Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB/Gyn > ACOG Qs > Flashcards

ACOG Qs Flashcards

1
Q

describe screening for gestational diabetes

A
  • done at 24-28 wks in women w/o risk factors
  • done at 1st prenatal appt for women w/risk factors (previous hx gestational DM, obese bmi>30, glucose metabolism issues
  • screen with 50g oral glucose, diagnostic test w/ 75 g 2 hr oral glucose

OR

-75g 2 hour oral glucose challenge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

def of labor

A

onset of contractions+cervical effacement and dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Latent phase Active phase

A

latent phase: 0 cm to 6 cm dilated active phase: 6 cm to 10 cm dilated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

define the diagnosis of preeclampsia

A

-htn after 20 wks gestation -BP>140/90 2 times >4 hours apart -proteinuria: >300 mg/24 hour urine, protein/Cr>0.3, urine dipstick +1 OR -systemic signs: platelets <100K, Cr>1.1, LFTS 2x normal, pulmonary edema, visual or cerebral signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

pregnancy risk factors for developing preeclampsia

A

1-preeclampsia in prior pregnancy first pregnancy multiple gestation preeclampsia in 1st degree relative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what maternal past medical history increases the risk for preeclampsia?

A

renal disease chronic htn hypercoagulability diabetes mellitus obesity >40 years old lupus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

complications of preeclampsia

A

-eclampsia-development of seizures -HELLP syndrome: hemolysis, elevate liver enzymes, low platelets (epigastric pain, malaise, nausea, headache in 3rd trimester) -placental abruption -stroke -renal damage -liver damage -ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

normal fetal heart rate

A

110-160 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

preeclamptic woman with 3rd trimester vaginal bleeding is likely due to?

A

placental abruption -signs on fetal heart tracing:tachycardia, sinusoidal heart rate pattern)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what occurs at these different MgSO4 levels in mEq/L 4-7 7-10 10-15 >15

A

4-7: therapeutic level 7-10: loss of DTRs (deep tendon reflexes) 10-15: respiratory depression (<12 breathes/min) >15: cardiac arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

1st trimester vaginal bleeding differentials

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the 3 cardinal signs of an ectopic pregnancy

A

amenorrhea

vaginal bleeding (1st trimester)

abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

gardnerella

  • signs
  • RX
A

gray white discharge

foul odor

ph>4.5

RX: metronidazole or clindamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what maternal medical condition is assoc with the highest rate of mortality

A

pulmonary htn, eisenmengers (R–>L shunt)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the management for pregnant women with cardiac diseases

A
  • discuss terminating the pregnancy
  • labor and delivery management

–early epidural to minimize cardiac stress

–forceps or vacuum assisted vaginal delivery to prevent valsalva while pushing

–fluid management: bc postpartum there’s massive venous return as vena cava is no longer impinged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

management for renal disease in pregnant women

A

1st line-recommend termination of pregnancy

-inc risk of preeclampsia, gestational diabetes, htn

  • evaluate for preeclampsia via
    • baseline level of proteinuria (bc renal disease can cause proteinuria) vs new onset proteinuria
    • uric acid levels: dec renal clearance–>buildup
    • BP inc of > 30/15
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

pregnant woman experiences tachycardia, bulging eyes, diaphoresis…diagosis..RX

A

thyroid storm

  • RX
    • PTU/Methimazole-block production of T4, PTU also (-) peripheral conversion of T4–>T3
    • B blockers-to slow HR
    • dexamethasone (-) thryoid hormone production and periheral T4–>T3 conversion
    • antipyretics
      *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pregnany woman with asthma, what should be given for

  • mild asthma
  • moderate asthma
  • acute setting
A

mild asthma-SABA as needed

moderate-if SABA use is >2x per week give SABA+inhaled corticosteroids, cromolyn (mast cell stabilizer) if refractory

acute setting-systemic steroids (oral), terbutaline (B2 agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

can radioactive I131 be given to a pregnant woman in thyroid storm

A

No-bc it can cross the placenta causing neonatal hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

pregnant woman with lupus. what are the complications

A

placental thrombosis->2nd trimester fetal loss

neonatal lupus-malar rash, heart block

***lupus can resemble preeclampsia

***perform serial fetal echos to determine risk of fetal heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what meds should be given to pregnant women with lupus

A

lovenox or heparin-to prevent placental thrombosis

aspirin-to prevent thrombosis

steroids-bc lupus is an autoimmune disease

for refractory lupus-cyclophosphamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

you suspect postpartum depression in a woman. what is your next step.

-

A
  1. evaluate for harm to self or baby
  2. prescribe an SSRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

SSRIs during pregnancy

A
  • never give an SSRI to a person with a fam hx or diagnosis of Bipolar disorder bc it could provoke mania
  • paroxetine contraindicated-causes pulmonary htn and cardiac malformations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

name the different types of herpes infections

A

initial primary infection

-1st infection, symptoms severe, antibody (-)

initial non-primary infection

-1st infection, moderate severity, antibody (+)

recurrent infection

-recurrent symptoms, mild symptoms, antibody (+)

asymptomatic infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

at what wk do we induce women for elective c-sections and why

A

after 39 wks-to prevent prematurity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

is vaginal bleeding in a perimenopausal woman with menopause symptoms a contraindication for hormone replacement therapy?

A

yes

-abnormal vaginal bleeding can be a sign of endometrial cancer, and HRT (estrogen) can worsen it. Must either perform a biopsy or US with endometrial stripe <4 mm to ok giving HRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what amt of Ca is appropriate to give a postmenopausal woman

A

1200 mg Ca total

-With inc age there’s a decrease in bioavailable vit D, which dec Ca absorption

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

risks assoc with taking HRT (estrogen +progestin)

protective effects of HRT

A
  • inc risk of breast cancer
  • CV event: thromboembolism, DVT, PE, stroke

protective effects: dec risk of colon cancer and fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

risks assoc with taking estrogen only for menopause symptoms

A

-estrogen alone causes inc risk of cv events (stroke, thromboembolism)

give estrogen to post menopausal women w/o a uterus

give estrogen+progestin to women with a uterus-to prevent endometrial hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

contraindications to taking hormone replacement therapy

A

Contraindications

Undiagnosed vaginal bleeding-could be endometrial cancer

Pregnancy

Breast cancer/endometrial cancer

Chronic liver disease

Hyperlipidemia

Recent DVT/stroke

Coronary artery disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Recommendations of hormone replacement therapy

A
  • <60 yrs, within 10 yrs of menopause
  • only treat HRT with the smallest effect dose that affects daily life
  • only treat if the pt has symptoms affect daily living, if they don’t then do expectant management (watch & wait)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

for hormone replacement therapy

  • estrogen only inc risk of
  • estrogen+progestin inc risk of
A

estrogen only-no inc risk of breast cancer, inc risk of CV events

estrogen+progestin: breast cancer (so progestins are the culprits)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

describe the source of estrogen pre and post menopausal

A

premenopause-ovaries

postmenopause-ovarian androgens converted in the periphery (fat tissue)

  • after menopause ovaries stop making estrogen, but estrogen continues to be high bc ovaries make androgens that are converted into estrone by fat tissue
  • body weight is directly proportional to estrogen levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

most common symptom of gestational trophoblastic diseases?

A

Vaginal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

a woman has a molar pregnancy removed, her b-hcg after 2 months falls then rises again. Next step

A

-redo b-hcg 48 hrs later to determine the rate of rise. you don’t know if this is persistent trohoblastic disease or normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

a woman w likely molar pregnancy, if you suspect metastatic choriocarcinoma what is the next step

A
  • do not biopsy bc choriocarcinoma is too vascular
  • instead, do a chest xray (lung mets), liver labs (liver mets), brain mri (brain mets) before surgical D&C in case you need to
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

on pelvic exam you find a fleshy mass w/a stalk off the cervix. next step

A

polypectomy-you can confirm on pelvic exam a polyp. colposcopy is not done for polyps, it’s done for suspicion of cervical dysplasia and cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

fibroids and pregnancy

  • should fibroids be followed during pregnancy
  • should fibroids be removed during pregnancy
  • complications of fibroids during pregnancy
A
  • no need to follow them during pregnancy bc most are asymptomatic
  • fibroid removal (myomectomy) is contraindicated in pregnancy and during c-sections
  • soft tissue dystocia and red (carneous) degeneration
40
Q

a pregnant woman with fibroids becomes symptomatic. what is the process causing this.

A

Red (carneous) degeneration/necrobiasis

  • venous thrombosis and
  • symptoms: pelvic/abdom pain, fever, inc wbc count

-

41
Q

which type of leiomyomas can affect implantation leading to pregnancy loss

A

submucosal and intracavitary fibroids

  • disturb endometrial vasculature
  • cause local inflammation
  • secrete vasoactive sources
  • Removal by hysteroscopic myomectomy can help improve pregnancy, but fibroids are an uncommon reason for miscarriage
42
Q

in perimenopausal and menopausal women with vaginal bleeding what is the next step in management

A

endometrial sampling to rule out endometrial hyperplasia

43
Q

mech of GnRH agonists play in treating fibroids

A

chronic GnRH use–>desensitize the pituitary via overstimulation–>dec estrogen and progesterone–>

  • dec fibroid size
  • amenorrhea->dec blood loss, improvement of anemia
44
Q

GnRH agonists for fibroid RX. characteristics

A
  • should only be used for a few months to dec fibroid size before surgery to improve anemia, and dec blood loss during surgery
  • if you stop the drug the fibroid will start growing again at its original rate
  • SE: hot flashes, last 1-2 months will on the drug
  • who should use it: women close to menopause bc at menopause dec estrogen will cause the fibroid to shrink, women who will be undergoing surgical removal
45
Q

surgical treatment options for fibroids

A
  • myomectomy: for women who want to still have kids
  • hysterectomy: for women done having kids
  • uterine artery embolization: contraindicated in women who want kids
  • endometrial ablation-contraindicated in women who want kids
46
Q

what diagnostic test would help determine kallman syndrome

A

-olfactory challenge: bc mech of disease is failure of migration of GnRH releasing hormones from the olfactory bulb—.>dec CnRH–>dec estrogen and progesterone–> lack of primary and secondary sexual characteristics+anosmia

*diagnosis of exclusion

47
Q

what other anomaly is associated with mullerian agenesis

A

renal anomalies

-should perform a renal ultrasound

48
Q

what organs does a pt with mullerian agenesis have

A

have ovaries–>secondary sex characteristics present

no uterus, no cervix, no upper vagina->ends in a blind pouch

49
Q

bluish color of the cervix…

A

Chadwicks sign-inc blood flow to the cervix=sign of pregnancy

50
Q

critical elements of sexual characteristics development

A

weight: min of 85-106 pounds is need to start menses

optic exposure to sunlight

sleep

51
Q

how does signif weight loss, excercise and anorexia lead to amenorrhea

A

anorexia causes HPO axis dysfunction by causing dec GnRH pulsatile secretion–>dec FSH, LH–>dec estrogen, progesterone->amenorrhea

**excercise induced ->normal FSH, low estrogen

-RX: gonadotropins: give FSH, LH. This is more effective than giving clomiphene

52
Q

Infertility: pt with hx of PID. What diagnostic would be used to evaluate her

A

Hysterosalpingogram-xray that visualizes the uterus and fallopian tubes. PID can cause both uterine adhesions and blockage of the fallopian tubes

-if adhesions are found the perform hysteroscopy or laproscopy to remove adhesions

53
Q

Infertility: pt with obesity, hirsutism can’t get pregnant after a year of trying. Which hormone will help aid in the dx?

A

Testosterone-high, due to inc lh>fsh ratio. Most other causes of infertility cause dec testosterone

Progesterone levels-imp after dx PCOS as low progesterone indicates anovulation.

54
Q

infertiity: woman can’t conceive after 1 yr. She is bipolar and takes antipsychotics.
- what hormone is high?
- next step

A

Prolactin is high: antipsychotics=Dopamine antagonists which inc prolactin->(-) GnRH->(-) FSH, LH,–>dec estrogen, progesterone

  • next step: change to a new drug
  • if after changing to a new drug prolactin levels are still high then –>MRI to determine if
55
Q

Infertility: Woman professional runner has hypothalamic amenorrhea and hasn’t been able to get pregnant for over 1 yr.

-RX

A

Gondadotropins (LH, FSH)

2nd line-Clomiphene:

56
Q

can basal body temp be used to time intercourse to conceive?

A

NO!

  • basal body temp rises 1 degree at ovulation, so it tells you you have already ovulated and the egg is viable for only 24 hours
  • instead use an ovulation predictor kit
57
Q

A G0P0 woman can’t get pregnant for >1 yr. She and her husband are both early with no prior STIs. next step?

A

-check male factor

–sperm

58
Q

what 2 drugs can be used to induce ovulation for women with pcos

A

metformin-drug for DM, but also inc fertility

Clomiphene-SERM

59
Q

colnonoscopy criteria

A

start at 50 yrs old

do either a colonoscopy every 10 yrs or guided sigmoidoscopy every 5 yrs

if they have risk factors: 1st degree relative with colon cancer before 60 yrs old then either start colonoscopy at 40 yrs old or 10 yrs before colon cancer diagnosis

60
Q

When should a dexa scan be performed

A

dexa scan at age 65 or if risk factors then before

61
Q

mom w/ hx of opioid abuse (merperidine) delivers a limp baby. next step in RX?

A
  • give the baby PEEP and prepare to intubate
  • wrong ans: suction and give naloxone-if mom used opiates this can cause lifethreatening neonatal withdrawal
62
Q

APGAR SCORE

A
  1. Appearance
    - pink (acyanotic)=2
  2. Pulse

>100=2

  1. Grimace
    - cough, sneeze, pull away from suction=2
    - grimace in response to nasal suction=1
    - no response to nasal suction=0
  2. Activity
    - move all 4 limbs=2
    - weak tone=1
    - flaccid=1
  3. R-respirations
    - good breathing/crying=2
    - slow, irreg breathing=1
    - absent breathing
63
Q

a baby is born vaginally. What are the immediate things to do in order

A
  1. place skin to skin contact with mom for thermoregulation, then light suction if needed
    - do not oversuction (Delee) bc (+) the posterior pharyx (+) vagus–>bradycardia
  2. 30-60 sec after birth clamp and cut umbilical cord
  3. dry off with a towel
64
Q

Naegels rule for estimated due date

A

know your LMP, have regular periods

EDD=LMP-3 months+7days

65
Q

For 1st trimester pregnancy wht is the best dating option

A

Ultrasound to measure crown rump length

66
Q

hcg

  • purpose
  • describe its rate of rise
A

-purpose: maintains the corpus luteum until the placenta takes over at 8 wks

r-ate of rise: doubles every 48 hrs. if it plateaus or doesnt rise–>ectopic, miscarriage

-

67
Q

urine hcg test

serum hcg test

A
  • urine hcg test-qualitative, only tells you if you’re pregnant or not, hcg is present in urine by day 14
  • serum hcg-quantitative, tells if you’re pregnant and hcg value, present in serum by day 6-9

-hcg peaks at 10 wks (100,000) then falls

68
Q

what week can you prove that a pregnancy is not ectopic

A

week 6-yolk sac seen on TVUS

69
Q

A D+C is being performed and fatty tissue is coming through the currette. Whats going on

A

omental fat w/possible accidental removal of bowel

-stop the D+C and perform laparoscopy to access the abdomen and look at the bowel for any signs of damage

70
Q

Complications of vacuum vs forceps delivery

A

vacuum delivery

  • cephalohematoma–>jaundice due to hemorrhage
  • lateral rectus paralysis (temporary)
  • neonatal scalp lacerations

forceps delivery

  • maternal lacerations
  • cn palsies

-

71
Q

breech presentation

-types of breech

A
72
Q

breech presentation

-management

A

before 37 wks–>nothing, bc baby is likely to move spontaneously into the vertex position

after 37 wks–>attempt external cephalic inversion (press on abdomen to get baby to move. better than internal cephalic version

-cant do this in active labor or if there are any anomalies/issues with the baby

73
Q

if a woman is in active labor and the baby is breech what is the recommendation

A

recommend a c-section to dec risk of fetal complications

74
Q

how do question stems discuss breech presentaton

A

ex: the sacrum is anterior

75
Q

what is the #1 complication of tubal ligation

A

unplanned pregnancy–>1/3 of post-tubal pregnancies end in ectopics

76
Q

cervical insufficiency

-RX

A

-painless cervical dilation causing loss of nonviable fetuses

RX: cerclage (McDonald procedure)-make a pursestring suture and the cervicovaginal junction to close the cervix.

cerclage must be removed at 37 wks or prior to labor

77
Q

biggest risk factor for ectopic pregnancy

A

previous ectopic pregnancy>inflammation (PID), tubal surgery (tubual ligation), smoking (dec fallopian tube cilia

78
Q

1st trimester bleeding differential and how to evaluate them

A

spontaneous abortion

normal intrauterine pregnancy w/implantation bleeding

ectopic pregnancy

-evaluate via b-hcg, transvaginal US

79
Q

cardinal features of ectopic pregnancy

A

1st trimester vaginal bleeding

amenorrhea+other pregnancy signs

abdominal pain

80
Q
A
81
Q

ectopic pregnancy, what to do

  • stable unruptured ectopic pregnancy confirmed
  • ruptured ectopic pregnancy, unstable

-

A
  • stable unruptured ectopic pregnancy confirmed–>salpingectomy/salpingostomy/methotrexate
  • ruptured ectopic pregnancy, unstable-exploratory laparotomy first to identify and stop abdom bleeding
82
Q

risk factors for ectopic pregnancy

A
  • # 1 previous hx of ectopic pregnancy
  • age btwn 35-44 yrs
  • tubal surgery
  • abdominal/pelvic surgery
  • congenital uterine malformations
  • inflammation (PID, endometritis)
83
Q

consequence of septic abortions

A
  1. hemorrhage
  2. infections
84
Q
A
85
Q

RX for septic abortions

A

1-maintain bp–>give IV isotonic NS, maybe vasopressors

-MAP<65 means tissues are not being perfused

86
Q

woman has a septic abortion and receives 48 hrs of antibiotics.

A
87
Q

what is hematometra

A

blood collecting in the uterus

  • cause : imperferate hymen, transverse vaginal septum, congenital cervical stenosis, can develop after an abortion
  • symptoms: cyclical abdominal pain with a pelvic mass (blood)
88
Q

when should a cerclage placed and when should it be taken out

A

placed at wk 14-to allow time to perform fetal assessments to check for chrom abnormalities etc.

removed-prior to labor at 37 wks

89
Q

Lupus

  • what does it often mimic in presentation
  • rx for myalgias/serositis, rx for severe flare ups
A
  • mimics HELLP syndrome
  • rx for myalgia, serositis: nsaids
  • rx for more severe flare ups: corticosteroids
90
Q

Pregnant woman with n/v, abdominal pain

  • diagnosis
  • Which imaging to choose
A

Appendicitis

  • Dx
    1. Compression US-show a “non-compressible tubular blind ended structure”
    2. MRI-if findings are inconclusive on US.
91
Q
A

-

  • congenital varicella-is less likely to occur if mom is infected in the 1st>3rd trimester. sx: limb hypoplasia, cns defects, cutaneous scar in dermatome pattern
  • neonatal varicella-greatest risk of developing this right before delivery, baby can then dev varicella zoster
  • contracting varicella during preg doesn’t change the mode of delivery (vaginal or c section)

RX: acyclovir 5x/day for 7 days

92
Q

pelvic pain, urinary frequency, urgency, dysparunia

A

interstitial cystitis-chronic bladder inflammation, assoc with autoimmune diseases, endometritis…

93
Q

in evaluating treatmnet options for pelvic pain, what is the biggeest predictor of treatment response

A

depression

94
Q

2 most common non-gyn reasons for chronic pelvic pain

A

irritable bowel syndrome

interstitial cystitis

95
Q

pelvic fullness, heaviness that extends to the vagina, vulva

A

pelvic congestion syndromes-dilation, stasis, and congestion of pelvic veins

  • unknown cause
  • standing for long periods, coitus, fatigue

OB/Gyn (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions