1MTB step 3 OB

Question 1

Transvaginal and Abdominal ultrasound bHCG and wks

Answer 1

Vaginal sonogram at 5 weeks gestation when serum ß-hCG >

1,500 mIU

Abdominal sonogram at 6 weeks gestation when ß-hCG >

6,500 mIU

Question 2

fetal heart motion time

Answer 2

5-6 weeks

Question 3

fetal heart sounds time

Answer 3

8-10 weeks

Question 4

When can fetal motion be felt by doctor

Answer 4

20 weeks

Question 5

first trimester tests

Answer 5

A.Routine tests
1) Anemia/ blood disorders: CBC

2) Blood type, Rh, and antibody: Type and screen, Direct & indirect Coombs
3) GU Screening: Cervical PAP smear, UA, UCx
4) Immunization: Rubella Ab, Hep B surface antigen

5) Infections:
-Chlamydia/Gonorrhea: Cervical Cx, Gram stain
-HIV: ELISA
-Syphilis: Screen: VDRL or RPR
Confirmatory tests: FTA or MHA-TP

B. Optional Tests

1) TB: PPD
2) Trisomy 21: B-hCG, PAPPA-A, fetal nuchal translucency

Question 6

low hemoglobin

Answer 6

MCC is fe def anemia worry if < 10

check MCV : low = fe high =folate

Question 7

Who gets Rhogam

Answer 7

1) At 28 weeks.
2) Within 72 hours of delivery.
3) After miscarriage or abortion.
4) During amniocentesis or CVS.
5) With heavy vaginal bleeding.

Question 8

UTI

Answer 8

asymptomatic bacturia must treat nitrofurantoin <30 weeks cephalosporins amoxicillin

Question 9

Infection: Chlamydia/ Gonorrhea

1. Tests
2. Dx significance
3. Next step in Mgmt

Answer 9

1. Test: Cervical Culture
2. Dx Significance:
   a. Gram stain
   b. Chlamydia and gonorrhea culture
   c. Also treat Trichomonas vaginalis (can cause premature labor).
3. Next Step in Mx:
   a. (+) Chlamydia/gonorrhea
   - PO azithromycin + IM ceftriaxone (TOC)
   - Alternative: PO amoxicillin
   b. (+) Bacterial vaginitis
   - PO metronidazole or clindamycin
   c. (+) Trichomonas vaginalis
   - PO metronidazole

Question 10

Bacterial vaginosis

Answer 10

metronidazole

Question 11

trichomonas vag

Answer 11

metronidazole

Question 12

+ ppd ? check CXR and tx

Answer 12

+ ppd - cxr : INH + B6 x 9 months + ppd + cxr + sputum: triple therapy no streptomycin

Question 13

trisomy 21 screen in first trimestery

Answer 13

who: > 35 y/o, history of prior trisomy 21 chorionic vili sampling

Question 14

2nd trimester screen

Answer 14

1. Triple/Quad screen:Screen
   15-20 weeks:

MS-AFP, B-hCG, Estriol, Inhibin A

Question 15

inc AFP causes

Answer 15

check US for more accurate gestational age 1. wrong age 2. multiparity 3. NTD or abd wall defect 4. placental bleeding 5. renal disease 6. sacrococcygeal teratoma

Question 16

down syndromme triple screen

Answer 16

dec AFP dec estriol inc HCG

Question 17

Trisomy 18 triple screen

Answer 17

dec AFP dec estriol dec HCG

Question 18

inc AFP what to do next?

Answer 18

amniocentesis for AFP + acetylcholineresterase activity (NTD)

Question 19

dec AFP

Answer 19

amniocentesis for karyotyping

Question 20

third trimester screen (>24 weeks)

Answer 20

24-28 wks:

• Anemia: CBC
• Diabetes: 1hr 50 g OGTT –> 3 hr 100g OGTT

28 wks:
-Atypical Ab (Rh): Indirect Coombs

35-37 wks:
-GBS screening: Vaginal & Rectal Cx for GBS

Question 21

DM screen:

Answer 21

1. 1 hour 50 g test + > 140 2. 3 hour gluc tolerance test fbs >125 1 hr >180 2 hr >155 3 hr >140 if 1+ then gluc intolerance if 2+ then DM

Question 22

NAME?

Answer 22

penicillin G intrapartum clinda or erythro if pen allergic

Question 23

N/V during preg

Answer 23

1) zofran 2) reglan 3) B6 4) doxyalamine 5) promethazine

Question 25

steps third trimester bleeding

Answer 25

1) vitals, external fetal monitor, start IVF, 2) CBC, DIC, type and cross, OB US to r/o previa 3) give blood, foley, vaginal exam, delivery if \>36 wks and in jeopardy 4) NO digital or speculum until r/o previa

Question 26

placental abruptio

Answer 26

painful bleeding RF: cocaine, trauma, HTN, complication : DIC TX: \<34 weeks and stable --\> monitor \> 34 weeks --\>\> deliver unstable --\>\> deliver

Question 27

placental previa

Answer 27

painless bleeding RF: trauma, previous previa, fibroids, age Complication: placental accreta TX: \<34 weeks and stable --\> monitor \> 36 weeks --\>\> vaginal deliver unstable --\>\> deliver

Question 28

vasa previa

Answer 28

painless bleeding + fetal bradycardia + rupture of membranes NO speculum exams complications: fetal exsanguination Tx: c section

Question 29

uterine rupture

Answer 29

abd pain + vaginal bleeding + stop of contractions + fetus rescends + loss of fetal HR tx: immediate delivery

Question 30

tx for GBS

Answer 30

intrapartum: IV amp pen allergic: cefazolin, clinda, erythro

Question 31

indication tx GBS

Answer 31

previous preg neonatal GBS sepsis + anytime during preg preterm, rupture \>18 hrs, maternal fever,

Question 32

no tx GBS

Answer 32

planned C-section with no ROM culture + prev preg

Question 33

toxo congenital

Answer 33

1) hydrocephalus 2) intracranial calcifications 3) chorioretinitis

Question 34

mom with toxo treatment

Answer 34

sulfadiazine + pyramethamine

Question 35

varicella when most infectious tx:

Answer 35

rash 2 days before to 5 days afterwards baby: IVIG + IV acyclovir mom: acyclovir + IVIG

Question 36

varicella congenital

Answer 36

1) rash 2) chorioretinitis 3) cataracts 4) microcephaly

Question 37

congenital rubella

Answer 37

1) blueberry muffin rash 2) cataracts 3) HSM 4) heart: PDA 5) congenital deafness + cataracts

Question 38

why does gestational DM develop

Answer 38

human placental lactogen inc insulin resistance induces lipolysis

Question 39

how to measure gestational age in 1sst trimester

Answer 39

transvaginal u/s for crown rump length

Question 40

HSV 1. when to suspect in mom

Answer 40

1. malaise, genital lesions, fever

Question 41

HSV congenital

Answer 41

1) meningoencephalitis 2) PNA 3) hepatosplenomegaly 4) petechial rash 5) jaundice

Question 42

HSV diagnosis

Answer 42

HSV PCR or culture

Question 43

HSV treatment

Answer 43

if genital lesions are suspected schedule C section treat mom with IV acyclovir

Question 44

HIV treatment

Answer 44

continue ARTs during preg regardless of viral load till 6 weeks after Zidovudine in one of hte meds do triple therapy Elective C section of viral load \> 1000 DO NOT breastfeed

Question 45

HIV tx newborn

Answer 45

zidovudine for 6 wks

Question 46

early congenital syphilis

Answer 46

1) hydrops fetalis 2) maculopapular rash on palms and soles 3) anemia, thrombocytopenia 4) large placenta

Question 47

late congenital syphilis

Answer 47

1) hutchinsons teeth 2) mulberry molars 3) saber shins 4) saddle nose 5) deafness

Question 48

syphilis tx

Answer 48

benzathine pen x 1

Question 49

HBV infectivity

Answer 49

check hbe Ag

Question 50

treatment ofr HB s Ag + mom

Answer 50

IVIG + Hep vaccine to mom and baby

Question 51

Chronic HTN

Answer 51

hx of elevated BP \> 140/90 before preg or before 20 weeks gestation

Question 52

gestational HTN

Answer 52

after 20 weeks and returns to normal 6 weeks after BP \> 140/90

Question 53

Cause of Anemia in pregnancy

Answer 53

Anemia in pregnancy is caused by increased levels of hepcidin, which inhibits iron transport. Pregnancy increases iron demand, but hepcidin prevents absorption.