4 P's</b>"" used to treat&nbsp;<b>thyroid storm</b>?</div><div><br /></div><div>&nbsp;1.&nbsp;<b>P</b>ropranolol&nbsp;(a beta-blocker)</div><div>&nbsp;2.&nbsp;<b>P</b>ropylthiouracil (PTU) &gt; Methimazole (block TPO)</div><div>&nbsp;3.&nbsp;<span class=cloze>[...]</span>&nbsp;(a corticosteroid)</div><div>&nbsp;4.&nbsp;<span class=cloze>[...]</span>&nbsp;(Lugol iodine) &nbsp;</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>What are the ""<b>4 P's</b>"" used to treat&nbsp;<b>thyroid storm</b>?</div><div><br /></div><div>&nbsp;1.&nbsp;<b>P</b>ropranolol&nbsp;(a beta-blocker)</div><div>&nbsp;2.&nbsp;<b>P</b>ropylthiouracil (PTU) &gt; Methimazole (block TPO)</div><div>&nbsp;3.&nbsp;<span class=cloze><b>P</b>rednisolone (↓ T4 to T3)</span>&nbsp;(a corticosteroid)</div><div>&nbsp;4.&nbsp;<span class=cloze><b>P</b>otassium iodide (Wolff-Chaikoff)</span>&nbsp;(Lugol iodine) &nbsp;</div></div><br><br> <div class=extra><div><div><i><div></div></i><i><b>recall:&nbsp;</b>with KI,&nbsp;</i><i>inhibition occurs via&nbsp;<u>transient</u>&nbsp;inhibition of&nbsp;<b>thyroid peroxidase (TPO)</b></i></div><div><b><i><img src=""paste-3141467929313281.jpg"" /></i></b></div><img src=""paste-2965279780896769.jpg"" /><i><div><b></b></div></i><i><img src=""paste-3143559578386433.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Turner Syndrome </b>can be diagnosed with ↑ <span class=cloze>[LH + FSH or GnRH levels]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Turner Syndrome </b>can be diagnosed with ↑ <span class=cloze>LH + FSH</span></div><br><br> <div class=extra><div><div><b><i><br /></i></b></div><div><img src=""xo.PNG"" /><b><i><div></div><img src=""paste-2991723894538241.jpg"" /></i></b></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a&nbsp;<u>pregnant</u>&nbsp;woman that presents with&nbsp;<b>hand</b>&nbsp;<b>numbness</b>&nbsp;and&nbsp;<b>weakness</b>&nbsp;in the thumb/index finger?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a&nbsp;<u>pregnant</u>&nbsp;woman that presents with&nbsp;<b>hand</b>&nbsp;<b>numbness</b>&nbsp;and&nbsp;<b>weakness</b>&nbsp;in the thumb/index finger?<div><br /></div><div><span class=cloze>Carpal tunnel syndrome</span></div></div><br><br> <div class=extra><i>more common during the third-trimester of pregnancy due to <b>accumulation of fluid in the carpal tunnel;</b> usually resolves following delivery</i><div><i><br /></i></div><div><i><img src=""paste-3002615931600897 (1).jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>↑ oxytocin </b>levels can lead to <span class=cloze>[...]</span> decelerations. Why?</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>↑ oxytocin </b>levels can lead to <span class=cloze>late</span> decelerations. Why?</div><br><br> <div class=extra><i></i><i><div>uterine tachysystole → compression of blood flow to baby → hypoxia.</div><div><br /></div><div></div></i><i></i><i><img src=""paste-3006172164521985.jpg"" /></i><i></i><i><div style=""display: inline !important; ""><img src=""paste-3009883016265729.jpg"" /></div></i><i></i><i><img src=""paste-326451874234371_1529603012320.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>treatment for <b>newborn</b> <b>infant</b> if <u>mother</u> displays symptoms of <b>varicella</b> <b>&lt; 5 days before delivery </b>= <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>treatment for <b>newborn</b> <b>infant</b> if <u>mother</u> displays symptoms of <b>varicella</b> <b>&lt; 5 days before delivery </b>= <span class=cloze>varicella IVIG</span></div><br><br> <div class=extra><i></i><div><i>also given as <b>postexposure</b> <b>prophylaxis</b> to <b>mother</b>&nbsp;if she is exposed</i></div><i><img src=""paste-3018408526348289.jpg"" /><div><img src=""paste-3018395641446401.jpg"" /></div></i></div> <div class=tags></div>"
"<div class=card>What is a fever on the first day postop?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is a fever on the first day postop?<div><br /></div><div><span class=cloze>Atelectasis</span></div></div><br><br> <div class=extra><i></i><div><i>lack of <b>high</b> fever in the question below r/o pneumonia</i></div><div><i><img src=""paste-3023536717299713.jpg"" /></i></div><div><i><br /></i></div><i><img src=""paste-4303557230593_1509457489342.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>underlying pathophysiology</i>&nbsp;that results in&nbsp;<u>increased susceptibility</u>&nbsp;to&nbsp;<b>gonorrheal</b>/<b>chlamydial</b>&nbsp;<b>infection</b>&nbsp;in&nbsp;<b>younger</b>&nbsp;patients?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>underlying pathophysiology</i>&nbsp;that results in&nbsp;<u>increased susceptibility</u>&nbsp;to&nbsp;<b>gonorrheal</b>/<b>chlamydial</b>&nbsp;<b>infection</b>&nbsp;in&nbsp;<b>younger</b>&nbsp;patients?<div><br /></div><div><span class=cloze>Increased cervical cell vulnerability to infection</span></div></div><br><br> <div class=extra><i>young women have an&nbsp;<u>increased amount of columnar epithelium</u>&nbsp;lining their cervix which makes them more susceptible to infections; overtime this is&nbsp;<b>replaced by squamous epithelium</b>, which offers&nbsp;<b>more microbial resistance</b></i><div><i><b><br /></b></i></div><div><i><b><br /></b></i></div><div><i><b><img src=""paste-3034613437956097.jpg"" /></b></i></div></div> <div class=tags></div>"
"<div class=card>In a woman with<b> Factor V Leiden</b>, what is the most common location of <b>thrombosis</b> that can cause fetal demise?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>In a woman with<b> Factor V Leiden</b>, what is the most common location of <b>thrombosis</b> that can cause fetal demise?<div><br /></div><div><span class=cloze>Uteroplacental artery</span></div></div><br><br> <div class=extra></div> <div class=tags></div>
"<div class=card>What should be done if fetal heart rate cannot be assessed using external methods?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>What should be done if fetal heart rate cannot be assessed using external methods?<div><br /></div><div><span class=cloze>Apply a<b> fetal scalp electrode</b> to monitor fetal well-being</span></div></div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card>When should obese pts or pts with FamHx of DM be screened for GDM?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>When should obese pts or pts with FamHx of DM be screened for GDM?<div><br /></div><div><span class=cloze>ASAP</span></div></div><br><br> <div class=extra><i>i.e., their first visit with 50g 1 hour</i></div> <div class=tags></div>
"<div class=card>What is the&nbsp;<b>fetal pole</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<b>fetal pole</b>?<div><br /></div><div><span class=cloze>The first direct <b>imaging manifestation of the fetus</b></span></div></div><br><br> <div class=extra>is seen as a <b>thickening</b> on the margin of the<b> yolk sac </b>during early pregnancy. It is often used synonymously with the term ""embryo"".<div><br /></div><div><img src=""4457d4372c0bd337e1c63bd19a5c0809--miscarriage-to-grow.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>Can <b>MgSO4</b> be used on myesthenia gravis pts?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Can <b>MgSO4</b> be used on myesthenia gravis pts?<div><br /></div><div><span class=cloze>No</span></div></div><br><br> <div class=extra><i>- No <b>Mg in MG </b>patients</i><div><i>- nifedipine is okay to use.</i></div></div> <div class=tags></div>
"<div class=card>Besides preventing <b>RDS</b>, <span class=cloze>[...]</span> use decreases the risk of <b>intracerebral</b> <b>hemorrhage</b> and <b>necrotizing enterocolitis.&nbsp;</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Besides preventing <b>RDS</b>, <span class=cloze>betamethasone (steroid)</span> use decreases the risk of <b>intracerebral</b> <b>hemorrhage</b> and <b>necrotizing enterocolitis.&nbsp;</b></div><br><br> <div class=extra><i><br /></i></div> <div class=tags></div>
"<div class=card><b>Placental abruption </b>presents with <span class=cloze>[...]</span>-frequency, <span class=cloze>[...]</span>-intensity uterine contractions with a hypertonic uterus.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Placental abruption </b>presents with <span class=cloze>high</span>-frequency, <span class=cloze>low</span>-intensity uterine contractions with a hypertonic uterus.</div><br><br> <div class=extra><i><div></div></i><i>abrupt and strong (tone and frequency); being abrupt means you're short, quick frequency.</i><div><i><br /></i></div><img src=""chart.png"" /></div> <div class=tags></div>"
"<div class=card><b>Placental abruption </b>presents with high-frequency, low-intensity uterine contractions with a <span class=cloze>[...]</span>tonic uterus.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Placental abruption </b>presents with high-frequency, low-intensity uterine contractions with a <span class=cloze>hyper</span>tonic uterus.</div><br><br> <div class=extra><i><div></div></i><i>abrupt and strong (tone and frequency); being abrupt means you're short, quick frequency.</i><div><i><br /></i></div><img src=""chart.png"" /></div> <div class=tags></div>"
"<div class=card><b>Miscarriage</b> + <u>stable</u> vital signs can use <b>misoprostol</b>, <b>surgical</b> management, but also simply <span class=cloze>[...]</span> management</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Miscarriage</b> + <u>stable</u> vital signs can use <b>misoprostol</b>, <b>surgical</b> management, but also simply <span class=cloze><b>expectant</b></span> management</div><br><br> <div class=extra><i><div></div><div></div></i><i><br /></i><img src=""paste-52089363365889.jpg"" /></div> <div class=tags></div>"
"<div class=card>Low pelvic pain, urinary freq/urgency.&nbsp;<div><br /></div><div>A <span class=cloze>[test]</span> should be performed to look for a <span class=cloze>[diagnosis]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Low pelvic pain, urinary freq/urgency.&nbsp;<div><br /></div><div>A <span class=cloze>urinalysis</span> should be performed to look for a <span class=cloze>UTI</span></div></div><br><br> <div class=extra><i><div></div><div></div><br /></i></div> <div class=tags></div>
"<div class=card><b>Tenderness</b> confined to the <span class=cloze>[...]</span> is the best predictor of <b>hysterectomy</b> succesfully <u>eliminating chronic pelvic pain.</u></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>Tenderness</b> confined to the <span class=cloze>uterus</span> is the best predictor of <b>hysterectomy</b> succesfully <u>eliminating chronic pelvic pain.</u></div><br><br> <div class=extra><i><div></div><div></div><br /></i></div> <div class=tags></div>
"<div class=card>40-50% of women with <b>chronic pelvic pain </b>have a history of <span class=cloze>[social hx]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>40-50% of women with <b>chronic pelvic pain </b>have a history of <span class=cloze>physical/sexual abuse</span></div><br><br> <div class=extra><i><div></div><div></div><br /></i></div> <div class=tags></div>
"<div class=card>What malignancy must be ruled out in all <b>postmenopausal women </b>with uterine bleeding?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What malignancy must be ruled out in all <b>postmenopausal women </b>with uterine bleeding?<div><br /></div><div><span class=cloze>Endometrial carcinoma</span></div></div><br><br> <div class=extra><div><i>get an<b> endometrial biopsy</b></i></div><i><img src=""paste-30588757082113_1529603012320.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>Indications for&nbsp;<u>endometrial biopsy</u>&nbsp;include&nbsp;<b>abnormal</b>&nbsp;<b>uterine</b>&nbsp;or&nbsp;<b>postmenopausal</b>&nbsp;<b>bleeding</b>&nbsp;in women age&nbsp;<u>&gt;</u>&nbsp;<span class=cloze>[...]</span>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Indications for&nbsp;<u>endometrial biopsy</u>&nbsp;include&nbsp;<b>abnormal</b>&nbsp;<b>uterine</b>&nbsp;or&nbsp;<b>postmenopausal</b>&nbsp;<b>bleeding</b>&nbsp;in women age&nbsp;<u>&gt;</u>&nbsp;<span class=cloze>45</span>&nbsp;</div><br><br> <div class=extra><img src=""didnt see that heh.png"" /></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>treatment</u>&nbsp;for&nbsp;<b>pelvic inflammatory disease</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>treatment</u>&nbsp;for&nbsp;<b>pelvic inflammatory disease</b>?<div><br /></div><div><span class=cloze>Ceftriaxone + azithromycin/doxycycline</span></div></div><br><br> <div class=extra><div><i>for&nbsp;<u>both</u>&nbsp;<b>Neisseria gonorrhea&nbsp;</b>and&nbsp;<b>Chlamydia trachomatis</b>&nbsp;coverage</i></div><div><i><br /></i></div><img src=""i suk.png"" /></div> <div class=tags></div>"
"<div class=card>Inpatient<font color=""#ff0000"">&nbsp;PID</font>&nbsp;therapy:<div><br /></div><div>1. <span class=cloze>[drug]</span></div><div>2. <span class=cloze>[drug]</span></div><div><br /></div><div>OR&nbsp;</div><div><br /></div><div>1. clindamycin</div><div>2. gentamicin</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Inpatient<font color=""#ff0000"">&nbsp;PID</font>&nbsp;therapy:<div><br /></div><div>1. <span class=cloze>cefoxitin/cefotetan</span></div><div>2. <span class=cloze>doxycycline</span></div><div><br /></div><div>OR&nbsp;</div><div><br /></div><div>1. clindamycin</div><div>2. gentamicin</div></div><br><br> <div class=extra><div><i><div>- cephalosporin (gonorrhea chandelier) + doxycycline (chlamydia) - ""foxy doxy""</div><div>- gently clean the uterus</div><div>-&nbsp;<b>inpatient</b>&nbsp;(vs. outpatient) treatment preferred in teenagers (lack of f/o) or severe symptoms (see below for example)</div><div><br /></div><div><br /></div><div><img src=""paste-3067598786789377.jpg"" /></div></i></div><div><i><br /></i></div><img src=""i suk.png"" /></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>recommended treatment</i>&nbsp;for a patient with suspected&nbsp;<b>postpartum endometritis</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>recommended treatment</i>&nbsp;for a patient with suspected&nbsp;<b>postpartum endometritis</b>?<div><br /></div><div><span class=cloze>Clindamycin plus gentamicin</span></div></div><br><br> <div class=extra><i>postpartum endometritis is a&nbsp;<b>polymicrobrial</b>&nbsp;<b>infection</b>, thus requires broad-spectrum coverage; gently clean the dirty uterus&nbsp;</i><div><i><img src=""wats a lochia.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a well-appearing child that presents with a&nbsp;<u>microcytic, hypochromic anemia</u>&nbsp;with&nbsp;<b>normal</b>&nbsp;<b>RBC</b>&nbsp;<b>count</b>&nbsp;and&nbsp;<b>RDW</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a well-appearing child that presents with a&nbsp;<u>microcytic, hypochromic anemia</u>&nbsp;with&nbsp;<b>normal</b>&nbsp;<b>RBC</b>&nbsp;<b>count</b>&nbsp;and&nbsp;<b>RDW</b>?&nbsp;<div><br /></div><div><span class=cloze>Thalassemia minor</span></div></div><br><br> <div class=extra><div><i></i><i>impaired production of&nbsp;<b>globin chains</b>;&nbsp;normal RBC count and RDW help distinguish thalassemia from iron deficiency anemia (low RBC count with&nbsp;<b>high</b>&nbsp;<b>RDW</b>)</i></div><div><i><br /></i></div><img src=""more IDA.png"" /><div><img src=""paste-619188255195137.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>Diagnosis of&nbsp;<b>β-thalassemia minor</b>&nbsp;is confirmed by an&nbsp;<i>isolated</i>&nbsp;<u>increase</u>&nbsp;in&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;(&gt; 3.5%) on electrophoresis&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Diagnosis of&nbsp;<b>β-thalassemia minor</b>&nbsp;is confirmed by an&nbsp;<i>isolated</i>&nbsp;<u>increase</u>&nbsp;in&nbsp;<b><span class=cloze>HbA₂</span></b>&nbsp;(&gt; 3.5%) on electrophoresis&nbsp;</div><br><br> <div class=extra><div><i></i><i>normal is 2.5% (↓ beta chain = more shunting to delta chain version)</i><div><i>may also have slightly elevated HbF and slightly decreased HbA</i>&nbsp;</div><div><br /></div><div><img src=""paste-605693467951107.jpg"" /></div></div><div><i><br /></i></div><img src=""more IDA.png"" /><div><img src=""paste-619188255195137.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>Diagnosis of&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;is confirmed by an&nbsp;<i>isolated</i>&nbsp;<u>increase</u>&nbsp;in&nbsp;<b>HbA₂</b>&nbsp;(&gt; 3.5%) on electrophoresis&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Diagnosis of&nbsp;<b><span class=cloze>β-thalassemia minor</span></b>&nbsp;is confirmed by an&nbsp;<i>isolated</i>&nbsp;<u>increase</u>&nbsp;in&nbsp;<b>HbA₂</b>&nbsp;(&gt; 3.5%) on electrophoresis&nbsp;</div><br><br> <div class=extra><div><i></i><i>normal is 2.5% (↓ beta chain = more shunting to delta chain version)</i><div><i>may also have slightly elevated HbF and slightly decreased HbA</i>&nbsp;</div><div><br /></div><div><img src=""paste-605693467951107.jpg"" /></div></div><div><i><br /></i></div><img src=""more IDA.png"" /><div><img src=""paste-619188255195137.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><div>Iron deficiency anemia = <span class=cloze>[normal/high]</span> RDW</div><div>Thalassemia = <span class=cloze>[...]</span> RDW</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>Iron deficiency anemia = <span class=cloze>high</span> RDW</div><div>Thalassemia = <span class=cloze>normal</span> RDW</div></div><br><br> <div class=extra><div><i>some RBCs get enough iron, others don't → variable.</i></div><div><i><br /></i></div><div><img src=""MicrocyticAnemia.png"" /></div></div> <div class=tags></div>"
"<div class=card>pregnancy = <span class=cloze>[↑↓↔]</span> hematocrit</div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>pregnancy = <span class=cloze>↓</span> hematocrit</div><br><br> <div class=extra><b><i>Dilutional anemia</i></b>&nbsp;d/t Plasma volume &gt;&gt; RBC volume</div> <div class=tags></div>
"<div class=card>The&nbsp;<u>first test</u>&nbsp;to order for&nbsp;<b>precocious puberty</b>&nbsp;is <span class=cloze>[...]</span>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The&nbsp;<u>first test</u>&nbsp;to order for&nbsp;<b>precocious puberty</b>&nbsp;is <span class=cloze>wrist X-ray</span>.</div><br><br> <div class=extra><i><div></div></i><i>IF the&nbsp;<b>bone age &gt; patient's age</b>&nbsp;by at least 2 years, move on to second test, which is&nbsp;measuring<b> LH level / GnRH stimulation test.&nbsp;</b></i><div><i><br /></i></div><div><i>IF the bone age is at the appropriate age, diagnosis is simply either premature thelarche or premature adrenarche depending on your physical exam findings.&nbsp;</i></div><div style=""font-weight: bold; ""><i><br /></i></div><b><img src=""paste-65854733549569.jpg"" /><img src=""big_5939744306ae0.jpg"" /></b></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span> precocious puberty</b>&nbsp;is diagnosed when&nbsp;<b>leuprolide (GnRH stimulation)</b>&nbsp;causes an&nbsp;<u>increase in LH production</u>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Central</span> precocious puberty</b>&nbsp;is diagnosed when&nbsp;<b>leuprolide (GnRH stimulation)</b>&nbsp;causes an&nbsp;<u>increase in LH production</u>.</div><br><br> <div class=extra><i><div></div></i><i>Here, it implies that there's a premature activation of the hypothalamic pituitary axis. You might have to suspect cancer as a possible cause of this, and thus order an <b>MRI</b>.</i><br /><div style=""font-weight: bold; ""><i><br /></i></div><b><img src=""paste-65854733549569.jpg"" /><img src=""big_5939744306ae0.jpg"" /></b></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span> precocious puberty</b>&nbsp;is diagnosed when&nbsp;<b>leuprolide (GnRH stimulation)</b>&nbsp;causes&nbsp;<u>no change in&nbsp;LH production</u>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Peripheral</span> precocious puberty</b>&nbsp;is diagnosed when&nbsp;<b>leuprolide (GnRH stimulation)</b>&nbsp;causes&nbsp;<u>no change in&nbsp;LH production</u>.</div><br><br> <div class=extra><i><div></div></i><div><i></i><i>There will be low FSH/LH levels due to&nbsp;negative&nbsp;feedback&nbsp;from peripherally produced high estrogen/testosterone levels.<b>&nbsp;</b></i></div><b><img src=""paste-65854733549569.jpg"" /><img src=""big_5939744306ae0.jpg"" /></b></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>most likely</i>&nbsp;<i>diagnosis</i>&nbsp;in for&nbsp;<b>precocious puberty</b>&nbsp;in patient with....<div><br /><div><b><span class=cloze>[Normal/Advanced]</span> bone age</b>: Premature thelarche or adrenarche</div><div><br /></div><div><b><span class=cloze>[...]</span> bone age</b>: Peripheral PC (<i><u>low</u>&nbsp;LH</i>), Central PC (<i><u>high</u>&nbsp;LH</i>)</div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>most likely</i>&nbsp;<i>diagnosis</i>&nbsp;in for&nbsp;<b>precocious puberty</b>&nbsp;in patient with....<div><br /><div><b><span class=cloze>Normal</span> bone age</b>: Premature thelarche or adrenarche</div><div><br /></div><div><b><span class=cloze>Advanced</span> bone age</b>: Peripheral PC (<i><u>low</u>&nbsp;LH</i>), Central PC (<i><u>high</u>&nbsp;LH</i>)</div></div></div><br><br> <div class=extra><div><i>excess androgens → ↑ bone age</i></div><i><img src=""PrecociousPuberty.png"" /></i></div> <div class=tags></div>"
"<div class=card>The most common causes of&nbsp;<u>post-operative fever</u>&nbsp;(&gt;&nbsp;<b>100.4</b>) may be remembered with the ""<b>5 W's</b>"":&nbsp;<div><br /></div><div><b>POD 2-3</b>: Wind (atelectasis)</div><div><b>POD 3-5</b>: <span class=cloze>[...]</span></div><div><b>POD 5+</b>: Walking (DVT/PE)</div><div><b>POD 7</b>: Wound infection</div><div><b>POD 8-15</b>: Wonder drugs (drug fever)</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The most common causes of&nbsp;<u>post-operative fever</u>&nbsp;(&gt;&nbsp;<b>100.4</b>) may be remembered with the ""<b>5 W's</b>"":&nbsp;<div><br /></div><div><b>POD 2-3</b>: Wind (atelectasis)</div><div><b>POD 3-5</b>: <span class=cloze>Water (UTI)</span></div><div><b>POD 5+</b>: Walking (DVT/PE)</div><div><b>POD 7</b>: Wound infection</div><div><b>POD 8-15</b>: Wonder drugs (drug fever)</div></div><br><br> <div class=extra><div><br /></div><div><img src=""paste-14860586844296.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>The most common causes of&nbsp;<u>post-operative fever</u>&nbsp;(&gt;&nbsp;<b>100.4</b>) may be remembered with the ""<b>5 W's</b>"":&nbsp;<div><br /></div><div><b>POD 2-3</b>: Wind (atelectasis)</div><div><b>POD 3-5</b>: Water (UTI)</div><div><b>POD 5+</b>: <span class=cloze>[...]</span></div><div><b>POD 7</b>: Wound infection</div><div><b>POD 8-15</b>: Wonder drugs (drug fever)</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The most common causes of&nbsp;<u>post-operative fever</u>&nbsp;(&gt;&nbsp;<b>100.4</b>) may be remembered with the ""<b>5 W's</b>"":&nbsp;<div><br /></div><div><b>POD 2-3</b>: Wind (atelectasis)</div><div><b>POD 3-5</b>: Water (UTI)</div><div><b>POD 5+</b>: <span class=cloze>Walking (DVT/PE)</span></div><div><b>POD 7</b>: Wound infection</div><div><b>POD 8-15</b>: Wonder drugs (drug fever)</div></div><br><br> <div class=extra><div><br /></div><div><img src=""paste-14860586844296.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>The most common causes of&nbsp;<u>post-operative fever</u>&nbsp;(&gt;&nbsp;<b>100.4</b>) may be remembered with the ""<b>5 W's</b>"":&nbsp;<div><br /></div><div><b>POD 2-3</b>: Wind (atelectasis)</div><div><b>POD 3-5</b>: Water (UTI)</div><div><b>POD 5+</b>: Walking (DVT/PE)</div><div><b>POD 7</b>: <span class=cloze>[...]</span></div><div><b>POD 8-15</b>: Wonder drugs (drug fever)</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The most common causes of&nbsp;<u>post-operative fever</u>&nbsp;(&gt;&nbsp;<b>100.4</b>) may be remembered with the ""<b>5 W's</b>"":&nbsp;<div><br /></div><div><b>POD 2-3</b>: Wind (atelectasis)</div><div><b>POD 3-5</b>: Water (UTI)</div><div><b>POD 5+</b>: Walking (DVT/PE)</div><div><b>POD 7</b>: <span class=cloze>Wound infection</span></div><div><b>POD 8-15</b>: Wonder drugs (drug fever)</div></div><br><br> <div class=extra><div><br /></div><div><img src=""paste-14860586844296.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>The most common causes of&nbsp;<u>post-operative fever</u>&nbsp;(&gt;&nbsp;<b>100.4</b>) may be remembered with the ""<b>5 W's</b>"":&nbsp;<div><br /></div><div><b>POD 2-3</b>: Wind (atelectasis)</div><div><b>POD 3-5</b>: Water (UTI)</div><div><b>POD 5+</b>: Walking (DVT/PE)</div><div><b>POD 7</b>: Wound infection</div><div><b>POD 8-15</b>: <span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The most common causes of&nbsp;<u>post-operative fever</u>&nbsp;(&gt;&nbsp;<b>100.4</b>) may be remembered with the ""<b>5 W's</b>"":&nbsp;<div><br /></div><div><b>POD 2-3</b>: Wind (atelectasis)</div><div><b>POD 3-5</b>: Water (UTI)</div><div><b>POD 5+</b>: Walking (DVT/PE)</div><div><b>POD 7</b>: Wound infection</div><div><b>POD 8-15</b>: <span class=cloze>Wonder drugs (drug fever)</span></div></div><br><br> <div class=extra><div><br /></div><div><img src=""paste-14860586844296.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a postpartum patient on post-operative day 5 with a&nbsp;<b>fever</b>&nbsp;that is&nbsp;<u>unreponsive</u>&nbsp;to broad-spectrum antibiotic therapy with a&nbsp;<u>negative</u>&nbsp;infectious workup (blood/urine cultures, urinalysis)?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a postpartum patient on post-operative day 5 with a&nbsp;<b>fever</b>&nbsp;that is&nbsp;<u>unreponsive</u>&nbsp;to broad-spectrum antibiotic therapy with a&nbsp;<u>negative</u>&nbsp;infectious workup (blood/urine cultures, urinalysis)?&nbsp;<div><br /></div><div><span class=cloze>Septic pelvic thrombophlebitis</span></div></div><br><br> <div class=extra><i><b>diagnosis of exclusion</b>; due to an infected thrombosis of the deep pelvic or ovarian veins&nbsp;</i><div><i><br /></i><div><i><img src=""spt.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>Karyotype of&nbsp;<b>Mullerian Agenesis</b>&nbsp;= <span class=cloze>[...]</span> + ↔ testosterone levels<div><br /><div>Karyotype of&nbsp;<b>Androgen Insensitivity Syndrome&nbsp;</b>= <span class=cloze>[...]</span> + ↑ testosterone levels</div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Karyotype of&nbsp;<b>Mullerian Agenesis</b>&nbsp;= <span class=cloze>XX</span> + ↔ testosterone levels<div><br /><div>Karyotype of&nbsp;<b>Androgen Insensitivity Syndrome&nbsp;</b>= <span class=cloze>XY</span> + ↑ testosterone levels</div></div></div><br><br> <div class=extra><div><i>The presentation is the&nbsp;<u style=""font-weight: bold; "">same</u>&nbsp;except for karyotype and testosterone levels.&nbsp;<div><b>Testosterone</b>&nbsp;comes from&nbsp;<b>testes</b>&nbsp;in AIS.&nbsp;<br /><div><br /></div><div><img src=""paste-277042570461185.jpg"" /></div></div></i></div><div><i><b><br /></b></i></div><i><img src=""chart (1).png"" /></i></div> <div class=tags></div>"
"<div class=card>Karyotype of&nbsp;<b>Mullerian Agenesis</b>&nbsp;= XX + <span class=cloze>[...]</span> testosterone levels<div><br /><div>Karyotype of&nbsp;<b>Androgen Insensitivity Syndrome&nbsp;</b>= XY + <span class=cloze>[...]</span> testosterone levels</div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Karyotype of&nbsp;<b>Mullerian Agenesis</b>&nbsp;= XX + <span class=cloze>↔</span> testosterone levels<div><br /><div>Karyotype of&nbsp;<b>Androgen Insensitivity Syndrome&nbsp;</b>= XY + <span class=cloze>↑</span> testosterone levels</div></div></div><br><br> <div class=extra><div><i>The presentation is the&nbsp;<u style=""font-weight: bold; "">same</u>&nbsp;except for karyotype and testosterone levels.&nbsp;<div><b>Testosterone</b>&nbsp;comes from&nbsp;<b>testes</b>&nbsp;in AIS.&nbsp;<br /><div><br /></div><div><img src=""paste-277042570461185.jpg"" /></div></div></i></div><div><i><b><br /></b></i></div><i><img src=""chart (1).png"" /></i></div> <div class=tags></div>"
"<div class=card><span class=cloze>[AIS/Mullerian Agenesis]</span> = hair absent<div><span class=cloze>[...]</span> = hair present</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>AIS</span> = hair absent<div><span class=cloze>Mullerian Agenesis</span> = hair present</div></div><br><br> <div class=extra><div><i><div><div></div></div></i><i>no androgen receptors to make hair</i></div><div><img src=""paste-277042570461185.jpg"" /></div><div><i><b><br /></b></i></div><i><img src=""chart (1).png"" /></i></div> <div class=tags></div>"
"<div class=card><b>Premature ovarian failure</b>&nbsp;is diagnosed with <u>increased</u>&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;levels.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Premature ovarian failure</b>&nbsp;is diagnosed with <u>increased</u>&nbsp;<b><span class=cloze>FSH</span></b>&nbsp;levels.</div><br><br> <div class=extra><i>due to&nbsp;<u>lack</u>&nbsp;of feedback inhibition from estrogen</i><div><i><br /></i></div><div><i></i><i><img src=""paste-1367689385738243.jpg"" /></i><br /><div><i><br /></i><div><i><img src=""premature ovarian.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card><b>Menopause</b>&nbsp;<i>before</i>&nbsp;age&nbsp;<b>40</b>&nbsp;suggests <span class=cloze>[...]</span> insufficiency</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Menopause</b>&nbsp;<i>before</i>&nbsp;age&nbsp;<b>40</b>&nbsp;suggests <span class=cloze>primary ovarian</span> insufficiency</div><br><br> <div class=extra><i>also known as&nbsp;premature ovarian failure&nbsp;or&nbsp;<u>hyper</u>gonadotropic hypogonadism 2/2 ↓ ovarian follicles; more common in women who&nbsp;<b>smoke</b>&nbsp;or those receiving&nbsp;<b><u><font color=""#ff0000"">chemotherapy</font></u></b>/<b>radiation</b>&nbsp;</i><div><i><br /></i><div><i><img src=""paste-1367689385738243.jpg"" /><br /></i><div><i><img src=""premature ovarian.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a patient with&nbsp;<u>primary amenorrhea</u>&nbsp;and the following physical exam:&nbsp;<b>absent uterus</b>/<b>upper</b>&nbsp;<b>vagina</b>,&nbsp;<b><u>minimal pubic hair</u></b>, and&nbsp;<b>normal lower vagina</b>,&nbsp;<b>breast</b>&nbsp;<b>development</b><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a patient with&nbsp;<u>primary amenorrhea</u>&nbsp;and the following physical exam:&nbsp;<b>absent uterus</b>/<b>upper</b>&nbsp;<b>vagina</b>,&nbsp;<b><u>minimal pubic hair</u></b>, and&nbsp;<b>normal lower vagina</b>,&nbsp;<b>breast</b>&nbsp;<b>development</b><div><br /></div><div><span class=cloze>Androgen insensitivity syndrome</span></div></div><br><br> <div class=extra><i>patient's are 46,XY and have&nbsp;<u>normal testicular secretion</u>&nbsp;of&nbsp;<b>anti-Mullerian hormone</b>&nbsp;(absent upper vagina, cervix, uterus) and&nbsp;<b>testosterone</b>&nbsp;(converted to estrogen for breast development) -&nbsp;<u>minimal hair&nbsp;</u>distinguishes AIS from Mullerian agenesis.</i><div><i><br /></i></div><div><i></i><i><img src=""paste-277042570461185.jpg"" /></i><br /></div><div><div><i><img src=""chart (1).png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>When a patient comes in with&nbsp;<b>galactorrhea</b>&nbsp;and&nbsp;<b>amenorrhea</b>, you should first screen her <span class=cloze>[...]</span> level and order a(n)&nbsp;<span class=cloze>[...]</span> if it's elevated.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>When a patient comes in with&nbsp;<b>galactorrhea</b>&nbsp;and&nbsp;<b>amenorrhea</b>, you should first screen her <span class=cloze>prolactin</span> level and order a(n)&nbsp;<span class=cloze>MRI</span> if it's elevated.</div><br><br> <div class=extra><i>Her clinical vignette already possibly points to either prolactinoma or drug induced prolactinemia. You want to get an&nbsp;<b>MRI</b>&nbsp;to catch the pituitary tumor.</i><div><i><br /></i></div><div><i>HOWEVER, bear in mind, if you already got a Hx of a certain drug she's using that's causing this, you don't need MRI. You found your culprit.</i></div><div><i><br /></i></div><div><i><img src=""paste-6257767350273.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>first line treatment in&nbsp;<b>prolactinoma</b>&nbsp;= <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>first line treatment in&nbsp;<b>prolactinoma</b>&nbsp;= <span class=cloze>medication (dopamine agonist)</span></div><br><br> <div class=extra><div><i>dopamine = ↓ prolactin</i></div><i><img src=""paste-136906377527297 (1).jpg"" /></i></div> <div class=tags></div>"
"<div class=card>What should be suspected in&nbsp;<b>long term fetal tachycardia (over 160)?</b><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What should be suspected in&nbsp;<b>long term fetal tachycardia (over 160)?</b><div><br /></div><div><span class=cloze>Maternal fever or chorioamnionitis</span></div></div><br><br> <div class=extra><i><img src=""paste-2726428059631617.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>Of what the following&nbsp;<b>decelerations</b>&nbsp;on&nbsp;<u>contraction stress testing</u>&nbsp;indicative?<div><br /></div><div>Early: <span class=cloze>[...]</span></div><div>Variable:&nbsp;<span class=cloze>[...]</span></div><div>Late:&nbsp;<span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Of what the following&nbsp;<b>decelerations</b>&nbsp;on&nbsp;<u>contraction stress testing</u>&nbsp;indicative?<div><br /></div><div>Early: <span class=cloze>head compression</span></div><div>Variable:&nbsp;<span class=cloze>cord compression</span></div><div>Late:&nbsp;<span class=cloze>uteroplacental insufficiency</span></div></div><br><br> <div class=extra><img src=""paste-326696687370243.jpg"" /></div> <div class=tags></div>"
"<div class=card>Treatment of&nbsp;<b>prolonged vs. arrested</b>&nbsp;<u>active</u>&nbsp;phase of labor?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Treatment of&nbsp;<b>prolonged vs. arrested</b>&nbsp;<u>active</u>&nbsp;phase of labor?<div><br /></div><div><span class=cloze>Oxytocin vs. C-section</span></div></div><br><br> <div class=extra><i><div></div></i><i></i><div><img src=""wtf (3).png"" /></div><div><i><br /></i></div><div><i><img src=""paste-315469642858497.jpg"" /><br /></i><div><i><br /></i></div><div><i><div></div></i><i><img src=""mvu.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>On average,&nbsp;<u>how long</u>&nbsp;does the&nbsp;<b>latent phase</b>&nbsp;last for a nulli? Multiparous?<div><br /></div><div>Nulli: <span class=cloze>[...]</span> hours</div><div>Multi: <span class=cloze>[...]</span> hours</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>On average,&nbsp;<u>how long</u>&nbsp;does the&nbsp;<b>latent phase</b>&nbsp;last for a nulli? Multiparous?<div><br /></div><div>Nulli: <span class=cloze>20</span> hours</div><div>Multi: <span class=cloze>14</span> hours</div></div><br><br> <div class=extra><i><div></div></i><i></i><div><i>give <b>oxytocin</b> if need help.</i></div><div><i><br /></i></div><div><i><img src=""paste-315469642858497.jpg"" /><br /></i><div><i><br /></i></div><div><i><div></div></i><i><img src=""mvu.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the definition of&nbsp;<b><u>second</u> stage arrest of labor</b>&nbsp;in a&nbsp;<u>nulliparous vs. multiparous woman</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the definition of&nbsp;<b><u>second</u> stage arrest of labor</b>&nbsp;in a&nbsp;<u>nulliparous vs. multiparous woman</u>?<div><br /></div><div><span class=cloze>Insufficient fetal descent after pushing for&nbsp;<b>&gt; 3 hours vs. &gt; 2 hours</b></span></div></div><br><br> <div class=extra><i><div></div></i><i></i><div><i><br /></i></div><div><i><br /></i></div><div><i><img src=""paste-315469642858497.jpg"" /><br /></i><div><i><br /></i></div><div><i><div></div></i><i><img src=""mvu.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>recommended management</i>&nbsp;for a laboring patient with&nbsp;<b><u>&gt;</u>&nbsp;6 cm dilation</b>&nbsp;that experiences&nbsp;<u>no further dilation</u>&nbsp;for&nbsp;<b>4 hours</b>&nbsp;and&nbsp;<b>in</b><b>adequate</b>&nbsp;<b>contractions</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>recommended management</i>&nbsp;for a laboring patient with&nbsp;<b><u>&gt;</u>&nbsp;6 cm dilation</b>&nbsp;that experiences&nbsp;<u>no further dilation</u>&nbsp;for&nbsp;<b>4 hours</b>&nbsp;and&nbsp;<b>in</b><b>adequate</b>&nbsp;<b>contractions</b>?<div><br /></div><div><span class=cloze>Cervical examination in 2 hours</span></div></div><br><br> <div class=extra><i>arrest of active labor is not diagnosed with&nbsp;<u>inadequate contractions</u>&nbsp;until there is&nbsp;<b><u>&gt;</u>&nbsp;6 hours of no cervical change</b>&nbsp;</i><div><i><img src=""wtf (3).png"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>recommended management</i>&nbsp;for a patient with&nbsp;<b>arrest of active labor</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>recommended management</i>&nbsp;for a patient with&nbsp;<b>arrest of active labor</b>?<div><br /></div><div><span class=cloze>Cesarean delivery</span></div></div><br><br> <div class=extra><i></i><i><u>arrest</u>&nbsp;of active labor is&nbsp;differentiated from&nbsp;<u>protraction</u>&nbsp;of active labor by the <b><u>absence</u> of more cervical dilation</b> (versus abnormally <u>slow</u> cervical dilation)&nbsp;</i><div><i><br /></i><div><i><img src=""wtf (3).png"" /></i></div></div><div><i><br /></i></div><div><i></i><i><img src=""paste-315469642858497.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span> fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>second/third trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<b>placental insufficiency</b>&nbsp;(e.g. hypertension, diabetes)</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Asymmetric</span> fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>second/third trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<b>placental insufficiency</b>&nbsp;(e.g. hypertension, diabetes)</div><br><br> <div class=extra><i>characterized by normal growth in&nbsp;<b>vital</b>&nbsp;organs (e.g. brain, heart, placenta) at the expense of&nbsp;<b>less</b>&nbsp;<b>vital</b>&nbsp;organs (e.g. abdominal viscera) due to&nbsp;<u>fetal hypoxia</u>&nbsp;and preferred shunting of blood to vital organs.&nbsp;</i><div><i><br /></i></div><div><i><img src=""paste-348201588621313.jpg"" /><br /></i></div><div><div><i><br /></i></div><div><i><img src=""fgr.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>Asymmetric fetal growth restriction</b>&nbsp;begins in the&nbsp;<u><span class=cloze>[...]</span> trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<b>placental insufficiency</b>&nbsp;(e.g. hypertension, diabetes)</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Asymmetric fetal growth restriction</b>&nbsp;begins in the&nbsp;<u><span class=cloze>second/third</span> trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<b>placental insufficiency</b>&nbsp;(e.g. hypertension, diabetes)</div><br><br> <div class=extra><i>characterized by normal growth in&nbsp;<b>vital</b>&nbsp;organs (e.g. brain, heart, placenta) at the expense of&nbsp;<b>less</b>&nbsp;<b>vital</b>&nbsp;organs (e.g. abdominal viscera) due to&nbsp;<u>fetal hypoxia</u>&nbsp;and preferred shunting of blood to vital organs.&nbsp;</i><div><i><br /></i></div><div><i><img src=""paste-348201588621313.jpg"" /><br /></i></div><div><div><i><br /></i></div><div><i><img src=""fgr.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>Asymmetric fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>second/third trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Asymmetric fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>second/third trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<span class=cloze><b>placental insufficiency</b>&nbsp;(e.g. hypertension, diabetes)</span></div><br><br> <div class=extra><i>characterized by normal growth in&nbsp;<b>vital</b>&nbsp;organs (e.g. brain, heart, placenta) at the expense of&nbsp;<b>less</b>&nbsp;<b>vital</b>&nbsp;organs (e.g. abdominal viscera) due to&nbsp;<u>fetal hypoxia</u>&nbsp;and preferred shunting of blood to vital organs.&nbsp;</i><div><i><br /></i></div><div><i><img src=""paste-348201588621313.jpg"" /><br /></i></div><div><div><i><br /></i></div><div><i><img src=""fgr.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>Fetal complications of&nbsp;<b>maternal hypertension</b>&nbsp;include oligohydramnios, preterm delivery, and fetal <span class=cloze>[...]</span> (size)</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Fetal complications of&nbsp;<b>maternal hypertension</b>&nbsp;include oligohydramnios, preterm delivery, and fetal <span class=cloze>growth restriction</span> (size)</div><br><br> <div class=extra><div><i>-&nbsp;<b>small size&nbsp;</b>due to&nbsp;<u>uteroplacental insufficiency.</u>&nbsp;""less stuff"" - pre, oligo, restricted.&nbsp;</i></div><div><i>- maternal complications include superimposed preeclampsia and placental abruption</i></div><div><i><br /></i></div><img src=""zzz (2).png"" /></div> <div class=tags></div>"
"<div class=card>Fetal complications of&nbsp;<b>maternal hypertension</b>&nbsp;include oligohydramnios, <span class=cloze>[...]</span>term delivery, and fetal growth restriction (size)</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Fetal complications of&nbsp;<b>maternal hypertension</b>&nbsp;include oligohydramnios, <span class=cloze>pre</span>term delivery, and fetal growth restriction (size)</div><br><br> <div class=extra><div><i>-&nbsp;<b>small size&nbsp;</b>due to&nbsp;<u>uteroplacental insufficiency.</u>&nbsp;""less stuff"" - pre, oligo, restricted.&nbsp;</i></div><div><i>- maternal complications include superimposed preeclampsia and placental abruption</i></div><div><i><br /></i></div><img src=""zzz (2).png"" /></div> <div class=tags></div>"
"<div class=card>Fetal complications of&nbsp;<b>maternal hypertension</b>&nbsp;include <span class=cloze>[...]</span>hydramnios, preterm delivery, and fetal growth restriction (size)</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Fetal complications of&nbsp;<b>maternal hypertension</b>&nbsp;include <span class=cloze>oligo</span>hydramnios, preterm delivery, and fetal growth restriction (size)</div><br><br> <div class=extra><div><i>-&nbsp;<b>small size&nbsp;</b>due to&nbsp;<u>uteroplacental insufficiency.</u>&nbsp;""less stuff"" - pre, oligo, restricted.&nbsp;</i></div><div><i>- maternal complications include superimposed preeclampsia and placental abruption</i></div><div><i><br /></i></div><img src=""zzz (2).png"" /></div> <div class=tags></div>"
"<div class=card>The effects of <b>hyperemesis</b> <b>gravidarum</b> are mostly to the <span class=cloze>[mother/fetus]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The effects of <b>hyperemesis</b> <b>gravidarum</b> are mostly to the <span class=cloze>mother</span></div><br><br> <div class=extra><i><div></div></i><i>Other than quality of life and productivity, NVP has limited negative impact on outcomes of pregnancy;</i><img src=""hg.png"" /></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>first-line</i><i>&nbsp;test/imaging study</i>&nbsp;to evaluate&nbsp;<u>infertility</u>&nbsp;in a patient with a history of&nbsp;<b>pelvic inflammatory disease</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>first-line</i><i>&nbsp;test/imaging study</i>&nbsp;to evaluate&nbsp;<u>infertility</u>&nbsp;in a patient with a history of&nbsp;<b>pelvic inflammatory disease</b>?<div><br /></div><div><span class=cloze>hysterosalpingogram</span></div></div><br><br> <div class=extra><i>minimally invasive way to detect fallopian tube patency and/or uterine cavity anomalies</i><div><i><img src=""paste-2798987237130241.jpg"" /><br /></i><div><i><img src=""i suk.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>Any kind of <b><span class=cloze>[...]</span></b> <b>anomaly (septate, bicornuate, didelphys)&nbsp;</b>&nbsp;can increase the risk of <u><b>pre</b></u><b>term labor,&nbsp;ectopic pregnancy, and cervical incompetence</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Any kind of <b><span class=cloze>uterine</span></b> <b>anomaly (septate, bicornuate, didelphys)&nbsp;</b>&nbsp;can increase the risk of <u><b>pre</b></u><b>term labor,&nbsp;ectopic pregnancy, and cervical incompetence</b></div><br><br> <div class=extra><i>errors of mullerian duct fusion; assess with hysterosalpingogram.&nbsp;</i><div><i><br /><b><img src=""Screen Shot 2018-02-15 at 10.43.28 AM.png"" /><img src=""paste-367275538382849.jpg"" /></b></i></div></div> <div class=tags></div>"
"<div class=card><u>&lt;30 y.o.</u>&nbsp;with with breast lump, initially&nbsp;<b>reassurance (watch/wait);</b>&nbsp;if it persists, then get an <span class=cloze>[Imaging]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>&lt;30 y.o.</u>&nbsp;with with breast lump, initially&nbsp;<b>reassurance (watch/wait);</b>&nbsp;if it persists, then get an <span class=cloze>ultrasound</span></div><br><br> <div class=extra><div>- IF&nbsp;<b>cyst</b>&nbsp;→ needle aspiration</div><div>- IF<b>&nbsp;mass or blood or recurrance or &gt; 30</b>&nbsp;→ mammogram / core biopsy route</div><div><br /></div><div><i><img src=""okaay...png"" /></i></div><img src=""120133_Breast Cancer_091317-edit.png"" /></div> <div class=tags></div>"
"<div class=card>Breast lump +&nbsp;<b>ultrasound</b>&nbsp;shows a&nbsp;<u>mass</u>, the aspirate is <u>bloody</u>, the&nbsp;<u>cyst recurs</u>, or she’s older than <span class=cloze>[...]</span> years old<div><br /></div><div><b>next step:</b> go to the&nbsp;<u>mammogram</u>&nbsp;and&nbsp;<u>core needle&nbsp;biopsy</u> route</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Breast lump +&nbsp;<b>ultrasound</b>&nbsp;shows a&nbsp;<u>mass</u>, the aspirate is <u>bloody</u>, the&nbsp;<u>cyst recurs</u>, or she’s older than <span class=cloze><u>30</u></span> years old<div><br /></div><div><b>next step:</b> go to the&nbsp;<u>mammogram</u>&nbsp;and&nbsp;<u>core needle&nbsp;biopsy</u> route</div></div><br><br> <div class=extra><div><br /></div><div><br /></div><div><i><img src=""okaay...png"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-9285719294638.jpg"" /></i></div><img src=""120133_Breast Cancer_091317-edit.png"" /></div> <div class=tags></div>"
"<div class=card>Breast lump +&nbsp;<b>ultrasound</b>&nbsp;shows a&nbsp;<u>mass</u>, the aspirate is <u>bloody</u>, the&nbsp;<u>cyst recurs</u>, or she’s older than <u>30</u> years old<div><br /></div><div><b>next step:</b> go to the&nbsp;<span class=cloze>[...]</span> route</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Breast lump +&nbsp;<b>ultrasound</b>&nbsp;shows a&nbsp;<u>mass</u>, the aspirate is <u>bloody</u>, the&nbsp;<u>cyst recurs</u>, or she’s older than <u>30</u> years old<div><br /></div><div><b>next step:</b> go to the&nbsp;<span class=cloze><u>mammogram</u>&nbsp;and&nbsp;<u>core needle&nbsp;biopsy</u></span> route</div></div><br><br> <div class=extra><div><br /></div><div><br /></div><div><i><img src=""okaay...png"" /></i></div><div><i><br /></i></div><div><i><img src=""paste-9285719294638.jpg"" /></i></div><img src=""120133_Breast Cancer_091317-edit.png"" /></div> <div class=tags></div>"
"<div class=card>screening&nbsp;modality for<font color=""#ff0000"">&nbsp;</font>breast cancer for pt w/&nbsp;<b>normal risk<font color=""#ff0000"">&nbsp;</font></b>= <span class=cloze>[...]</span><div><br /><div>screening modality for breast cancer for pt w/&nbsp;<b>high risk</b>&nbsp;(family hx, radiation)&nbsp;= <span class=cloze>[...]</span></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>screening&nbsp;modality for<font color=""#ff0000"">&nbsp;</font>breast cancer for pt w/&nbsp;<b>normal risk<font color=""#ff0000"">&nbsp;</font></b>= <span class=cloze><b>mammography</b></span><div><br /><div>screening modality for breast cancer for pt w/&nbsp;<b>high risk</b>&nbsp;(family hx, radiation)&nbsp;= <span class=cloze>MRI</span></div></div></div><br><br> <div class=extra><img src=""paste-9079560864252.jpg"" /></div> <div class=tags></div>"
"<div class=card><u>afebrile</u>&nbsp;postpartum patient with a&nbsp;<u>non-erythematous,&nbsp;fluctuant</u>&nbsp;breast mass &nbsp;= <span class=cloze>[diagnosis&nbsp;]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>afebrile</u>&nbsp;postpartum patient with a&nbsp;<u>non-erythematous,&nbsp;fluctuant</u>&nbsp;breast mass &nbsp;= <span class=cloze>galactocele</span></div><br><br> <div class=extra><i><div>- 2/2 blockage of milk duct.</div><div>- no fever, breast is not warm or erythematous so it rules out an abscess</div><div><br /></div><div style=""text-decoration: underline; ""></div></i><i><u><img src=""paste-2408239702474753.jpg"" /></u></i><u><img src=""paste-2408007774240769.jpg"" /></u></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a breastfeeding woman that presents with&nbsp;<b><font color=""#ff0000"">fever</font></b>&nbsp;and&nbsp;<b>localized breast</b>&nbsp;<b>erythema</b>/<b>tenderness</b>&nbsp;with a palpable,&nbsp;<u>fluctuant</u>&nbsp;mass on physical exam?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a breastfeeding woman that presents with&nbsp;<b><font color=""#ff0000"">fever</font></b>&nbsp;and&nbsp;<b>localized breast</b>&nbsp;<b>erythema</b>/<b>tenderness</b>&nbsp;with a palpable,&nbsp;<u>fluctuant</u>&nbsp;mass on physical exam?<div><br /></div><div><span class=cloze>Breast abscess</span></div></div><br><br> <div class=extra><i><div>no fever seen in galactocele.</div><div><br /></div><div></div></i><i><img src=""hmm (2).png"" /></i><div><br /></div><div style=""text-decoration: underline; ""></div><i><u><img src=""paste-2408239702474753.jpg"" /></u></i><u><img src=""paste-2408007774240769.jpg"" /></u></div> <div class=tags></div>"
"<div class=card>The diagnosis of a&nbsp;<b>palpable</b>&nbsp;<b>breast</b>&nbsp;<b>mass</b>&nbsp;can only be&nbsp;<u>confirmed</u>&nbsp;with a&nbsp;<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The diagnosis of a&nbsp;<b>palpable</b>&nbsp;<b>breast</b>&nbsp;<b>mass</b>&nbsp;can only be&nbsp;<u>confirmed</u>&nbsp;with a&nbsp;<span class=cloze>biopsy</span></div><br><br> <div class=extra><i>e.g. fine needle aspiration or core needle biopsy (if <b>suspicious</b> for<b>&nbsp;cancer</b> do a biopsy!</i><div><i><br /></i></div><div><i><br /></i><div><i><img src=""okaay...png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a young female that presents with a triad of&nbsp;<b>polyarthalgias</b>,&nbsp;<b>tenosynovitis</b>, and a&nbsp;<b>vesiculopustular skin rash</b>?<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""dgii.png"" /></div><div><br /></div><div><img src=""paste-229050605895681.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a young female that presents with a triad of&nbsp;<b>polyarthalgias</b>,&nbsp;<b>tenosynovitis</b>, and a&nbsp;<b>vesiculopustular skin rash</b>?<div><br /></div><div><span class=cloze>Disseminated gonococcal infection</span></div><div><br /></div><div><img src=""dgii.png"" /></div><div><br /></div><div><img src=""paste-229050605895681.jpg"" /></div></div><br><br> <div class=extra><div>arthritis knee; treat gonorrhea and chlamydia&nbsp;</div><div><br /></div><div><img src=""dgi.png"" /></div><div><br /></div><div><br /></div><div><img src=""paste-495055110406147.jpg"" /></div><div><br /></div><div><br /></div></div> <div class=tags></div>"
"<div class=card><b>primary</b>&nbsp;herpes infections are usually preceded by <span class=cloze>[...]</span>-like symptoms preceding genital lesions.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>primary</b>&nbsp;herpes infections are usually preceded by <span class=cloze>viral</span>-like symptoms preceding genital lesions.</div><br><br> <div class=extra><i><div></div></i><i><b>viral/systemic sx:</b> fever, HA, malaise, myalgias<div><br /></div></i><img src=""hmm (3).png"" /></div> <div class=tags></div>"
"<div class=card><div>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a young sexually active woman that presents with<b>&nbsp;multiple</b>&nbsp;<b><u>papular</u> lesions</b>&nbsp;around the vagina? Some lesions bleed with manipulation.&nbsp;</div><div><br /></div><span class=cloze>[...]</span><div><br /></div><div><img src=""acumi-not-a.png"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a young sexually active woman that presents with<b>&nbsp;multiple</b>&nbsp;<b><u>papular</u> lesions</b>&nbsp;around the vagina? Some lesions bleed with manipulation.&nbsp;</div><div><br /></div><span class=cloze>Condylomata acuminata (genital warts)</span><div><br /></div><div><img src=""acumi-not-a.png"" /></div></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div></div></i><i>due to infection with <b>HPV</b> (strains 6 &amp; 11); in contrast, <b>condyloma lata</b> (secondary syphilis) typically causes&nbsp;<u><b>flat</b></u>, velvety lesions (accumulating and getting bigger)</i><div><span style=""font-weight: 800;""><br /></span></div><b><img src=""whoop (3).png"" /><img src=""Screen Shot 2017-04-26 at 10.40.49 AM.jpg"" /></b></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a postmenopausal woman that presents with&nbsp;<u>vulvar itching</u>&nbsp;and&nbsp;<b>thin</b>,&nbsp;<b>dry</b>,&nbsp;<b>white</b>&nbsp;<b>plaque-like vulvar skin</b>?<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""paste-13543161460686851.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a postmenopausal woman that presents with&nbsp;<u>vulvar itching</u>&nbsp;and&nbsp;<b>thin</b>,&nbsp;<b>dry</b>,&nbsp;<b>white</b>&nbsp;<b>plaque-like vulvar skin</b>?<div><br /></div><div><span class=cloze>Lichen sclerosus</span></div><div><br /></div><div><img src=""paste-13543161460686851.jpg"" /></div></div><br><br> <div class=extra><i>skin is classically described as ""<b>cigarette paper</b>"" quality and patient's may have retraction of normal anatomical landmarks (e.g. clitoral retraction); think about a&nbsp;<b>thin&nbsp;white skull.</b></i><div><i><br /></i><div><i><img src=""LS.png"" /><br /></i><div><i><img src=""lichen sclerosis.png"" /><img src=""img-78163-800-0.GIF"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>next step&nbsp;</i>in management for a woman that presents with a&nbsp;<u>thin, white plaque</u>&nbsp;suspicious for&nbsp;<b>lichen</b>&nbsp;<b>sclerosus</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>next step&nbsp;</i>in management for a woman that presents with a&nbsp;<u>thin, white plaque</u>&nbsp;suspicious for&nbsp;<b>lichen</b>&nbsp;<b>sclerosus</b>?<div><br /></div><div><span class=cloze>Vulvar punch biopsy</span></div></div><br><br> <div class=extra><i></i><i>necessary to confirm the diagnosis and rule out vulvar squamous cell carcinoma</i><br /><div><i><br /></i><div><i><img src=""LS.png"" /><br /></i><div><i><img src=""lichen sclerosis.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>preferred imaging modality</i>&nbsp;for diagnosis of&nbsp;<b>nephrolithiasis</b>&nbsp;during&nbsp;<u>pregnancy</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>What is the&nbsp;<i>preferred imaging modality</i>&nbsp;for diagnosis of&nbsp;<b>nephrolithiasis</b>&nbsp;during&nbsp;<u>pregnancy</u>?<div><br /></div><div><span class=cloze>Pelvic and renal ultrasound</span></div></div><br><br> <div class=extra><i></i><i>low-dose CT urography can be considered in the 2nd or 3rd trimester if ultrasound is not helpful</i></div> <div class=tags></div>
"<div class=card>Which&nbsp;<b>stromal cell tumor</b>&nbsp;is associated with female showing&nbsp;<u>rapid</u>&nbsp;signs of&nbsp;<u>hirsutism/virilization</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which&nbsp;<b>stromal cell tumor</b>&nbsp;is associated with female showing&nbsp;<u>rapid</u>&nbsp;signs of&nbsp;<u>hirsutism/virilization</u>?<div><br /></div><div><span class=cloze>Sertoli-Leydig tumor</span></div></div><br><br> <div class=extra><i></i><i>e.g., voice deepening, male-pattern baldness, increased muscle bulk, clitoromegaly.</i><div><i><br /></i></div><div><i><img src=""paste-1139222895394819.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Sertoli-Leydig</b>&nbsp;tumors cause <span class=cloze>[...]</span> testosterone and <span class=cloze>[...]</span> FSH/LH</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Sertoli-Leydig</b>&nbsp;tumors cause <span class=cloze>↑</span> testosterone and <span class=cloze>↓</span> FSH/LH</div><br><br> <div class=extra><i></i><div><i></i><i>testosterone = (-) feedback on FSH/LH =&nbsp;<b>amenorrhea.</b></i></div><div><i></i><i><b><br /></b></i></div><div><i><img src=""paste-1139222895394819.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span> fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>first trimester</u>&nbsp;and is typically caused by&nbsp;<b>chromosomal</b>&nbsp;<b>abnormalities or intrauterine&nbsp;<u>infection</u>&nbsp;(TORCH).</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Symmetric</span> fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>first trimester</u>&nbsp;and is typically caused by&nbsp;<b>chromosomal</b>&nbsp;<b>abnormalities or intrauterine&nbsp;<u>infection</u>&nbsp;(TORCH).</b></div><br><br> <div class=extra><i>global growth lag that affects fetal organs uniformly</i><div><i>imagine a symmetric TORCH burning<br /></i><div><i><img src=""fgr.png"" /></i></div></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card><b>Symmetric fetal growth restriction</b>&nbsp;begins in the&nbsp;<u><span class=cloze>[...]</span> trimester</u>&nbsp;and is typically caused by&nbsp;<b>chromosomal</b>&nbsp;<b>abnormalities or intrauterine&nbsp;<u>infection</u>&nbsp;(TORCH).</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Symmetric fetal growth restriction</b>&nbsp;begins in the&nbsp;<u><span class=cloze>first</span> trimester</u>&nbsp;and is typically caused by&nbsp;<b>chromosomal</b>&nbsp;<b>abnormalities or intrauterine&nbsp;<u>infection</u>&nbsp;(TORCH).</b></div><br><br> <div class=extra><i>global growth lag that affects fetal organs uniformly</i><div><i>imagine a symmetric TORCH burning<br /></i><div><i><img src=""fgr.png"" /></i></div></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[...]</span> fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>second/third trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<b>placental insufficiency</b>&nbsp;(e.g. hypertension, diabetes)</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>Asymmetric</span> fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>second/third trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<b>placental insufficiency</b>&nbsp;(e.g. hypertension, diabetes)</div><br><br> <div class=extra><i>characterized by normal growth in&nbsp;<b>vital</b>&nbsp;organs (e.g. brain, heart, placenta) at the expense of&nbsp;<b>less</b>&nbsp;<b>vital</b>&nbsp;organs (e.g. abdominal viscera) due to&nbsp;<u>fetal hypoxia</u>&nbsp;and preferred shunting of blood to vital organs.&nbsp;</i><div><i><br /></i><div><i><img src=""fgr.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>Asymmetric fetal growth restriction</b>&nbsp;begins in the&nbsp;<u><span class=cloze>[...]</span> trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<b>placental insufficiency</b>&nbsp;(e.g. hypertension, diabetes)</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Asymmetric fetal growth restriction</b>&nbsp;begins in the&nbsp;<u><span class=cloze>second/third</span> trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<b>placental insufficiency</b>&nbsp;(e.g. hypertension, diabetes)</div><br><br> <div class=extra><i>characterized by normal growth in&nbsp;<b>vital</b>&nbsp;organs (e.g. brain, heart, placenta) at the expense of&nbsp;<b>less</b>&nbsp;<b>vital</b>&nbsp;organs (e.g. abdominal viscera) due to&nbsp;<u>fetal hypoxia</u>&nbsp;and preferred shunting of blood to vital organs.&nbsp;</i><div><i><br /></i><div><i><img src=""fgr.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>Asymmetric fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>second/third trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Asymmetric fetal growth restriction</b>&nbsp;begins in the&nbsp;<u>second/third trimester</u>&nbsp;and is associated with conditions that cause&nbsp;<span class=cloze><b>placental insufficiency</b>&nbsp;(e.g. hypertension, diabetes)</span></div><br><br> <div class=extra><i>characterized by normal growth in&nbsp;<b>vital</b>&nbsp;organs (e.g. brain, heart, placenta) at the expense of&nbsp;<b>less</b>&nbsp;<b>vital</b>&nbsp;organs (e.g. abdominal viscera) due to&nbsp;<u>fetal hypoxia</u>&nbsp;and preferred shunting of blood to vital organs.&nbsp;</i><div><i><br /></i><div><i><img src=""fgr.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a healthy pregnant woman at&nbsp;<u>37 weeks gestation</u>&nbsp;that&nbsp;<b>desires a</b>&nbsp;<b>vaginal</b>&nbsp;<b>delivery</b>? Ultrasound reveals the fetus is in a&nbsp;<b>frank&nbsp;breech</b>&nbsp;<b>presentation</b>.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a healthy pregnant woman at&nbsp;<u>37 weeks gestation</u>&nbsp;that&nbsp;<b>desires a</b>&nbsp;<b>vaginal</b>&nbsp;<b>delivery</b>? Ultrasound reveals the fetus is in a&nbsp;<b>frank&nbsp;breech</b>&nbsp;<b>presentation</b>.&nbsp;<div><br /></div><div><span class=cloze>External cephalic version</span></div></div><br><br> <div class=extra><i>can be attempted in women with breech pregnancies at<b>&nbsp;<u>&gt;</u>&nbsp;37 weeks of gestational age&nbsp;</b>if there's no contraindications to vaginal delivery and the fetus is in good health&nbsp;</i><div><i><br /></i><div><i><img src=""ecv2.png"" /></i></div><div><i><img src=""ECV.png"" /></i></div><div><i><img src=""breech.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>best screening test</i>&nbsp;for&nbsp;<b>gestational diabetes mellitus</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>best screening test</i>&nbsp;for&nbsp;<b>gestational diabetes mellitus</b>?&nbsp;<div><br /></div><div><span class=cloze>50g 1-hour glucose challenge</span></div></div><br><br> <div class=extra><div><i><u>prior risk factors: </u><b>prior </b>gestational diabetes, fetal <b>macrosomia</b>, recurrent pregnancy loss.</i></div><div><i><br /></i></div><div><i>if &gt;&nbsp;<b>140</b>, follow with<b>&nbsp;100g, 3-hour</b>&nbsp;glucose tolerance test; do after<b>&nbsp;24 weeks&nbsp;<u>except</u>&nbsp;if have risk factors (prior diabetes, obese) - can do at first visit.</b></i></div><div><i><br /></i><div style=""font-weight: bold; ""><i><img src=""routine pnc.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>risk factors for <b>gestational diabetes </b>include <b>prior&nbsp;</b><span class=cloze>[...]</span>, fetal&nbsp;<b>macrosomia</b>, recurrent pregnancy loss.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>risk factors for <b>gestational diabetes </b>include <b>prior&nbsp;</b><span class=cloze>gestational diabetes</span>, fetal&nbsp;<b>macrosomia</b>, recurrent pregnancy loss.</div><br><br> <div class=extra><div><br></div><div><i><br></i><div style=""font-weight: bold; ""><i><img src=""routine pnc.png""></i></div></div></div> <div class=tags></div>"
"<div class=card><b>Nulliparity</b> and <b>extremes of age (&lt;20 or &gt; 40) </b><span class=cloze>[...]</span> the risk for pre-eclampsia.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Nulliparity</b> and <b>extremes of age (&lt;20 or &gt; 40) </b><span class=cloze>increase</span> the risk for pre-eclampsia.</div><br><br> <div class=extra><i>others risk factors include <u>prior</u>&nbsp;preeclampsia, chronic HTN, <b>twin</b> and <b>molar</b> pregnancy.</i><div><i><br /></i></div><div><i><span style=""color: rgb(255, 255, 255)""><img src=""paste-68152541052929.jpg"" /></span></i></div></div> <div class=tags></div>"
"<div class=card>The most common risk factor for <b>PROM/PPROM</b> is ascending <span class=cloze>[...]</span>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The most common risk factor for <b>PROM/PPROM</b> is ascending <span class=cloze>infection</span>.</div><br><br> <div class=extra><div><i>imagine bacteria ascending and poking a hole in the sac.</i></div><div><i><br /></i></div><img src=""paste-527692566888449_1505754167063.jpg"" /><div><br /></div><div><img src=""paste-5415953760258.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in management if you have a&nbsp;<b>pap smear</b>&nbsp;revealing&nbsp;<u>ASCUS</u>?<div><br /></div><div><span class=cloze>[...]</span> OR<div><span class=""clozed c1""><span class=cloze>[...]</span></span></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in management if you have a&nbsp;<b>pap smear</b>&nbsp;revealing&nbsp;<u>ASCUS</u>?<div><br /></div><div><span class=cloze>HPV DNA testing</span> OR<div><span class=""clozed c1""><span class=cloze>Increase pap smear to q6 months</span></span></div></div></div><br><br> <div class=extra><div>If HPV is positive, then perform&nbsp;<b>colposcopy</b>&nbsp;in women<b>&nbsp;over 24.</b></div><div><b>Repeat cytology</b>&nbsp;only in <b>one</b> year in women<b>&nbsp;21-24.</b></div><div><br /></div><img src=""paste-8525510083262.jpg"" /></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in an intrapartum patient that presents after &gt;18 hours of membrane rupture and prolonged labor with&nbsp;<b>fever</b>&nbsp;and&nbsp;<b>tachycardia</b>? Fetal heart tracing demonstrates&nbsp;<u>fetal tachycardia</u>.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in an intrapartum patient that presents after &gt;18 hours of membrane rupture and prolonged labor with&nbsp;<b>fever</b>&nbsp;and&nbsp;<b>tachycardia</b>? Fetal heart tracing demonstrates&nbsp;<u>fetal tachycardia</u>.&nbsp;<div><br /></div><div><span class=cloze>Chorioamnionitis (intra-amniotic infection)</span></div></div><br><br> <div class=extra><i>intra-amniotic infection caused by migration of vaginal or enteric flora through the cervix, typically in a patient with premature or prolonged rupture of membranes;&nbsp;<u>intrapartum</u>&nbsp;fever is a distinguishing feature</i><div><i><br /></i><div><i><img src=""whoop (2).png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>breast mass &gt;&nbsp;<b>30</b>&nbsp;years old&nbsp;<u>after</u>&nbsp;mammogram = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>breast mass &gt;&nbsp;<b>30</b>&nbsp;years old&nbsp;<u>after</u>&nbsp;mammogram = <span class=cloze>biopsy</span></div><br><br> <div class=extra><i><img src=""okaay...png"" /><img src=""paste-2795830436167681.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><div>Treatment for&nbsp;<b>acute (lactational) mastitis</b>&nbsp;is&nbsp;<span class=cloze>[...]</span> plus <span class=cloze>[...]</span>&nbsp;</div><div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>Treatment for&nbsp;<b>acute (lactational) mastitis</b>&nbsp;is&nbsp;<span class=cloze>continued drainage (e.g. feeding)</span> plus <span class=cloze>antibiotics (e.g. dicloxacillin)</span>&nbsp;</div><div><br /></div></div><br><br> <div class=extra><i>clogged milk ducts → flu-like symptoms, focal unilateral breast pain with<font color=""#ff0000"">&nbsp;erythema/induration</font>&nbsp;and axillary lymphadenopathy</i><div style=""font-weight: bold; ""><b><i></i><i><br /></i></b></div><div style=""font-weight: bold; ""><b><i><img src=""why do i suck .png"" /></i></b></div><div style=""font-weight: bold; ""><b><i><br /></i></b></div><b><img src=""bandicam 2017-12-13 12-58-09-537.jpg"" /></b><br class=""Apple-interchange-newline"" /><b><img src=""bandicam 2017-12-13 12-58-18-337.jpg"" /></b><br /><div style=""font-weight: bold; ""><i><img src=""bandicam 2017-12-13 12-57-27-523.jpg"" /><img src=""bandicam 2017-12-13 12-57-48-696.jpg"" /><img src=""bandicam 2017-12-13 12-58-05-186.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a postpartum patient on&nbsp;<u>post-operative day 2</u>&nbsp;that presents with&nbsp;<b>fever</b>,&nbsp;<b>uterine</b>&nbsp;<b>tenderness</b>, and&nbsp;<b>purulent</b>&nbsp;<b>lochia</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a postpartum patient on&nbsp;<u>post-operative day 2</u>&nbsp;that presents with&nbsp;<b>fever</b>,&nbsp;<b>uterine</b>&nbsp;<b>tenderness</b>, and&nbsp;<b>purulent</b>&nbsp;<b>lochia</b>?<div><br /></div><div><span class=cloze>Postpartum endometritis</span></div></div><br><br> <div class=extra><i>most common cause of postpartum fever</i><div><i><br /></i><div><i><img src=""paste-567223445880833.jpg"" /><br /></i></div><div><div><i><img src=""wats a lochia.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>Dysmenorrhea, dyspareunia, nodularity of uterosacral ligaments. Likely dx?<br /><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Dysmenorrhea, dyspareunia, nodularity of uterosacral ligaments. Likely dx?<br /><div><br /></div><div><span class=cloze>Endometriosis</span></div></div><br><br> <div class=extra><div><i>diagnose with <b>laporoscopy</b>, but can treat with <b>OCPs/NSAIDs</b> beforehand</i></div><div><i><br /></i></div><i><img src=""endometriosis.png"" /></i></div> <div class=tags></div>"
"<div class=card>urge incontinence + 3 cm fibroid - what is causing the incontinence?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>urge incontinence + 3 cm fibroid - what is causing the incontinence?<div><br /></div><div><span class=cloze>detrusor instability</span></div></div><br><br> <div class=extra><i>fibroid is too small to cause problems.</i><div><br /></div><div><img src=""paste-2662269838163969.jpg"" /></div><div><img src=""paste-1268836418453507.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>likely</i>&nbsp;<i>diagnosis</i>&nbsp;in an adolescent girl at&nbsp;<u>15 weeks gestation</u>&nbsp;that presents with symptoms of&nbsp;<b>preeclampsia with severe features</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>likely</i>&nbsp;<i>diagnosis</i>&nbsp;in an adolescent girl at&nbsp;<u>15 weeks gestation</u>&nbsp;that presents with symptoms of&nbsp;<b>preeclampsia with severe features</b>?<div><br /></div><div><span class=cloze>Hydatidiform molar pregnancy</span></div></div><br><br> <div class=extra><i></i><i>the presence of preeclampsia with severe features at&nbsp;<b>&lt; 20 weeks gestation</b>&nbsp;can be a complication of hydatidiform moles; typically resolves after mole removal&nbsp;</i><div><i><img src=""interestin' last question.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>recommended management&nbsp;</i>for a pregnant woman with a suspected&nbsp;<b>theca luteum cyst</b>&nbsp;secondary to a&nbsp;<u>complete&nbsp;molar pregnancy</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>recommended management&nbsp;</i>for a pregnant woman with a suspected&nbsp;<b>theca luteum cyst</b>&nbsp;secondary to a&nbsp;<u>complete&nbsp;molar pregnancy</u>?<div><br /></div><div><span class=cloze>Suction curettage of the hydatidiform mole</span></div></div><br><br> <div class=extra><div><i>theca luteum cysts typically resolve following removal of the hydatidiform mole</i></div><img src=""this is gonna suck.png"" /></div> <div class=tags></div>"
"<div class=card>hydatidiform mole = <span class=cloze>[treatment]</span> to evacuate the uterus</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>hydatidiform mole = <span class=cloze>suction curettage</span> to evacuate the uterus</div><br><br> <div class=extra><div><i><div><div></div></div></i><i>- need&nbsp;<b>surgery</b>&nbsp;to&nbsp;<u>completely&nbsp;</u>evacuate the uterus (imagine sucking up a mole from the ground)</i></div><div><i>- follow with&nbsp;<b>hCG</b>&nbsp;levels.</i></div><div><i><br /></i></div><div><i><img src=""Suction+Curettage+Abortion.jpg"" /></i></div><div><i><img src=""paste-580404700512259.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>Diagnosis of <b>umbilical cord prolapse</b> is done with <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Diagnosis of <b>umbilical cord prolapse</b> is done with <span class=cloze>physical palpation</span></div><br><br> <div class=extra><i>If you have <u>recurrent variable decelerations </u>with bradycardia, do a<b> cervical exam</b> first before doing intrauterine resuscitation / amnioinfusion to see if there's a cord that prolapsed!</i><div><br /></div><div><br /></div><div><img src=""paste-623105265369089.jpg"" /></div><div><img src=""paste-326696687370243.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[intrahepatic cholestasis of pregnancy or acute fatty liver of pregnancy]</span> has&nbsp;<b>↑ bile acids and itchiness.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>intrahepatic cholestasis of pregnancy</span> has&nbsp;<b>↑ bile acids and itchiness.</b></div><br><br> <div class=extra><i></i><i>increased E/P cause hepatobiliary tract&nbsp;<b>stasis&nbsp;</b>and ↓ bile excretion leading to&nbsp;<b>itchiness;&nbsp;</b>bile acids may kill baby.</i><br /><div><i><br /></i></div><div><i><br /></i><div><i><img src=""heh.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>suspect intrahepatic cholestasis of pregnancy = get serum <span class=cloze>[...]</span> levels</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>suspect intrahepatic cholestasis of pregnancy = get serum <span class=cloze>bile acid</span> levels</div><br><br> <div class=extra><div><i>most specific for this condition (vs. ALP, AST/ALT)</i></div><i><img src=""paste-631154034081793.jpg"" /><br /></i><div><i><br /></i></div><div><i><br /></i><div><i><img src=""heh.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>Do women with<b> IUD + PID</b> require <u>IUD removal</u> prior to antibiotic therapy?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Do women with<b> IUD + PID</b> require <u>IUD removal</u> prior to antibiotic therapy?<div><br /></div><div><span class=cloze>No</span></div></div><br><br> <div class=extra><i><img src=""paste-635156943601665.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a pregnant woman at 25 weeks gestation that presents after feeling&nbsp;<b>no fetal movement</b>&nbsp;for the past two days? Fetal heart sounds are&nbsp;<u>not</u>&nbsp;heard on Doppler.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a pregnant woman at 25 weeks gestation that presents after feeling&nbsp;<b>no fetal movement</b>&nbsp;for the past two days? Fetal heart sounds are&nbsp;<u>not</u>&nbsp;heard on Doppler.&nbsp;<div><br /></div><div><span class=cloze><u>Transabdominal</u>&nbsp;ultrasound</span></div></div><br><br> <div class=extra><i></i><i>the patient likely has&nbsp;<b>intrauterine fetal</b>&nbsp;<b>demise</b>&nbsp;(fetal death at&nbsp;<u>&gt;</u>&nbsp;20 weeks), which must be confirmed by the absence of fetal cardiac activity on ultrasound&nbsp;</i><div><i><br /></i><div><i><img src=""sad (2).png"" /></i></div><div><i><img src=""part 2.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><u>Staphylococcus aureus - Treatment</u><div><br /></div><div><div><span class=cloze>[MRSA/MSSA]</span>: nafcillin, oxacillin, dicloxacillin<div><br /></div><div><span class=cloze>[...]</span>: vancomycin, daptomycin, linezolid, ceftaroline</div></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>Staphylococcus aureus - Treatment</u><div><br /></div><div><div><span class=cloze>MSSA</span>: nafcillin, oxacillin, dicloxacillin<div><br /></div><div><span class=cloze>MRSA</span>: vancomycin, daptomycin, linezolid, ceftaroline</div></div></div></div><br><br> <div class=extra><div><i>if mastitis doesn't improve with dicloxacillin, it may be 2/2 <b>MRSA</b></i></div><i><img src=""why do i suck .png"" /></i></div> <div class=tags></div>"
"<div class=card>preterm labor = labor before <span class=cloze>[gestational week]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>preterm labor = labor before <span class=cloze>37 weeks</span></div><br><br> <div class=extra><img src=""paste-22153441312771.jpg"" /><div><br /></div><div><img src=""ptl.png"" /></div></div> <div class=tags></div>"
"<div class=card>Normal&nbsp;<b>postvoid residual volume</b>&nbsp;in&nbsp;<u>women</u>&nbsp;is &lt; <span class=cloze>[...]</span> mL</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Normal&nbsp;<b>postvoid residual volume</b>&nbsp;in&nbsp;<u>women</u>&nbsp;is &lt; <span class=cloze>150</span> mL</div><br><br> <div class=extra><i>&lt; 50 mL in men; high PVR may be seen with overflow incontinence&nbsp;</i><div><i><br /></i><div><i><img src=""afdgdhj.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the most common cause of UTI?<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the most common cause of UTI?<div><br /></div><div><span class=cloze><i>Escherichia coli</i></span></div><div><br /></div></div><br><br> <div class=extra><img src=""Screen Shot 2017-02-20 at 12.35.51 AM.jpg"" /></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">doxylamine (unisom)&nbsp;</font>&nbsp;+&nbsp;<font color=""#ff0000"">pyridoxine (B6)</font>&nbsp;= 1st line for&nbsp;<font color=""#ff0000"">nausea</font>&nbsp;2° to <span class=cloze>[condition]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">doxylamine (unisom)&nbsp;</font>&nbsp;+&nbsp;<font color=""#ff0000"">pyridoxine (B6)</font>&nbsp;= 1st line for&nbsp;<font color=""#ff0000"">nausea</font>&nbsp;2° to <span class=cloze>pregnancy</span></div><br><br> <div class=extra><i>also small, bland high carb, low fat meals</i><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>underlying cause</i>&nbsp;of&nbsp;<b>tinnitus</b>&nbsp;and a&nbsp;<b>metallic</b>&nbsp;<b>taste</b>&nbsp;in the mouth after administration of epidural anesthesia?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>underlying cause</i>&nbsp;of&nbsp;<b>tinnitus</b>&nbsp;and a&nbsp;<b>metallic</b>&nbsp;<b>taste</b>&nbsp;in the mouth after administration of epidural anesthesia?<div><br /></div><div><span class=cloze><b>Intravascular</b>&nbsp;injection of the anesthetic agent</span></div></div><br><br> <div class=extra><div><i>systemic toxicity&nbsp;</i></div><div style=""font-style: italic; ""><img src=""paste-2935627326685185.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>Which pregnancies require&nbsp;<b><u>weekly</u>&nbsp;antepartum fetal surveillance&nbsp;</b>starting at&nbsp;<b>32 weeks</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which pregnancies require&nbsp;<b><u>weekly</u>&nbsp;antepartum fetal surveillance&nbsp;</b>starting at&nbsp;<b>32 weeks</b>?<div><br /></div><div><span class=cloze>Pregnancies with <b>maternal</b> comorbidities or <b>fetal</b> conditions</span></div></div><br><br> <div class=extra><div><img src=""paste-101795019882497.jpg"" /></div><div><br /></div><div><ol type=""1"" start=""1""><li>Antepartum fetal surveillance evaluates for<b>&nbsp;fetal hypoxia</b>. &nbsp;It is performed in pregnancies with a high risk of fetal demise due to maternal (eg, hypertension, diabetes mellitus) or fetal (eg, post-term pregnancy,<b>&nbsp;growth restriction</b>) conditions. &nbsp;The most common surveillance modality is the&nbsp;<b>biophysical profile (<font color=""#ff0000"">BPP</font>),</b>&nbsp;which includes a nonstress test <font color=""#ff0000""><b>(NST)</b></font> and an ultrasound evaluation of amniotic fluid, fetal tone, movement, and breathing movement. &nbsp;Each parameter is assigned a score of 0 or 2 and summed for a total of 0-10.</li></ol><div><img src=""paste-2744630131032065.jpg"" /></div><div><br /></div><div><img src=""L18832.jpg"" />&nbsp;<img src=""paste-28643136897025_1529603012320.jpg"" /></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>next step in management</u>&nbsp;for a patient that has&nbsp;<b>primary amenorrhea</b>&nbsp;and a&nbsp;<u>dysfunctional endocrine axis</u>,&nbsp;but&nbsp;<u>intact uterus</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>next step in management</u>&nbsp;for a patient that has&nbsp;<b>primary amenorrhea</b>&nbsp;and a&nbsp;<u>dysfunctional endocrine axis</u>,&nbsp;but&nbsp;<u>intact uterus</u>?<div><br /></div><div><span class=cloze>FSH levels</span></div></div><br><br> <div class=extra><i>IF the patient has reduced FSH levels, perform MRI of the head because you suspect Kallman syndrome or craniopharyngioma.</i><div><i><br /></i></div><div><i>IF the patient has elevated FSH levels, perform karyotyping because you suspect Turner syndrome.</i></div><div><i><br /></i></div><div><i><img src=""paste-70789650972673_1529603012320.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>PCP (phencyclidine)<div>cocaine</div><div>cannabis in milk</div><div><br /></div><div>are all <span class=cloze>[...]</span> to breast feeding</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>PCP (phencyclidine)<div>cocaine</div><div>cannabis in milk</div><div><br /></div><div>are all <span class=cloze>contraindications</span> to breast feeding</div></div><br><br> <div class=extra><img src=""paste-1225448658829313.jpg"" /><div><br /></div><div><img src=""paste-746048704217089.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[...]</span> = complication of<font color=""#ff0000"">&nbsp;</font><i>Listeria monocytogenes</i>&nbsp;seen in&nbsp;<u>neonates</u>&nbsp;with&nbsp;<u>disseminated abscesses/granulomas&nbsp;</u>(liver, lungs)</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>Granulomatosis Infantiseptica</span> = complication of<font color=""#ff0000"">&nbsp;</font><i>Listeria monocytogenes</i>&nbsp;seen in&nbsp;<u>neonates</u>&nbsp;with&nbsp;<u>disseminated abscesses/granulomas&nbsp;</u>(liver, lungs)</div><br><br> <div class=extra><img src=""paste-1751221375336449.jpg"" /></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>recommended management</i>&nbsp;for patients with&nbsp;<u>PPROM</u>&nbsp;at&nbsp;<b>&lt; 34 weeks</b>&nbsp;<b>gestation</b>&nbsp;and&nbsp;<u>NO signs of infection/fetal compromise?</u><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>recommended management</i>&nbsp;for patients with&nbsp;<u>PPROM</u>&nbsp;at&nbsp;<b>&lt; 34 weeks</b>&nbsp;<b>gestation</b>&nbsp;and&nbsp;<u>NO signs of infection/fetal compromise?</u><div><br /></div><div><span class=cloze>antibiotics, corticosteroids, and&nbsp;<b>expectant</b>&nbsp;<b>management</b></span></div></div><br><br> <div class=extra><i><u>don't need to deliver</u></i>&nbsp;<i>until</i>&nbsp;<i><b>34</b>&nbsp;weeks gestation or if signs of infection/fetal compromise develop; antibiotics prolongs duration until labor and decreases infection risk (GBS).</i><div><i><img src=""gonna be a long day.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>Prior <b>classical</b> c-section<div>Prior extensive uterine <b>myomectomy</b></div><div>Placenta <b>previa</b></div><div><br /></div><div>are indications for <span class=cloze>[delivery plan]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Prior <b>classical</b> c-section<div>Prior extensive uterine <b>myomectomy</b></div><div>Placenta <b>previa</b></div><div><br /></div><div>are indications for <span class=cloze>C-section at 37 weeks</span></div></div><br><br> <div class=extra><i>these are all contraindications for vaginal delivery</i></div> <div class=tags></div>
"<div class=card><u>Nonclassic</u> <b>congenital adrenal hyperplasia</b> presents in <u>women</u> with <span class=cloze>[acute/chronic]</span> <b>hyper-androgen</b> features (acne, hirsutism).</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>Nonclassic</u> <b>congenital adrenal hyperplasia</b> presents in <u>women</u> with <span class=cloze>chronic</span> <b>hyper-androgen</b> features (acne, hirsutism).</div><br><br> <div class=extra><i>vs. <b>fast virilization (&lt; 1 yr)&nbsp;</b>in androgen-secreting <b>tumors</b> (e.g., Sertoli, adrenal tumor)</i><br /><div style=""font-style: italic; ""><br /></div><div style=""font-style: italic; ""><img src=""paste-15410712025235457.jpg"" /><div><i><img src=""asfsdg.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>rapid-onset <b>virilization</b> - evaluate an <b>androgen</b>-secreting tumor of <span class=cloze>[...]</span> or <span class=cloze>[...]</span> origin.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>rapid-onset <b>virilization</b> - evaluate an <b>androgen</b>-secreting tumor of <span class=cloze>ovarian</span> or <span class=cloze>adrenal</span> origin.</div><br><br> <div class=extra><i><img src=""paste-266013094445059.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>What is&nbsp;<u>management</u>&nbsp;of a&nbsp;<b>biophysical profile of &lt;4</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is&nbsp;<u>management</u>&nbsp;of a&nbsp;<b>biophysical profile of &lt;4</b>?<div><br /></div><div><span class=cloze>Urgent delivery</span></div></div><br><br> <div class=extra><div>&nbsp;consistent with fetal hypoxia due to&nbsp;<b>placental insufficiency</b></div><div><b><br /></b></div><div><b><img src=""paste-68526203207681.jpg"" /></b></div><div><b><br /></b></div><img src=""paste-28643136897025_1529603012320.jpg"" /><div><br /></div></div> <div class=tags></div>"
"<div class=card><font color=""#ff0000"">systolic</font>&nbsp;murmur +&nbsp;<font color=""#ff0000"">s3 gallop</font>&nbsp;+&nbsp;<font color=""#ff0000"">JVD</font>&nbsp;during&nbsp;<font color=""#ff0000"">pregnancy</font>&nbsp;= <span class=cloze>[condition]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><font color=""#ff0000"">systolic</font>&nbsp;murmur +&nbsp;<font color=""#ff0000"">s3 gallop</font>&nbsp;+&nbsp;<font color=""#ff0000"">JVD</font>&nbsp;during&nbsp;<font color=""#ff0000"">pregnancy</font>&nbsp;= <span class=cloze>normal</span></div><br><br> <div class=extra><div><u>pregnant </u>= ↑ blood volume (preload), which rapidly decelerates upon hitting ventricle.</div><div><br /></div><div><img src=""paste-128440996986881 (2).jpg"" /></div><div><br /></div><div><img src=""paste-3026985576038401.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for an elderly women that presents with&nbsp;<b>urinary incontinence</b>&nbsp;for the past week? The patient is delirious. History and physical exam are unremarkable.<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for an elderly women that presents with&nbsp;<b>urinary incontinence</b>&nbsp;for the past week? The patient is delirious. History and physical exam are unremarkable.<div><br /></div><div><span class=cloze>Urinalysis and culture</span></div></div><br><br> <div class=extra><div><i>UTI should be excluded even with no fever or dysuria (elderly patients may have atypical presentations)</i></div><div><i><br /></i><div style=""text-decoration: underline; ""><i><img src=""ugh.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>""oil cysts"" and ""foam cells"" on mammography = <span class=cloze>[dx]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>""oil cysts"" and ""foam cells"" on mammography = <span class=cloze>fat necrosis</span></div><br><br> <div class=extra><div><i>benign, reassurance.</i></div><div><i><br /></i></div><div><i></i><i><img src=""paste-215091962183681.jpg"" /></i></div><div><i></i><i><br /></i></div><div><i></i><i><br /></i></div><div><i></i><i><img src=""dksfgsj.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Esophageal atresia</b><b>&nbsp;with tracheoesophageal fistula</b>&nbsp;(TEF) often presents with <span class=cloze>[...]</span> on prenatal ultrasound&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Esophageal atresia</b><b>&nbsp;with tracheoesophageal fistula</b>&nbsp;(TEF) often presents with <span class=cloze><u>polyhydramniosis</u></span> on prenatal ultrasound&nbsp;</div><br><br> <div class=extra><i>due to inability to swallow amniotic fluid</i><div><i><img src=""afdgm.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><img src=""quizlet-t3w0wVvNHaiPm0pbjlEcFQ_m.png"" /><div><br /></div><div><br /><div>strawberry cervix (<font color=""#ff0000"">erythematous</font>&nbsp;with <b>petechiae</b>) = <span class=cloze>[infection]</span></div><div><br /></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><img src=""quizlet-t3w0wVvNHaiPm0pbjlEcFQ_m.png"" /><div><br /></div><div><br /><div>strawberry cervix (<font color=""#ff0000"">erythematous</font>&nbsp;with <b>petechiae</b>) = <span class=cloze>trichomonas vaginalis</span></div><div><br /></div></div></div><br><br> <div class=extra><i><img src=""dammit.png"" /><img src=""paste-63020055134681.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>Patients with a&nbsp;<b>positive BRCA risk assessment screen</b>&nbsp;should first receive:&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Patients with a&nbsp;<b>positive BRCA risk assessment screen</b>&nbsp;should first receive:&nbsp;<div><br /></div><div><span class=cloze>Genetic counseling</span></div></div><br><br> <div class=extra><i>then BRCA testing&nbsp;</i><div><i><br /></i></div><div><i><img src=""paste-10913511899137 (1).jpg"" /><img src=""paste-447913549365249.jpg"" /></i></div><div><i><span style=""font-style: normal;""><br /></span></i></div><div></div></div> <div class=tags></div>"
"<div class=card>What is the<i>&nbsp;next step&nbsp;</i>in&nbsp;management&nbsp;for a patient with suspected&nbsp;<u>mild</u>&nbsp;<b>carpal tunnel syndrome</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the<i>&nbsp;next step&nbsp;</i>in&nbsp;management&nbsp;for a patient with suspected&nbsp;<u>mild</u>&nbsp;<b>carpal tunnel syndrome</b>?&nbsp;<div><br /></div><div><span class=cloze>Wrist splinting</span></div></div><br><br> <div class=extra><i></i><i><div></div></i><i>- no thenar or hypothenar atrophy on physical exam → not severe disease.</i><div><i>-&nbsp;<b>glucocorticoids and/or decompression surgery&nbsp;</b>may be considered in patients with&nbsp;<b>severe disease.</b></i></div><div><br /></div><div><img src=""paste-536445710237697.jpg"" /><div><br /></div><div><img src=""paste-610443701780481 (1).jpg"" /><div><i><br /></i></div><div><i><img src=""paste-601883831959553.jpg"" /><br /></i></div><div><div><i><br /></i></div><div><i><img src=""this aint lookin pretty.png"" /></i></div></div></div></div></div> <div class=tags></div>"
"<div class=card>When (week gestation) should you repeat the&nbsp;<b>Rh (D) antibody testing</b>&nbsp;for all&nbsp;<u>unsensitized (D)-negative women</u>:&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>When (week gestation) should you repeat the&nbsp;<b>Rh (D) antibody testing</b>&nbsp;for all&nbsp;<u>unsensitized (D)-negative women</u>:&nbsp;<div><br /></div><div><span class=cloze>24- to 28-week's gestation&nbsp;</span></div></div><br><br> <div class=extra><i></i><i><div></div><img src=""paste-25967372271617.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>Infants of <b>diabetic</b> mothers are at increased risk of <b><span class=cloze>[...]</span></b> <b>malformations</b>, such as <b>cardiac and CNS, renal, and limb deformities.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Infants of <b>diabetic</b> mothers are at increased risk of <b><span class=cloze>congenital</span></b> <b>malformations</b>, such as <b>cardiac and CNS, renal, and limb deformities.</b></div><br><br> <div class=extra><i></i><i><div></div></i><div><i><br /></i></div><div><br /></div><div><img src=""paste-551430851133441.jpg"" /></div></div> <div class=tags></div>"
"<div class=card>abrupt <b>fetal</b> <b>bradycardia</b> / decelerations after rupture of membranes = <span class=cloze>[cause]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>abrupt <b>fetal</b> <b>bradycardia</b> / decelerations after rupture of membranes = <span class=cloze>umbilical cord <b>prolapse</b></span></div><br><br> <div class=extra><img src=""paste-575297984397313.jpg"" /></div> <div class=tags></div>"
"<div class=card>dimpled&nbsp;<font color=""#ff0000"">flesh-colored</font>&nbsp;dome&nbsp;<u>papules</u>&nbsp;= <span class=cloze>[virus]</span><div><br /></div><div><img src=""big_5081d948278d7.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>dimpled&nbsp;<font color=""#ff0000"">flesh-colored</font>&nbsp;dome&nbsp;<u>papules</u>&nbsp;= <span class=cloze>molluscum contagiosum (often with HIV)</span><div><br /></div><div><img src=""big_5081d948278d7.jpg"" /></div></div><br><br> <div class=extra></div> <div class=tags></div>"
"<div class=card><b>Pregnant woman</b> concerned about <b>varicella</b> vaccination status = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card><b>Pregnant woman</b> concerned about <b>varicella</b> vaccination status = <span class=cloze>get IgG titers</span></div><br><br> <div class=extra><i><b>IgG </b>titers check for immunity status (long-term) - not IgM!</i></div> <div class=tags></div>
"<div class=card>Can <b>IUDs</b> be used when someone has <b>cervicitis</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Can <b>IUDs</b> be used when someone has <b>cervicitis</b>?<div><br /></div><div><span class=cloze>No</span></div></div><br><br> <div class=extra><div><i>use <b>nexplanon</b> instead.</i></div><div><span style=""font-weight: 800;""><i><br /></i></span></div><i style=""font-weight: bold; ""><img src=""paste-606380662718465.jpg"" /></i></div> <div class=tags></div>"
"<div class=card><span class=cloze>[intrahepatic cholestasis of pregnancy or acute fatty liver of pregnancy]</span> has&nbsp;<b>↑ bile acids and itchiness.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>intrahepatic cholestasis of pregnancy</span> has&nbsp;<b>↑ bile acids and itchiness.</b></div><br><br> <div class=extra><div><i></i><i>- increased E/P cause hepatobiliary tract&nbsp;<b>stasis&nbsp;</b>and ↓ bile excretion leading to&nbsp;<b>itchiness;&nbsp;</b>bile acids may kill baby.</i><br /></div><div><i></i><i>- compare with AFLP that presents with signs of <b>liver failure&nbsp;</b></i></div><div><i></i><i><br /></i></div><div><i><img src=""paste-23553600651267_1496784870471.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What are the target&nbsp;<u>1-hour</u>&nbsp;and&nbsp;<u>2-hour postprandial</u>&nbsp;blood glucose levels in patients with&nbsp;<b>gestational diabetes mellitus</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What are the target&nbsp;<u>1-hour</u>&nbsp;and&nbsp;<u>2-hour postprandial</u>&nbsp;blood glucose levels in patients with&nbsp;<b>gestational diabetes mellitus</b>?<div><br /></div><div><span class=cloze><u>&lt;</u>&nbsp;140 and&nbsp;<u>&lt;</u>&nbsp;120 mg/dL, respectively</span></div></div><br><br> <div class=extra><div><i><img src=""GDM.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>After instructing the laboring patient to breath and&nbsp;<i>not</i>&nbsp;push, management of&nbsp;<u>shoulder dystocia</u>&nbsp;includes&nbsp;<b>flexing the hips toward the abdomen</b>&nbsp;(McRoberts manuever)&nbsp;and&nbsp;<b>application of <span class=cloze>[...]</span></b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>After instructing the laboring patient to breath and&nbsp;<i>not</i>&nbsp;push, management of&nbsp;<u>shoulder dystocia</u>&nbsp;includes&nbsp;<b>flexing the hips toward the abdomen</b>&nbsp;(McRoberts manuever)&nbsp;and&nbsp;<b>application of <span class=cloze>suprapubic pressure</span></b></div><br><br> <div class=extra><div><i><div></div></i><i>these maneuvers relieve ~50% of shoulder dystocias with no further intervention</i></div><div><i><br /></i></div><div><img src=""becalm.png"" /></div><img src=""mcrobert.png"" /></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>recommended management</i>&nbsp;for a&nbsp;<u>pregnant</u>&nbsp;patient with&nbsp;<b>chronic hepatitis C infection</b>&nbsp;and&nbsp;<b>no immunity</b>&nbsp;to&nbsp;<b>hepatitis A</b>/<b>B</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>recommended management</i>&nbsp;for a&nbsp;<u>pregnant</u>&nbsp;patient with&nbsp;<b>chronic hepatitis C infection</b>&nbsp;and&nbsp;<b>no immunity</b>&nbsp;to&nbsp;<b>hepatitis A</b>/<b>B</b>?<div><br /></div><div><span class=cloze>Administer hepatitis A and B vaccines (prevent further liver damage)</span></div></div><br><br> <div class=extra><div><i><div></div></i><i>acute hepatitis on top of chronic HCV → ↑ risk of&nbsp;<b>cirrhosis</b>; can be safely administered during pregnancy; <b>ribavirin</b> is&nbsp;<u><b>contraindicated</b></u>&nbsp;due to teratogenic effects</i><div><i><br /></i></div><div><i><img src=""paste-387599323628047.jpg"" /></i></div><div><i><br /></i><div><i><img src=""hep c in prego.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a postmenopausal woman that presents with&nbsp;<u>vulvar itching</u>&nbsp;and&nbsp;<b>thin</b>,&nbsp;<b>dry</b>,&nbsp;<b>white</b>&nbsp;<b>plaque-like vulvar skin</b>?<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""paste-13543161460686851.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a postmenopausal woman that presents with&nbsp;<u>vulvar itching</u>&nbsp;and&nbsp;<b>thin</b>,&nbsp;<b>dry</b>,&nbsp;<b>white</b>&nbsp;<b>plaque-like vulvar skin</b>?<div><br /></div><div><span class=cloze>Lichen sclerosus</span></div><div><br /></div><div><img src=""paste-13543161460686851.jpg"" /></div></div><br><br> <div class=extra><div><i></i><i>skin is classically described as ""<b>cigarette paper</b>"" quality and patient's may have retraction of normal anatomical landmarks (e.g. clitoral retraction); think about a&nbsp;<b>thin&nbsp;white skull.</b></i></div><div><i></i><i><b><br /></b></i></div><div><i><div></div><img src=""LS.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><img src=""paste-1510222170423299.jpg"" /><div><br /></div><div>What's going on?</div><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><img src=""paste-1510222170423299.jpg"" /><div><br /></div><div>What's going on?</div><div><br /></div><div><span class=cloze>Vitiligo</span></div></div><br><br> <div class=extra><div><i></i><i>- autoimmune&nbsp;destruction of melanocytes leading to&nbsp;<b>flat, hypopigmented macules with distinct borders</b>, a/w other autoimmune (type 1 diabetes)&nbsp;</i><div><i><font color=""#ff0000"">- vitiligo = villain = destruction</font><br /></i><div><b><img src=""paste-633245683155389.jpg"" /></b></div></div></div></div> <div class=tags></div>"
"<div class=card><b>Oligohydramnios</b>&nbsp;is characterized by an amniotic fluid index&nbsp;<u>&lt;</u>&nbsp;5 cm or a single deepest pocket&nbsp;<u>&lt;</u>&nbsp;<span class=cloze>[...]</span> cm&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Oligohydramnios</b>&nbsp;is characterized by an amniotic fluid index&nbsp;<u>&lt;</u>&nbsp;5 cm or a single deepest pocket&nbsp;<u>&lt;</u>&nbsp;<span class=cloze>2</span> cm&nbsp;</div><br><br> <div class=extra><div><i><div><div><b>indication for delivery in late-term pregnancies </b>(sign of uteroplacental insufficiency)</div></div><div style=""font-weight: bold; ""><br /></div><div style=""font-weight: bold; ""><img src=""paste-1395482119110657.jpg"" /></div><div style=""font-weight: bold; ""><img src=""paste-1395495004012545.jpg"" /></div></i></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[Hirsutism/Virilization]</span> = weight gain + male pattern hair growth<div><span class=cloze>[...]</span> = above + masculinization (clitoromegaly,&nbsp;<font color=""#ff0000""><b>deep</b>&nbsp;<b>voice</b></font>, muscles)</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>Hirsutism</span> = weight gain + male pattern hair growth<div><span class=cloze>Virilization</span> = above + masculinization (clitoromegaly,&nbsp;<font color=""#ff0000""><b>deep</b>&nbsp;<b>voice</b></font>, muscles)</div></div><br><br> <div class=extra><div><i><div><div></div></div></i><i>Virilization is worse due to ↑↑ androgens; concerning for&nbsp;androgen-secreting tumor (e.g., <b>Sertoli</b>-<b>Leydig</b>)</i><div style=""font-weight: bold; ""><b><i><br /></i></b><div><i><img src=""paste-1139218600427523.jpg"" /></i></div></div><div style=""font-weight: bold; ""><i><br /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>endometrial cells</b>&nbsp;on pap smear in women &gt;<b>&nbsp;45&nbsp;</b>= <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>endometrial cells</b>&nbsp;on pap smear in women &gt;<b>&nbsp;45&nbsp;</b>= <span class=cloze>endometrial biopsy</span></div><br><br> <div class=extra><div><i><div><div></div></div></i><div><i></i><i>may be due to<b> endometrial shedding</b> from cancer; &lt; 45 is normal.</i><div style=""font-weight: bold; ""><i><br /></i></div><div style=""font-weight: bold; ""><i><img src=""paste-1566821249449987.jpg"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>Of what the following&nbsp;<b>decelerations</b>&nbsp;on&nbsp;<u>contraction stress testing</u>&nbsp;indicative?<div><br /></div><div>Early: <span class=cloze>[...]</span></div><div>Variable:&nbsp;<span class=cloze>[...]</span></div><div>Late:&nbsp;<span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Of what the following&nbsp;<b>decelerations</b>&nbsp;on&nbsp;<u>contraction stress testing</u>&nbsp;indicative?<div><br /></div><div>Early: <span class=cloze>head compression</span></div><div>Variable:&nbsp;<span class=cloze>cord compression</span></div><div>Late:&nbsp;<span class=cloze>uteroplacental insufficiency</span></div></div><br><br> <div class=extra><div><i><div><div></div></div></i><div><i><img src=""paste-326696687370243.jpg"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>↑ oxytocin&nbsp;</b>levels can lead to <span class=cloze>[...]</span> decelerations. Why?</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>↑ oxytocin&nbsp;</b>levels can lead to <span class=cloze>late</span> decelerations. Why?</div><br><br> <div class=extra><div><i><div><div></div></div></i><div><i></i><i><div>uterine tachysystole → compression of blood flow to baby → hypoxia.</div><div><br /></div></i></div><div><i><img src=""paste-326696687370243.jpg"" /><img src=""paste-3006172164521985.jpg"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>Uterine tachysystole&nbsp;</b>can cause fetal compromise (hypoxemia, acidemia) due to&nbsp;<b>disruption of <span class=cloze>[...]</span></b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Uterine tachysystole&nbsp;</b>can cause fetal compromise (hypoxemia, acidemia) due to&nbsp;<b>disruption of <span class=cloze>intervillous blood flow.</span></b></div><br><br> <div class=extra><div><i><div><div></div></div></i><div><i></i><i><div></div></i><i><b>&gt; 5 contractions in 10 minutes</b></i></div><div><i><b>discontinue</b>&nbsp;<b>utertonic agents</b>&nbsp;to slow down contractions and give more time for blood flow.</i></div><div><i><br /></i></div><div><img src=""paste-1452463450226691.jpg"" /></div></div><div><i><img src=""paste-326696687370243.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>pregnancy + syphilis + PCN allergy &nbsp;= <span class=cloze>[treatment]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>pregnancy + syphilis + PCN allergy &nbsp;= <span class=cloze>penicillin (patients need to be desensitized)</span></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><div><i><div style=""font-weight: bold; ""></div></i><i><b>penicillin is the treatment of choice for syphilis in pregnancy</b> regardless of drug allergies</i></div><div><i><br /><div style=""font-weight: bold; ""></div></i><i><img src=""biiitch.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in an&nbsp;<u>afebrile</u>&nbsp;postpartum woman that presents with&nbsp;<b>bilateral</b>,&nbsp;<b>symmetric</b>&nbsp;<b>warmth&nbsp;</b>and&nbsp;<b>tenderness</b>&nbsp;<b>of the breasts</b>&nbsp;3 days after delivery?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in an&nbsp;<u>afebrile</u>&nbsp;postpartum woman that presents with&nbsp;<b>bilateral</b>,&nbsp;<b>symmetric</b>&nbsp;<b>warmth&nbsp;</b>and&nbsp;<b>tenderness</b>&nbsp;<b>of the breasts</b>&nbsp;3 days after delivery?&nbsp;<div><br /></div><div><span class=cloze>Breast engorgement</span></div></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><div><i></i><i>common 3-5 days after delivery when&nbsp;<b>colostrum is replaced by milk</b>; improves with breastfeeding</i><div><i><br /></i><div><i><img src=""hmm (2).png"" /></i></div></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a patient with&nbsp;<u>primary amenorrhea</u>&nbsp;and the following physical exam:&nbsp;<b>absent uterus</b>/<b>upper</b>&nbsp;<b>vagina with normal lower vagina</b>,<font color=""#ff0000"">&nbsp;</font><u><b><font color=""#ff0000"">minimal pubic hair but present&nbsp;</font></b><font color=""#ff0000""><b>breast</b>&nbsp;<b>development</b></font></u><div><br></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a patient with&nbsp;<u>primary amenorrhea</u>&nbsp;and the following physical exam:&nbsp;<b>absent uterus</b>/<b>upper</b>&nbsp;<b>vagina with normal lower vagina</b>,<font color=""#ff0000"">&nbsp;</font><u><b><font color=""#ff0000"">minimal pubic hair but present&nbsp;</font></b><font color=""#ff0000""><b>breast</b>&nbsp;<b>development</b></font></u><div><br></div><div><span class=cloze>Androgen insensitivity syndrome</span></div></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><div><i></i><i>patient's are 46,XY and have&nbsp;<u>normal testicular secretion</u>&nbsp;of&nbsp;<b>anti-Mullerian hormone</b>&nbsp;(absent cervix, uterus, upper vagina) and&nbsp;<b>testosterone</b>&nbsp;(converted to estrogen for breast development) -&nbsp;<u>minimal hair&nbsp;</u>distinguishes AIS from Mullerian agenesis.</i></div><div><i></i><i><img src=""paste-277042570461185.jpg"" /></i></div><div><i><img src=""chart (1).png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>female-appearing child with&nbsp;<font color=""#ff0000"">virilization</font><font color=""#ff0000"">&nbsp;at puberty</font>, bilateral undescended testes, and&nbsp;<u>no</u>&nbsp;breasts =&nbsp;<span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>female-appearing child with&nbsp;<font color=""#ff0000"">virilization</font><font color=""#ff0000"">&nbsp;at puberty</font>, bilateral undescended testes, and&nbsp;<u>no</u>&nbsp;breasts =&nbsp;<span class=cloze>5α-reductase deficiency</span></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><i><div></div></i><div><i>- female with&nbsp;<b>masculinzation at puberty</b>&nbsp;due to testes producing ↑↑ testosterone ""saturating"" limited 5a-reductase and making DHT.</i></div><div><i>- No DHT = no penis (looks female).&nbsp;</i></div><div><i>- ddx.&nbsp;<b>CAIS</b>: breasts, no hair (androgen → estrogen conversion and androgen receptor insensitivity)</i></div><div><i>- ddx <b>congenital adrenal hyperplasia</b>: 46XX - no testes.</i></div><div><i><br /></i></div><div><i><img src=""paste-2048596320976899.jpg"" /></i></div><div><i><br /></i></div><div><img src=""paste-2732617107505155.jpg"" /></div><i><div></div></i><div><img src=""paste-351160821088257.jpg"" /></div><div><i><div></div></i><i><br /></i></div><div><br /></div><div><i><br /></i></div><div><br /></div></div></div> <div class=tags></div>"
"<div class=card><b>Female puberty</b>&nbsp;occurs through the&nbsp;<u>following stages</u>:<div><br /></div><div><span class=cloze>[...]</span> at 8 years</div><div><span class=cloze>[...]</span> at 9 years</div><div><span class=cloze>[...]</span> at 10 years</div><div><span class=cloze>[...]</span> at 11 years</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Female puberty</b>&nbsp;occurs through the&nbsp;<u>following stages</u>:<div><br /></div><div><span class=cloze>Breasts (<u>The</u>larche)</span> at 8 years</div><div><span class=cloze><u>A</u>xillary hair (<u>A</u>drenarche)</span> at 9 years</div><div><span class=cloze>Growth spurt</span> at 10 years</div><div><span class=cloze><font color=""#ff0000"">Menarche</font></span> at 11 years</div></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><i><div></div></i><div><i></i><i>8 = ""The"" two breasts</i><div><i>Hairy Cat</i></div><div><i>Imagine 10 toes growing toenails</i></div><div><i>Skiis poking vagina (also 11/51 for puberty/menopause)<br /></i></div><div><i><br /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>Which&nbsp;<i>selective estrogen receptor modulator</i>&nbsp;(SERM) is preferred for treatment of&nbsp;<b>postmenopausal osteoporosis&nbsp;</b>(especially those with&nbsp;<b>breast cancer&nbsp;</b>risk)?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which&nbsp;<i>selective estrogen receptor modulator</i>&nbsp;(SERM) is preferred for treatment of&nbsp;<b>postmenopausal osteoporosis&nbsp;</b>(especially those with&nbsp;<b>breast cancer&nbsp;</b>risk)?<div><br /></div><div><span class=cloze>Raloxifene</span></div></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><i><div></div></i><div><i></i><div><i></i><i></i><i>estrogen <b>agonist</b> at bone, estrogen&nbsp;<b>antagonist</b>&nbsp;in&nbsp;<u>both</u>&nbsp;breast and endometrium therefore no associated cancer risk; however&nbsp;<strong><font color=""#ff0000"">it will still increase DVT risk&nbsp;</font></strong>(like all SERMs) - relax, no endometrial cancer!</i></div><div><i></i><i></i><i><br /></i></div><div><i></i><i>anything that has&nbsp;<b>estrogen</b>&nbsp;<b>agonist</b>&nbsp;activity (even just at bone) can<font color=""#ff0000""><b> increase DVT risk</b></font> by&nbsp;<b>increasing protein C resistance (aka like factor V leiden)</b></i></div><div><i></i><i><b><br /></b></i></div><div><i><img src=""paste-327246443184607.jpg"" /><img src=""SERM_1358629116483.png"" /></i></div></div></div><div><i><br /></i></div><div><i><img src=""paste-3038229800419331.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Endometriosis</b>&nbsp;can lead to <span class=cloze>[...]</span> because of disruption of pelvic anatomy.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Endometriosis</b>&nbsp;can lead to <span class=cloze>infertility</span> because of disruption of pelvic anatomy.</div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><i><div></div></i><div><i></i><div><i></i><i>the ectopic glands can disrupt oocyte release, sperm entry, ovarian function (endometrioma); resection improves the infertility.&nbsp;</i></div></div></div><div><i></i><i><br /></i></div><div><i></i><i><img src=""endometriosis.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a 35-year-old woman that presents with&nbsp;<b>infertility</b>,&nbsp;<b>irregular menses</b>, and&nbsp;<b>hot flashes</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a 35-year-old woman that presents with&nbsp;<b>infertility</b>,&nbsp;<b>irregular menses</b>, and&nbsp;<b>hot flashes</b>?<div><br /></div><div><span class=cloze>Primary ovarian insufficiency</span></div></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><i><div></div></i><div><i></i><div><i></i><i>i.e. cessation of ovarian function before 40 years of age →&nbsp;<b>menopausal</b>&nbsp;symptoms due to decreased estrogen.</i></div><div><i><br /><div></div></i><i><img src=""paste-1367689385738243.jpg"" /><br /></i><div><i><img src=""premature ovarian.png"" /></i></div></div></div></div></div> <div class=tags></div>"
"<div class=card>Fragile X syndrome premutation carriers = <span class=cloze>[...]</span> risk of primary ovarian insufficiency</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Fragile X syndrome premutation carriers = <span class=cloze>↑</span> risk of primary ovarian insufficiency</div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><i><div></div></i><div><i></i><div><i><br /></i></div><div><i><div></div></i><i><img src=""paste-1367689385738243.jpg"" /><br /></i><div><i><img src=""premature ovarian.png"" /></i></div></div></div></div></div> <div class=tags></div>"
"<div class=card>Vaccinations recommended for&nbsp;<u>all</u>&nbsp;pregnant women during each pregnancy include&nbsp;<u>inactivated</u>&nbsp;<b>influenzae</b>&nbsp;and <span class=cloze>[...]</span>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Vaccinations recommended for&nbsp;<u>all</u>&nbsp;pregnant women during each pregnancy include&nbsp;<u>inactivated</u>&nbsp;<b>influenzae</b>&nbsp;and <span class=cloze><b>Tdap</b></span>&nbsp;</div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><i><div></div></i><div><i></i><div><i></i><i><b>live vaccines are contraindicated.</b></i></div><div><i></i><i><br /></i></div><div><i><img src=""hm (5).png"" /></i></div><div><i><div></div><br /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in working up a fetus with a&nbsp;<b>nonreactive NST</b>&nbsp;that&nbsp;<u>did NOT react to vibroacoustic stimulation</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>next best step</u>&nbsp;in working up a fetus with a&nbsp;<b>nonreactive NST</b>&nbsp;that&nbsp;<u>did NOT react to vibroacoustic stimulation</u>?<div><br /></div><div><span class=cloze>Biophysical profile</span></div></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><b><i><div></div></i></b><div><div><b><i>NST → VAS → BPP</i></b></div><div><b><i><br /></i></b></div><div><b><i><img src=""paste-20431159428692.jpg"" /></i></b><i></i></div></div></div><div><b><i><br /></i></b></div><div><b><i><br /></i></b></div><div><b><i><br /></i></b></div><div><b><i><img src=""paste-1688471903141889.jpg"" /></i></b></div><div><b><i><br /></i></b></div><div><b><i><img src=""paste-1688360233992193.jpg"" /></i></b></div><div><b><i><br /></i></b></div><div><b><i><img src=""paste-1688501967912961.jpg"" /></i></b></div></div> <div class=tags></div>"
"<div class=card>An&nbsp;<u>abnormal</u>&nbsp;<b>biophysical profile score</b>&nbsp;(0 - 4) is consistent with <span class=cloze>[...]</span> due to&nbsp;<b>placental insufficiency</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>An&nbsp;<u>abnormal</u>&nbsp;<b>biophysical profile score</b>&nbsp;(0 - 4) is consistent with <span class=cloze>fetal hypoxia</span> due to&nbsp;<b>placental insufficiency</b></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><b><i><div></div></i></b><div><div><b><i><br /></i></b></div></div></div><div><b><i><img src=""paste-1688360233992193.jpg"" /></i></b></div><div><b><i><br /></i></b></div><div><b><i><img src=""paste-1688501967912961.jpg"" /></i></b></div></div> <div class=tags></div>"
"<div class=card><b>Preeclampsia</b>&nbsp;is defined as hypertension&nbsp;with&nbsp;<span class=cloze>[...]</span>&nbsp;<i>or</i>&nbsp;<span class=cloze>[...]</span>&nbsp;<u>after</u>&nbsp;the 20th week of gestation&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Preeclampsia</b>&nbsp;is defined as hypertension&nbsp;with&nbsp;<span class=cloze>proteinuria</span>&nbsp;<i>or</i>&nbsp;<span class=cloze>end-organ dysfunction</span>&nbsp;<u>after</u>&nbsp;the 20th week of gestation&nbsp;</div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><b><i><div></div></i></b><div><div><i><b>end organ dysfunction</b>&nbsp;= ↑ LFTs, Cr, thrombocytopenia, pulmonary edema, cerebral edema.&nbsp;</i></div></div></div><div><b><i><div></div></i><i></i></b><b><br /></b></div><img src=""paste-1702164258881537.jpg"" /></div> <div class=tags></div>"
"<div class=card><b>Preeclampsia</b>&nbsp;is defined as hypertension&nbsp;with&nbsp;proteinuria&nbsp;<i>or</i>&nbsp;end-organ dysfunction&nbsp;<u>after</u>&nbsp;the <span class=cloze>[...]</span> week of gestation&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Preeclampsia</b>&nbsp;is defined as hypertension&nbsp;with&nbsp;proteinuria&nbsp;<i>or</i>&nbsp;end-organ dysfunction&nbsp;<u>after</u>&nbsp;the <span class=cloze>20th</span> week of gestation&nbsp;</div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><b><i><div></div></i></b><div><div><i><b>end organ dysfunction</b>&nbsp;= ↑ LFTs, Cr, thrombocytopenia, pulmonary edema, cerebral edema.&nbsp;</i></div></div></div><div><b><i><div></div></i><i></i></b><b><br /></b></div><img src=""paste-1702164258881537.jpg"" /></div> <div class=tags></div>"
"<div class=card>gestational hypertension or eclampsia diagnosis starts &gt; <span class=cloze>[...]</span> weeks</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>gestational hypertension or eclampsia diagnosis starts &gt; <span class=cloze>20</span> weeks</div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><b><i><div></div></i></b><div><div><i><b>&lt; 20 weeks </b>= chronic HTN</i></div><div><i><br /></i></div><div><b><i><img src=""paste-3676492005880.jpg"" /></i></b></div></div></div></div> <div class=tags></div>"
"<div class=card><div><font color=""#ff0000"">dilated</font>&nbsp;cervix + products of conception&nbsp;<u>not&nbsp;outside</u>&nbsp;uterine cavity = <span class=cloze>[condition]</span></div><div><br /></div><font color=""#ff0000"">dilated</font>&nbsp;cervix + products of conception&nbsp;<u>within and outside</u>&nbsp;of uterine cavity&nbsp;= <span class=cloze>[condition]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div><font color=""#ff0000"">dilated</font>&nbsp;cervix + products of conception&nbsp;<u>not&nbsp;outside</u>&nbsp;uterine cavity = <span class=cloze>inevitable abortion</span></div><div><br /></div><font color=""#ff0000"">dilated</font>&nbsp;cervix + products of conception&nbsp;<u>within and outside</u>&nbsp;of uterine cavity&nbsp;= <span class=cloze>incomplete abortion</span></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><b><i><div></div></i></b><div><div>""incompletely out""</div><div><br /></div><div><img src=""paste-15040975470593 (1).jpg"" /><img src=""Spontaneous+Miscarriage.jpg"" /></div><div><b><i><br /></i></b></div></div></div></div> <div class=tags></div>"
"<div class=card><b>Spontaneous abortion</b>&nbsp;is unprovoked pregnancy loss at &lt;&nbsp;<span class=cloze>[...]</span> weeks gestation and is a common cause of&nbsp;<u>first trimester</u>&nbsp;bleeding</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Spontaneous abortion</b>&nbsp;is unprovoked pregnancy loss at &lt;&nbsp;<span class=cloze>20</span> weeks gestation and is a common cause of&nbsp;<u>first trimester</u>&nbsp;bleeding</div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><b><i><div></div></i></b><div><div><img src=""spont abort.png"" /></div></div></div></div> <div class=tags></div>"
"<div class=card>What type of pregnancy does<b>&nbsp;Twin-twin Transfusion Syndrome&nbsp;</b>occur in?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What type of pregnancy does<b>&nbsp;Twin-twin Transfusion Syndrome&nbsp;</b>occur in?<div><br /></div><div><span class=cloze>Monochorionic</span></div></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><b><i><div></div></i></b><div><div><div><i>- when two amnions share the SAME<font color=""#ff0000"">&nbsp;blood</font>&nbsp;supply (chorion = &nbsp;placenta),&nbsp;<b>unbalanced&nbsp;AV anastomoses</b>&nbsp;are present between shared placental vessels shunting blood from one baby to another.&nbsp;</i></div><div><i>- monozygotic&nbsp;<u><b>monochorionic</b></u>&nbsp;diamniotic and monozygotic&nbsp;<u><b>monochorionic</b></u>&nbsp;monoamniotic</i></div><div><i><br /></i></div><div><i><img src=""paste-1117662159568897.jpg"" /></i></div><div><i><img src=""paste-152814936391681.jpg"" /></i></div><div><i><img src=""paste-1100800117964801.jpg"" /></i></div><div><i><img src=""paste-545108659274508.jpg"" /><img src=""paste-1033051303837697.jpg"" /></i></div><div><i><br /></i></div><i><div></div></i><i></i><i><img src=""paste-38779259717026.jpg"" /></i><img src=""paste-275225799294977.jpg"" /><div><i><br /></i></div></div></div></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[...]</span>-<u>chorionic</u>&nbsp;twins:&nbsp;<b>L</b>ambda sign<div><span class=cloze>[...]</span>-<u>chorionic</u>&nbsp;twins:&nbsp;<b>T</b>-sign&nbsp;</div><div><br /></div><div><img src=""paste-178490250887169.jpg"" /><img src=""paste-178812373434369.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze><b>D</b>i</span>-<u>chorionic</u>&nbsp;twins:&nbsp;<b>L</b>ambda sign<div><span class=cloze><b>M</b>ono</span>-<u>chorionic</u>&nbsp;twins:&nbsp;<b>T</b>-sign&nbsp;</div><div><br /></div><div><img src=""paste-178490250887169.jpg"" /><img src=""paste-178812373434369.jpg"" /></div></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><b><i><div></div></i></b><div><div><div><i><div></div></i><i><b>Chorion</b> = # placentas</i></div><div><i><b>D is closer to L&nbsp;</b>- Lambda sign where the two placentas and intertwin membranes (amnions) meet.</i></div><div><i><b>M closer to T</b>&nbsp;- T shape is the 90 degree angle between the placenta and intertwin membrane (amnions)</i></div><div><i><br /></i></div><div><i><img src=""paste-1052095188828161.jpg"" /><img src=""paste-1053400858886145.jpg"" /></i></div><div></div><div><i><span><br /></span></i></div><div><i><span style=""font-style: normal; ""><br /></span></i></div><img src=""paste-4310867264929793.jpg"" /></div></div></div></div> <div class=tags></div>"
"<div class=card><b>Monozygotic twins</b>&nbsp;arise from <span class=cloze>[...]</span> egg + <span class=cloze>[...]</span> sperm, with time of cleavage determining # chorions and amnions:<div><br /></div><div><div><b>ƒƒCleavage 0–4 days:</b>&nbsp;<span class=cloze>[...]</span></div><div><b>ƒƒCleavage 4–8 days</b>: <span class=cloze>[...]</span></div><div><b>ƒƒCleavage 8–12 days:</b>&nbsp;<span class=cloze>[...]</span></div><div>ƒƒ<b>Cleavage 13+ days:&nbsp;</b><span class=cloze>[...]</span></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Monozygotic twins</b>&nbsp;arise from <span class=cloze>1</span> egg + <span class=cloze>1</span> sperm, with time of cleavage determining # chorions and amnions:<div><br /></div><div><div><b>ƒƒCleavage 0–4 days:</b>&nbsp;<span class=cloze><b>S</b>eparate chorion and amnion</span></div><div><b>ƒƒCleavage 4–8 days</b>: <span class=cloze><u>shared</u>&nbsp;<b>C</b>horion</span></div><div><b>ƒƒCleavage 8–12 days:</b>&nbsp;<span class=cloze><u>shared</u>&nbsp;<b>A</b>mnion</span></div><div>ƒƒ<b>Cleavage 13+ days:&nbsp;</b><span class=cloze><u>shared</u><b>&nbsp;B</b>ody (conjoined)</span></div></div></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><b><i><div></div></i></b><div><div><div><i><div></div><div><b><u>Di</u>zygotic</b>&nbsp;= 2 eggs/2 sperm = 2 amnions, chorions, placentas (all separate)</div><div>(SCAB)</div><img src=""paste-4310867264929793.jpg"" /></i></div></div></div></div></div> <div class=tags></div>"
"<div class=card>Which&nbsp;<u>twin classification(s)</u>&nbsp;is associated with&nbsp;<b>umbilical cord entanglement</b>&nbsp;as a complication?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which&nbsp;<u>twin classification(s)</u>&nbsp;is associated with&nbsp;<b>umbilical cord entanglement</b>&nbsp;as a complication?<div><br /></div><div><span class=cloze>Monozygotic monochorionic monoamniotic</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i><i>same amniotic sac → tangle; therefore, deliver at 32-34 weeks via<b>&nbsp;C-section</b></i></div><div style=""text-decoration: underline; font-weight: bold; ""><i><b><br /></b></i></div><div style=""text-decoration: underline; font-weight: bold; ""><b><i><img src=""paste-1127373080625153.jpg"" /></i></b></div><div style=""text-decoration: underline; font-weight: bold; ""><i><b><img src=""paste-177884660498433.jpg"" /></b></i></div><div style=""text-decoration: underline; font-weight: bold; ""><i><b><br /></b></i></div><div style=""text-decoration: underline; font-weight: bold; ""><i><b><img src=""paste-1033055598804993.jpg"" /></b></i></div><div style=""text-decoration: underline; font-weight: bold; ""><i><b><br /></b></i></div><i style=""text-decoration: underline; font-weight: bold; ""><img src=""paste-4310867264929793.jpg"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>An initial measure to treat fetal hypoperfusion causing&nbsp;<b>late decels</b>&nbsp;is to move mom into the <span class=cloze>[...]</span> position</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>An initial measure to treat fetal hypoperfusion causing&nbsp;<b>late decels</b>&nbsp;is to move mom into the <span class=cloze>left lateral</span> position</div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i><i><b>treat with ""intrauterine resuscitation:""&nbsp;</b></i><i>Various interventions with the specific aim of increasing delivery of oxygen to the placenta and fetus (e.g., oxygen, treat hypotension, stop oxytocin, IVF); <font color=""#ff0000""><b>if this fails do&nbsp;C-section</b></font></i></div></div></div></div><div><i></i><i><b><br /></b></i></div></div> <div class=tags></div>"
"<div class=card>When is&nbsp;<b>operative vaginal delivery</b>&nbsp;(eg, vacuum, forceps) indicated during the&nbsp;<u>second-stage of labor</u>?<div><ol type=""1"" start=""1""><li><span class=cloze>[...]</span></li><li><span class=cloze>[...]</span></li></ol></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>When is&nbsp;<b>operative vaginal delivery</b>&nbsp;(eg, vacuum, forceps) indicated during the&nbsp;<u>second-stage of labor</u>?<div><ol type=""1"" start=""1""><li><span class=cloze><u>Protracted</u>&nbsp;<b>2nd</b>&nbsp;stage of labor</span></li><li><span class=cloze>&nbsp;<b>2nd</b>-stage fetal&nbsp;<u>heart</u>&nbsp;rate abnormalities</span></li></ol></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i><i><b>C-section</b>&nbsp;if fetal head isn't engaged</i></div><div style=""font-weight: bold; ""><i><br /></i></div><div style=""font-weight: bold; ""><i><img src=""paste-315469642858497.jpg"" /><br /></i><div><i><br /></i></div><div><i></i></div></div></div> <div class=tags></div>"
"<div class=card><b>painful</b>&nbsp;bleeding +&nbsp;<b>loss of contractions</b>&nbsp;+&nbsp;<b>loss of fetal station&nbsp;</b>+ <b>palpable fetal parts</b> with a history of&nbsp;<b>c-section</b>&nbsp;= <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>painful</b>&nbsp;bleeding +&nbsp;<b>loss of contractions</b>&nbsp;+&nbsp;<b>loss of fetal station&nbsp;</b>+ <b>palpable fetal parts</b> with a history of&nbsp;<b>c-section</b>&nbsp;= <span class=cloze>uterine rupture</span></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><i></i><i>baby birthed into peritoneum, so lost fetal station (e.g., 0 to -3) and no more contractions;<b>&nbsp;immediate C-section.</b></i></div><div><i></i><i><b><br /></b></i></div><div><i></i><i><b><img src=""paste-1819038908940289.jpg"" /></b></i></div><div><i></i><i><b><img src=""paste-1819026024038401.jpg"" /></b></i></div><div style=""font-weight: bold; ""><i></i></div></div></div> <div class=tags></div>"
"<div class=card>How do you manage&nbsp;<b>preterm premature rupture of membrane (PPROM)?</b><div><br /></div><div>&gt; 34 weeks: <span class=cloze>[...]</span></div><div>Signs of infection: <span class=cloze>[...]</span></div><div>24-34 weeks:&nbsp;<span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>How do you manage&nbsp;<b>preterm premature rupture of membrane (PPROM)?</b><div><br /></div><div>&gt; 34 weeks: <span class=cloze>deliver the baby</span></div><div>Signs of infection: <span class=cloze>deliver the baby</span></div><div>24-34 weeks:&nbsp;<span class=cloze>steroids + antibiotics</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><i>since PPROM is often 2/2 infection, antibiotics will prolong interval between membrane rupture and delivery.</i></div><div><i><br /></i></div><div><i><img src=""paste-1827920901308419.jpg"" /></i></div><div style=""font-weight: bold; ""><i></i></div></div></div> <div class=tags></div>"
"<div class=card><b>External cephalic version</b>&nbsp;can be attempted for&nbsp;<u>breech presentations</u>&nbsp;at&nbsp;<u>&gt;</u>&nbsp;<span class=cloze>[...]</span> weeks gestation</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>External cephalic version</b>&nbsp;can be attempted for&nbsp;<u>breech presentations</u>&nbsp;at&nbsp;<u>&gt;</u>&nbsp;<span class=cloze>37</span> weeks gestation</div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><i>-&nbsp;</i><i><b>should</b>&nbsp;<b>not</b>&nbsp;be attempted if the patient is in <b>active</b> labor</i><br /><div><i>- if the patient refuses ECV, cesarean delivery is typically performed at 39 weeks gestation</i></div><div><i><br /></i><div><i><img src=""ecv2.png"" /></i></div><div><img src=""paste-1843485862789121.jpg"" /></div></div></div><div style=""font-weight: bold; ""><i></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely<i>&nbsp;diagnosis</i>&nbsp;in a woman that experiences&nbsp;<b>mood</b>&nbsp;<b>swings</b>,&nbsp;<b>fatigue</b>,&nbsp;<b>bloating</b>, and&nbsp;<b>hot</b>&nbsp;<b>flashes</b>&nbsp;one week&nbsp;<b><u>prior to menstruation</u></b>? The symptoms&nbsp;<u>resolve</u>&nbsp;with menses.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely<i>&nbsp;diagnosis</i>&nbsp;in a woman that experiences&nbsp;<b>mood</b>&nbsp;<b>swings</b>,&nbsp;<b>fatigue</b>,&nbsp;<b>bloating</b>, and&nbsp;<b>hot</b>&nbsp;<b>flashes</b>&nbsp;one week&nbsp;<b><u>prior to menstruation</u></b>? The symptoms&nbsp;<u>resolve</u>&nbsp;with menses.&nbsp;<div><br /></div><div><span class=cloze>Premenstrual syndrome (PMS)</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><i>- next steps: <b>diary → SSRI</b></i></div><div><i><div></div></i><i></i><i>- symptoms typically occur 1-2 weeks before menses (<b>luteal</b>&nbsp;<b>phase</b>) and resolve after menses (follicular phase); see if there's a cyclic change in the bad mood (if constant, may be 2/2 medical condition like hypothyroidism)</i></div><i><div style=""display: inline !important; ""></div></i><i>- symptoms must cause&nbsp;<u>impairment of function</u>&nbsp;(e.g. missed work)</i></div><i><div></div></i><i><br /></i><div><img src=""this guy fucks.png"" /></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a postmenopausal woman that presents with&nbsp;<b>vaginal</b>&nbsp;<b>pruritus</b>/<b>dryness</b>,&nbsp;<b>dysuria/dyspareunia</b><b>,</b>&nbsp;and&nbsp;<b>increased</b>&nbsp;<b>urinary</b>&nbsp;<b>frequency and urgency</b>? Urinalysis is&nbsp;<u>normal</u>.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a postmenopausal woman that presents with&nbsp;<b>vaginal</b>&nbsp;<b>pruritus</b>/<b>dryness</b>,&nbsp;<b>dysuria/dyspareunia</b><b>,</b>&nbsp;and&nbsp;<b>increased</b>&nbsp;<b>urinary</b>&nbsp;<b>frequency and urgency</b>? Urinalysis is&nbsp;<u>normal</u>.&nbsp;<div><br /></div><div><span class=cloze>Atrophic vaginitis (genitourinary syndrome of menopause)</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><i>- next steps: <b>lubricants/moisturizers/vaginal estrogen</b></i></div><div><i><div></div></i><i>- due to&nbsp;<u>reduced estrogen support</u>&nbsp;after menopause causing&nbsp;<b>loss of epithelial elasticity</b>; in the urethra/trigone, this loss of support → urge incontinence; can also see&nbsp;<b>petechiae/fissures/bleeding&nbsp;</b>due to thin tissue;&nbsp;<b>dyspareunia</b>&nbsp;due to narrowed vagina and dryness from less lubrication.</i></div><div><i><br /></i><div><i><img src=""paste-1886542909931521.jpg"" /></i></div><div><i><br /></i></div><div><i><br /></i></div><div><i><img src=""paste-1885275894579201.jpg"" /><br /></i><div><i><img src=""howd everyone know.png"" /></i></div></div><div><i><br /></i></div></div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a post-menopausal woman that presents with&nbsp;<u>chronic pelvic pain</u>&nbsp;and a&nbsp;<b>solid ovarian mass with</b>&nbsp;<b>thick</b>&nbsp;<b>septations</b>&nbsp;and&nbsp;<b>ascites</b>&nbsp;on ultrasound?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a post-menopausal woman that presents with&nbsp;<u>chronic pelvic pain</u>&nbsp;and a&nbsp;<b>solid ovarian mass with</b>&nbsp;<b>thick</b>&nbsp;<b>septations</b>&nbsp;and&nbsp;<b>ascites</b>&nbsp;on ultrasound?&nbsp;<div><br /></div><div><span class=cloze>Epithelial ovarian carcinoma</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i></i><i>due to abnormal proliferation of<b>&nbsp;<u>ovarian or tubal epithelium or peritoneum</u></b>; may also present with&nbsp;<b>bloating</b>&nbsp;and/or<b>&nbsp;early&nbsp;satiety&nbsp;</b>2/2 ascites.</i><div style=""font-weight: bold; ""><b><i><br /></i></b><div><i><img src=""epithel ovarian carc.png"" /></i></div></div></div></div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a patient that is&nbsp;<u>6 hours postpartum</u>&nbsp;that presents with&nbsp;<b>inability to void</b>,&nbsp;<b>diffuse lower abdominal tenderness</b>, and&nbsp;<b>persistent urinary dribbling</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a patient that is&nbsp;<u>6 hours postpartum</u>&nbsp;that presents with&nbsp;<b>inability to void</b>,&nbsp;<b>diffuse lower abdominal tenderness</b>, and&nbsp;<b>persistent urinary dribbling</b>?<div><br /></div><div><span class=cloze>Postpartum urinary retention</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i>- retention due to epidural anesthesia →&nbsp;<b><font color=""#ff0000"">bladder atony</font></b> and<b><font color=""#ff0000"">&nbsp;</font>pudendal nerve palsy.</b></i></div><div><i><b>-</b> treat with<b> intermittent cath</b></i></div><div><i><b>- ddx. </b>with <b>vesicovaginal fistula</b> which takes <u>days</u>&nbsp;to develop and doesn't have <u>bladder distension.</u></i></div><div><i><u><br /></u></i></div><div><i><img src=""paste-132237748076547.jpg"" /></i></div></div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>recommended treatment</i>&nbsp;for&nbsp;<u>confirmed</u>&nbsp;<b>gonorrhea</b>&nbsp;infection?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>recommended treatment</i>&nbsp;for&nbsp;<u>confirmed</u>&nbsp;<b>gonorrhea</b>&nbsp;infection?<div><br /></div><div><span class=cloze>azithromycin + ceftriaxone</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><div></div></i><i><b>Confirmed chlamydia:</b> Azithromycin</i></div><i><b>Confirmed gonorrhea:</b> Ceftriaxone + azithromycin (you really gonorrhea<u>&nbsp;gone,</u>&nbsp;so use two) - it's because of growing gonorrhea cephalosporin resistance&nbsp;</i></div><div><i><br /></i></div><div><i><img src=""aah.png"" /></i></div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>right mid-to-upper quadrant or flank pain during pregnancy with <b>peritoneal</b> signs but&nbsp;<u>without</u>&nbsp;uterine tenderness= <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>right mid-to-upper quadrant or flank pain during pregnancy with <b>peritoneal</b> signs but&nbsp;<u>without</u>&nbsp;uterine tenderness= <span class=cloze>appendicitis</span></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i>fever and fetal tachycardia may also be present.</i></div><div><i><b>next steps: </b><font color=""#ff0000""><b>immediate surgery</b></font></i></div><div><i><b>uterine tenderness </b>= chorio</i></div></div></div><div><i><br /></i></div><div><i><img src=""paste-2031360617218051.jpg"" /></i></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>Is&nbsp;<u>weight gain</u>&nbsp;an adverse effect associated with&nbsp;<b>oral contraceptive pills</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Is&nbsp;<u>weight gain</u>&nbsp;an adverse effect associated with&nbsp;<b>oral contraceptive pills</b>?<div><br /></div><div><span class=cloze>No</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i></i><i>adverse effects include breakthrough bleeding (most common), worsening of hypertension, increased risk of <b>cervical</b> <b>cancer</b>, and increased risk of venous thromboembolism; the <b>injectable medroxyprogesterone </b>contraceptive can cause weight gain.&nbsp;</i></div><div><b><i><br /></i></b><img src=""yeehaw (1).png"" /><img src=""http://www.ncregister.com/images/uploads/Depo-Provera-Injection.jpg"" /><b><i><div><br /></div></i></b></div><div></div></div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>Do uterine fibroids cause&nbsp;<b>breech</b>&nbsp;presentation?&nbsp;<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Do uterine fibroids cause&nbsp;<b>breech</b>&nbsp;presentation?&nbsp;<span class=cloze>Yes</span></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><div></div></i><i>Prevents re-positioning of the fetus by distorting uterine cavity.</i></div><div><i><br /></i></div><b><i><img src=""paste-247510375333891.jpg"" /></i></b></div><div></div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card><div><span class=cloze>[...]</span>hydramnios = single deepest pocket <b>&lt; 2 cm or AFI &lt; 5 cm</b></div><span class=cloze>[...]</span>dramnios = single deepest pocket <b>&gt; 8 cm or AFI &gt; 24 cm</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div><span class=cloze>oligo</span>hydramnios = single deepest pocket <b>&lt; 2 cm or AFI &lt; 5 cm</b></div><span class=cloze>poly</span>dramnios = single deepest pocket <b>&gt; 8 cm or AFI &gt; 24 cm</b></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i>2/5</i></div><div><i>8/24</i></div><div><i><div></div>8 x 3 = 24</i></div></div><div><i>singles are smaller</i></div><div></div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card><u>unstable</u>&nbsp;ectopic = <span class=cloze>[next step]</span><div><u>stable</u>&nbsp;ectopic = <span class=cloze>[next step]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><u>unstable</u>&nbsp;ectopic = <span class=cloze>surgery</span><div><u>stable</u>&nbsp;ectopic = <span class=cloze>methotrexate</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i></i><i>often presents as abdominal pain and vaginal bleeding</i></div><div><i></i><i><br /></i></div><div><i><img src=""ectopic.png"" /><img src=""okie (4).png"" /></i></div></div><div></div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>postpartum endometritis =&nbsp;<span class=cloze>[treatment]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>postpartum endometritis =&nbsp;<span class=cloze>Clindamycin + gentamicin</span></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i></i><i>- <b>fever, purulent lochia, and uterine tenderness.</b></i></div><div><i></i><i>- postpartum endometritis is a&nbsp;<b>polymicrobrial</b>&nbsp;<b>infection</b>, thus requires broad-spectrum coverage; gently clean the dirty uterus&nbsp;</i></div><div><i><br /><div></div></i><i><img src=""wats a lochia.png"" /></i></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>initial screening test</i>&nbsp;of choice for&nbsp;<b>fetal</b>&nbsp;<b>aneuploidy</b>&nbsp;in pregnant women at&nbsp;<b>&gt; 10 weeks&nbsp;</b>gestation with&nbsp;<u>high-risk factors</u>&nbsp;(e.g. age&nbsp;<u>&gt;</u>&nbsp;35)?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>initial screening test</i>&nbsp;of choice for&nbsp;<b>fetal</b>&nbsp;<b>aneuploidy</b>&nbsp;in pregnant women at&nbsp;<b>&gt; 10 weeks&nbsp;</b>gestation with&nbsp;<u>high-risk factors</u>&nbsp;(e.g. age&nbsp;<u>&gt;</u>&nbsp;35)?<div><br /></div><div><span class=cloze>Cell-free fetal DNA testing</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i></i><i>check for trisomies;&nbsp;<b><u>confirm</u></b> with&nbsp;<b>chorionic villus sampling (10-13 wks)</b>&nbsp;or&nbsp;<b>amniocentesis (15-20 wks)</b></i><div><i><br /></i></div><div><i><br /></i><div><i><img src=""not happy about it.png"" /></i></div><div><i><img src=""prenatal testing.png"" /></i></div></div></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>T/F: Follow up abnormal first-trimester&nbsp;<u>combined</u>&nbsp;screen with&nbsp;<u>quadruple</u>&nbsp;screen.<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>T/F: Follow up abnormal first-trimester&nbsp;<u>combined</u>&nbsp;screen with&nbsp;<u>quadruple</u>&nbsp;screen.<div><br /></div><div><span class=cloze>F</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><div></div></i><i>These are both&nbsp;<u><b>screening</b></u>&nbsp;tests but cannot&nbsp;<u><b>confirm</b></u>&nbsp;(to confirm, need <b><u>villus sampling / amniocentesis</u></b>) - amniocentesis is a longer word than villus --&gt; later/longer.&nbsp;</i></div><i><img src=""paste-454609403379713.jpg"" /></i><br /><div><i><br /></i></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>Evaluation of&nbsp;<u><b>atypical glandular cells</b></u>&nbsp;on Pap test in<b> women&nbsp;<u>&gt;</u>&nbsp;35</b>&nbsp;includes&nbsp;<b>colposcopy</b>,&nbsp;<b><u>endo</u>cervical</b>&nbsp;<b>curettage</b>, and&nbsp;<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Evaluation of&nbsp;<u><b>atypical glandular cells</b></u>&nbsp;on Pap test in<b> women&nbsp;<u>&gt;</u>&nbsp;35</b>&nbsp;includes&nbsp;<b>colposcopy</b>,&nbsp;<b><u>endo</u>cervical</b>&nbsp;<b>curettage</b>, and&nbsp;<span class=cloze><b>endometrial</b>&nbsp;<b>biopsy</b></span></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><div></div></i></div><div><i><div>these cells may be due to <b>cervical or endometrial adenocarcinoma.</b></div><div><b>colposcopy</b> → ectocervix</div><div><b>curettage</b> → endocervix</div><div><b>biopsy</b> → endometrium</div><div><br /></div><img src=""didnt see that heh.png"" /></i></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>multiloculated adnexal mass + fever, leukocytosis, CA-125 = <span class=cloze>[infection/malignancy]</span><div>multiloculated adnexal mass &nbsp;= <span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>multiloculated adnexal mass + fever, leukocytosis, CA-125 = <span class=cloze>infection</span><div>multiloculated adnexal mass &nbsp;= <span class=cloze>malignancy</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div>i.e., tubo-ovarian abscess vs. ovarian cancer.&nbsp;</div><div style=""font-weight: bold; ""></div></div></i><i><b><br /></b></i></div><div style=""font-weight: bold; ""><i><b><img src=""paste-59369332932609.jpg"" /></b></i></div><b><img src=""gonna be a rough one.png"" /></b></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>uterine inversion = <span class=cloze>[physical treatment]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>uterine inversion = <span class=cloze>manual replacement</span></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div><b>IVF → manually replace</b><b>&nbsp;→ remove placenta and start uterotonics</b> (oxytocin, misoprostol) to cause uterine contraction, which stops bleeding / re-prolapse.&nbsp;</div><div><br /></div><div></div></div></div></i><i><img src=""paste-279190054109185.jpg"" /></i></div><div><i><br /></i></div></div></div><i><div style=""display: inline !important; ""><div style=""display: inline !important; ""><img src=""UI2.png"" /></div></div></i><i><div><div><div></div></div></div></i><i><img src=""cmrcr-3-122-001.gif"" /></i><br /><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card><b><u>Arrest</u>&nbsp;of&nbsp;<u>active</u>&nbsp;1^st&nbsp;phase of labor</b>&nbsp;is defined as no cervical changes after <span class=cloze>[...]</span> hours of&nbsp;<u>adequate</u>&nbsp;contraction or <span class=cloze>[...]</span> hours of&nbsp;<u>any other contraction.</u></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><u>Arrest</u>&nbsp;of&nbsp;<u>active</u>&nbsp;1^st&nbsp;phase of labor</b>&nbsp;is defined as no cervical changes after <span class=cloze>4</span> hours of&nbsp;<u>adequate</u>&nbsp;contraction or <span class=cloze>6</span> hours of&nbsp;<u>any other contraction.</u></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i><i>adequate&nbsp;contraction =&nbsp;200&nbsp;MVUs&nbsp;</i></div></div></div><div><i><br /></i></div><div><i><img src=""paste-2223006352932865.jpg"" /></i></div><div><i><br /></i></div><img src=""wtf (3).png"" /><br /><div><div><div><b><img src=""paste-315469642858497.jpg"" /></b></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card><b>Active</b> phase of labor normally progresses<b> &gt; <span class=cloze>[...]</span> cm every 2 hours.&nbsp;</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Active</b> phase of labor normally progresses<b> &gt; <span class=cloze>1</span> cm every 2 hours.&nbsp;</b></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div>&lt; 1 cm every 2 hours is <b>protracted.&nbsp;</b></i></div></div></div><div><i><b><img src=""paste-3613351691157507.jpg"" /></b></i></div><div><i><b><br /></b></i></div><div><i><b><img src=""paste-2223010647900161.jpg"" /></b></i></div><div><i><b><br /></b></i></div><div><i><br /></i></div><img src=""wtf (3).png"" /><br /><div><div><div><b><img src=""paste-315469642858497.jpg"" /></b></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>The&nbsp;<u>transition</u>&nbsp;between the&nbsp;<b>latent and active phase of&nbsp;<u>first</u>&nbsp;stage of labor</b>&nbsp;typically occurs at <span class=cloze>[...]</span> dilation.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The&nbsp;<u>transition</u>&nbsp;between the&nbsp;<b>latent and active phase of&nbsp;<u>first</u>&nbsp;stage of labor</b>&nbsp;typically occurs at <span class=cloze>6 cm</span> dilation.</div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div><img src=""paste-2223006352932865.jpg"" /><img src=""paste-315469642858497.jpg"" /></i></div></div></div><div><i><br /></i></div><br /><div><div><div><b><br /></b></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>Treatment of&nbsp;<i>small</i>&nbsp;<b>genital</b>&nbsp;<b>warts</b>&nbsp;includes&nbsp;<u>topical medications</u>, such as <span class=cloze>[...]</span> or podophyllin resin</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Treatment of&nbsp;<i>small</i>&nbsp;<b>genital</b>&nbsp;<b>warts</b>&nbsp;includes&nbsp;<u>topical medications</u>, such as <span class=cloze><b>t</b>ri<b>c</b>hloroacetic&nbsp;<b>a</b>cid</span> or podophyllin resin</div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><i>- larger lesions may require&nbsp;surgical removal; <b>imiquimod and podophyillin resin are&nbsp;<u>contraindicated</u> </b>during pregnancy&nbsp;</i><div><i>- imagine cauliflower warts inside the<b> TCA</b> cycle.</i></div><div style=""font-weight: bold; ""><i><br /></i><div><i><img src=""whoop (3).png"" /></i></div></div></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>First-line treatment options for&nbsp;<b>asymptomatic bacteriuria</b>&nbsp;during&nbsp;<u>pregnancy</u>&nbsp;include <span class=cloze>[...]</span>, amoxicillin-clavulanate, and nitrofurantoin</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>First-line treatment options for&nbsp;<b>asymptomatic bacteriuria</b>&nbsp;during&nbsp;<u>pregnancy</u>&nbsp;include <span class=cloze>cephalexin</span>, amoxicillin-clavulanate, and nitrofurantoin</div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><i><div></div></i><i>all women are screened during the first prenatal visit due to risk of&nbsp;<b>pyelonephritis</b>,&nbsp;<b>preterm</b>&nbsp;<b>birth</b>, and&nbsp;<b>low</b>&nbsp;<b>birth</b>&nbsp;<b>weight</b>&nbsp;associated with ASB (<u>always treat UTI in pregnancy)</u></i></div><div><i><br /></i></div><img src=""daaangit.png"" /></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>palpable, tender mass in the <b>anterior vaginal wall </b>with postvoid dribbling, dysuria, and dyspareunia&nbsp;&nbsp;= <span class=cloze>[diagnosis]</span>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>palpable, tender mass in the <b>anterior vaginal wall </b>with postvoid dribbling, dysuria, and dyspareunia&nbsp;&nbsp;= <span class=cloze>urethral diverticulum</span>&nbsp;</div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><i><div></div></i><i>the outpouching collects urine which can&nbsp;dribble&nbsp;out later or cause&nbsp;infection&nbsp;(causing dyspareunia, tender mass, bloody discharge); <b><u>diagnose with MRI</u></b></i><div><br /></div><div><div><img src=""paste-213614493433859.jpg"" /></div><div><br /></div><div><img src=""paste-213627378335747.jpg"" /></div></div></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card><b>↑ AFP</b>&nbsp;=&nbsp;<span class=cloze>[...]</span>&nbsp;defects,&nbsp;<span class=cloze>[...]</span>&nbsp;defects, and&nbsp;<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>↑ AFP</b>&nbsp;=&nbsp;<span class=cloze>neural&nbsp;tube</span>&nbsp;defects,&nbsp;<span class=cloze>abdominal&nbsp;wall</span>&nbsp;defects, and&nbsp;<span class=cloze>multiple&nbsp;gestation</span></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><i><div></div><div></div></i><i>typically measured between 15 - 20 weeks and correlated with&nbsp;<b>ultrasound evaluation</b></i></div><div><i><b><br /></b></i></div><img src=""msafp.png"" /></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a pregnant woman at 25 weeks gestation that presents after feeling&nbsp;<b>no fetal movement</b>&nbsp;for the past two days? Fetal heart sounds are&nbsp;<u>not</u>&nbsp;heard on Doppler.&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a pregnant woman at 25 weeks gestation that presents after feeling&nbsp;<b>no fetal movement</b>&nbsp;for the past two days? Fetal heart sounds are&nbsp;<u>not</u>&nbsp;heard on Doppler.&nbsp;<div><br /></div><div><span class=cloze><u>Transabdominal</u>&nbsp;ultrasound</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><i></i><i>the patient likely has&nbsp;<b>intrauterine fetal</b>&nbsp;<b>demise</b>&nbsp;(fetal death at&nbsp;<u>&gt;</u>&nbsp;20 weeks), which must be confirmed by the absence of fetal cardiac activity on ultrasound; follow with <b>autopsy, karyotype, placental examination, and maternal lab testing for hypercoagability</b></i><div><i><br /></i><div><i><img src=""sad (2).png"" /></i></div><div><i><img src=""part 2.png"" /></i></div></div></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b>extensive</b>,&nbsp;<b><u>painless</u>&nbsp;ulcer<u>s</u></b>&nbsp;<u>without</u>&nbsp;<b>lymphadenopathy</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""paste-2327953878810625.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b>extensive</b>,&nbsp;<b><u>painless</u>&nbsp;ulcer<u>s</u></b>&nbsp;<u>without</u>&nbsp;<b>lymphadenopathy</b>?&nbsp;<div><br /></div><div><span class=cloze><i>Klebsiella granulomatis</i>&nbsp;(granuloma inguinale)</span></div><div><br /></div><div><img src=""paste-2327953878810625.jpg"" /></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><i><div></div></i><i>primarily seen in India, Guyana, and New Guinea (rare in the U.S); having fun with no pain while you're in the club.</i></div><div><i><br /></i></div><div><i><br /></i></div><div><img src=""way better chart dafuq.png"" /></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>Which<i>&nbsp;genital infection</i>&nbsp;is characterized by a&nbsp;<b>single painless ulcer</b>&nbsp;(chancre) often with&nbsp;<u>painless</u>&nbsp;bilateral lymphadenopathy?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which<i>&nbsp;genital infection</i>&nbsp;is characterized by a&nbsp;<b>single painless ulcer</b>&nbsp;(chancre) often with&nbsp;<u>painless</u>&nbsp;bilateral lymphadenopathy?&nbsp;<div><br /></div><div><span class=cloze><i>Treponema pallidum</i>&nbsp;(primary syphilis)</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><i><div></div></i><i>single papule turns into painless, nonexudative ulcer (syphilis is all painless - nodes and lesion)</i></div><div><i><br /></i></div><div><img src=""way better chart dafuq.png"" /></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>suspected ectopic + hcg &lt; 1500 + (-) TVUS = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>suspected ectopic + hcg &lt; 1500 + (-) TVUS = <span class=cloze>repeat hCG in 2 days</span></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><i><div></div></i><i>in a&nbsp;<u>viable</u>&nbsp;pregnancy, beta-hCG levels should&nbsp;<b>double every 2 days</b>&nbsp;(ectopic and non-viable pregnancies are associated with a slower rise);<b> <font color=""#ff0000"">once beta-hCG is &gt; 1500 IU/L, a TVUS should be repeated</font></b></i></div><div><i><br /><div></div></i><i><img src=""fakk.png"" /></i></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>T/F: The majority of<b>&nbsp;placenta previas</b>&nbsp;resolve&nbsp;<u>spontaneously</u><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>T/F: The majority of<b>&nbsp;placenta previas</b>&nbsp;resolve&nbsp;<u>spontaneously</u><div><br /></div><div><span class=cloze>T</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><i><div></div><div></div></i><i>therefore continue with routine care and do an<b>&nbsp;u/s in third trimester</b>&nbsp;to check for resolution.</i></div><div><i><br /></i></div><div><i><img src=""paste-2356730159693827.jpg"" /></i></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>no history of preterm labor + <b>short</b> cervix ( &lt; 2.5 cm) = <span class=cloze>[treatment]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>no history of preterm labor + <b>short</b> cervix ( &lt; 2.5 cm) = <span class=cloze>vaginal progesterone</span></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><div><i>- isolated&nbsp;<b>short</b>&nbsp;cervix =&nbsp;<b>local</b>&nbsp;progesterone (vs. <b>systemic</b> progesterone for history of preterm + short cervix) - less for incidental finding, systemic for history of preterm.&nbsp;</i></div><div><i><br /></i></div><div></div></div><div><i><div></div><div></div><img src=""preterm.png"" /></i></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a pregnant woman at 35 weeks gestation that presents with&nbsp;<b>abdominal pain</b>,<b>&nbsp;<u>painful</u>&nbsp;vaginal</b>&nbsp;<b>bleeding</b>&nbsp;and a&nbsp;<b><u>firm</u></b>,&nbsp;<b>tender</b>&nbsp;<b>uterus</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a pregnant woman at 35 weeks gestation that presents with&nbsp;<b>abdominal pain</b>,<b>&nbsp;<u>painful</u>&nbsp;vaginal</b>&nbsp;<b>bleeding</b>&nbsp;and a&nbsp;<b><u>firm</u></b>,&nbsp;<b>tender</b>&nbsp;<b>uterus</b>?<div><br /></div><div><span class=cloze>Abruptio placentae (placental abruption)</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><i><div></div><div></div></i><i>also may have&nbsp;<u><b>high</b></u>-frequency, low-intensity uterine contractions (abrupt and strong); bleeding may be concealed; compare with&nbsp;<b>uterine rupture</b>&nbsp;with&nbsp;<b><u>loss</u>&nbsp;of contraction and loss of fetal station.&nbsp;</b></i></div><div><i><br /></i></div><img src=""chart.png"" /><div><img src=""placental abrupt.png"" /></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>age &lt; 45 w/ abnormal uterine bleeding + <u>failed</u> OCPs = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>age &lt; 45 w/ abnormal uterine bleeding + <u>failed</u> OCPs = <span class=cloze>endometrial biopsy</span></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><i>risk of endometrial cancer with unopposed estrogen.</i></div><div><i><br /></i></div><div><i><div></div><div></div><img src=""didnt see that heh.png"" /></i></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card><b>Uterine <span class=cloze>[...]</span></b>&nbsp;is a form of&nbsp;<u>pelvic organ prolapse</u>&nbsp;in which the&nbsp;<b>entire uterus herniates</b>&nbsp;through the vagina.&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Uterine <span class=cloze>procidentia</span></b>&nbsp;is a form of&nbsp;<u>pelvic organ prolapse</u>&nbsp;in which the&nbsp;<b>entire uterus herniates</b>&nbsp;through the vagina.&nbsp;</div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><div><i>treat with&nbsp;<font color=""#ff0000""><b>pessaries&nbsp;or&nbsp;surgery</b></font>&nbsp;(pelvic floor exercises are used for <u>mild</u>&nbsp;cases - this is too much)</i></div><div><i><br /></i></div><i><img src=""sigh.png"" /></i></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>What kind of <b>contraceptive</b> has these mechanisms?<br /><div><br /></div><div>1. <b>Thickens</b> cervical mucus →&nbsp;<span class=""clozed c1"">impairs&nbsp;</span><u>sperm penetration</u></div><div>2. Endometrial <b>thinning</b> → impairs <u>implantation</u></div><div><u><br /></u></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What kind of <b>contraceptive</b> has these mechanisms?<br /><div><br /></div><div>1. <b>Thickens</b> cervical mucus →&nbsp;<span class=""clozed c1"">impairs&nbsp;</span><u>sperm penetration</u></div><div>2. Endometrial <b>thinning</b> → impairs <u>implantation</u></div><div><u><br /></u></div><div><span class=cloze>Locally acting progestins</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><div><i><div></div></i><i>- e.g., mini-pill, levonorgestrel IUD (mini/local)</i></div><div><i><br /></i></div><div><i><img src=""fsdjgj.png"" /></i></div><img src=""paste-13000866004993_1529603012320.jpg"" /></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card><b>Gestational diabetes</b>&nbsp;is a result of pancreatic beta-cell&nbsp;<u>hyperplasia</u>&nbsp;and&nbsp;<u>increased</u>&nbsp;<span class=cloze>[...]</span> secondary to&nbsp;<i>elevated</i>&nbsp;levels of&nbsp;<b>human placental lactogen</b>&nbsp;during the <b><u>third</u></b> trimester of pregnancy&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Gestational diabetes</b>&nbsp;is a result of pancreatic beta-cell&nbsp;<u>hyperplasia</u>&nbsp;and&nbsp;<u>increased</u>&nbsp;<span class=cloze>insulin resistance</span> secondary to&nbsp;<i>elevated</i>&nbsp;levels of&nbsp;<b>human placental lactogen</b>&nbsp;during the <b><u>third</u></b> trimester of pregnancy&nbsp;</div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><div><i><div></div></i><i>hPL (a type of&nbsp;<u>placental</u>&nbsp;somatomammotropin) production ceases after delivery resulting in resolution of GDM</i></div></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card><b>Gestational diabetes</b>&nbsp;is a result of pancreatic beta-cell&nbsp;<u>hyperplasia</u>&nbsp;and&nbsp;<u>increased</u>&nbsp;insulin resistance secondary to&nbsp;<i>elevated</i>&nbsp;levels of&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;during the <b><u>third</u></b> trimester of pregnancy&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Gestational diabetes</b>&nbsp;is a result of pancreatic beta-cell&nbsp;<u>hyperplasia</u>&nbsp;and&nbsp;<u>increased</u>&nbsp;insulin resistance secondary to&nbsp;<i>elevated</i>&nbsp;levels of&nbsp;<b><span class=cloze>human placental lactogen</span></b>&nbsp;during the <b><u>third</u></b> trimester of pregnancy&nbsp;</div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><div><i><div></div></i><i>hPL (a type of&nbsp;<u>placental</u>&nbsp;somatomammotropin) production ceases after delivery resulting in resolution of GDM</i></div></div></div></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>best screening test</i>&nbsp;for&nbsp;<b>gestational diabetes mellitus</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>best screening test</i>&nbsp;for&nbsp;<b>gestational diabetes mellitus</b>?&nbsp;<div><br /></div><div><span class=cloze>50g 1-hour glucose challenge</span></div></div><br><br> <div class=extra><div><div><i><b><u><div></div></u></b></i></div><i><b><u><div></div></u></b></i><div><div><div><i><div style=""text-decoration: underline; font-weight: bold; ""></div><div><div></div></div></i></div></div></div></div><div><i><div></div></i></div><div><div><b><i><div></div></i></b><div><i><b><div></div></b></i></div><div><i><div><div><div></div></div></div></i></div></div></div><div><div><div><div><i></i><i>if &gt;&nbsp;<b>140</b>, follow with<b>&nbsp;100g, 3-hour</b>&nbsp;glucose tolerance test; do after<b>&nbsp;24 weeks&nbsp;<u>except</u>&nbsp;if have risk factors (prior diabetes, obese) - can do at first visit.</b></i></div><div><i><span style=""font-style: normal;""></span></i><i><b><br /></b></i></div><div><i><div></div><span style=""font-style: normal;""><img src=""paste-88935887798275_1496784870471.jpg"" /></span><img src=""paste-41339060224003.jpg"" /></i></div></div></div></div><div><i><br /></i></div><div><i><br /></i></div><div></div><div style=""font-weight: bold; ""><i></i></div></div> <div class=tags></div>"
"<div class=card>The most significant&nbsp;<u>risk factors</u>&nbsp;for&nbsp;<b><u>vaginal</u>&nbsp;squamous cell carcinoma</b>&nbsp;are <span class=cloze>[...]</span> and <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The most significant&nbsp;<u>risk factors</u>&nbsp;for&nbsp;<b><u>vaginal</u>&nbsp;squamous cell carcinoma</b>&nbsp;are <span class=cloze>smoking</span> and <span class=cloze>HPV infection</span></div><br><br> <div class=extra><i>- smoking decreases immune response → can't clear HPV</i><div><i>- similar to the risk factors for&nbsp;<b>cervical cancer</b></i><div><b><i><br /></i></b><div><i><img src=""im afraid to pick anything!.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[...]</span>&nbsp;is a blood pressure&nbsp;<b><u>&gt;</u>&nbsp;140/90 mmHg</b>&nbsp;<i>before</i>&nbsp;the&nbsp;20th week of gestation</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze><b>Chronic</b><b>&nbsp;hypertension</b></span>&nbsp;is a blood pressure&nbsp;<b><u>&gt;</u>&nbsp;140/90 mmHg</b>&nbsp;<i>before</i>&nbsp;the&nbsp;20th week of gestation</div><br><br> <div class=extra><i></i><i>elevated blood pressure must be seen on&nbsp;<u>2 separate measurements</u>&nbsp;taken&nbsp;<b>at least 4 hours apart</b>&nbsp;</i><div><i><img src=""i found chart!.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>What are the&nbsp;<u>exceptions</u>&nbsp;to universal screening of&nbsp;<b>GBS</b>?<div><br /></div><div>1. <span class=cloze>[...]</span><br />2.&nbsp;<span class=cloze>[...]</span></div><div><br /></div><div>Why:&nbsp;<span class=cloze>[...]</span>.</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What are the&nbsp;<u>exceptions</u>&nbsp;to universal screening of&nbsp;<b>GBS</b>?<div><br /></div><div>1. <span class=cloze>History of&nbsp;<b>GBS bacteriuria</b>&nbsp;at any point during&nbsp;<u>current</u>&nbsp;pregnancy</span><br />2.&nbsp;<span class=cloze>Invasive early-onset GBS disease in a&nbsp;<u>prior</u>&nbsp;child</span></div><div><br /></div><div>Why:&nbsp;<span class=cloze>These patients are <b>empirically</b> treated</span>.</div></div><br><br> <div class=extra><div><div><br /></div></div><div><img src=""paste-25817048416259.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b>Intrapartum penicillin</b>&nbsp;should be administered to those with&nbsp;<u>unknown GBS status</u>&nbsp;if they are&nbsp;<b>&lt; 37 weeks gestation</b>, have&nbsp;<b>intrapartum</b>&nbsp;<b>fever</b>, or have&nbsp;<b>ROM for&nbsp;<u>&gt;</u>&nbsp;<span class=cloze>[...]</span> hours</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Intrapartum penicillin</b>&nbsp;should be administered to those with&nbsp;<u>unknown GBS status</u>&nbsp;if they are&nbsp;<b>&lt; 37 weeks gestation</b>, have&nbsp;<b>intrapartum</b>&nbsp;<b>fever</b>, or have&nbsp;<b>ROM for&nbsp;<u>&gt;</u>&nbsp;<span class=cloze>18</span> hours</b>&nbsp;</div><br><br> <div class=extra><div><div><img src=""gbs (1).png"" /></div></div></div> <div class=tags></div>"
"<div class=card><b>Intrapartum penicillin</b>&nbsp;should be administered to those with&nbsp;<u>unknown GBS status</u>&nbsp;if they are&nbsp;<b>&lt; <span class=cloze>[...]</span> weeks gestation</b>, have&nbsp;<b>intrapartum</b>&nbsp;<b>fever</b>, or have&nbsp;<b>ROM for&nbsp;<u>&gt;</u>&nbsp;18 hours</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Intrapartum penicillin</b>&nbsp;should be administered to those with&nbsp;<u>unknown GBS status</u>&nbsp;if they are&nbsp;<b>&lt; <span class=cloze>37</span> weeks gestation</b>, have&nbsp;<b>intrapartum</b>&nbsp;<b>fever</b>, or have&nbsp;<b>ROM for&nbsp;<u>&gt;</u>&nbsp;18 hours</b>&nbsp;</div><br><br> <div class=extra><div><div><img src=""gbs (1).png"" /></div></div></div> <div class=tags></div>"
"<div class=card>Maternal sensitization to a fetus'&nbsp;<font color=""#ff0000"">Rh⁺&nbsp;blood</font>&nbsp;may be reduced using <span class=cloze>[treatment]</span>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Maternal sensitization to a fetus'&nbsp;<font color=""#ff0000"">Rh⁺&nbsp;blood</font>&nbsp;may be reduced using <span class=cloze>Rh-immune globulin (Rhogam)</span>.</div><br><br> <div class=extra><div><div><div><i>prevents&nbsp;<b>maternal&nbsp;antibody production</b></i></div><div><i>give at&nbsp;<b>28</b>&nbsp;<b>weeks</b>&nbsp;<u>and&nbsp;</u><b>within 72</b>&nbsp;<b>hours</b>&nbsp;of delivery (each dose lasts 12 weeks)</i></div><div><i>also give any time <b>blood mixes</b></i></div><div><br /></div><div><img src=""okaaaay....png"" /></div></div></div></div> <div class=tags></div>"
"<div class=card><b>Mullerian agenesis</b>&nbsp;are associated with <span class=cloze>[organ]</span> anomalies</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Mullerian agenesis</b>&nbsp;are associated with <span class=cloze>renal</span> anomalies</div><br><br> <div class=extra><div><div><div><i>due to their common embryological source and synchronous development (mesonephric duct produces <b>kidneys</b>)&nbsp;</i></div><div><i><div style=""display: inline !important; ""></div></i><i><img src=""paste-331747568910337.jpg"" /></i><i><img src=""chart (1).png"" /></i><i><img src=""paste-2886789253562369.jpg"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a&nbsp;<u>postmenopausal</u>&nbsp;woman with an incidentally discovered&nbsp;<b>ovarian</b>&nbsp;<b>cyst</b>&nbsp;on ultrasound?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a&nbsp;<u>postmenopausal</u>&nbsp;woman with an incidentally discovered&nbsp;<b>ovarian</b>&nbsp;<b>cyst</b>&nbsp;on ultrasound?<div><br /></div><div><span class=cloze>Measure CA-125 levels</span></div></div><br><br> <div class=extra><div><div><div><i></i><i>an elevated CA-125 level in a&nbsp;<u>postmenopausal</u>&nbsp;patient is suspicious for malignancy, even if the ultrasound findings seem benign - t</i><i>he other conditions that cause elevated CA-125 are&nbsp;<b>pre</b>-menopausal conditions (endometriosis, fibroids)</i><div><i><br /></i><div><i><img src=""epithel ovarian carc.png"" /></i></div></div></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a pregnant woman that presents with&nbsp;<b>intense generalized pruritus</b>, especially at&nbsp;<u>night</u>, and&nbsp;<b>elevated</b>&nbsp;<b>aminotransferases</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a pregnant woman that presents with&nbsp;<b>intense generalized pruritus</b>, especially at&nbsp;<u>night</u>, and&nbsp;<b>elevated</b>&nbsp;<b>aminotransferases</b>?<div><br /></div><div><span class=cloze>Intrahepatic cholestasis of pregnancy</span></div></div><br><br> <div class=extra><div><div><div><i></i><i>2/2 estrogen/progesterone causing bile tract stasis; <b><u>treat with ursodeoxycholic acid and deliver at 37 weeks.</u></b></i><div><i><br /></i></div><div><i><img src=""paste-2678045253042179.jpg"" /><br /></i></div><div><div><i><br /></i></div><div><i><img src=""heh.png"" /></i></div></div></div></div></div></div> <div class=tags></div>"
"<div class=card><b>painless</b> <u>second</u>-trimester <b>cervical</b> <b>dilation</b> in the absence of labor = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>painless</b> <u>second</u>-trimester <b>cervical</b> <b>dilation</b> in the absence of labor = <span class=cloze>cervical insufficiency</span></div><br><br> <div class=extra><div><div><div><i>- may or may not have light spotting.</i></div><div><i>- anything that damages the cervix will predispose to this; monitor cervical length.</i></div></div></div><div><i><br /></i></div><div><i><img src=""paste-2684380329803779.jpg"" /></i></div><div><i><br /></i></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card><div>age &gt; 25 with CIN3 on coloposcopy =&nbsp;<span class=cloze>[next step]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>age &gt; 25 with CIN3 on coloposcopy =&nbsp;<span class=cloze>Ablate&nbsp;(conization, LEEP)</span></div></div><br><br> <div class=extra><div><div><div><i><b>HSIL</b> on pap → <b>CIN3 </b>on colp → remove → f/o with <b>Pap/HPV </b>in 1-2 years.&nbsp;<br /><div></div></i><i><br /></i><div><i><img src=""CIN3.png"" /><img src=""paste-2691814918193153.jpg"" /><br /></i><div><i><img src=""cone bx (1).png"" /></i></div><div><i><img src=""leeep.png"" /></i></div></div></div></div></div></div> <div class=tags></div>"
"<div class=card>What complication of&nbsp;<u>shoulder dystocia</u>&nbsp;manifests as a ""<b><u>claw</u></b>&nbsp;<b>hand</b>"", an&nbsp;<b>impaired</b>&nbsp;<b><u>grasp</u></b>&nbsp;<b>reflex</b>, and&nbsp;<b><u>Horner</u></b>&nbsp;<b>syndrome</b>&nbsp;in a newborn?<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""paste-472961798635521.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What complication of&nbsp;<u>shoulder dystocia</u>&nbsp;manifests as a ""<b><u>claw</u></b>&nbsp;<b>hand</b>"", an&nbsp;<b>impaired</b>&nbsp;<b><u>grasp</u></b>&nbsp;<b>reflex</b>, and&nbsp;<b><u>Horner</u></b>&nbsp;<b>syndrome</b>&nbsp;in a newborn?<div><br /></div><div><span class=cloze>Klumpke palsy (due to lower trunk injury involving C8 and T1)</span></div><div><br /></div><div><img src=""paste-472961798635521.jpg"" /></div></div><br><br> <div class=extra><div><div><div><i></i><i>- <b>K</b>lumpke <b>K</b>law; Grasp the Horn with the Klaw.</i></div><div><i></i><i>- Horner syndrome 2/2 damage to SNS fibers (miosis + ptosis)</i></div><div><i></i><i>- compare with decreased Moro / biceps reflex for Erb's (C5/C6)</i></div><div><i></i><i><br /></i></div><div><i><b><img src=""brachial plexus injury.png"" /></b><div style=""font-weight: bold; ""></div></i><i><img src=""big chart.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>In a&nbsp;<u>pregnant patient</u>, ultrasound findings of&nbsp;<b>intraplacental villous lakes</b>&nbsp;is suggestive of what?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>In a&nbsp;<u>pregnant patient</u>, ultrasound findings of&nbsp;<b>intraplacental villous lakes</b>&nbsp;is suggestive of what?<div><br /></div><div><span class=cloze>Placenta accreta</span></div></div><br><br> <div class=extra><div><div><div><i><div><div><img src=""paste-3787877687230465.jpg"" /></div></div><div><br /></div><img src=""paste-54945516617731.jpg"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>placenta accreta = <span class=cloze>[delivery method]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>placenta accreta = <span class=cloze>c-section</span></div><br><br> <div class=extra><div><div><div><i><div><div>abnormal&nbsp;attachment&nbsp;of the placenta to the&nbsp;<u>myometrium</u>,&nbsp;without&nbsp;penetrating it; causes bleeding due to inability for placenta to detach from uterus.&nbsp;</div></div><div><br /></div><div><div></div></div></i><i>A-I-P (ABC order)</i></div><div><i>Accreta, Increta, Percreta</i></div></div><img src=""paste-54945516617731.jpg"" /></div></div> <div class=tags></div>"
"<div class=card><b>elevated</b>&nbsp;DHEAS and normal testosterone = <span class=cloze>[ovarian/adrenal]</span> tumor<div><br /></div><div>normal DHEAS and&nbsp;<b>elevated</b>&nbsp;testosterone = <span class=cloze>[ovarian/adrenal]</span> tumor</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>elevated</b>&nbsp;DHEAS and normal testosterone = <span class=cloze>adrenal</span> tumor<div><br /></div><div>normal DHEAS and&nbsp;<b>elevated</b>&nbsp;testosterone = <span class=cloze>ovarian</span> tumor</div></div><br><br> <div class=extra><div><div><div><i><div><div></div></div></i><i>both cause&nbsp;<b>rapid</b>-onset virilization (&lt; 1 year)&nbsp;</i><div><i>contrast with PCOS which doesn't cause virilization</i></div></div></div><div><i><br /></i></div><div><i><img src=""paste-3196688323837953.jpg"" /></i></div><div><i><br /></i></div><div><i><img src=""hirsutism.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>Twin pregnancies&nbsp;</b>increase the risk for&nbsp;<u>spontaneous</u>&nbsp;<span class=cloze>[...]</span> labor because of uterine&nbsp;<u>crowding</u>&nbsp;and&nbsp;<u>overdistension</u>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Twin pregnancies&nbsp;</b>increase the risk for&nbsp;<u>spontaneous</u>&nbsp;<span class=cloze>preterm</span> labor because of uterine&nbsp;<u>crowding</u>&nbsp;and&nbsp;<u>overdistension</u>.</div><br><br> <div class=extra><div><div><div><i><div><div></div></div></i><i>- overdistension --&gt; stretch --&gt; increased&nbsp;<b>prostaglandins and oxytocin receptors&nbsp;</b>--&gt; increased contractility.&nbsp;</i><div><i>- also&nbsp;<u>medically required</u>&nbsp;for maternal (preeclampsia) and fetal (growth restriction) abnormalities.&nbsp;</i></div><div><i><br /></i></div><div><i><img src=""paste-2822656801898499.jpg"" /></i></div></div></div></div></div> <div class=tags></div>"
"<div class=card>Newborn is withered, meconium stained, long-nailed, fragile, and has small associated placenta.&nbsp;<div><br /></div><div>1) Likely dx?&nbsp;</div><div>2) What is the greatest risk factor for this?<div><br /></div><div><br /></div><div><span class=cloze>[...]</span><br /></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>Newborn is withered, meconium stained, long-nailed, fragile, and has small associated placenta.&nbsp;<div><br /></div><div>1) Likely dx?&nbsp;</div><div>2) What is the greatest risk factor for this?<div><br /></div><div><br /></div><div><span class=cloze>1) Fetal dysmaturity<div>2) Post-term birth</div></span><br /></div></div></div><br><br> <div class=extra><div><div><div><i><div><div></div></div></i><i>due to age-related placental changes and resultant uteroplacental insufficiency.&nbsp;</i></div></div></div></div> <div class=tags></div>
"<div class=card>An&nbsp;<u>abnormal</u>&nbsp;<b>biophysical profile score</b>&nbsp;(0 - 4) is consistent with <span class=cloze>[...]</span> due to&nbsp;<b>placental insufficiency.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>An&nbsp;<u>abnormal</u>&nbsp;<b>biophysical profile score</b>&nbsp;(0 - 4) is consistent with <span class=cloze>fetal hypoxia</span> due to&nbsp;<b>placental insufficiency.</b></div><br><br> <div class=extra><div><div><div><div style=""font-style: italic; ""><div></div></div><i>- e.g., due to late-term pregnancies</i></div><div><i>- normal is 8-10</i></div></div></div><div><i><br /></i></div><div><i><div><b></b></div></i><i><img src=""paste-1688360233992193.jpg"" /></i></div><div><b><i><br /></i></b></div><div><b><i><img src=""paste-1688501967912961.jpg"" /></i></b></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>recommended management</i>&nbsp;for patients with&nbsp;<u>PPROM</u>&nbsp;at&nbsp;<b>&lt; 34 weeks</b>&nbsp;<b>gestation</b>&nbsp;and&nbsp;<u>signs of infection/fetal compromise</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>recommended management</i>&nbsp;for patients with&nbsp;<u>PPROM</u>&nbsp;at&nbsp;<b>&lt; 34 weeks</b>&nbsp;<b>gestation</b>&nbsp;and&nbsp;<u>signs of infection/fetal compromise</u>?<div><br /></div><div><span class=cloze>corticosteroids, antibiotics,&nbsp;<b>delivery</b>&nbsp;+/- magnesium</span></div></div><br><br> <div class=extra><div><div><div><i><div></div></i><i>- tachycardia/fever/maternal leukocytosis/purulent amniotic fluid → indiciative of&nbsp;<b>chorioamnionitis</b>&nbsp;(fever, fetal tachy) →&nbsp;<font color=""#ff0000""><b>delivery&nbsp;regardless of age.</b></font></i></div><div><i><b>-</b>&nbsp;<b>antibiotics</b>&nbsp;delay labor and prevent infection</i></div></div><div><div style=""font-style: italic; ""><div></div></div><i><img src=""gonna be a long day.png"" /></i></div></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card><b>empty gestational sac</b> <u>without</u> a fetal pole with <b>decreasing</b> hCG levels at &lt; 20 weeks = <span class=cloze>[diagnosis]</span><div><br /></div><div><img src=""Blighted-Ovum-2.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>empty gestational sac</b> <u>without</u> a fetal pole with <b>decreasing</b> hCG levels at &lt; 20 weeks = <span class=cloze>missed abortion</span><div><br /></div><div><img src=""Blighted-Ovum-2.jpg"" /></div></div><br><br> <div class=extra><div><div><div><i>closed cervix, no heartbeat, loss of pregnancy symptoms</i></div><div><i><div></div><img src=""paste-21281562951681.jpg"" /><img src=""types of miscarriage.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a postpartum patient on post-operative day 5 with a&nbsp;<b>fever</b>&nbsp;that is&nbsp;<u>unreponsive</u>&nbsp;to broad-spectrum antibiotic therapy with a&nbsp;<u>negative</u>&nbsp;infectious workup (blood/urine cultures, urinalysis)?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a postpartum patient on post-operative day 5 with a&nbsp;<b>fever</b>&nbsp;that is&nbsp;<u>unreponsive</u>&nbsp;to broad-spectrum antibiotic therapy with a&nbsp;<u>negative</u>&nbsp;infectious workup (blood/urine cultures, urinalysis)?&nbsp;<div><br /></div><div><span class=cloze>Septic pelvic thrombophlebitis</span></div></div><br><br> <div class=extra><div><div><div><i></i><i>due to an infected <u>thrombosis</u> of the <b>deep pelvic or ovarian veins</b>; treat with <b>anticoagulation and broad-spectrum antibiotics.</b></i><div><i><br /></i><div><i><img src=""spt.png"" /></i></div></div></div></div></div></div> <div class=tags></div>"
"<div class=card><div>twin-twin transfusion syndrome = mono<span class=cloze>[...]</span></div><div>umbilical cord entanglement = mono<span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>twin-twin transfusion syndrome = mono<span class=cloze>chorionic</span></div><div>umbilical cord entanglement = mono<span class=cloze>amniotic</span></div></div><br><br> <div class=extra><div><div><div><i><div></div></i><i><b>same chorion (placenta) → </b>unbalanced AV anastomses - think about one blood source that is shared.</i></div><div><i><b>same amniotic sac → tangle </b>- think about one sac so not much space and tangle.</i></div><div><i><b><br /></b></i></div><div><b><i><img src=""paste-1033055598804993.jpg"" /><img src=""paste-1127373080625153.jpg"" /></i></b></div><div><i><b><img src=""paste-177884660498433.jpg"" /></b></i></div><div><i><b><br /></b></i></div><div><b><br /></b></div><div><i><b><br /></b></i></div><i><img src=""paste-4310867264929793.jpg"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>D</b>i-<u><span class=cloze>[...]</span></u>&nbsp;twins:&nbsp;<b>L</b>ambda sign<div><b>M</b>ono-<u><span class=cloze>[...]</span></u>&nbsp;twins:&nbsp;<b>T</b>-sign&nbsp;</div><div><br /></div><div><img src=""paste-178490250887169.jpg"" /><img src=""paste-178812373434369.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>D</b>i-<u><span class=cloze>chorionic</span></u>&nbsp;twins:&nbsp;<b>L</b>ambda sign<div><b>M</b>ono-<u><span class=cloze>chorionic</span></u>&nbsp;twins:&nbsp;<b>T</b>-sign&nbsp;</div><div><br /></div><div><img src=""paste-178490250887169.jpg"" /><img src=""paste-178812373434369.jpg"" /></div></div><br><br> <div class=extra><div><div><b><i><div></div></i></b></div><b><i><div></div></i></b><div><div><div><i><div></div></i><i><b>Chorion</b> = # placentas</i></div><div><i><b>D is closer to L&nbsp;</b>- Lambda sign where the two placentas and intertwin membranes (amnions) meet.</i></div><div><i><b>M closer to T</b>&nbsp;- T shape is the 90 degree angle between the placenta and intertwin membrane (amnions)</i></div><div><i><br /></i></div><div><i><img src=""paste-1052095188828161.jpg"" /><img src=""paste-1053400858886145.jpg"" /></i></div><div></div><div><i><span><br /></span></i></div><div><i><span style=""font-style: normal; ""><br /></span></i></div><img src=""paste-4310867264929793.jpg"" /></div></div></div></div> <div class=tags></div>"
"<div class=card>peri-<b>anal</b> ""figure of 8"" + <b>white</b> <b>plaques</b> = <span class=cloze>[lichen sclerosus or vulvovaginal atrophy]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>peri-<b>anal</b> ""figure of 8"" + <b>white</b> <b>plaques</b> = <span class=cloze>lichen sclerosus</span></div><br><br> <div class=extra><div><div><div><i>- imagine a skull and a plaque coming out of the anus</i></div><div><i>- treat with <b>high dose steroids </b>and <b>biopsy </b>to exclude malignancy (skull = bad)</i></div><div><i><br /></i></div><div><i><img src=""paste-2920156854484995.jpg"" /></i></div><div><i><div></div><img src=""LS.png"" /></i></div></div></div><div><i><br /></i></div><div><i><img src=""paste-2920143969583105.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Mammary</b>&nbsp;<b>Paget's disease</b>&nbsp;is typically associated with an&nbsp;<u>underlying</u>&nbsp;<span class=cloze>[...]</span> and therefore must be biopsed</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Mammary</b>&nbsp;<b>Paget's disease</b>&nbsp;is typically associated with an&nbsp;<u>underlying</u>&nbsp;<span class=cloze>adenocarcinoma (e.g. DCIS)</span> and therefore must be biopsed</div><br><br> <div class=extra><div><div><div><i><div></div></i><i>adenocarcinoma = cancer that starts in&nbsp;<b>glandular</b>&nbsp;tissue; migration of cancer cells&nbsp;<b>into the ducts</b>&nbsp;causes the characteristic skin changes.</i></div><div><i><img src=""more PG.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card><b>Mammary</b>&nbsp;<b>Paget's disease</b>&nbsp;is typically associated with an&nbsp;<u>underlying</u>&nbsp;adenocarcinoma (e.g. DCIS) and therefore must be <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Mammary</b>&nbsp;<b>Paget's disease</b>&nbsp;is typically associated with an&nbsp;<u>underlying</u>&nbsp;adenocarcinoma (e.g. DCIS) and therefore must be <span class=cloze>biopsed</span></div><br><br> <div class=extra><div><div><div><i><div></div></i><i>adenocarcinoma = cancer that starts in&nbsp;<b>glandular</b>&nbsp;tissue; migration of cancer cells&nbsp;<b>into the ducts</b>&nbsp;causes the characteristic skin changes.</i></div><div><i><img src=""more PG.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>What level of&nbsp;<u>proteinuria</u>&nbsp;is required to make a diagnosis of&nbsp;<b>preeclampsia</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What level of&nbsp;<u>proteinuria</u>&nbsp;is required to make a diagnosis of&nbsp;<b>preeclampsia</b>?<div><br /></div><div><span class=cloze>≥ 300 mg/day (or a protein/creatinine ratio&nbsp;<u>&gt;</u>&nbsp;0.3)</span></div></div><br><br> <div class=extra><div><div><div><i><div></div><img src=""i found chart!.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>oxytocin toxicity leading to hyponatremia can cause <span class=cloze>[neuro]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>oxytocin toxicity leading to hyponatremia can cause <span class=cloze>seizures</span></div><br><br> <div class=extra><div><div><div><i><div></div>oxytocin ~ ADH --&gt; hyponatremia;<b> treat with 3% saline.&nbsp;</b><div><br /></div><img src=""hrm.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>postmenopausal bleeding = <span class=cloze>[diagnostic test]</span> + TVUS/endometrial biopsy</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>postmenopausal bleeding = <span class=cloze>pap smear</span> + TVUS/endometrial biopsy</div><br><br> <div class=extra><div><div><div><i><div></div>test for cervical cancer and endometrial cancer (<b>&gt; 4</b> mm → biopsy)</i></div></div></div><div><i><br /></i></div><div><i><img src=""paste-2982953571319811.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>postmenopausal bleeding = pap smear + <span class=cloze>[diagnostic test]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>postmenopausal bleeding = pap smear + <span class=cloze>TVUS/endometrial biopsy</span></div><br><br> <div class=extra><div><div><div><i><div></div>test for cervical cancer and endometrial cancer (<b>&gt; 4</b> mm → biopsy)</i></div></div></div><div><i><br /></i></div><div><i><img src=""paste-2982953571319811.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b><span class=cloze>[state]</span>&nbsp;</b>can cause&nbsp;increased&nbsp;<b>aromatization</b>&nbsp;of&nbsp;<b>androgens</b>&nbsp;to&nbsp;<b>estrone&nbsp;</b>leading&nbsp;to&nbsp;<b>anovulation</b>&nbsp;and<b>&nbsp;abnormal uterine bleeding.</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b><span class=cloze>obesity</span>&nbsp;</b>can cause&nbsp;increased&nbsp;<b>aromatization</b>&nbsp;of&nbsp;<b>androgens</b>&nbsp;to&nbsp;<b>estrone&nbsp;</b>leading&nbsp;to&nbsp;<b>anovulation</b>&nbsp;and<b>&nbsp;abnormal uterine bleeding.</b></div><br><br> <div class=extra><div><div><div><i><div></div></i><i>-&nbsp;<b>recall</b>: fat cells contain aromatase</i><div><i>- obesity causes&nbsp;<b>elevated</b>&nbsp;<b>androgen</b>&nbsp;levels due to&nbsp;<b>↓ sex hormone binding globulin</b></i></div><div><i>- estrone causes (-) feedback → ↓ GnRH, LH, FSH → no LH surge → anovulation; treat with&nbsp;<b>weight loss and OCPs.&nbsp;</b></i><div><i><br /></i></div><div><i><br /></i></div><div><i><img src=""paste-1610629915869187.jpg"" /></i></div></div></div></div></div></div> <div class=tags></div>"
"<div class=card>Prior&nbsp;<b>classical</b>&nbsp;c-section<div>Prior extensive uterine&nbsp;<b>myomectomy</b></div><div>Placenta&nbsp;<b>previa</b></div><div><br /></div><div>are indications for <span class=cloze>[delivery plan]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Prior&nbsp;<b>classical</b>&nbsp;c-section<div>Prior extensive uterine&nbsp;<b>myomectomy</b></div><div>Placenta&nbsp;<b>previa</b></div><div><br /></div><div>are indications for <span class=cloze>C-section at 37 weeks</span></div></div><br><br> <div class=extra><div><div><div><i><div></div></i><i>these are all contraindications for vaginal delivery</i></div></div></div><div><i></i><i><br /></i></div><div><i></i><i><img src=""paste-139564962283523.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<u>most accurate</u>&nbsp;measurement of&nbsp;<b>gestational age</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<u>most accurate</u>&nbsp;measurement of&nbsp;<b>gestational age</b>?<div><br /></div><div><span class=cloze>First trimester ultrasound with&nbsp;<b>crown-rump length&nbsp;</b>measurement</span></div></div><br><br> <div class=extra><div><div><div><i><div></div><div></div></i><i><b>last menstrual period</b>&nbsp;may be used to estimate gestational age if the patient has&nbsp;<u>normal</u>&nbsp;28-day cycle with fertilization occuring on day 14 and a reliable LMP;&nbsp;<b>don't</b>&nbsp;change measurements based on later imaging.&nbsp;</i></div><div><i><span style=""color: rgb(255, 255, 255)""><div><br /></div><div><img src=""crl.jpg"" /><div></div></div></span></i><i><img src=""GA (1).png"" /></i></div><div><i><br /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a young woman that presents with a&nbsp;<b>soft</b>,&nbsp;<b>mobile</b>,&nbsp;<b>well-circumscribed mass</b>&nbsp;at the<b>&nbsp;<u>base of the labia majora</u>?</b><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a young woman that presents with a&nbsp;<b>soft</b>,&nbsp;<b>mobile</b>,&nbsp;<b>well-circumscribed mass</b>&nbsp;at the<b>&nbsp;<u>base of the labia majora</u>?</b><div><br /></div><div><span class=cloze>Bartholin duct cysts</span></div></div><br><br> <div class=extra><div><div><div><i><div></div><div></div></i></div><div><i></i><i><b>- 4 and 8 o'clock&nbsp;positions&nbsp;</b></i></div><div><i><b>- <u>observe</u> if asymptomatic</b></i></div><div><i><b>- <u>incision and drainage&nbsp;with word cath placement</u> if symptomatic/abscess.</b></i></div></div></div><div><i>- compare with <b>skene glands </b>found lateral to the <b>urethra.</b></i></div><div><i></i><i><br /></i></div><div><i></i><i><img src=""paste-3022604709396483.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>most likely cause</i>&nbsp;of&nbsp;<u>postpartum hemorrhage</u>&nbsp;in a patient that presents with profuse vaginal bleeding with a&nbsp;<b>soft</b>,&nbsp;<b>boggy,</b>&nbsp;<b>enlarged</b>&nbsp;<b>uterus</b>&nbsp;on pelvic examination? Ultrasound reveals a<u>&nbsp;thin</u>&nbsp;endometrial stripe.<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>What is the&nbsp;<i>most likely cause</i>&nbsp;of&nbsp;<u>postpartum hemorrhage</u>&nbsp;in a patient that presents with profuse vaginal bleeding with a&nbsp;<b>soft</b>,&nbsp;<b>boggy,</b>&nbsp;<b>enlarged</b>&nbsp;<b>uterus</b>&nbsp;on pelvic examination? Ultrasound reveals a<u>&nbsp;thin</u>&nbsp;endometrial stripe.<div><br /></div><div><span class=cloze>Uterine atony</span></div></div><br><br> <div class=extra><div><div><div><i><div></div><div></div></i></div><div><i>- next steps: <b>massage, uterotonics (oxytocin)</b></i></div><div><i></i><i>- lack of contraction --&gt; cannot compress placental blood vessels.</i><div><i>- risk factors include&nbsp;<b>prolonged</b>&nbsp;labor,&nbsp;<b>large</b>&nbsp;fetal weight &gt; 4000g,&nbsp;<b>induction</b>&nbsp;of labor, and&nbsp;<b>operative</b>&nbsp;vaginal delivery (think about uterus getting tired b/c of all this force or not needing to do anything at all)</i></div><div><i></i><i>-&nbsp;<b>thin stripe&nbsp;</b>suggests empty endometrial cavity (i.e., not retained placenta)</i></div></div></div></div></div> <div class=tags></div>
"<div class=card>contraindication to methylergonovine = <span class=cloze>[...]</span><div>contraindication to carboprost = <span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>contraindication to methylergonovine = <span class=cloze>HTN</span><div>contraindication to carboprost = <span class=cloze>asthma</span></div></div><br><br> <div class=extra><div><div><div><i><div></div><div></div></i></div><div><i>- due to vasoconstriction vs. bronchoconstriction</i></div><div><i>- both can be used after oxytocin for postpartum hemorrhage</i></div><div><i><br /></i></div><div><i><img src=""hmmmm (1).png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[...]</span> fetal growth restriction = due to<u> infections / chromosomal abnormalities</u> in the <b>1st</b> trimester.<div><span class=cloze>[...]</span> fetal growth restriction = due to <u>uteroplacental insufficiency / malnutrition</u> in the <b>2nd/3rd</b> trimesters.</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>symmetric</span> fetal growth restriction = due to<u> infections / chromosomal abnormalities</u> in the <b>1st</b> trimester.<div><span class=cloze>asymmetric</span> fetal growth restriction = due to <u>uteroplacental insufficiency / malnutrition</u> in the <b>2nd/3rd</b> trimesters.</div></div><br><br> <div class=extra><div><div><div><i><div></div><div></div></i></div><div><i><b>symmetric</b> - everything affected by infection and chromosomal issues early on</i></div><div><i><b>asymmetric</b> - normal in vital brain, shunted away from abdomen</i></div><div><i><br /></i></div><div><i><img src=""fgr.png"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>What&nbsp;<i>type(s) of fibroids</i>&nbsp;are most associated with&nbsp;<u>bulk-related symptoms</u>&nbsp;and&nbsp;<b><i>irregular</i>&nbsp;uterine enlargement</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What&nbsp;<i>type(s) of fibroids</i>&nbsp;are most associated with&nbsp;<u>bulk-related symptoms</u>&nbsp;and&nbsp;<b><i>irregular</i>&nbsp;uterine enlargement</b>?<div><br /></div><div><span class=cloze>subserosal and pedunculated<b>&nbsp;fibroids</b>&nbsp;(leiomyomata)</span></div></div><br><br> <div class=extra><div><div><div><b><i><div></div><div></div></i></b></div><div><b><i><div></div></i><i>e.g. constipation, incomplete voiding, pelvic pressure</i></b></div><div><i><br /></i></div><img src=""fibroids.png"" /></div></div></div> <div class=tags></div>"
"<div class=card>The risk of developing&nbsp;<u>breast cancer</u>&nbsp;is directly correlated with&nbsp;<i>lifetime exposure</i>&nbsp;to&nbsp;<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>The risk of developing&nbsp;<u>breast cancer</u>&nbsp;is directly correlated with&nbsp;<i>lifetime exposure</i>&nbsp;to&nbsp;<span class=cloze>estrogen</span></div><br><br> <div class=extra><div><div><div><b><i><div></div><div></div></i></b></div><div><div><i></i><i>e.g. </i>nulliparity<i>,&nbsp;early&nbsp;menarche,&nbsp;late&nbsp;menopause,&nbsp;obesity,&nbsp;HRT (<u>not</u>&nbsp;OCPs) - think about estrogen receptors on the breast (ER+)</i></div><i><div style=""font-weight: bold; ""></div></i><i><b><br /></b></i></div></div><div><b><i><div></div><img src=""dang (3).png"" /></i></b></div></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[...]</span> race and increasing <span class=cloze>[...]</span> = ↑ risk of breast cancer</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>white</span> race and increasing <span class=cloze>age</span> = ↑ risk of breast cancer</div><br><br> <div class=extra><div><div><div><b><i><div></div><div></div></i></b></div><div><div><i><br /></i></div></div></div><div><b><i><div></div><img src=""dang (3).png"" /></i></b></div></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[...]</span> consumption is a&nbsp;<u>dose-dependent</u>&nbsp;risk factor for&nbsp;<b>breast cancer</b>&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>Alcohol</span> consumption is a&nbsp;<u>dose-dependent</u>&nbsp;risk factor for&nbsp;<b>breast cancer</b>&nbsp;</div><br><br> <div class=extra><div><div><div><b><i><div></div><div></div></i></b></div><div><div><i><br /></i></div></div></div><div><b><i><div></div><img src=""dang (3).png"" /></i></b></div></div></div> <div class=tags></div>"
"<div class=card>loss of fetal station (0 to -3) = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>loss of fetal station (0 to -3) = <span class=cloze>uterine rupture</span></div><br><br> <div class=extra><div><div><div><b><i><div></div><div></div></i></b></div><div><div><i>prior C-section</i></div><div><i>palpable fetal parts</i></div><div><i>vaginal bleeding with abdominal pain.</i></div><div><i><br /></i></div><div><i><img src=""finally.png"" /><img src=""Uterine rupture.png"" /></i></div></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>recommended treatment</i>&nbsp;for patients with&nbsp;<b>septic abortion</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>recommended treatment</i>&nbsp;for patients with&nbsp;<b>septic abortion</b>?<div><br /></div><div><span class=cloze><u>broad</u>-spectrum antibiotics and <b>suction curettage</b></span></div></div><br><br> <div class=extra><div><div><div><b><i><div></div><div></div></i></b></div><div><div><i>needs&nbsp;<b>surgery (suction)</b> - not just misoprostol (for spontaneous abortion, too slow for septic abortion)&nbsp;<br /><div style=""font-weight: bold; ""></div></i><i><br /></i><div><i><img src=""help (2).png"" /></i></div></div></div></div></div></div> <div class=tags></div>"
"<div class=card><b>Preterm labor</b>&nbsp;refers to regular contractions causing cervical&nbsp;<u>dilation</u>&nbsp;and/or&nbsp;<u>effacement</u>&nbsp;at &lt; <span class=cloze>[...]</span> weeks gestation</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Preterm labor</b>&nbsp;refers to regular contractions causing cervical&nbsp;<u>dilation</u>&nbsp;and/or&nbsp;<u>effacement</u>&nbsp;at &lt; <span class=cloze>37</span> weeks gestation</div><br><br> <div class=extra><div><div><div><b><i><div></div><div></div></i></b></div><div><div><i><b>steroids</b> given always</i></div><div><i><b>PCN</b> if GBS (+) or unknown&nbsp;</i></div><div><i><b>tocolytics </b>only if<b> &lt; 34</b> weeks (risk closure of ductus arteriosus with indomethacin)</i></div><div><i><b>magnesium</b> if <b>&lt; 32</b> weeks</i></div><div><i><br /></i></div><div><i><img src=""ptl.png"" /></i></div></div></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>likely</i>&nbsp;<i>diagnosis</i>&nbsp;in an adolescent girl at&nbsp;<u>15 weeks gestation</u>&nbsp;that presents with symptoms of&nbsp;<b>preeclampsia with severe features</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>likely</i>&nbsp;<i>diagnosis</i>&nbsp;in an adolescent girl at&nbsp;<u>15 weeks gestation</u>&nbsp;that presents with symptoms of&nbsp;<b>preeclampsia with severe features</b>?<div><br /></div><div><span class=cloze>Hydatidiform molar pregnancy</span></div></div><br><br> <div class=extra><i>the presence of preeclampsia with severe features at&nbsp;<b>&lt; 20 weeks gestation</b>&nbsp;can be a complication of hydatidiform moles</i><div><i><br /></i><div><i><img src=""interestin' last question.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>next step&nbsp;</i>in diagnosis for a patient with&nbsp;<b>secondary amenorrhea</b>&nbsp;and a&nbsp;<u>negative</u>&nbsp;pregnancy test?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>next step&nbsp;</i>in diagnosis for a patient with&nbsp;<b>secondary amenorrhea</b>&nbsp;and a&nbsp;<u>negative</u>&nbsp;pregnancy test?<div><br /></div><div><span class=cloze>Measure serum prolactin, TSH, and FSH</span></div></div><br><br> <div class=extra><i></i><i>- secondary amenorrhea = &gt; 3 months (regular) or &gt; 6 months (irregular)&nbsp;</i><div><i>- assesses for the most common causes of secondary amenorrhea (hyperprolactinemia, hypothyroidism, premature ovarian failure)</i><div><i><br /></i><div><img src=""paste-3184606580834307.jpg"" /></div></div></div></div> <div class=tags></div>"
"<div class=card><b>mixed</b> urinary incontinence = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>mixed</b> urinary incontinence = <span class=cloze>voiding diary</span></div><br><br> <div class=extra><i>- ascertains the predominant type of incontinence to determine ideal treatment.&nbsp;</i><div><i>- generally all mixed patients require <b>bladder training </b>with Kegels, lifestyle changes (weight loss, smoking cessation, decreased caffeine)</i></div><div><i><img src=""Urinary incontinence differential.png"" /><img src=""paste-1268836418453507.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>first-line intervention</i>&nbsp;for a woman in the first stage of labor with&nbsp;<b><u>recurrent</u>&nbsp;variable decelerations</b>&nbsp;and&nbsp;<b>moderate</b>&nbsp;<b>variability</b>&nbsp;on fetal heart tracing?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>first-line intervention</i>&nbsp;for a woman in the first stage of labor with&nbsp;<b><u>recurrent</u>&nbsp;variable decelerations</b>&nbsp;and&nbsp;<b>moderate</b>&nbsp;<b>variability</b>&nbsp;on fetal heart tracing?&nbsp;<div><br /></div><div><span class=cloze>Maternal <b>repositioning</b> (e.g. left lateral decubitus)</span></div></div><br><br> <div class=extra><i></i><i><b>- recurrent&nbsp;</b>= &gt; 50% of contractions have variable decels.</i><div><div><i>- <b><font color=""#ff0000"">repositioning</font></b> may reduce cord compression<br /><div></div></i><i><b>- </b>if unresponsive →&nbsp;<b><font color=""#ff0000"">amnioinfusion</font> </b>(increases fluid)</i></div><div><i><br /></i></div><div><div><div><i><img src=""rec.png"" /><img src=""paste-3088094370725889.jpg"" /></i></div></div></div><div><i><br /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>Category III</b>&nbsp;fetal heart tracing = intrauterine resuscitative intervention; if refractory do <span class=cloze>[...]</span><div><br /></div><div><img src=""paste-345839356608513.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Category III</b>&nbsp;fetal heart tracing = intrauterine resuscitative intervention; if refractory do <span class=cloze>C-section</span><div><br /></div><div><img src=""paste-345839356608513.jpg"" /></div></div><br><br> <div class=extra><i></i><div><div><i><b>IRI&nbsp;</b>= oxygen, repositioning, stop uterotonics.<div style=""font-weight: bold; ""><br /></div><div style=""font-weight: bold; ""><img src=""paste-393878565814275.jpg"" /></div></i></div></div></div> <div class=tags></div>"
"<div class=card><b>Category III</b>&nbsp;fetal heart tracing = <span class=cloze>[initial step]</span>; if refractory do C-section<div><br /></div><div><img src=""paste-345839356608513.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Category III</b>&nbsp;fetal heart tracing = <span class=cloze>intrauterine resuscitative intervention</span>; if refractory do C-section<div><br /></div><div><img src=""paste-345839356608513.jpg"" /></div></div><br><br> <div class=extra><i></i><div><div><i><b>IRI&nbsp;</b>= oxygen, repositioning, stop uterotonics.<div style=""font-weight: bold; ""><br /></div><div style=""font-weight: bold; ""><img src=""paste-393878565814275.jpg"" /></div></i></div></div></div> <div class=tags></div>"
"<div class=card>What is warrated in&nbsp;<b>intra-amniotic infection</b>&nbsp;with&nbsp;<b><u>reassuring</u>&nbsp;fetal heart tones?</b><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is warrated in&nbsp;<b>intra-amniotic infection</b>&nbsp;with&nbsp;<b><u>reassuring</u>&nbsp;fetal heart tones?</b><div><br /></div><div><span class=cloze>Induction of labor</span></div></div><br><br> <div class=extra><i>simply <b>augment</b> the labor to get rid of the infection;<b>&nbsp;C-section</b>&nbsp;if<u>&nbsp;non-&nbsp;reassuring heart tones.</u></i><div><i><u><br /></u></i></div><img src=""paste-60060822667267.jpg"" /></div> <div class=tags></div>"
"<div class=card>Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b>tender</b>,&nbsp;<b>small</b>&nbsp;<b>ulcers</b>&nbsp;with an <font color=""#ff0000"">erythematous </font>base and&nbsp;<u>mild</u>&nbsp;<b>lymphadenopathy</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b>tender</b>,&nbsp;<b>small</b>&nbsp;<b>ulcers</b>&nbsp;with an <font color=""#ff0000"">erythematous </font>base and&nbsp;<u>mild</u>&nbsp;<b>lymphadenopathy</b>?&nbsp;<div><br /></div><div><span class=cloze>Herpes simplex virus</span></div></div><br><br> <div class=extra><i><div></div></i><i>may also have&nbsp;<b>painful</b>&nbsp;<b>urination</b>&nbsp;(pee flows over raw area) and&nbsp;<b>sterile</b>&nbsp;<b>pyruria</b>&nbsp;(WBCs due to inflammation with negative urine culture)</i><div><i><br /></i></div><img src=""way better chart dafuq.png"" /></div> <div class=tags></div>"
"<div class=card>Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b>small</b>,&nbsp;<b>painless</b>&nbsp;<b>ulcers</b>&nbsp;that can progress to&nbsp;<u>painful&nbsp;inguinal lymphadenopathy</u>&nbsp;(buboes)?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""8838273.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b>small</b>,&nbsp;<b>painless</b>&nbsp;<b>ulcers</b>&nbsp;that can progress to&nbsp;<u>painful&nbsp;inguinal lymphadenopathy</u>&nbsp;(buboes)?&nbsp;<div><br /></div><div><span class=cloze><i>Chlamydia trachomatis</i>&nbsp;L1-L3 (lymphogranuloma venereum)</span></div><div><br /></div><div><img src=""8838273.jpg"" /></div></div><br><br> <div class=extra><i><div></div><br /></i><div><i><br /></i></div><img src=""way better chart dafuq.png"" /></div> <div class=tags></div>"
"<div class=card>Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b><u>painful</u></b>,&nbsp;<b>deep</b>&nbsp;<b>ulcers</b>&nbsp;with a&nbsp;<u><b>gray/yellow</b></u>&nbsp;exudate and&nbsp;<u>severe</u>&nbsp;<b>lymphadenopathy with pus</b>?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""paste-2775356327067649.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which<i>&nbsp;genital infection</i>&nbsp;is characterized by&nbsp;<b><u>painful</u></b>,&nbsp;<b>deep</b>&nbsp;<b>ulcers</b>&nbsp;with a&nbsp;<u><b>gray/yellow</b></u>&nbsp;exudate and&nbsp;<u>severe</u>&nbsp;<b>lymphadenopathy with pus</b>?&nbsp;<div><br /></div><div><span class=cloze><i>Haemophilus ducreyi</i>&nbsp;(chancroid)</span></div><div><br /></div><div><img src=""paste-2775356327067649.jpg"" /></div></div><br><br> <div class=extra><i><div></div><div></div></i><i>Crying gray and yellow tears</i><div><i>So painful you do cry</i></div><div><i><br /></i></div><img src=""way better chart dafuq.png"" /></div> <div class=tags></div>"
"<div class=card>primary hypothyroidism = <span class=cloze>[...]</span> prolactin</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>primary hypothyroidism = <span class=cloze>↑</span> prolactin</div><br><br> <div class=extra><i><div></div><div></div><div>low T3/T4 = lost negative feedback→ high TRH → high prolactin.</div><div><br /></div><img src=""fc35947284ecc475e8bd31b5c868ff1acd86dd33_tmpmklrs9.png"" /><img src=""paste-3273654137782275.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>alcohol + smoking = <span class=cloze>[...]</span> risk of osteoporosis</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>alcohol + smoking = <span class=cloze>↑</span> risk of osteoporosis</div><br><br> <div class=extra><i><div></div><div></div><div></div></i><i>↑ bone loss</i><div><br /></div><div><img src=""ok mate.png"" /></div></div> <div class=tags></div>"
"<div class=card>Following suction curettage for a&nbsp;<u>hydatidiform mole</u>, <b>beta-hCG</b>&nbsp;<b>levels</b>&nbsp;are measured&nbsp;<i>weekly</i>&nbsp;until undetectable and then&nbsp;<i>monthly</i>&nbsp;for&nbsp;<b><span class=cloze>[...]</span></b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Following suction curettage for a&nbsp;<u>hydatidiform mole</u>, <b>beta-hCG</b>&nbsp;<b>levels</b>&nbsp;are measured&nbsp;<i>weekly</i>&nbsp;until undetectable and then&nbsp;<i>monthly</i>&nbsp;for&nbsp;<b><span class=cloze>6 months</span></b></div><br><br> <div class=extra><div style=""font-style: italic; ""></div><div style=""font-style: italic; ""></div><div style=""font-style: italic; ""></div><div><i>to ensure there's no gestational trophoblastic neoplasia (choriocarcinoma)</i></div><div><i><b>give contraception during 6 months </b>(to make sure it's not pregnancy causing increased hCG)</i></div><i><img src=""mollemole.png"" /></i></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>recommended treatment</i>&nbsp;for a patient with&nbsp;<b>ovarian torsion</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>recommended treatment</i>&nbsp;for a patient with&nbsp;<b>ovarian torsion</b>?<div><br /></div><div><span class=cloze>Urgent surgical detorsion and ovarian cystectomy</span></div></div><br><br> <div class=extra><i><div></div><div></div><div></div><div>ovarian cystectomy is a surgery to remove a cyst/tumor from ovary.</div><div><br /></div><div><img src=""paste-911267506159617.jpg"" /></div><div><br /></div><img src=""gonna be a rough one.png"" /></i></div> <div class=tags></div>"
"<div class=card><div>Fetal <span class=cloze>[...]</span> contributes to <b>cephalopelvic disproportion</b>, the most common cause of<b> second stage arrest of labor.&nbsp;</b></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>Fetal <span class=cloze><u>malposition</u> (e.g., occiput transverse)</span> contributes to <b>cephalopelvic disproportion</b>, the most common cause of<b> second stage arrest of labor.&nbsp;</b></div></div><br><br> <div class=extra><i><div></div><div></div><div></div><div></div></i><i>- position is relation of fetal presenting part to maternal pelvis; the optimal fetal position is&nbsp;<b>occiput anterior</b>&nbsp;</i><div><i>- other causes include maternal <b>obesity</b>, inadequate contractions (&lt; 200)<br /></i><div><i><img src=""paste-1068789726707713.jpg"" /></i><br /><div><i><img src=""Screenshot 2018-02-28_13-58-20.png"" /><img src=""darn (2).png"" /></i></div></div></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card>Contractions generating &gt;<span class=cloze>[...]</span>&nbsp;Montevideo units (MVUs) in a 10-minute interval are considered&nbsp;<b>adequate</b>.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Contractions generating &gt;<span class=cloze>200</span>&nbsp;Montevideo units (MVUs) in a 10-minute interval are considered&nbsp;<b>adequate</b>.</div><br><br> <div class=extra><i><div></div><div></div><div></div><div></div></i><div><i><div><div></div></div></i><i>MVU = # uterine contractions in 10 minutes x contraction strength.</i></div><div><i><img src=""mvu.png"" /></i></div><div><i><br /></i></div><i><img src=""paste-135261405052931.jpg"" /></i></div> <div class=tags></div>"
"<div class=card>digital cervical exam shows a taut, bulging bag <u>without</u> palpable fetal presenting parts = <span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>digital cervical exam shows a taut, bulging bag <u>without</u> palpable fetal presenting parts = <span class=cloze>transabdominal u/s</span></div><br><br> <div class=extra><i><div></div><div></div><div></div><div></div></i><div><div style=""font-style: italic; ""><div></div></div><i>- can't feel fetal parts → ambiguous fetal presentation</i></div><div><i>- need to get u/s to determine the fetal presentation to determine route of delivery (<b>cephalic</b> → vaginal, <b>breech/transverse</b> → C-section)</i></div><div><i><br /></i></div><div><i><br /></i></div><div><i><br /></i></div><div><i><img src=""paste-3334724277764099.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<u>diagnosis</u>&nbsp;in this patient with&nbsp;<b>vulvar itchiness, intermittent&nbsp;</b><font color=""#ff0000"" style=""font-weight: bold; "">bleeding</font><b>, and a&nbsp;</b><u style=""font-weight: bold; "">unifocal, fr</u><b><u>iable&nbsp;mass</u></b> on the<b> labia majora?</b><div><div><br /></div><div><span class=cloze>[...]</span><br /><div><br /></div><div><img src=""paste-237180978987009.jpg"" /></div></div></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<u>diagnosis</u>&nbsp;in this patient with&nbsp;<b>vulvar itchiness, intermittent&nbsp;</b><font color=""#ff0000"" style=""font-weight: bold; "">bleeding</font><b>, and a&nbsp;</b><u style=""font-weight: bold; "">unifocal, fr</u><b><u>iable&nbsp;mass</u></b> on the<b> labia majora?</b><div><div><br /></div><div><span class=cloze>Vulvar cancer</span><br /><div><br /></div><div><img src=""paste-237180978987009.jpg"" /></div></div></div></div><br><br> <div class=extra><i><div></div><div></div><div></div><div></div></i><div><i>tobacco use / immunodeficiency → less likely to clear HPV → ↑ risk&nbsp;</i></div><div><div style=""font-style: italic; ""><div></div></div><i>diagnose with <b>biopsy&nbsp;</b></i></div><div><i><b><br /></b></i></div><div><i><b><img src=""paste-3355610703724547.jpg"" /></b></i></div><div><i><b><br /></b></i></div><div><i><img src=""paste-2735215562719233.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>HSIL on pap + pregnancy =&nbsp;<span class=cloze>[next step]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>HSIL on pap + pregnancy =&nbsp;<span class=cloze>Immediate&nbsp;<b><font color=""#ff0000"">colposcopy</font></b>&nbsp;+/- biopsy (<u>safe</u>&nbsp;during pregnancy)</span></div><br><br> <div class=extra><i><div></div><div></div><div></div><div></div></i><div><i></i><i>- colposcopy helps&nbsp;<b>visualize</b>&nbsp;possible neoplastic changes (e.g., CIN2, CIN3)</i></div><div><i></i><i>-&nbsp;<b>don't do more invasive things (LEEP/curettage) unless it's INVASIVE</b> - risk of preterm delivery.</i></div><div><i><div style=""display: inline !important; ""><div style=""display: inline !important; ""><br /></div></div></i></div><div><i><div style=""display: inline !important; ""><div style=""display: inline !important; ""><img src=""paste-2691814918193153.jpg"" /></div></div></i><i><div><div><div></div></div></div></i><i><img src=""gonna be along one.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[lichen sclerosis / lichen simplex chronicus]</span> = ↑ risk of&nbsp;<font color=""#ff0000"">vulvar</font>&nbsp;cancer</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>lichen sclerosis</span> = ↑ risk of&nbsp;<font color=""#ff0000"">vulvar</font>&nbsp;cancer</div><br><br> <div class=extra><i><div></div><div></div><div></div><div></div></i><div><i>skull = bad = cancer; <b>get vulvar biopsy </b>if there's a new vulvar lesion (e.g., firm, white plaque)</i></div><div><i><img src=""paste-8837758499946497.jpg"" /><img src=""img-78163-800-0.GIF"" /></i></div></div> <div class=tags></div>"
"<div class=card><span class=cloze>[ovarian]</span> cell tumors = high levels of<b> estradiol and inhibin</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><span class=cloze>granulosa</span> cell tumors = high levels of<b> estradiol and inhibin</b></div><br><br> <div class=extra><i><div></div><div></div><div></div><div></div></i><div><i></i><i>analogous to the testes</i><div><i>""inside"" one</i></div><div><i><b>estradiol</b> from aromatase activity → <b>precocious puberty</b></i></div><div><i><b>inhibin</b> inhibits FSH</i></div><div><i><br /></i></div><div><i><img src=""paste-8481143070392323.jpg"" /><img src=""paste-8481259034509315.jpg"" /></i></div></div></div> <div class=tags></div>"
"<div class=card><b>Severe fetal anemia</b>&nbsp;typically presents with a <span class=cloze>[...]</span>&nbsp;<b>fetal</b>&nbsp;<b>heart</b>&nbsp;<b>tracing</b><div><br /></div><div><img src=""paste-3790665121005569.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Severe fetal anemia</b>&nbsp;typically presents with a <span class=cloze><u>sinusoidal</u></span>&nbsp;<b>fetal</b>&nbsp;<b>heart</b>&nbsp;<b>tracing</b><div><br /></div><div><img src=""paste-3790665121005569.jpg"" /></div></div><br><br> <div class=extra><i><div></div><div></div><div></div><div></div></i><div><i></i><i>e.g., 2/2 vasa previa; needs&nbsp;<b>urgent C-section</b></i></div></div> <div class=tags></div>"
"<div class=card>How do the following laboratory values change during&nbsp;<u>pregnancy</u>?<div><br /></div><div><b>Total T3</b>/<b>T4</b>:&nbsp;<span class=cloze>[...]</span></div><div><b>Free T3</b>/<b>T4</b>:&nbsp;<span class=cloze>[...]</span></div><div><b>TSH</b>:&nbsp;<span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>How do the following laboratory values change during&nbsp;<u>pregnancy</u>?<div><br /></div><div><b>Total T3</b>/<b>T4</b>:&nbsp;<span class=cloze>Increased</span></div><div><b>Free T3</b>/<b>T4</b>:&nbsp;<span class=cloze>Unchanged</span></div><div><b>TSH</b>:&nbsp;<span class=cloze>Decreased</span></div></div><br><br> <div class=extra><i><div></div><div></div><div></div><div></div></i><div><i></i><i><div><div></div></div></i><i><b>↑&nbsp;TBG&nbsp;</b>=&nbsp;↑&nbsp;<b>Total</b>&nbsp;T4&nbsp;</i></div><div><div><i><div></div></i><i><br /></i></div><div><i><b><u>free</u></b>&nbsp;T3/T4 and TSH remains&nbsp;<b>normal</b>&nbsp;(the HPP axis is normal, so the thyroid has less negative feedback due to less free T3/T4 and produces more T3/T4, maintaining free levels)&nbsp;</i></div></div><div><br /></div><u><img src=""potay.png"" /></u></div> <div class=tags></div>"
"<div class=card>Pregnant women with a history of&nbsp;<u>genital HSV infection</u>&nbsp;should receive&nbsp;<b>prophylactic</b>&nbsp;<b>acyclovir</b>&nbsp;or&nbsp;<b>valacyclovir</b>&nbsp;beginning at <span class=cloze>[...]</span> weeks of pregnancy</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Pregnant women with a history of&nbsp;<u>genital HSV infection</u>&nbsp;should receive&nbsp;<b>prophylactic</b>&nbsp;<b>acyclovir</b>&nbsp;or&nbsp;<b>valacyclovir</b>&nbsp;beginning at <span class=cloze>36</span> weeks of pregnancy</div><br><br> <div class=extra><i><div></div><div></div><div></div><div></div></i><div><i><div style=""font-weight: bold; ""><div></div></div></i><i>regardless of symptoms!</i><div style=""font-weight: bold; ""><i><br /></i><div><i><img src=""paste-251972846354433.jpg"" /></i></div></div></div></div> <div class=tags></div>"
"<div class=card>PCOS = <span class=cloze>[...]</span> GnRH + <span class=cloze>[...]</span> estrogen levels&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>PCOS = <span class=cloze>↑</span> GnRH + <span class=cloze>↑</span> estrogen levels&nbsp;</div><br><br> <div class=extra><i>high androgen → estrone peripheral conversion</i><div><i>↑ estrone = ↑ continuous high frequency pulses of GnRH → preferential LH production → ↑ LH/FSH ratio.</i></div><div><i><br /></i></div><div><i><img src=""pcos.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><i>Maternal</i>&nbsp;complications associated with&nbsp;<u>placental abruption</u>&nbsp;include&nbsp;<b><span class=cloze>[...]</span></b>&nbsp;and&nbsp;<b>hypovolemic</b>&nbsp;<b>shock</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><i>Maternal</i>&nbsp;complications associated with&nbsp;<u>placental abruption</u>&nbsp;include&nbsp;<b><span class=cloze>DIC</span></b>&nbsp;and&nbsp;<b>hypovolemic</b>&nbsp;<b>shock</b></div><br><br> <div class=extra><i><div></div></i><i>-&nbsp;<b>DIC</b>&nbsp;due to tissue factor release by the decidual bleeding</i><div><i>- fetal complications include hypoxia and preterm delivery</i></div><div><i><br /></i></div><img src=""chart.png"" /></div> <div class=tags></div>"
"<div class=card><i>Maternal</i>&nbsp;complications associated with&nbsp;<u>placental abruption</u>&nbsp;include&nbsp;<b>DIC</b>&nbsp;and&nbsp;<span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><i>Maternal</i>&nbsp;complications associated with&nbsp;<u>placental abruption</u>&nbsp;include&nbsp;<b>DIC</b>&nbsp;and&nbsp;<span class=cloze><b>hypovolemic</b>&nbsp;<b>shock</b></span></div><br><br> <div class=extra><i><div></div></i><i>-&nbsp;<b>DIC</b>&nbsp;due to tissue factor release by the decidual bleeding</i><div><i>- fetal complications include hypoxia and preterm delivery</i></div><div><i><br /></i></div><img src=""chart.png"" /></div> <div class=tags></div>"
"<div class=card>Which&nbsp;<u>hormone</u>&nbsp;affects&nbsp;<b>respiration in pregnancy</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Which&nbsp;<u>hormone</u>&nbsp;affects&nbsp;<b>respiration in pregnancy</b>?<div><br /></div><div><span class=cloze>Progesterone (increases tidal volume)</span></div></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div><span style=""font-weight: 800;"">-</span>&nbsp;RR is unchanged.&nbsp;</div><div>- progesterone → ↑ TV → ↑ minute ventilation&nbsp;</div><div>- elevated diaphagram → ↓ FRC&nbsp;</div><div><br /></div></i><i><b>imagine a big tide washing over a baby.&nbsp;</b></i><div style=""font-weight: bold; ""><i><br /></i></div><div style=""font-weight: bold; ""><i><img src=""paste-65416646885379_1529603012320.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Postpartum thyroiditis</b>&nbsp;is associated with&nbsp;<span class=cloze>[...]</span> antibodies</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Postpartum thyroiditis</b>&nbsp;is associated with&nbsp;<span class=cloze>anti-thyroid peroxidase</span> antibodies</div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><b>= painless thyroiditis</b> in the post-partum period (hyperthyroid, → &nbsp;hypothyroid → euthyroid); both are variants of hashimoto → <b>Tpo antibody.</b></i><div><i><br /><div style=""font-weight: bold; ""></div></i><i><img src=""interesstin.png"" /><img src=""paste-4269193197256705.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><i>All</i>&nbsp;pregnant women should be screened for&nbsp;<u>gestational diabetes mellitus</u>&nbsp;at&nbsp;<b><span class=cloze>[...]</span> - <span class=cloze>[...]</span> weeks gestation</b></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><i>All</i>&nbsp;pregnant women should be screened for&nbsp;<u>gestational diabetes mellitus</u>&nbsp;at&nbsp;<b><span class=cloze>24</span> - <span class=cloze>28</span> weeks gestation</b></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i></i><i>placental hormones in the 2nd and 3rd trimester create&nbsp;<u>increased maternal insulin resistance</u>;&nbsp;patients with risk factors (e.g. obesity, previous GDM) should be screened earlier and re-screened at 24-28 weeks if negative</i><div><i><br /><div style=""font-weight: bold; ""></div></i><i><img src=""GDM.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>young girl&nbsp;</b>with<b>&nbsp;thin, fused</b>&nbsp;<u>labia minora</u>&nbsp;is due to <span class=cloze>[...]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>young girl&nbsp;</b>with<b>&nbsp;thin, fused</b>&nbsp;<u>labia minora</u>&nbsp;is due to <span class=cloze>labial adhesions.&nbsp;</span></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div></div></i><i>2/2 low estrogen + inflammation; if symptomatic treat with&nbsp;<b>topical estrogen.</b></i><div><i><br /></i></div><div><i><img src=""paste-1489202600476675.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Oral contraceptives</b>&nbsp;are&nbsp;<u>contraindicated</u>&nbsp;in women&nbsp;<u>&gt;</u>&nbsp;<span class=cloze>[...]</span> that use tobacco&nbsp;</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Oral contraceptives</b>&nbsp;are&nbsp;<u>contraindicated</u>&nbsp;in women&nbsp;<u>&gt;</u>&nbsp;<span class=cloze>35</span> that use tobacco&nbsp;</div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div></div><div></div></i><i>other contraindications include history of <b>venous thromboembolic disease</b>, uncontrolled&nbsp;<b>hypertension</b>&nbsp;(&gt; 160/110), and <b>liver</b> disease</i><div><i><br /></i></div><div><i><img src=""paste-3832034246000643.jpg"" /></i></div><img src=""this is painful.png"" /></div> <div class=tags></div>"
"<div class=card>Adolescents with&nbsp;<u>irregular menstrual bleeding</u>&nbsp;due to&nbsp;<b>anovulatory</b>&nbsp;<b>cycles</b>&nbsp;may benefit from <span class=cloze>[...]</span> therapy</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Adolescents with&nbsp;<u>irregular menstrual bleeding</u>&nbsp;due to&nbsp;<b>anovulatory</b>&nbsp;<b>cycles</b>&nbsp;may benefit from <span class=cloze>progesterone</span> therapy</div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div></div><div></div></i><i>progesterone, which is normally secreted by the corpus luteum during ovulatory cycles, causes&nbsp;<b>differentiation</b>&nbsp;of the proliferative endometrium into&nbsp;<b>secretory</b>&nbsp;<b>endometrium</b>;&nbsp;<u>withdrawal</u>&nbsp;causes&nbsp;<b>menstruation</b></i><div><i><br /></i><div><i><br /></i><div><img src=""nasty.png"" /></div></div></div></div> <div class=tags></div>"
"<div class=card><b>Hormone replacement therapy</b>&nbsp;is&nbsp;<i>only</i>&nbsp;indicated for the treatment of <span class=cloze>[...]</span> in<b>&nbsp;women age &lt; 60</b>&nbsp;who have undergone&nbsp;<u>menopause</u>&nbsp;within the past 10 years</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Hormone replacement therapy</b>&nbsp;is&nbsp;<i>only</i>&nbsp;indicated for the treatment of <span class=cloze>vasomotor symptoms</span> in<b>&nbsp;women age &lt; 60</b>&nbsp;who have undergone&nbsp;<u>menopause</u>&nbsp;within the past 10 years</div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div></div><div></div></i><i>e.g. hot flashes, sleep disturbances;&nbsp;<u>not</u>&nbsp;indicated for chronic disease prevention (e.g. osteoporosis, coronary heart disease); recall the WHI showed bad stuff for&nbsp;<b>older</b>&nbsp;women</i><div><i><br /><div></div></i><i><img src=""paste-2606954954358785.jpg"" /></i></div><div><i><img src=""youve seen this before idiot.png"" /></i></div></div> <div class=tags></div>"
"<div class=card><b>Hormone replacement&nbsp;</b><b>therapy (E+P)&nbsp;</b>for&nbsp;<u>vasomotor</u>&nbsp;postmenopausal symptoms&nbsp;<i>increases</i>&nbsp;the risk for&nbsp;<span class=cloze>[...]</span> cancer.</div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><b>Hormone replacement&nbsp;</b><b>therapy (E+P)&nbsp;</b>for&nbsp;<u>vasomotor</u>&nbsp;postmenopausal symptoms&nbsp;<i>increases</i>&nbsp;the risk for&nbsp;<span class=cloze>breast</span> cancer.</div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div></div><div></div></i><i>WHI showed that estrogen-only didn't increase the risk of breast cancer - perhaps&nbsp;<b>progestin&nbsp;</b>is the culprit.&nbsp;</i><br /><div><i><br /></i></div><div><i><img src=""paste-3214495258247169.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>recommended management</i>&nbsp;for a woman with medically-managed&nbsp;<b>hypothyroidism</b>&nbsp;that desires to get pregnant in the near future?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>recommended management</i>&nbsp;for a woman with medically-managed&nbsp;<b>hypothyroidism</b>&nbsp;that desires to get pregnant in the near future?<div><br /></div><div><span class=cloze>Increase levothyroxine dose <b>at the time pregnancy is detected</b></span></div></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div></div><div></div></i><i>women with pre-existing hypothyroidism are unable to increase thyroxine production enough to maintain free T₃/T₄&nbsp;levels with a rising thyroxine-binding globulin</i><div><i><img src=""potay.png"" /></i></div></div> <div class=tags></div>"
"<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a&nbsp;<u>premenopausal</u>&nbsp;woman with a&nbsp;<b>palpable adnexal mass</b>&nbsp;on physical exam?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the&nbsp;<i>next step</i>&nbsp;in management for a&nbsp;<u>premenopausal</u>&nbsp;woman with a&nbsp;<b>palpable adnexal mass</b>&nbsp;on physical exam?<div><br /></div><div><span class=cloze>Pelvic ultrasound</span></div></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div></div><div></div><div></div></i><i>- An&nbsp;<b>adnexal mass&nbsp;</b>is a lump in tissue of the adnexa of uterus (structures closely related structurally and functionally to the uterus such as the<b>&nbsp;ovaries, fallopian tubes,&nbsp;</b>or&nbsp;<b>connective</b>&nbsp;<b>tissue</b>)</i><div><i><br /></i></div><div><i>-<b><font color=""#ff0000""> CA-125 levels are not as useful </font></b>for initial evaluation of an ovarian mass in&nbsp;<b><font color=""#ff0000"">pre</font></b>menopausal women (in&nbsp;<b>post</b>menopausal women, pelvic ultrasound&nbsp;<u>and</u>&nbsp;CA-125 are part of the initial workup)&nbsp;</i></div><div><i><br /></i></div><div><i><img src=""paste-344585226158081.jpg"" /></i></div><div><i><br /></i></div><img src=""epithel ovarian carc.png"" /></div> <div class=tags></div>"
"<div class=card>raised, red granulation tissue on anterior vaginal wall with continuous watery vaginal discharge = <span class=cloze>[diagnosis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> "<div class=card>raised, red granulation tissue on anterior vaginal wall with continuous watery vaginal discharge = <span class=cloze>vesiculovaginal fistula</span></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div></div><div></div><div></div>- often due to <b>obstructed labor </b>(causes necrosis / fistula development)</i><div><i>- <b>bladder dye testing </b>to confirm</i></div></div> <div class=tags></div>
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in an&nbsp;<u>afebrile</u>&nbsp;middle-aged woman that presents with&nbsp;<b>unilateral</b>&nbsp;<b>breast</b>&nbsp;<b>warmth</b>,&nbsp;<b>erythema</b>, and&nbsp;<b>swelling</b>&nbsp;refractory to antibiotics?&nbsp;<div><br /></div><div><span class=cloze>[...]</span></div><div><br /></div><div><img src=""paste-18245021073409_1505754167063.jpg"" /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in an&nbsp;<u>afebrile</u>&nbsp;middle-aged woman that presents with&nbsp;<b>unilateral</b>&nbsp;<b>breast</b>&nbsp;<b>warmth</b>,&nbsp;<b>erythema</b>, and&nbsp;<b>swelling</b>&nbsp;refractory to antibiotics?&nbsp;<div><br /></div><div><span class=cloze>Inflammatory breast carcinoma</span></div><div><br /></div><div><img src=""paste-18245021073409_1505754167063.jpg"" /></div></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div></div><div></div><div></div></i><i><u>lack</u>&nbsp;of fever and&nbsp;<u>no response</u>&nbsp;to antibiotics help distinguish inflammatory breast cancer from mastitis; other distinguishing features include&nbsp;<b>axillary</b>&nbsp;<b>lymphadenopathy</b>&nbsp;and a&nbsp;<b>peau</b>&nbsp;<b>d'orange appearance</b>&nbsp;</i><div><i><br /></i><div><i><img src=""inflammatory breast cancer.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What are the&nbsp;<i>most common causes</i>&nbsp;(2) of&nbsp;<b>hyperandrogenism</b>&nbsp;in&nbsp;<u>pregnancy</u>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What are the&nbsp;<i>most common causes</i>&nbsp;(2) of&nbsp;<b>hyperandrogenism</b>&nbsp;in&nbsp;<u>pregnancy</u>?<div><br /></div><div><span class=cloze>luteomas and theca luteum cysts</span></div></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div style=""text-decoration: underline; ""></div><div style=""text-decoration: underline; ""></div><div style=""text-decoration: underline; ""></div></i><i>2/2&nbsp;<b>b-hCG</b>&nbsp;stimulation; may manifest as new-onset hirsutism and/or acne; appear as&nbsp;<b>solid, bilateral ovarian masses</b></i><div style=""text-decoration: underline; ""><b><i><br /></i></b><div><i><img src=""this is gonna suck.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the preferred&nbsp;<i>method of contraception</i>&nbsp;for patients with&nbsp;<b>breast cancer</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the preferred&nbsp;<i>method of contraception</i>&nbsp;for patients with&nbsp;<b>breast cancer</b>?<div><br /></div><div><span class=cloze>Copper IUD</span></div></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div style=""text-decoration: underline; ""></div><div style=""text-decoration: underline; ""></div><div style=""text-decoration: underline; ""></div></i><i><b>all hormone-containing contraceptives</b>&nbsp;are&nbsp;<u>contraindicated</u>&nbsp;in patients with breast cancer (both estrogen and progesterone may have a&nbsp;<u>proliferative</u>&nbsp;effect on breast tissue)</i><div><i><br /></i><div><i><img src=""womp (4).png"" /><img src=""paste-3053893546147841.jpg"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a&nbsp;<u>stillborn fetus</u>&nbsp;with&nbsp;<b>multiple limb fractures</b>&nbsp;and a&nbsp;<b>hypoplastic thoracic cavity</b>?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>What is the likely&nbsp;<i>diagnosis</i>&nbsp;in a&nbsp;<u>stillborn fetus</u>&nbsp;with&nbsp;<b>multiple limb fractures</b>&nbsp;and a&nbsp;<b>hypoplastic thoracic cavity</b>?<div><br /></div><div><span class=cloze>Type II osteogenesis imperfecta</span></div></div><br><br> <div class=extra><i><div></div></i><i><div></div></i><i><div style=""text-decoration: underline; ""></div><div style=""text-decoration: underline; ""></div><div style=""text-decoration: underline; ""></div></i><i></i><i>due to mutations in<span style=""font-weight: bold"">&nbsp;type 1 collagen (bONE);</span><span style=""font-weight: bold; "">&nbsp;type II OI is the&nbsp;most</span><span style=""font-weight: bold; "">&nbsp;severe</span>&nbsp;<b>type</b> and often manifests as fatal perinatal disease</i><div style=""font-weight: bold; ""><i><br /></i><div><i><img src=""typeIIoi.png"" /></i></div></div></div> <div class=tags></div>"
"<div class=card>Complications of <b>PPROM</b> include:<div><br /></div><div><span class=cloze>[...]</span>term labor</div><div>intraamniotic <span class=cloze>[...]</span></div><div>placental abruption</div><div>umbilical cord prolapse</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Complications of <b>PPROM</b> include:<div><br /></div><div><span class=cloze>pre</span>term labor</div><div>intraamniotic <span class=cloze>infection</span></div><div>placental abruption</div><div>umbilical cord prolapse</div></div><br><br> <div class=extra><div><div><i><b>preterm labor: </b>well, you lost your fluid already so you're probably going to deliver early.</i></div><div><i><b>infection:</b> since ROM occurred you're exposed and can get ascending infection</i></div><div><i><b>abruption: </b>decreased amniotic fluid volume → placenta can tear off the uterus</i></div><div><i><b>cord prolapse: </b>decreased amniotic fluid volume → cord can get stuck.</i></div><div><i><br /></i></div><div><i><div></div><div></div><img src=""paste-7316296400109571.jpg"" /></i></div><div><br /></div><div><img src=""paste-5415953760258.jpg"" /></div></div><div></div></div> <div class=tags></div>"
"<div class=card>Complications of <b>PPROM</b> include:<div><br /></div><div>preterm labor</div><div>intraamniotic infection</div><div>placental <span class=cloze>[...]</span></div><div><span class=cloze>[...]</span> prolapse</div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>Complications of <b>PPROM</b> include:<div><br /></div><div>preterm labor</div><div>intraamniotic infection</div><div>placental <span class=cloze>abruption</span></div><div><span class=cloze>umbilical cord</span> prolapse</div></div><br><br> <div class=extra><div><div><i><b>preterm labor: </b>well, you lost your fluid already so you're probably going to deliver early.</i></div><div><i><b>infection:</b> since ROM occurred you're exposed and can get ascending infection</i></div><div><i><b>abruption: </b>decreased amniotic fluid volume → placenta can tear off the uterus</i></div><div><i><b>cord prolapse: </b>decreased amniotic fluid volume → cord can get stuck.</i></div><div><i><br /></i></div><div><i><div></div><div></div><img src=""paste-7316296400109571.jpg"" /></i></div><div><br /></div><div><img src=""paste-5415953760258.jpg"" /></div></div><div></div></div> <div class=tags></div>"
"<div class=card>cervicitis affects the <span class=cloze>[anatomical structure]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>cervicitis affects the <span class=cloze>endocervical glands</span></div><br><br> <div class=extra><img src=""paste-1457634590851073.jpg"" /></div> <div class=tags></div>"
"<div class=card><div>What is the treatment for&nbsp;<b>preeclampsia</b>&nbsp;or&nbsp;<b>eclampsia</b>&nbsp;to</div><div>&nbsp;<u>prevent</u>&nbsp;<b>seizures</b>?</div><div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card><div>What is the treatment for&nbsp;<b>preeclampsia</b>&nbsp;or&nbsp;<b>eclampsia</b>&nbsp;to</div><div>&nbsp;<u>prevent</u>&nbsp;<b>seizures</b>?</div><div><br /></div><div><span class=cloze>IV magnesium sulfate</span></div></div><br><br> <div class=extra><img src=""i found chart!.png"" /></div> <div class=tags></div>"
"<div class=card>GBS (+) and<b> non-anaphylatic</b>&nbsp;PCN allergy = <span class=cloze>[intrapartum prophylaxis]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>GBS (+) and<b> non-anaphylatic</b>&nbsp;PCN allergy = <span class=cloze>cefazolin</span></div><br><br> <div class=extra><i><b>1st line:</b> IV PCN and ampicillin.</i><div><i><b>2nd line:</b> cefazolin (lower risk for cross-reactivity)</i></div><div><i><b>3rd line: </b>clindamycin (check susceptibility esp. if there is resistance to erythromycin)&nbsp;</i></div><div><i><b>4th line: </b>vancomycin&nbsp;</i></div><div><i><br /></i></div><div><i><img src=""paste-5660766896476.jpg"" /><img src=""paste-48846663057828.jpg"" /></i></div><div><i><img src=""gbs (1).png"" /></i></div><div><i><br /></i></div></div> <div class=tags></div>"
"<div class=card>large amount of intraabdominal fluid after gyn surgery + watery vaginal discharge = <span class=cloze>[cause]</span></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>large amount of intraabdominal fluid after gyn surgery + watery vaginal discharge = <span class=cloze>unilateral ureteral laceration</span></div><br><br> <div class=extra><div><i>woman will still be able to pee w/ normal kidney function because other ureter is working.</i></div><div><i><br /></i></div><div><b><i><img src=""paste-20830591385603 (1).jpg"" /></i></b></div></div> <div class=tags></div>"
"<div class=card>a <b>short</b> interpregnancy interval predisposes to:<div><br /></div><div>maternal <span class=cloze>[...]</span></div><div>preterm labor / PPROM → <u>low</u> birth weight</div><div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>a <b>short</b> interpregnancy interval predisposes to:<div><br /></div><div>maternal <span class=cloze>anemia</span></div><div>preterm labor / PPROM → <u>low</u> birth weight</div><div><br /></div></div><br><br> <div class=extra><div><i><b>maternal anemia: </b>you just fed the previous baby and now you're depleted (iron/folate)</i></div><div><i><br /></i></div><div><i><b>preterm: </b>since the genital tract is still messed up from previous pregnancy</i></div><div><i><br /></i></div><div><i><b>note: </b>cervical insufficiency is about intrinsic structural issues (collagen defect, cervical conization), which isn't affected by extrinsic issues like short interval.</i></div><div><i><br /></i></div><div><i><img src=""paste-1634776222007299.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>a <b>short</b> interpregnancy interval predisposes to:<div><br /></div><div>maternal anemia</div><div><span class=cloze>[...]</span>term labor / <span class=cloze>[...]</span> → <u>low</u> birth weight</div><div><br /></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>a <b>short</b> interpregnancy interval predisposes to:<div><br /></div><div>maternal anemia</div><div><span class=cloze>pre</span>term labor / <span class=cloze>PPROM</span> → <u>low</u> birth weight</div><div><br /></div></div><br><br> <div class=extra><div><i><b>maternal anemia: </b>you just fed the previous baby and now you're depleted (iron/folate)</i></div><div><i><br /></i></div><div><i><b>preterm: </b>since the genital tract is still messed up from previous pregnancy</i></div><div><i><br /></i></div><div><i><b>note: </b>cervical insufficiency is about intrinsic structural issues (collagen defect, cervical conization), which isn't affected by extrinsic issues like short interval.</i></div><div><i><br /></i></div><div><i><img src=""paste-1634776222007299.jpg"" /></i></div></div> <div class=tags></div>"
"<div class=card>when should <b>cryptorchidism</b> be surgically corrected with orchiopexy?<div><br /></div><div><span class=cloze>[...]</span></div></div> <br/> <span class=""timer"" id=""s2""><span> <script> ""<div class=card>when should <b>cryptorchidism</b> be surgically corrected with orchiopexy?<div><br /></div><div><span class=cloze> by 1 year</span></div></div><br><br> <div class=extra><div><i>- first monitor for <b>spontaneous descent </b>until after 6 months.&nbsp;</i></div><div><i>- this reduces complications (e.g., torsion, infertility, malignancy)</i></div><div><i><br /></i></div><div><i><img src=""mmkay (1).png"" /></i></div></div> <div class=tags></div>"