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ABOG > ABOG > Flashcards

ABOG Flashcards

1
Q

At what week is amniotic fluid composed of urine?

A

20w

before that it comes through fetal skin

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2
Q

How much does atypical ductal hyperplasia increase the risk of breast cancer?

A

4-5 fold risk

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3
Q

What percentage of patients with atypical ductal hyperplasia have concurrent cancer?

A

30%

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4
Q

Clinical diagnostic factors of APAS?

A

personal h/o VTE or pregnancy morbidity:
missed at >10w
delivery at <34w d/t PIH
3+ SABs at <10w

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5
Q

Lab diagnositc factors of APAS?

A

Anti-cardiolipin antibodies
Anti beta 2 glycoprotein
lupus anticoagulant
(x2 12 w apart- same lab abnormality)

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6
Q

How do you dx APAS?

A

one lab abnormaility (12w apart) and 1 clinical factor

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7
Q

What medication should patients take when pregnant with APAS? Which is most helpful?

A

heparin and aspirin from pregnancy through 6w PP

Heparin reduces VTE and fetal loss

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8
Q

At what spinal level does the abdominal aorta exist?

A

T12 to L4

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9
Q

What is the order of vessels off the abdominal aorta from top to bottom

A

Celiac Trunk
SMA
Ovarians
IMA

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10
Q

What do the ovarian veins drain into?

A

Right ovarian > IVC

Left ovarian > left renal

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11
Q

What is add back therapy?

A

Norethindrone 5 mg daily

Prolongs use of lupron from 6 mo to 12 mo

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12
Q

What is the biggest worry with prolonged lupron use?

A

decrease in bone density

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13
Q

Definition of arrest of labor

A

> 6 cm with ROM
with adequate ctx x4h (200 MVU)
without adequate ctx x6h

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14
Q

What is the definition of prolonged latent phase of labor?

A

Nullip: >20h
Multip: > 14h

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15
Q

3 signs of AFE

A

hypoxia
hypotension
coagulopathy

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16
Q

What happens to the heart in an early stage AFE? Late phase AFE?

A

Early phase: right ventricular failure

Late phase: left ventricular failure

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17
Q

What should you limit in management of an AFE?

A

Limit excessive fluid resuscitation to avoid pulmonary edema

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18
Q

How do you calculate an anion gap? What is normal?

A

Na - (Cl+HCO3)

Normal: 12 +/- 4

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19
Q

What is the risk of ovarian cancer in the general public?

A

1.5%

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20
Q

What is the risk of ovarian cancer in a BRCA1 patient? BRCA2 patient?

A

Ovarian cancer
BRCA1 40%
BRCA2 15%

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21
Q

What is the risk of breast cancer in a BRCA1 patient? BRCA2 patient?
What types of breast cancer develop?

A

Breast cancer
BRCA1 60%- triple negative
BRCA2 50%= ER/PR +

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22
Q

What percentage of term pregnancies will be breech?

A

2-3%

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23
Q

Breech maneuvers: what is the pinnard manuever?

A

Deliver legs

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24
Q

Breech maneuvers: What is the Loveset maneuver?

A

resolve nuchal arm

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25
Q

Breech maneuvers: What is the Mauiceau-Smelli-Veit maneuver?

A

maxillary pressure

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26
Q

Breech maneuvers: What is the Prague maneuver?

A

flexing neck by supporting body

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27
Q

Criteria for breech delivery of second twin?

A

EFW >1500g

A larger than B

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28
Q

EFW cut off for breech delivery of singleton?

A

EFW > 2500g

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29
Q

Most common “mortal complication” of laparoscopy?

A

1) anesthesia
2) vessel injury
3) bowel injury

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30
Q

Repair of bowel injury at time of laparoscopy: serosal abrasion

A

no repair

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31
Q

Repair of bowel injury at time of laparoscopy: serosal and muscularis injury

A

oversew

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32
Q

Repair of bowel injury at time of laparoscopy: Veress needle

A

conservative management

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33
Q

Repair of bowel injury at time of laparoscopy: Defect <6 mm

A

closure in layers with 3-0 vicryl or PDS

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34
Q

Repair of bowel injury at time of laparoscopy: Full thickness defect > 2cm

A

double layer closure

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35
Q

Repair of bowel injury at time of laparoscopy: injury >1/2 of lumen or affecting mesenteric blood supply

A

bowel resection

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36
Q

Repair of bowel injury at time of laparoscopy: thermal injury

A

resection with 5 cm margin to prevent future perforation

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37
Q

Repair of bowel injury at time of laparoscopy: needle stick

A

irrigation, suction, ABX

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38
Q

Amsel’s criteria for BV

A

3 out of 4:

1) thin grey discharge
2) pH >4.5
3) + whiff amine test (10% KOH)
4) clue cells on >20% of epithelial cells

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39
Q

True or false. It is inappropriate to screen or treat asymptomatic pregnant women for BV w/o h/o PTD.

A

true

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40
Q

Contraindications to breast feeding

A 
active herpes on breast (continue to pump)
HIV
Ebola
Infant with galactossemia
Meth use
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41
Q

Which aspect of the BPP indicates chronic fetal well being?

A

MVP

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42
Q

BPP. At what week GA does tone develop?

A

8w

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43
Q

BPP. At what week GA does gross movements develop?

A

9w

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44
Q

BPP. At what week GA does breathing develop?

A

21w

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45
Q

BPP. At what week GA does FHR reactivity develop?

A

26-32w

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46
Q

What is the order of disappearance in BPP?

A

breathing, FHR
decrease movement
decreased tone

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47
Q

At what BPP score should you deliver? At what score should you crash?

A

deliver at 4/10

crash at 0 or 2/10

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48
Q

Components and definitions of aspects of BPP

A 
Breathing: 1+ episode >30 seconds
Movement: 3+ limb movements
Tone: 1+ extend/flex ext or open/close hand
MVP >2 cm
NST reactive
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49
Q

What is needed for a contraction stress test?

A

3 ctx (lasting 40 sec) per 10 minutes

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50
Q

What is a + CST?

A

FAIL

lates after >50% of ctx

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51
Q

What is an equivocal CST?

A

If ctx last too long or occur too often > decels

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52
Q

What is an equivocal-suspicious CST?

A

“occasional” decels

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53
Q

What is a negative CST?

A

PASS!

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54
Q

What kind of virus is CMV?

A

Double stranded DNA

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55
Q

What is the incubation period of CMV?

A

28-60 days

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56
Q

How do you test a mother who might have CMV?

A

maternal IgG and IgM (M can be elevated x9-12 mo)

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57
Q

How does CMV manifest in fetuses?

A 
Intracranial calcifications
Hydrocephalus
Microcephaly
Hepatosplenomegaly
FGR
Echogenic bowel
Hydrops
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58
Q

What percentage of deliveries are affected by chorio?

A

2-5%

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59
Q

What is the treatment for chorio (with dose)

A

amp 2g q6h +

gent 5 mg/kg daily

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60
Q

What are the most common presentations of chorio in order?

A

1) maternal fever
2) leukocytosis (supportive but not diagnostic)
3) maternal tachycardia
4) fetal tachycardia

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61
Q

What is the most common type of fetal malformation?

A

VSD (accounts for 50%)

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62
Q

What is the least common type of fetal cardiac anomaly?

A

Truncus arteriosus

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63
Q

What fetal anomalies does T2DM put you at risk for the most (in order)

A

1) Cardiac
2) spina bifida
3) sacral agenesis

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64
Q

What affect does uncontrolled T2DM have on the risk of fetal anomalies?

A

HgbA1c 10+ = 20-25%risk of fetal cardiac anomalies

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65
Q

How is cervical cancer staged?

A

clinically

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66
Q

What is a rad hyst?

A

taking uterines at their origin
all ligaments at their attachments
top 1/3 of vagina

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67
Q

What are normal cord gases?

A 
pH 7.28 +/- 0.05
pCO2 50 +/- 8
pO2 20 +/- 16
HCO3 20 +/- 2
Base deficit 4 +/-3
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68
Q

What level of base deficit indicates metabolic acidosis?

A

12

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69
Q

Which cardiac disease is most associated with death during delivery? when?

A

aortic stenosis. (often from bicuspid aorta)

at CLE placement (2/2 decrease in preload)

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70
Q

NY class of CHF

A

1: normal
2: no symptoms at rest, starts at 2 blocks
3: dyspnea with any activity, okay at rest
4) dyspnea at rest

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71
Q

Karyotype of CAH

A

46 XX

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72
Q

How is CAH inherited?

A

Autosomal recessive

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73
Q

Most common cause of CAH?

A

21-hydroxylase deficiency causes increase in 17-OHP

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74
Q

Cholestasis of pregnancy presentation?

A

intense pruitis without rash

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75
Q

What increases your chance of cholestasis? by how much?

A

Hep c by 20%

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76
Q

How is CF inherited?

A

AR

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77
Q

Which chromosome is CF mutation on?

A

Chromosome 7, delta 508

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78
Q

What is CF?

A

mutated CL channel in epithelial cells

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79
Q

Cerclage indications:

A

1) Hx indicated: h/o 2t SAB without labor or abruption OR h/o cerclage due to cervical insufficiency
2) Physical exam: rescue cerclage. Cervical insufficiency in 2T
3) US indicated: h/o PTD <34w AND CXL <25mm at <24w

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80
Q

How long will a rescue cerclage prolong pregnancy?

A

4w

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81
Q

Cardinal Movements of labor

A 
Engagement
Descent
Flexion
Internal Rotation
Extension
External rotation (restitution)
Expulsion
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82
Q

At what glucose level should you check ketones?

A

200

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83
Q

What is the goal potassium during DKA? How to keep it there?

A

K= 3.3-5.3
if <3.3 hold insulin and give K
if >5.3 trend q2h

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84
Q

What does insulin do to potassium?

A

drives K into cells, so in DKA patient’s K will look okay, but will actually need repletion

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85
Q

What is the dose (bolus and maintenence) of insulin for a patient in DKA?

A

Bolus: 0.1 unit/kg
Maintainence: 0.1 unit/kg/hr

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86
Q

Goal glucose for patient in DKA

A

<200

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87
Q

Soft Markers for Down’s Syndrome on 1T scan

A

cystic hygroma

thickened nuchal tranlucency

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88
Q

Soft Markers for Down’s Syndrome on 2T scan

A 
echogenic cardiac focus
pyelectasis
echogenic bowel
ventriculomegaly
choroid plexus cyst
short femur
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89
Q

When is the highest risk for DVT?

A

6 weeks PP

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90
Q

How long should a patient stay on AC for a provoked DVT/ Unprovoked DVT?

A

Provoked: 3 months

Unprovoked (or with active cancer): indefinitely

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91
Q

How long does lovenox need to be help prior to CLE placement?

A

PPX dose: 12h

Therapeutic dose: 24h

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92
Q

What is the immediate treatment for an acute DVT?

A

IV heparin: bolus 80u/kg + maintenance 18u/kg/hr
Then transition to warfarin (or lovenox 1 mg/kg BID)
- DVT x3 mo
- PE x6 mo

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93
Q

What percentage of US adults have T2DM?

A

15%

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94
Q

When should screening for T2DM start?

A

at age 45yo

OR in patient with BMI >25 with other risk factors (sedentary life style)

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95
Q

How oftern do you screen for T2DM?

A

q3y

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96
Q

What lab values are diagnostic of T2DM?

A

HgbA1c 6.5%+
fasting >126
2h >200
random >200* only if pt has polyuria/polydypsia

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97
Q

HgbA1c cut offs?

A

normal: <5.7
Pre-DM: 5.7-6.5
DM: 6.5

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98
Q

Delivery timing for diabetic who is CONTROLLED by insulin?

A

up to 39w6d, not past 40w

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99
Q

How much does obesity increase your risk of endometrial cancer?

A

2-4x

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100
Q

What is the false negative rate of an EBx?

A

1%

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101
Q

What percent of the endometrial cavity does an EBx sample?

A

5-15%

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102
Q

Compare Type 1 endometrial cancer to Type 2

A

Type 1:

  • endometrioid (adeno)
  • low grade, less aggressive
  • white women
  • estrogen dependent

Type 2:

  • clear cell, pap serous
  • high grade, aggressive
  • non-white women
  • p53 mutation
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103
Q

What cell is present in clear cell?

A

hob nail

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104
Q

What is the most common diagnosis associated with echogenic bowel as an isolated finding?

A

normal pregnancy (80-90%)

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105
Q

First line treatment for endo? 2nd line? Then what?

A

1st: NSAIDs
2nd: continuous OCP’s or progesterone only
3rd: dx l/s

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106
Q

What percent of women with endometriosis will still have symptoms after surgery?

A

15%

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107
Q

Where is the most common endometriosis implant?

A

Ovary (50%)

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108
Q

What is ulipristal? How long does it work? How does it work?

A

form of emergency contraception
effective up to 5 days
inhibits follicular rupture

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109
Q

How is levonorgestrel used as emergency contraception? dose, how long does it work, MOA

A

levonorgestrel 1.5 mg once of 0.75 mg x2
effective up to 3 days
delays follicular development

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110
Q

What is the most effective form of emergency contraception? How does it work and for how long?

A

Copper IUD
up to 5 days
affects sperm viability

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111
Q

How to measure EDD?

A

<14 weeks by CRL

>14w by growth scan

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112
Q

When to change EDD?

A 
<9w: if 5+ days
9-16w: 7 days
16-22w: 10 days
22-28w: 14 days
>28w: 21 days
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113
Q

Most common cause of endocarditis

A

staph aureus (>50%)

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114
Q

When would a woman need ABX PPD for vaginal delivery or dental procedures?

A

if she has a prosthetic valve to prevent endocarditis

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115
Q

Indications for EBx in post-menopausal women?

A

with VB and ES > 4mm

without VB and ES> 11mm

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116
Q

Indications for EBx in pre-menopausal women?

A 
if >45yo any AUB
if <45yo: obese with AUB
- obese with extra estrogen exposure
- Lynch syndrome
- anovulatory > 6 months
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117
Q

When to perform EBx on patient with AGUS?

A

only if they are >35yo

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118
Q

What kind of mutation is Fragile X?

A

trnucleotide repeats on FMR1 mutation (CGG)

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119
Q

What is considered a premutation of Fragile X (vs a mutation) and why is this clinically significant?

A

Pre-mutation: 55-200 repeats
- 25% develop POF (<40 yo)
Mutation: 200+ repeats (not associated with POF)
- hypermethylation causes gene inactivation

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120
Q

What is the definition of FGR?

A

EFW or AC < 10%Ile

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121
Q

When to deliver FGR baby?

A

Isolated: 38-39w6
If < 3%ile: 37w

If complicated by oligo or abnormal dopplers: 32-37w6d

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122
Q

What is a common pregnancy outcome of women with flu?

A

PTD

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123
Q

Oseltamivir, when to give, dose

A

give to pregnant women with the flu within 48h of onset and + test.
75 mg x 5d

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124
Q

Dose of folic acid for pregnant women?

A

normal: 400 mg daily

h/o NTD (personal or fam hx): 4 mg (4k mcg)

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125
Q

How much does appropriate folic acid supplementation decrease the risk of a NTD in a high risk woman?

A

decrease risk by 70%

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126
Q

What is fetal SVT? First line treatment?

A

FHR > 200 bpm

1st line: digoxin (50% success rate)

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127
Q

Chance of VTE in pt with factor V leiden?

A

h/o VTE: 17%

without h/o VTE: 1%

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128
Q

What is the most common inherited thrombophilia?

A

Factor V Leiden

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129
Q

Diagnostic for failed IUP

A

CRL > 7 mm without CA
Mean sac diameter > 25 without embryo
No embryo with CA 14 days after GS without YS
No embryo with CA 11 days after GS with YS

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130
Q

Most common aneuploidy associated with failed IUP

A

trisomy 16

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131
Q

What percentage of women with gDM will develop T2DM?

A

in PP period: 1/3

in lifetime: 70%

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132
Q

Risk of GTN in complete mole? In incomplete mole?

A

complete mole: 15%

incomplete mole: 1%

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133
Q

How to treat GTN?

A

very chemosensitive:
if WHO score< 7 MTX
if WHO score > 7 EMA/CO

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134
Q

How to diagnose GTN?

A

Hcg plateau over 4w (+/- 10%)

Hcg rise 10% over 3 values in 3w

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135
Q

What is needed after dx of GTN?

A

CXR, check TSH

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136
Q

Which GTN has a different treatment and what is it?

A

Placental site trophoblastic tumor is not chemosensitive, needs hyst

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137
Q

When would you expect to see treatment response for genital warts?

A

3w

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138
Q

What is the treatment for genital warts in a pregnant woman?

A

Trichloroacetic acid

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139
Q

Pregnancy outcomes for women with Grave’s dz?

A

medically indicated preterm delivery

babies can be hyper- or hypo-thyroid

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140
Q

Doses of gardasil

A

if <15yo= 2 doses
0 and 6-12 mo
if >15yo = 3 doses
0, 1-2 mo and 6 mo

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141
Q

Which strains of HPV does gardasil cover?

A

6, 11, 16, 18, 31, 33, 45, 52, 58

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142
Q

Which aneuploidy is associated with holoprosencephaly?

A

Trisomy 13

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143
Q

How does holoprosencephaly present?

A 
fused thalami
single ventricle
no CSP or midline facial structures
cyclopia
nasal agenesis
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144
Q

When is hysteroscopy best performed?

A

Early proliferative phase

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145
Q

Examples of electrolyte poor fluid

A

glycine 1.5%
sorbitol 3%
mannitol 5%

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146
Q

What is the max fluid deficit for electrolyte poor fluid in hysteroscopy?

A

1L

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147
Q

What is an advantage to electrolyte poor fluid in hysteroscopy?

A

use of monopolar energy

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148
Q

What is an example of high viscosity fluid in hysteroscopy and what is an adverse event it can cause?

A

Dextran can cause DIC

fluid deficit is 300 cc

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149
Q

Examples of electrolyte rich fluid

A

NS

LR

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150
Q

What is the max fluid deficit for electrolyte rich fluid in hysteroscopy?

A

2.5 L

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151
Q

Mechanism of active of heparin

A

binds anti-thrombin 3, indirectly inhibits thrombin

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152
Q

How to reverse heparin

A

Protamine sulfate

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153
Q

What is FDA approved for hair growth associated with hirsutism? MOA?

A

Eflornithine (topical)

inhibits ornithine decarboxylase

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154
Q

What kind of virus is Herpes?

A

double stranded DNA

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155
Q

What is the incubation period for herpes?

A

2-12 day

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156
Q

What is the treatment for herpes?

A

Acyclovir 400mg PO TID x 5 days

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157
Q

How much does suppressive treatment during pregnancy decrease herpes outbreaks at time of delivery?

A

decrease by 75%

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158
Q

What percentage of women will develop genital herpes in their lifetime?

A

20%

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159
Q

What percentage of women with herpes will have a recurrence during pregnancy?

A

75%

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160
Q

What is the gold standard diagnostic tool for herpes?

A

PCR of vesicular fluid

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161
Q

What is the percentage of herpes transmission to baby in an active outbreak? Both primary and recurrent?

A

Primary: 40-80%
Recurrent: 1-3%

162
Q

What pregnancy outcomes can uncontrolled hyperthyroidism have during pregnancy for mom? For baby?

A

maternal: CHF, PIH
fetal: hydrops

163
Q

What meds do you use for hyperthyroidism in pregnancy?

A

1T: PTU
2T: Methimazole

164
Q

What adverse outcomes does PTU cause?

A

maternal hepatotoxicity

165
Q

What adverse outcomes does methimazole cause?

A

cutis aplasia

esophageal atresia

166
Q

What kind of virus is HPV?

A

double stranded DNA virus

167
Q

What percentage of cervical cancer are HPV 16 and 18 responsible for?

A

together: 70% of cervical cancer
16: 60% of sqCC and 40% of adeno
18: 40% of adeno and 15% of sqCC

168
Q

What is E6 and how does it work?

A

E6: oncoprotein

inhibits p53> tumor suppressor gene

169
Q

What is E7 and how does it work?

A

E7 inhibits Rb

Rb normal induces apoptosis for damaged DNA

170
Q

How fast will a woman with a normal immune system clear HPV?

A

90% of women will clear in 8-24 mo

171
Q

Normal HgB electophoresis

A

HgB A: 95%
HgB A2: 3%
HgB F: 2%

172
Q

Who should have a HgB screen in pregnancy?

A

Black women should have electrophoresis with their CBC

Mediterranean or southeast Azn need electrophoresis if their CBC is abnormal

173
Q

What causes Hypoxic Ischemic Encephalopathy?

A

an acute hypoxic event before delivery

174
Q

How do you diagnose hypoxic ischemic encephalopathy?

A

apgar <5 at 10 minutes
fetal umbilical arterial acidemia
multi-system organ failure
quadriplegia or CP

175
Q

What imaging is used to help diagnose hypoxic ischemic encephalopathy?

A

MRI 2h after birth

176
Q

APGAR score

A

Appearence: cyanotic 0/ peripheral cyanois 1/ pink 2

Pulse: 0=0/ <100=1/ 100-140=2

Grimace: no response to stimuli=0/ weak cry= 1/ cry when stimulated=2

Activity (tone): floppy: 0/ some flexion=1/ well flexed, resist extension=2

Respiration: apneic=0/ slow irreg breathing=1/ strong cry=2

177
Q

What is the viral load threshold for HIV?

A

1000

178
Q

Delivery planning for woman with HIV, viral load >1k?

A

CS at 38w

179
Q

When is vaginal delivery okay for a woman with HIV?

A

viral load <1k

180
Q

What is the transmission of HIV in a vaginal delivery of a woman with a viral load <1k?

A

1-2%

181
Q

What is the vertical transmission of HIV in a woman with viral load >1k?

A

25%

182
Q

What is the most common hemolytic dz of the newborn and how does it present?

A

ABO incompatibility

presents as jaundice

183
Q

Which hemolytic dz of the newborn is most deadly?

A

Kell. Causes fetal hemolysis and anemia

184
Q

What to do if a woman tested positive for Kell ab?

A

test dad.

if + : MCA Dopplers to assess for fetal anemia

185
Q

Which anti-body does not cause hemolytic dz of the newborn and why not?

A

Lewis (l), IgM can’t cross placenta

186
Q

Contra-indications to HRT

A

h/o DVT or stroke
estrogen dependent cancers
liver dz
undiagnosed vaginal bleeding

187
Q

Branches of the anterior branch of the internal iliac artery

A 
Uterine
Umbilical
Superior vesical
Obturator
Internal Pudendle
Inferior Gluteal
Middle Rectal
Vaginal
188
Q

Branches of the posterior branch of the internal iliac artery

A

Iliolumbar
Lateral Sacral
Superior gluteal

189
Q

How to induce an IUFD with h/o CS

A

<28w: prostaglandins (miso 200-400 PV)

>28w: pit (OB protocol)

190
Q

Best cells to send for microarray in the setting of an IUFD?

A

amniocentesis

191
Q

Pathogenesis of ITP

A

IgG anti-platelet

192
Q

When to treat ITP

A

if PLT <30
if PLT <70 before CLE
if PLT <50 before surgery
symptomatic (epistaxis)

193
Q

What is the treatment regimen for ITP?

A

1st line: Prednisone 10-20 mg daily x21 days, then taper
OR
dexamethasone 40mg daily x4 days (no taper)

2nd line: IVIG 1 mg/kg x1 dose

194
Q

When do you expect PLT to rise in a patient with ITP after treatment?

A

Steroid treatment: will rise over 2w

IVIG treatment: with rise over 1-3 days, peak at 1w

195
Q

Where does the iliohypogastric nerve innervate?

A

sensory to skin over superior lateral glutes

196
Q

Where does the ilioinguinal nerve innervate?

A

sensory to skin over labia majora and mons

197
Q

How to avoid injuring iliohypogastric nerve and iliolumbar nerve in CS?

A

“smile” fascia
keep incision within borders of rectus
incision 3 cm above pubic symphysis
avoid cautery of small vessels in SubQ

198
Q

What is the major cause of decreased UOP in laparoscopy?

A

decrease in Renin

199
Q

Which entry in laparoscopy is the safest?

A

no data to support this

200
Q

What advantage does entering laparoscopically with the Hassan (open) technique provide?

A

lowest vascular injury rate

201
Q

What muscles make up the levator ani?

A

pubococcygeus
ileococcygeus
puborectalis

202
Q

What causes leukorrhea of pregnancy?

A

increase in estrogen

203
Q

What anti-bodies are associated with neonatal lupus?

A

anti-Ro (SSA)
anti-La (SSB)
[normally associated with Sjogren’s]

204
Q

When is a lupus flare most predicative of how lupus during pregnancy will go?

A

within 6 months of conception.

flare within this time period is predictive of severity in pregnancy

205
Q

Medication for lupus during pregnancy?

A

Continue plaquenil (hydroxycholoroquine)

206
Q

How is Lynch syndrome inherited?

A

Autosomal dominant

207
Q

What genes carry Lynch syndrome?

A

MLH1, MSH2, MSH6, PMS2, or EPCAM

*micro-satellite instability

208
Q

What percentage of patient with Lynch syndrome get colon ca? endometrial ca?

A

Lynch syndrome
Colon Ca: 50%
Endo ca: 2%

209
Q

Cancer screening for patients with Lynch syndrome

A

Colonoscopy q1-2y starting at 20-25 yo (or 2-5 years before earliest dx)
EBx q1-2y starting at 30-35yo

210
Q

What test can you run (and when) to ensure your lovenox dosing is correct?

A

Anti-Xa 4 hours after administration

Goal: 0.6-1.0

211
Q

Which patients need testing to make sure they are getting the right dose of Lovenox?

A

morbidly obese or with renal dz

212
Q

When should you switch from lovenox to heparin in pregnancy?

A

at 36-37w

213
Q

How does listeria present?

A

headache, fatigue, myalgias

can cause abscesses in placenta or fetus

214
Q

What type of bacteria is listeria?

A

gram +

215
Q

What is the treatment for listeria in a pregnant woman?

A

amp IV x14d

if PCN ALL: bactrim

216
Q

What percent of lactating women will get mastitis?

A

5-10%

217
Q

What is the most common bacteria in mastitis?

A

staph aureus (40%)

218
Q

Treatment for mastitis? What if no response?

A

dicloxacillin 500 mg PO QID x10-14 days

if no response in 48-72h, US for abscess

219
Q

When does mastitis present?

A

3-4 w PP

220
Q

If you think a patient might have MRSA mastitis, what is the treatment?

A

clindamycin 450 PO TID x10-14d

221
Q

What is another name for Mullerian Agenesis?

A

Myer-Roktansky-Kuster-Hauser syndrome

222
Q

What is the prevalance of Mullerian Agenesis?

A

1 in 5k

223
Q

What percent of women with Mullerian agenesis have skeletal abnormalities?

A

90%

224
Q

What percent of women with Mullerian agenesis have renal abnormalities?

A

30%

225
Q

What is metabolic syndrome?

A

3 of the 5:

1) abd obesity (waist >88cm or 35 inches)
2) Triglycerides >150
3) HDL <50
4) BP > 130/85
5) Fasting glucose >100

226
Q

Who would qualify for an MRI for breast cancer screening?

A 
those at high risk:
1st degree relative with mutation
20% lifetime chance
radiation to chest at ages 10-30 yo
25-29yo with BRCA, li-frameni, Cowden, or Peutz-Jegher
227
Q

What is a therapeutic level of mag?

A

4-7 mEq/L

228
Q

What levels do mag toxicity occur?

A

loss of DTR 7-10 mEq/L
Respiratory depression >12
Cardiac arrest >15

229
Q

What is the treatment for mag toxicity?

A

1 g IV Ca gluconate

230
Q

What is a didelphys uterus? How does it occur? Pregnancy outcomes?

A

2 uteri, 2 cervixes
failed fusion of ducts
best pregnancy outcomes

231
Q

What is a septate uterus? How does it occur? Pregnancy outcomes?

A

fundal notch < 1 cm
failed medial regression
causes repeat preg loss and PTL

232
Q

What is a bicornuate uterus? How does it occur? Pregnancy outcomes?

A

fundal notch > 1 cm
incomplete fusion of ducts
causes repeat preg loss and PTL

233
Q

What is the primary procedure for a neovagina?

A

vaginal dilators (80% effective)

234
Q

What is the McIndoe neovagina procedure?

A

skin graft tube

235
Q

What is the Davydov neovagina procedure?

A

made of bowel wall/peritoneum

236
Q

What is the Vecchietti neovagina procedure?

A

traction to anterior abdominal wall

237
Q

What is the Williams neovagina procedure?

A

Skin flap from labia majora

238
Q

What measurement is an abnormal nuchal translucency?

A

> 3 mm

239
Q

When do you measure nuchal translucency?

A

10-13w (best at 13w)

240
Q

What fetal anomalies is an thickened nuchal translucency associated with?

A 
cardiac defects (septal)
abdominal wall defects
diaphragmatic hernias
241
Q

If a fetus has a thickened nuchal translucency, how much does this elevate its risk for aneuploidy?

A

increase by 50%

242
Q

What percentage of normal, healthy fetuses will have a thickened nuchal translucency?

A

<20%

243
Q

NIPT down syndrome detection rates?

A

Quad: 81%
Nuchal translucency + PAPP-A: 82%
cffDNA: 99% (10w to term)

244
Q

What is the first tri screen?

A

Nuchal translucency
Beta hcg
PAPP-A

245
Q

Work-up for patient with nipple discharge (uni) if >30yo

A

US and mammogram then possible bx

246
Q

Characteristics of nipple discharge concerning for cancer?

A

unilateral, uniductal
spontaneous (no manipulation required)
with mass or skin change
bloody

247
Q

Cut off T and Z scores for osteoporosis

A

T-score < -2.5

Z-score < -2.0

248
Q

When to use Z-score instead of T-score

A

Z-score in patients < 35yo

249
Q

When to treat for osteoporosis?

A

if 10yr major fracture risk >20%

or hip fracture risk > 3%

250
Q

When to start screening for osteoporosis and how often?

A

65yo

q15 y

251
Q

What is an omphalocele? Where is is located? What is it associated with?

A

MIDLINE abdominal wall defect at >12 w
with intestines outside of body, but COVERED by peritoneum
associated with aneuploidy and males

252
Q

What is gastroschisis? Where is is located? What is it associated with?

A

abdominal wall defect at >12w, uncovered. to the RIGHT of the umbilicus
bad outcomes, can still deliver VD
no association with aneuploidy

253
Q

How does obesity change the rates of gastroschisis?

A

decreases rates

254
Q

How does ovarian cancer spread?

A

“exfoliation” or transcoelomic (clockwise in peritoneal cavity)

255
Q

How does rupture of ovarian cancer intra-op change management?

A

Up-stage to 1C, needs chemo

256
Q

Stage that majority of ovarian cancer presents at?

A

3C (peritoneal implants >2 cm)

257
Q

Where do the majority of ovarian torsions happen?

A

right side (64%)

258
Q

What is the “whirl-pool” sign?

A

along with an enlarged ovary, this is ovarian torsion

259
Q

What percentage of ovarian torsions will have normal blood flow on doppler?

A

60%

260
Q

What percentage of Americans are obese?

A

40%

261
Q

BMI cut-offs for classes of obeseity

A

Class I: BMI 30-35
Class 2: 35-40
Class 3: >40

262
Q

What class of obesity qualifies for bariatric surgery?

A

Class 3 (BMI >40)

263
Q

Cell marker for choriocarcinoma

A

hcg

264
Q

Cell marker for dysgerminoma?

A

LDH

265
Q

Cell marker for Yolk sac (endodermal sinus)

A

AFP

266
Q

Cell marker for Epithelial ovarian cancer?

A

ca-125

267
Q

Cell marker for granulosa cell tumor?

A

inhibin

268
Q

Cell marker for mucinous adenoma?

A

CEA

269
Q

Cell associated with clear cell

A

Hob nail

270
Q

Cell associated with yolk sac (endodermal sinus)

A

Schiller-Duval

271
Q

Cell associated with granulosa cell

A

call-exner bodies

272
Q

What type of study is odds ratio used in

A

case-control (retrospective)

273
Q

When does odds ratio estimate relative risk?

A

when prevalence is < 5%

274
Q

How to calculate odds ratio?

A

AD/BC

275
Q

At what gestational age is vaccuum assisted delivery contra-indicated?

A

<34w (vacuum okay)

276
Q

What type of virus is Parvo?

A

single stranded DNA

277
Q

What is Parvo virus associated with in-utero?

A

SAB, hydrops (from aplastic anemia)

most have NO poor fetal outcomes

278
Q

How does Parvo present in women?

A

flu-like symptoms

279
Q

How to test mom for parvo? what to do if she tests positive?

A

IgM and IgG for diagnosis
if positive: serial US to look for hydrops + MCA dopplers for anemia
q 1-2 weeks for 8-12 weeks after exposure

280
Q

What percentage of weight loss is needed to decrease androgens in a patient with PCOS?

A

5%

281
Q

How do OCP’s help with hirsutism in PCOS?

A

(not FDA approved)

increase sex-hormone-binding-globulin which binds androgens, decreased hirsuitism

282
Q

What is “string of pearls” on TVUS?

A

+12 follicles per ovary (on periphery)

can be sign of PCOS

283
Q

When does perinatal depression occur? How long does it last?

A

within 1 year of delivery, lasts >2w

284
Q

What percentage of women get perinatal depression?

A

15% (1 in 7)

285
Q

Wat percentage of women get PP blues? What is it (timeline)?

A

40-80%

feeling down within 1 week of delivery, resolves in 2 weeks

286
Q

What is a normal acid-base status of pregnancy?

A

Respiratory alkalosis

287
Q

How much does plasma volume expand at term?

A

45% (1.5-2L)

288
Q

How much do RBC increase by at term?

A

25% (450cc)

289
Q

How much does SVR decrease by? And how early in pregnancy?

A

decreased by 35-40% in 1T

290
Q

How do cardiac output, stroke volume, and HR change in pregnancy?

A

Cardiac output increases by 20% (in 1T)
Stroke volume increases by 15% (in 1T)
HR increases

291
Q

How much blood flow does the uterus get a term? in a non-gravid state?

A

at term: 17% (450-650 cc)

non-gravid: 2%

292
Q

How much does renal blood flow increase in pregnancy?

A

increase by 50%

293
Q

What causes physiologic dyspnea in pregnancy?

A

increase in tidal volume causes decrease in pCO2 which increases “awareness to breathe”

294
Q

When does PP cardiomyopathy occur?

A

last month of pregnancy to 5 months PP

295
Q

When is anticoagulation needed in PPCM?

A

when EF <35%

296
Q

What medication reduces mortality in PPCM?

A

beta blockers

297
Q

If unknown etiology of pelvic pain, what percentage of women will have persistent pain after hyst?

A

40%

298
Q

How long does pelvic pain have to be there to be considered chronic?

A

> 6 mo

299
Q

What percentage of women with chronic pelvic pain have depression?

A

33%

300
Q

What percentage of women have chronic pelvic pain?

A

6-25%

301
Q

What does the pudendal nerve innervate?

A

sensory and motor of the perineum

302
Q

What nerve roots does the pudendal nerve originate from?

A

S2- S4

303
Q

What are the branches of the pudendal nerve?

A

clitoral
perineal
inferior hemorrhoidal

304
Q

Rate of preterm delivery in US

A

12%

305
Q

What percentage of women suffer from PP thyroiditis/

A

7-8%

306
Q

What causes postpartum thyroiditis? (timeline)

A

destructive antibodies within 1y of delivery or abortion releases thyroid hormone
(can be hyper or hypo)

307
Q

Why doesn’t PTU or methimazole work in PP thyroiditis?

A

Because it is due to antibodies causing thyroid hormone release, not overproduction

308
Q

Course and treatment of PP thyroiditis?

A

self-limited

beta-blockers can be used to relieve symptoms

309
Q

Pelvis type associated with transverse arrest

A

platypelloid

310
Q

Pelvis type associated with vaginal delivery (most common)

A

gynecoid

311
Q

Pelvis type associated with male pelvis, least favorable for vaginal delivery

A

android

312
Q

Pelvis type associated with OP position

A

anthropoid

313
Q

When is a presacral neurectomy indicated?

A

patient with chronic midline pelvic pain

after failure of OCP’s, NSAIDs, IUD and lupron)

314
Q

What are the most common complications with pre-sacral neurectomy and how long do these complications last?

A

urinary retention lasts 1-2w

constipation lasts 6w

315
Q

What is the dose of rhogam?

A

300 mcg

316
Q

How much whole fetal blood dose a regular dose of rhogam cover? How much fetal RBC’s?

A

Rhogam covers 30 cc of fetal whole blood

15 cc of fetal RBC’s

317
Q

When should you give PP rhogam?

A

within 72h of delivery (up to 4w)

318
Q

How much fetal blood can cause alloimmunization?

A

0.1 cc

319
Q

At what gestational age does fetal blood form?

A

7w3d

320
Q

How is sickle cell inheritied?

A

autosomal recessive

321
Q

Where is the sickle cell mutation?

A

beta globulin gene

thymine instead of adenine

322
Q

What is the risk of regret after sterilization?

A

7%

323
Q

Which type of sterilization has the highest risk of ectopic pregnancy?

A

bipolar coagulation (3cm of isthmus)

324
Q

What are benefits to permanent sterilization apart from contraception?

A

Decreases ovarian cancer risk

Decreases rates of PID

325
Q

When does a small bowel obstruction normally present?

A

4-6w post abdominal surgery

326
Q

What is the ideal imaging if you suspect SBO?

A

KUB

or CT with IV and PO contrast

327
Q

What will show on imaging of an SBO?

A

dilated loops of bowel with air-fluid levels.

Proximal dilation with distal collapse

328
Q

What physical exam finding differentiates SBO from ileus?

A

bowel sounds
hyperactive (high pitched) in SBO
absent in ileus

329
Q

What is the primary management of SBO?

A

NG tube and IVF hydration

330
Q

What is the definition of 2nd stage arrest of labor?

A

Primip without CLE >3h
Primip with CLE >4h

Multip without CLE >2h
Multip with CLE >3h

331
Q

When is a steroid taper required?

A

taking steroids for 3+ weeks or 5+ mg/day

332
Q

What is a typical steroid burst and taper at delivery?

A

hydrocortisone 25mg IV q6h.
Bolus at delivery of 100mg IV
then taper to baseline over 3d

333
Q

What does warfarin do to a fetus and when is it most susceptible?

A

nasal/midline facial hypoplasia
stippling vertebrae
worst around 8w

334
Q

What does lithium do to a pregnancy?

A

ebstein’s anomaly: downward displacement of tricuspid valve

335
Q

What does valproic acid due to a pregnancy?

A

NTD

336
Q

What does meth do to a pregnancy?

A

FGR

337
Q

What do Thalidomides do to a pregnancy?

A

limb abnormalities

338
Q

What does lisinopril do to a pregnancy and when?

A

renal agenesis

2 and 3T

339
Q

When it comes to teratogens, what are the GA cut-offs for when things are occurring that you should keep in mind?

A

0-4 w: “all or nothing”
4-11 w: organogenesis
12-15 w: CNS

340
Q

How should you adjust synthroid in a pt with hypothyroidism upon confirmation of pregnancy and why?

A

increase dose by 25% because hcg in T1 will decrease TSH (T4 stays unchanged)

341
Q

How often do you follow TSH in pregnancy in a woman with hypothyroidism?

A

q-4-6w

342
Q

What pregnancy outcomes can hypothyroidism have on a pregnancy? on a fetus?

A

SAB
PTD
abruption
PIH

demise
LBW
neurodevelopmental delays

343
Q

What is the most common TORCH infection?

A

CMV

344
Q

What pregnancy outcomes can toxo cause?

A

microcephaly

Intracranial calcifications

345
Q

What pregnancy outcomes can varicella cause?

A

FGR
limb hypoplasia
microcephaly

346
Q

What pregnancy outcomes can rubella cause?

A

FGR
cardiac defects
hepatosplenomegaly

347
Q

What pregnancy outcomes can CMV cause?

A 
FGR
venticulomegaly
hydrops
retinitis
intracranial calcifications
348
Q

What pregnancy outcomes can HSV cause?

A

FGR
microcephaly
hepatosplenomegaly

349
Q

What percentage of pregnant women with CMV are asymptomatic?

A

90%

350
Q

When is the risk of congenital CMV infection the highest? When is CMV infection the most common?

A

Highest risk in 1T

Most common in 3T

351
Q

What is the transplacental transmission rate of CMV?

A

30-40%

352
Q

If a pregnant woman gets chicken pox (varicella) at term, what is the treatment?

A

PO acyclovir within 24h of rash

353
Q

How much do multifetal gestations increase the risk of PTD?

A

twins: 6x
triplets: 10x

354
Q

What is considered discordant growth?

A

20%

355
Q

How to calculate growth discordance?

A

smaller - larger / larger

356
Q

Which type of zygosity is more common?

A

dizygotic twins (paternal) are more common than monozygotic twins

357
Q

If one twin demises >14w, what is the chance of the 2nd twin dying? What is the chance of neurologic deficit? In both mono and di twins?

A

mono:
chance of death: 15%
chance of neuro deficit: 18%

di:
chance of death: 3%
chance of neuro deficit: 1%

358
Q

When should you check chronicity in twins?

A

around 13w

359
Q

If you have mono twins, when should you start screening for TTTS and how often?

A

16w, q 2w

360
Q

Sign for di-di twins? For mo-di twins? Mo-Mo’s?

A

Di-Di: lamba (Twin peak)
Mo-Di: T sign (thinner)
Mo-Mo: no sign, same sac

361
Q

When is delivery indicated for mo-mo twins?

A

32-34w

362
Q

When is delivery indicated for mo-di twins?

A

34-37w6

363
Q

When is delivery indicated for di-di twins?

A

38w

364
Q

When do the fetuses separate for each type of twin? (days and cell stage)

A

Di-di: 1-3 days (morula)
Mo-di: 4-8 days (blastocyst0
Mo-mo: 8-13 days (implanted blastocyst)
conjoined: 13-15 days (embryonic disk)

365
Q

Definition of thrombocytopenia

A

PLT < 150

366
Q

Typical PLT level for ITP?

A

PLT <100

367
Q

What percentage of patient with ITP will have severe PPH?

A

1%

368
Q

What is the most common type of thrombocytopenia?

A

gestational

369
Q

How does gestational thrombocytopenia present?

A

PLT <150, but greater than 85

incidental finding on routine CBC

370
Q

What percentages of thrombocytopenias in pregnancy are gestational?

A

80%

371
Q

What is 2nd most common cause of thrombocytopenia in pregnancy?

A

Pre-eclampsia

372
Q

How often should you repeat labs in a pregnant woman with thrombocytopenia?

A

q3-4 w

373
Q

What is the most common acquired thrombophilia?

A

APAS

374
Q

What is the most thrombophilic thrombophilia?

A

Antithrombin deficiency

375
Q

Which factor in the clotting cascade is decreased in pregnancy (cannot test for this)?

A

Protein S

376
Q

Which thrombophilias can you not test if a patient is on anticoagulation?

A

Factor V leiden
protein C or S deficiency
anti-thrombin deficiency

377
Q

What percentage of mo-di twins have TTTS?

A

15%

378
Q

What are the stages of TTTS

A 
1 = poly-oly
2= absent bladder in donor twin
3= doppler abnormalities
4= hydrops
5= death
379
Q

What is the treatment for a TOA?

A

Cefoxitin 2g IV q6h +

Doxy 100 mg PO or OV q6h

380
Q

If no improvement of TOA after 72h of ABX, what is the next step?

A

IR drainage

381
Q

Who needs anticoagulation in pregnancy?

A

Women with a personal h/o VTE AND anti-thrombin deficiency will need lovenox during preg and 6w PP

Women with a personal h/o VTE AND all other def will need it PP for sure, intra-partum is per case

382
Q

Most common presenting signs of urethral diverticulum?

A

dribbling
dyspareunia
dysuria

383
Q

What percent of women will have recurrent UTI’s?

A

3-5%

384
Q

What is the definition of recurrent UTI’s?

A

> 2 UTI’s in 6 mo
or
3 UTI’s in 1 year

385
Q

What is the most effective treatment to prevent recurrent UTI’s?

A

1) macrobid 50-100mg PO daily (or postcoital)

2) bactrim 40/200 daily

386
Q

After ABX PPX, what other evidence based methods exist for preventing recurrent UTI’s?

A 
drink >1.5 L per day
vaginal estrogen (if postmenopausal)
387
Q

What is the Cr level of urine?

A

> 17

388
Q

What is the gold standard to diagnose ureterovaginal fistula?

A

IV Pyelogram

389
Q

What is the gold standard to diagnose urethrovaginal fistula?

A

cysto

390
Q

What dose of Vit D is in PNV?

A

400 IU (but need 600 IU daily)

391
Q

What dose of iodine is needed daily in pregnancy?

A

220 mcg

392
Q

What is the most important prognostic factor in sqCC of the vulva?

A

lymph node invasion!

inguino-femoral

393
Q

What is the most important prognostic factor in melanoma of the vulva?

A

depth of invasion

394
Q

How does vaginal cancer spread?

A

direct
lymphatically
and hemotogenously

395
Q

Which lymph nodes do the lower 1/3 of the vagina drain into? The upper 2/3?

A

lower 1/3: inguinal nodes > femoral nodes

upper 2/3: external/internal iliac nodes

396
Q

What risk factors of vulvar abscess necessitate I&D + IV ABX?

A

DM, immunosuppression of patient
>5 cm
involving other compartments
recurrent

**cover for MRSA

397
Q

Recommended weight gain in pregnancy

A

Under weight BMI <18.5: 28-40#

Normal BMI 19-25: 25-35#

Overweight BMI 25-30: 15-25#

Obese: BMI >30: 11-20#

398
Q

5 W’s and timeline of post-op fever

A 
Wind (PNA, atelectasis): POD#1-2
Water (UTI): POD#2-5
Wound (SSI): POD#5-7
Walking (DVT) : POD#5+
Wonder drugs: anytime
399
Q

What antigen is associated with Kell alloimmunization? Where does it come from?

A

K1 antigen, comes from blood transfusions

400
Q

If a pregnant woman tests + for Kell ab, what next?

A

Test dad.
If negative, no work-up.
If positive, MCA doppler’s q2w (from 18w-35w)

401
Q

What abnormal MCA doppler level necessitates a fetal transfusion?

A

MoM > 1.5

ABOG (2 decks)

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