Aaron: OB Flashcards
Polymicrobial, infection post C-section, what is the best abx course?
Clindamycin plus gentamicin
What is a prominent post birth infection risk?
C-section
Car accident
Uterine Tenderness
High amplitude contractions
What should I think about?
Abruptio Placenta
If a child does not have ADHD symptom relief after methylphenidate medications after two months, what should happen?
Switch to a different medication
Before starting methylphenidate, what are two things that must be done?
Cardiac history and physical exam, baseline weight
With a history of pre-eclampsia, what should be started between 12-14 weeks?
Aspirin, prophylatically
Woman under the age of 19, assuming no underlying risk factors are at an increased risk of what?
Pre-term birth
During pregnancy, what hormone level can be increased due to elevated estrogen?
TBG and T4 and T3
Advanced maternal age, over the 35 years old, what is a test that should be offered to all women?
Cell-free DNA fetal testing
Can you breast feed on methadone?
yes you can
If you take valproate during pregnancy, can you breast feed afterwards?
yes you can
Methotrexate is contraindicated in patients with what two diseases?
Renal Disease or Hepatic Disease, meds cannot be cleared quickly enough
Are GBS cultures done during labor?
When are GBS cultures done?
No
36-38 weeks
GBS unknown plus preterm delivery (<37 weeks), ruptured membranes for > 18 hours, intrapartum fever (intraamniotic infection), what should be given?
Antibiotics
Constant urinary dribbling, decreased perineum sensation (diabetic history), what is the most common cause?
Overflow Incontinence
Placenta Previa is painless vaginal bleeding after how many weeks?
20 weeks
Indomethacin is a uterine tocolytic that can be used when? How much time can it buy you?
< 32 weeks
48 hours
Woman that has had a mechanical valve replaced, what is the anticoagulation scheme for pregnancy?
First Trimester has LMWH use
Second and Third trimester use Warfarin
Just before birth, use LMWH
Unfractionated Heparin is cleared how?
Low Molecular Weight Heparin is cleared how?
Hepatically and Renally
LMWH is renally cleared, cannot use in bad renal patients
Baby with a cleft lip, what are the three things that are needed to make a surgical repair?
Reconstruction at 10 weeks, weight 10lbs, and 10 g of hemoglobin
Mammograms start at 50-74 and are how often?
Every 2 years
Mammograms start early if breast cancer has what in the family?
Breast Cancer occurs in 2 first degree family members
If a patient has bariatric surgery, how long should they wait to become pregnany?
1 year
What two antibiotics are contraindicated in 1st semester pregnancy?
Nitrofuratonin
TMP-SMX
What is the non-delusional belief that a woman is pregnant but she is not pregnant?
Pseudocyesis
What is an autoimmune inflammatory disease that can occur during pregnancy that is an antibody reaction to the basement membrane?
What is the best treatment?
pemphigoid gestations
Steroids
If a woman has intrahepatic cholestasis of pregnancy, what is the lab value going to show?
Increase in bile acids
Are there any screening tests that are required for Tamoxifen when being used?
No, only evaluate if symptoms start
Constant urine leaking and decreased perineal sensation is code for what?
Overflow Incontinence
Patient has an elevated AFP, unsure about fetal abnormalities, what is the next test that should be ordered?
Fetal Ultrasound
If a patient has PPROM, what condition is concerning regarding the baby?
Umbilical Cord Prolapse
At 28 weeks, what is the a standard blood test that pregnant woman should have, assuming nothing obviously wrong?
CBC
Overflow incontinence has what anatomical problem underlying the patient?
Impaired Detrusor contractility
Urge Incontinence has what anatomical problem underlying the patient?
Sudden, overwhelming urge to urinate
Stress Incontinence has what anatomical problem underlying the patient?
Decreased Urethral Sphincter Tone and Urethral Hypermobility
Urge incontinence will say what in the question STEM?
Sudden, Overwhelming urge to urinate
Untreated appendicitis can lead to what complication?
pylephlebitis or infective portal vein thrombosis
Preterm babies at risk of early delivery before week 32 weeks, what should be given?
Preterm babies at risk of early delivery before week 34 weeks what should be given?
Magnesium, indomethacin, steroids
Corticosteroids and Nifedipine (fetal lung development), no benefit for babies at week 34-37 week
If pregnant, have an exophytic mass (looks like cervical cancer), HIV+ viral load is super high, do I biopsy/investigate cervical cancer lesion?
yes, investigate, because the patient is immunocompromised
A woman has anti-phospholipid syndrome, a clot during pregnancy, heavy menstrual periods, chronic anticoagulation, and she would like to talk about contraception options. What is the best recommendation?
IUD with progesterone only
Cu IUDs cannot be prescribed with a heavy bleeding history
Estrogen cause what to happen to the TBG?
Increased synthesis
High TSH levels can be due to high BHCG levels, this can cause hyperthyroid symptoms. What is the name of this disease?
Gestational Transient Thyrotoxicosis
Breastfeeding mom has metronidazole given for Trichomonas, what should she do with her breast milk?
Breast Milk should be discarded for 24 hours, then resume, MTZ is a one-time dose
Hemodynamically stable patients, what drug should be given?
Methotrexate
Mifepristone and misoprostol are used to help do what?
Prime the uterus for aborition
Sickle Cell Patients are a high risk of Pre-eclampsia, what is a necessary test at the patient’s initial visit?
24 hour urine collection, looks at protein baseline
Do RH positive women need a Kleihauer-Betke test to evaluate for hemolytic disease of the new born?
No
Subchorionic hematomas are treated how?
Increased risk of what?
Expectant Management
Spontaneous Abortion
Pregnant woman gets bacterial vaginosis, what is the drug of choice?
Will it affect the baby?
Clindamycin
No baby impact
Patients that have acute cervicitis, IUD. ABX need to be given, does the IUD need to come out or cultures taken?
Given prophylactic abx and keep IUD in place
What gestational age is the oral glucose tolerance test done?
24-28 weeks
How is a urethral Diverticulum diagnosed?
MRI of the pelvis
Urethral Diverticulum can be described as what?
Tender fullness in the anterior vaginal wall, hx of multiple UTIs
What is the absolute smoking contraindications to OCPs?
Smoking more than 15 cigarettes a day and/or migraines
Can still do OCPs if a few cigarettes a day, I know
High risk of pre-eclampsia, had before, what should patients do at 12-16 weeks?
Start Aspirin
Probability of a test that is positive over general population, what test should be evaluated?
Likelihood ratio
Ethical Principal: ensures that methods used to achieve a worthwhile goal are necessary, appropriate, and not excessive, is what?
Proportionality
Neonatal Chlamydia can cause conjunctivitis and pneumonia, but what other condition can it cause?
Preterm prelabor rupture of membranes
If pregnant patient has genital warts, what is the best pregnancy route?
Vaginal and Expectant management, no C-section benefit
1st line abx treatment in a complicated UTI (acute cystitis) is what?
Fosfomycin
Vulvodynia is what?
Tx?
3 months or more of very sensitive vulva tenderness, sharp, raw burning pain with Q-tip contact
Cognitive Behavioral Therapy, Pelvic Floor PT, Behavior Modification
In a 1st trimester woman, a patient has a slightly decreased TSH and increased T4, is this normal?
Yes, 2/2 estrogen during pregnancy
Postmenopausal patients, tamoxifen use, and pelvic radiation cause an increase for what?
Uterine Sarcoma, remove Uterus
After a woman has a cerclage placed, is she allowed to exercise?
No she cannot exercise
Normal Amniotic fluid index is between what two numbers?
5 to 24 cm
Gestational Diabetes will cause oligohydramnios or polyhydramniosis?
Polyhydramniosis
A pregnant woman with nausea and vomiting can be discharged. What are the best medications to give her?
Oral Vitamin B6 and H1 antihistamine
No glaring past medical history, when should mammograms start?
Are breast self exams helpful when decreasing mortality?
Age 50
Not helpful with decreasing mortality
A nulliparious woman can push for how long with or without an epidural before a C-section can be discussed?
3 hours before C-section
4 hours before C-section with Epidural
If a patient is sexually assaulted, what is the best contraception opition?
Ulipristal therapy
Kidney Failure
AMS
Fever
Abdominal Pain/Nausea
Petechial Rash
What is this?
TTP
Acute Fatty liver of pregnancy and HELLP syndrome show up in what trimester and what else?
3rd trimester and elevated liver enzymes
A stable methadone use patient can or cannot breastfeed after a baby’s birth?
Can breastfeed, assuming she is stable
Amenorrhea before age 40, elevated FSH and low estrogen, what is the next best step?
Karotype Analysis
What medication types can decrease the patient’s OCP efficacy?
Anti-seizure medications
Positive Pregnancy test, vaginal bleeding, pelvic pain/pressure, and birth 4 months ago, and an enlarged uterus, what could this be?
Gestational Trophoblastic Neoplasia/choriocarcinoma, can be malignant, should remove ASAP
A clinic can “fire” a patient as long as notice is given of how long?
30 day notice
What weeks is the anti-RH(D) immunization given if a person requires the transfusion?
1st prenatal visit, 28 weeks, and postbirth (within 72 hours)
External Cephalic Version can be done during what timeframe?
Greater than 37 weeks
What syndrome is a contraindication to pregnancy?
Eisenmenger Syndrome
Rh(d) + mom and Rh(D) negative Dad, will they have problems?
No, mom with Rh(D) + does not have problems
Motile, Flagellated organisms are what disease?
What is the treatment?
Trichomonas
Oral Metronidazole for both patient and partner
Is the flu vaccine recommended during pregnancy?
Yes
Internal Cephalic Version does what?
The maneuver moves a baby from breech position to a breech position, i.e. the head is moved towards the stomach and feet toward the vagina
What does Letrozole do?
Inhibits aromatase and decreases estrogen production from androgen conversation, then it stimulates ovulation
Melasma during pregnancy can be treated how?
Sunscreen and sun exposure avoidance
DTAP should be given during what part of the pregnancy?
27-36 weeks
Pelvic Inflammatory disease, what is the most likely risk factor?
Multiple Sexual Partners
Unexplained nipple discharge from breast, what test should be ordered next?
Mammogram plus ultrasound
Patient has a pale vagina and type 1 DM history, what is the most likely diagnosis?
Vitiligo
Group B strept treatment, what is the best tx when the patient is allergic to penicillin?
Cefazolin
Over what number is fetal tachycardia?
160 bpm plus
If a patient has platelets between 100 to 150k is that normal despite almost having double the value earlier? Previous pregnancy visit
Yes, this is normal
If a patient has elevated prolactin levels over 200, what should be done next?
Order a Brain MRI, medications only increase around 100
What is a common psych medication that can decrease the seizure threshold?
Clozapine
If a patient takes Lithium, 2 years, no relapses, and wants to change, what should be done?
Keep same dose, same routine
Preeclampsia
Abruptio Placentae
Uteroplacental Insufficiency
Renal Anomalies
NSAIDs
These will do what to aminotic fluid index?
Oligohydramnios
Esophageal/duodenal atresia
Anencephaly
Multiple Gestation
Congenital Infection
Diabetes Mellitus
These will do what to aminotic fluid index?
Polyhydramnios, increased preterm pre-labor rupture of membranes
Placenta Previa will have light or heavy bleeding?
Vasa Previa will have light or heavy bleeding?
Which one will a patient present with hemodynamic instability?
Both are light
Placenta Previa will present with a mother hemodynamically unstable
