Brainscape's Knowledge GenomeTM

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


See full index

OB/GYN > CaseFiles_2 > Flashcards

CaseFiles_2 Flashcards

1
Q

The most common causes of abnormal serum triple test screening are

A

wrong dates and multiple gestations (assess via obstetric ultrasound)

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

What is the uterine height when it is the appropriate time for serum testing for Down’s, trisomy 18, and neural tube defects? What are the chemicals that are analyzed?

A

16-20 weeks (15-21). 16 weeks: fundus midway between symphysis pubis and the umbilicus. At 20 weeks: fundal height at umbilicus.

AFP, hCG, and unconjugated estriol (“triple screen”)

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

What is alpha-fetoprotein?

A

A glycoprotein made by the yolk sac and later by fetal liver/GI tract, analogous to albumin

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

What is first trimester screening?

A

performed between 10 and 13 weeks. PAPP-A, B-hCG and nuchal translucency for risk of Down or trisomy 18

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

AFP levels greater than ______ multiples of the median (MOM) are suspicious for neural tube defects. What are other causes of this level?

A

2-2.5
Can also be caused by multiple gestations, underestimation of gestational age, abdominal wall defects, oligohydramnios, and fetal skin defects.

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

Down syndrome is associated with (high/low) AFP. What are other causes of a similar AFP level?

A

LOW AFP. Also caused by molar pregnancy, fetal death, increased maternal weight, overestimation of gestational age.

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

What are the results of the triple test in Down syndrome?

A

1) AFP: low
2) hCG: high
3) unconjugated estriol: low
* *note, sometimes they add inhibin A: high

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

What are the results of the triple test in Edwards Syndrome?

A

1) AFP: low
2) hCG: low
3) unconjugated estriol: low

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

What are the results of the first trimester screening for the trisomies?

A

Trisomy 21: PAPP-A low, BhCG high, nuchal transulency low (thick!!!)
Trisomy 13 and 18: PAPP-A low, BhCGlow (nuchal transulency thick?)

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

What are findings on ultrasound suspicious for Down syndrome?

A

1) thickend nuchal fold
2) shortened femur length
3) echogenic bowel

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

What are the teratogenic effects of ACE-I?

A

skull anomalies, limb defects, miscarriage, renal failure in neonate, renal tubule dysgenesis, oligohydramnios

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

When does organogenesis occur in gestation?

A

Days 15-60

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

A double-bubble sign indicates ____________, related to what genetic abnormality?

A

duodenal atresia, associated with Down Syndrome

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

Pregnancies with elevated msAFP, which after evaluation are still unexplained, are at increased risk for:

A

stillbirth, growth restriction, preeclampsia, and placental abruption

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

Teratogenic exposure prior to ___ weeks gestation leads to an “all or nothing” effect.

A

2

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

What is velamentous cord insertion?

A

umbilical vessels separate before reaching the placenta, protected only by a thin fold of amnion, instead of by the cord or the placenta itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

The incidence of vasa previa (umbilical vessels not protected by cord or membranes crossing the internal cervical os in front of the fetal presenting part) is (increased/decreased) in IVF?

A

Increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Complications associated with twin gestation (x5):

A

1) preterm delivery
2) congenital malformations (esp in monozygotic)
3) preeclampsia
4) postpartum hemorrhage
5) twin-twin transfusion syndrome
6) gestational diabetes
7) DVTs

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

How is the use of OCPs related to twinning?

A

Since OCPs slow tubal motility (though to lead to monozygotic twinning), you should know if a mother used OCPs within 3 months of becoming pregnant

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

Monozygotic twins are associated with a (higher/lower) incidence of discordant growth and malformations.

(Mono/di)chorionic twins are associated with a higher rate of spontaneous abortion.

A 
Monozygotic = higher risk of malformations
Monochorionic = higher rate of spontaneous abortion
21
Q

How dos timing of division affect the chorionicity/amnionicity of monozygotic twins?

A

If timing of division is within:

1) 72 hours: dichorionic/diamniotic
2) Day 4-8: monochorionic/diamniotic
3) Day 8-12: monochorionic/monoamniotic
4) After day 12: conjoined

22
Q

The rate of dizygotic twinning (increases/decreases) with age and peaks at ___ years.

A

increases; 37 years

23
Q

What is the chorionicity/amnionicity of all dizygotic twins?

A

All dizygotic twins are dichorionic and diamniotic

24
Q

Why is there greater physiologic anemia in a twin pregnancy?

A

Blood volume and stroke volume are increased more than singleton pregnancy, but the red cell mass increases proportionately less

25
Q

Why can nausea/vomiting be increased in a twin gestation?

A

increased serum levels of hCG

26
Q

What are risk factors for vasa previa?

A

1) bilobed, succenturiate-lobed, or low-lying placenta
2) multifetal pregnancy
3) pregnancy resulting from IVF

27
Q

If vasa previa is idenfitied, when should the planned C section take place? What about vaginal digital examination?

A

C-section 35-36 weeks of gestation

digital examination is CONTRAINDICATED

28
Q

What is fetal blood volume at term?

A

250-500 cc

29
Q

What is the treatment for twin-twin transfusion syndrome?

A

1) laser ablation of the shared anastomotic vessels

2) serial amniocentesis for decompression

30
Q

Diagnosis of vasa previa is best made by

A

ultrasound with color Doppler

31
Q

Twin gestation without a dividing membrane (monoamniotic) is associated with a high stillbirth rate due to

A

cord entanglement

32
Q

A substantial discordance of the twins and a discrepancy of the distribution of the amniotic fluid volume should lead one to suspect:

A

TTT syndrome

33
Q

The use of oral suppressive antiviral therapy (acyclovir) at ___ weeks for women who have had a recurrence or first episode during pregnancy has been shown to decrease viral shedding and the frequency of outbreaks at term and decrease the need for C section.

A

36 weeks!

Also being used in women who have not had a recurrence during pregnancy.

34
Q

A woman with HSV may breastfeed if

A

there is no involvement of the breast

35
Q

T/F: Herpes zoster on the chest wall is a contraindication for breastfeeding.

A

True! Herpes zoster infection in a neonate can have fatal consequences.

36
Q

Painful lesions on the vulva with ragged edges, a necrotic base, and inguinal lymphadenopathy should make you think of

A

chancroid, by Haemophilus ducreyi
(syphilis has a painless chancre as first stage; vulvar CA is nontender and ulcerative and more common in post-menopausal women).

37
Q

The most common cause of infectious vulvar ulcers in the US is

A

Herpes simplex virus

38
Q

Although most neonatal herpes infections occur from genital tract secretions and fluids during birth, 5% of infections are aquired in utero. These latter cases are usually due to (recurrences/primary episodes).

A

Primary episodes –> higher chance of in utero infection

39
Q

What is antepartum bleeding?

A

Bleeding after 20 weeks gestation

40
Q

How can you distinguish between antepartum bleeding as a result of placenta previa or placental abruption (the two most common causes of antepartum bleeding)?

A

Placental abruption is associated with PAINFUL uterine contractions and excessive uterine tone; placenta previa is painless.

41
Q

T/F: Postcoital spotting is consistent with placenta previa.

A

True! Vaginal intercourse may induce bleeding in placenta previa.

42
Q

WHat is the difference between “marginal placenta previa” and low-lying placenta?

A

In low-lying placenta, the edge of htep lacenta is within 2 to 3 cm of the internal cervical os, while in marginal placenta previa, it abuts against the os.

43
Q

When a patient presents with antepartum hemorrhage, why should an ultrasound be used before speculum or digital examination?

A

The latter two may induce bleeding. Due the speculum before digital, BOTH after u/s

44
Q

The presence of placenta previa or placenta accreta requires that C section should occur at ___ weeks gestation. If they are presenting at ____ weeks gestation, they should have the C section immediately.

A

34 (to balance risk of prematurity with maternal benefit of scheduled delivery)
If they are presenting 35-36 weeks, C section immediately

45
Q

T/F: Placenta accreta is more common with placenta previa.

A

True! Especially in the presence of a uterine scar such as after C section or after prior uterine curettage.

46
Q

T/F: Grand multiparity is a risk factor for placenta previa.

A

True

47
Q

Polyhydramnios and hypertension are risk factors for what regarding the placenta?

A

Placental abruption

48
Q

Why is repeat sonography warranted when placenta previa is diagnosed at early gestation, such as the second trimester?

A

Placenta transmigration away from the cervix can occur

OB/GYN (6 decks)

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