HY lecture notes:
Endometritis + chorioamnionitis + Bartholin gland abscess –> polymicrobial always the answer on the USMLE.
Postpartum endometritis on 2CK + obgyn shelf –> woman had C-section two days ago + now has fever + lower abdominal pain –> answer = endometritis, not chorioamnionitis. Answer cannot be the latter because the woman already gave birth; if she’s still pregnant, then choose chorioamnionitis, not endometritis.
Chorioamnionitis is the answer when they tell you there’s prolonged rupture of membranes (>18 hours). This might occur if there’s delay in the woman arriving at hospital, or if rupture occurs at, e.g., 22 weeks gestation, when the fetus is not yet viable, and she’s being managed closely until a delivery can be made.
Septic abortion is the answer if they give you pregnant woman with high fever + severe cramping (labor in first trimester often presents as severe cramping pain) + they say it was an unexpected pregnancy + they mention laceration on the cervix (she tried to self-abort with, e.g., a hanger).
PID will be the answer when she has lower abdominal pain (diffuse or adnexal) + mucopurulent vaginal discharge. Always cotreat with IM ceftriaxone + oral azithromycin or doxycycline.
Bartholin gland cyst/abscess will be described as a 1-3-cm mass in a 4 or 8 o’clock position on the labia majora. Tx = warm compresses / sitz bath if non-inflamed or non-painful (i.e., just a cyst). If an abscess, answer always = drainage before Abx on the USMLE.
Vomiting + nausea are normal in pregnancy and are worst ~8-10 weeks gestation when beta-hCG is highest. Hyperemesis gravidarum is the term that’s applied when the vomiting becomes so bad that the woman is now ketogenic –> USMLE wants “urine ketones” as the answer for how you diagnose HG. Likewise, you’ll sometimes get a vignette where the woman is vomiting, and you’ll notice on the urinalysis it says, e.g., “ketones 2+”. The answer is “admit to hospital + give parenteral antiemetic therapy.” Metoclopramide is frequently given.
Acid-base disturbance in vomiting is standard hypokalemic (K <3.5), hypochloremic (Cl <95), metabolic alkalosis (bicarb >28). Although ketones are elevated, the overwhelming vomiting still yields metabolic alkalosis. CO2 would also be low (<33 mmHg) to compensate. Never pigeon-hole values on the 2CK, as, e.g., bicarb could by all means be 27, but be aware of general trends.
