obstetrics and urology

What are some probable signs of pregnancy?

Goodell sign, Chadwick's sign, Hegar's sign, enlarged uterus, positive urine or serum HCG.

What are some presumptive signs of pregnancy?

Amenorrhea, nausea, swollen and tender breasts, fatigue, quickening.

At what gestational age is the fundal height above the symphysis pubis?

At 12 weeks.

When can fetal heart tones be heard by Doppler?

By 10-12 weeks.

Where is the uterine fundus located at 20 weeks gestation?

At the level of the umbilicus.

What physiological changes occur in a pregnant woman's heart?

Maternal heart rate increases, cardiac output increases, plasma volume increases, leading to physiological anemia.

What is a common heart sound in pregnancy?

An S3 heart sound is common in 80% of pregnant women.

What is the significance of Nagel's rule?

It is used for estimating the due date based on the first day of the last menstrual period.

What screening tests are performed in the first trimester of pregnancy?

UA and Urine C&S, CBC, Hep B, Rubella, Varicella, RPR, HIV, blood type and RH.

What does the Quad Screen test for?

It combines alpha-fetoprotein, beta HCG, estriol, and inhibin-A to assess for Down syndrome and other conditions.

What is the target blood pressure range for treating severe hypertension in pregnancy?

130 to 150 systolic and 80 to 100 diastolic.

What medications are preferred for treating severe hypertension in pregnancy?

IV labetalol, nicardipine, or hydralazine.

What antihypertensive medication is contraindicated during pregnancy?

Angiotensin converting enzymes, angiotensin II receptor blockers, and direct renin inhibitors.

What is the postpartum hypertension management for patients with elevated blood pressure?

Oral medications similar to those used in the non-pregnant population, with modifications for breastfeeding.

When does blood pressure typically peak postpartum?

Three to six days postpartum.

What is the purpose of chorionic villus sampling (CVS)?

To test fetal cells and chromosomes for abnormalities, typically done between 11-12 weeks gestation.

What does the triple screen test measure?

Alpha-fetoprotein, beta HCG, and estriol serum levels.

What is the typical gestational age for amniocentesis?

15 to 18 weeks gestation.

What is the recommended follow-up for patients with non-severe hypertension after discharge?

Blood pressure should be checked no later than 7 to 10 days after discharge.

What medications are preferred for managing chronic hypertension in pregnant patients?

Labetalol, nifedipine, hydralazine, and methyldopa.

What should patients on calcium channel blockers switch to during pregnancy?

Switch to intermediate or extended release nifedipine.

What is the recommended action for patients on beta blockers like carvedilol during pregnancy?

Switch to labetalol.

When does preeclampsia typically occur during pregnancy?

In the late 3rd trimester, 34 weeks gestation or later, and can occur up to four weeks after delivery.

What are the diagnostic criteria for preeclampsia?

Classic triad of hypertension, proteinuria, and edema after 20 weeks gestation.

What systolic and diastolic blood pressure readings indicate hypertension in preeclampsia?

Systolic blood pressure greater than 140 or diastolic blood pressure greater than 90.

What is the most common organism responsible for urinary tract infections in pregnancy?

E. coli.

What are common signs and symptoms of acute cystitis in pregnant women?

Dysuria, frequency, urgency, and nocturia.

What is the treatment for urinary tract infections in pregnancy?

Amoxicillin, Keflex, Augmentin, or Macrobid, depending on the trimester.

When should the Tdap vaccine be administered during pregnancy?

Between 27 to 36 weeks gestation.

What vaccines are contraindicated in pregnancy?

MMR, varicella, smallpox, and BCG.

What should be avoided in the first trimester regarding decongestants?

Pseudoephedrine should be avoided.

Which antihistamines have reassuring pregnancy data?

Chlorpheniramine and diphenhydramine.

What is Asymptomatic Bacteriuria (ASB)?

colony count of at least 100,000/ml in the absence of symptoms, primarily screened in pregnancy.

What factors increase the prevalence of ASB?

Advancing age, pregnancy, structural abnormalities, prostatic hypertrophy, and indwelling urinary catheter use.

How is ASB confirmed in asymptomatic women?

In women,with two positive, consecutive clean catch specimens. In men and catheterized pts a single clean catch

What is the most common cause of Asymptomatic Bacteriuria?

E. coli.

What is the recommended management for ASB in pregnant women?

Amoxicillin 500mg BID x 7dys

nitrofurantoin (1st & 2nd tri only) 100mg BID x 7dys, or a cephalosporin 250-500mg qid x 7dys. with follow-up TOC

What abx should be avoided in pregnancy?

quinolones

tetracyclines

bactrim

What are some nonglomerular causes of Hematuria?

infections, neoplasms, calculi, polycystic kidney disease, trauma, strenuous exercise, endometriosis

what are some glomerular causes of hematuria?

masses, av malformation, fistula, hydronephrosis,

gross hematuria in older men is correlated with what?

high rates of malignancy

what are some risk factors for hematuria?

uti, stones, smoking (increases rsk of bladder cancer=bleeding),

unilateral flank pain w/radiation to groin is typically ?

obstructive in nature (calculus, stricture, and tumor)

urinary hesitance or dribbling may indicate

BPH, prostate Cancer

hematuria w/systemic symptoms, weight loss, edema, facial swelling, anuria, oligoria suggest

glomerular cause

hematuria w/ recent hx of URI, and sore throat consider

post streptococcal glomerulonephritis

intermittent painless gross hematuria is the most common presenting symptom for

bladder cancer

hematuria with CVA tenderness is indicative of

pyelonephritis or nephrolithiasis

DRE will r/o

prostatis or BPH

Red cell cast and/or marked proteinuria indicates

glomerular origin or crystals indicating nephrolithiasis

What are some causes of Glomerular proteinuria?

Diabetic neuropathy, hypertensive nephrosclerosis, and sickle cell disease.

What is the significance of transient proteinuria?

It is often self-limiting and can occur due to infection or fever.

What is the recommended screening for Proteinuria in patients over 60?

Annual screening is useful for early detection, especially in those with diabetes and hypertension.

What are the management strategies for Hematuria?

Treat underlying infections, consider surgical referral for nephrolithiasis, and refer to urology for persistent cases.

What are the common symptoms to inquire about during a history assessment for Hematuria?

Dysuria, frequency, urgency, and flank pain.

What are some examples of drug-induced proteinuria?

NSAIDs, lithium, cyclosporine, and cisplatin.

What is the role of imaging studies in the assessment of Hematuria?

To rule out malignancy and structural abnormalities, such as cysts or stones.

What are ACEIs and ARBs used for in renal protection?

They are used for managing renal patients and should be prescribed under specialist consultation.

What is the most common cause of uncomplicated lower UTIs?

E. coli

What diagnostic tests are recommended for UTIs in children?

VCUG for children under five.

What is the first-line treatment for uncomplicated UTIs?

Nitrofurantoin (Macrobid) 100mg BID for five days.

What is the most common organism causing acute pyelonephritis?

E. coli

What are common symptoms of acute pyelonephritis?

Fever, chills, flank pain, dysuria, and nausea.

What is the management approach for acute pyelonephritis?

Floroquinolones are the only abx for outpatient treatment, cipro or levaquin. Bactrim DS sometimes used x 14dys

What are common symptoms of urolithiasis?

Renal colic, hematuria, flank pain, nausea, and urinary urgency.

What is the significance of postcoital voiding in UTI prevention?

It helps to flush out bacteria that may have entered the urethra during intercourse.

What role does cranberry juice play in UTI prevention?

It may help prevent E. coli from adhering to the bladder.

What is the recommended treatment duration for male patients with UTIs?

5 days for fluoroquinolones and 7 days for other antibiotics.

What are the signs of dehydration to check during a physical examination for UTI?

Mucous membrane dryness and skin turgor.

What is the purpose of a voiding cystourethrogram (VCUG)?

To evaluate for vesicourethral reflux and structural abnormalities in children and males with UTIs.

What should be considered if a patient with pyelonephritis has renal abscess suspected?

An abdominal/pelvis CT should be ordered.

What is the importance of a pelvic examination in adolescents and adults with suspected STIs?

To assess for signs of infection or trauma in the genital area.

What are the common demographic factors for acute pyelonephritis?

More frequent in women aged 18 to 40 years.

What is the impact of systemic and topical estrogen therapy in postmenopausal women regarding UTIs?

It markedly reduces the incidence of recurrent UTIs.

What are the two main types of kidney stones mentioned?

Uric acid stones and cystine stones.

What is the difference between asymptomatic and symptomatic kidney stones?

Asymptomatic stones are found incidentally during imaging, while symptomatic stones cause pain and other symptoms as they pass from the renal pelvis into the ureter.

What is the most common symptom of kidney stones?

Pain, which can vary from mild discomfort to severe pain requiring parental analgesics.

What additional symptoms may accompany kidney stones?

Urinary frequency, hematuria, diaphoresis, restlessness, chills, fever, and nausea.

What diagnostic tests are recommended for suspected nephrolithiasis?

A basic metabolic panel, urinalysis, and a CT scan of the abdomen and pelvis without contrast.

What imaging is preferred for pregnant patients suspected of having kidney stones?

Ultrasound.

What is the initial management for patients with kidney stones?

Conservative management with pain medication and hydration until the stone passes.

What medication is preferred for pain control in kidney stone patients?

NSAIDs, with Ketorolac being commonly used in the ER.

What size of kidney stones is most likely to pass spontaneously?

Stones less than 5 millimeters in diameter.

What is urge incontinence?

Involuntary loss of a large amount of urine preceded by a strong, unexpected urge to void.

What is stress incontinence?

Involuntary loss of small amounts of urine associated with activities that increase intra-abdominal pressure, like coughing or sneezing.

What is total incontinence?

Loss of urine at all times and in all positions due to sphincter inefficiency or nerve damage.

What laboratory tests are important for assessing urinary incontinence?

Urinalysis, urine culture and sensitivity, and renal function tests.

What are the stages of chronic kidney disease based on GFR?

Stage 1: GFR ≥ 90; Stage 2: GFR 60-89; Stage 3: GFR 30-59; Stage 4: GFR 15-29; Stage 5: GFR < 15.

What is chronic kidney disease defined by?

Kidney damage with urinary albumin excretion > 30 mg/day and GFR < 60 mL/min for three or more months.

What are common causes of chronic kidney disease?

Hypertension, diabetes, and glomerulonephritis.

What is the significance of proteinuria in chronic kidney disease?

It indicates kidney damage and is associated with an increased risk of progressive kidney disease.

What is the recommended management for patients with chronic kidney disease?

Control of blood pressure, avoidance of nephrotoxic drugs, and management of urinary tract obstruction.

What medications are recommended for patients with proteinuria?

ACE inhibitors (lisinopril) or ARBs,(losartan) and SGLT2 inhibitors (jardiance)

What is the role of glycemic control in chronic kidney disease?

It can slow the development of albuminuria and the progression of kidney function loss in diabetic patients.

What follow-up is suggested for patients with incontinence who do not respond to initial treatments?

Consultation with specialists for further options like botulinum injections or sacral neuromodulation.

What is the purpose of urine cytology in renal diagnosis?

To rule out malignancy.

What imaging studies are used to rule out renal carcinoma?

IVP studies and renal ultrasound.