CM 3

Question 1

which special tests to do at 18-20 wks vs 24-28wks vs 28wks vs 36wks?

Answer 1

anatomy scan vs gtt vs rhogam vs gbs

Question 2

what does smaller vs bigger vs >2-3cm bigger for fundal height mean?

Answer 2

IUGR, inaccurate dates vs polyhydramnios, multiple, macrosomia vs US

Question 3

when to do fetal kick counts and how to do them? what do accels look like on NST?

Answer 3

28wks; water, move; 5 kicks/1hr or 10 kicks/2 hr. 10x10 <32wks, 15x15 >32wks

Question 4

preecl w/ severe features. when to tx?

Answer 4

preecl + >/=160/110, thrombocytopenia, impaired liver, renal insuff, pulm edema, vision/cerebral disturbance. w/in 15min b/c acute OB emergency

Question 5

when to give HTN meds during preg? how to ctrl severe acute HTN in preg? how to induce for preecl w/ severe features?

Answer 5

> /=160/105. note that all HTN meds cross placenta & reach fetal circ. labetalol, nifedipine, hydralazine. mg so4, manage bp w/ hydralazine or labetalol

Question 6

what does mg so4 do? Labetalol is good for HTN but careful w/?

Answer 6

CCB, neuroprotection, vasodil, sz prophylaxis; give if preecl w/ severe features. Avoid in asthmatics and hypoglycemia in babies

Question 7

how to manage eclampsia? how to prevent preecl?

Answer 7

mg for sz prophylaxis, IV HTN meds, deliver immediately. baby ASA at 12-28wks

Question 8

risk factors for early spont ab <13 wks?

Answer 8

AMA, abnl chrm, defective implant, cvx incompetence, ut anomalies, thy/DM, teratogens

Question 9

how to eval for threatened ab? how to manage spont ab?

Answer 9

cvx open/closed, ut non/tender; progesterone, BHCG, CBC, rhogam/type & screen, US. meds by PG or D&C

Question 10

how to eval for recurrent ab? how to get septic ab vs tx vs complications?

Answer 10

parental cytogenetics, thy/DM screen, antiphospholipid ab, thrombophilia, sonohyst/HSG. illegal induced ab -> staph or gram neg bacilli vs broad abx, suction curettage vs PID, hem, shock

Question 11

any bleed in preg should get a?

Answer 11

blood type for rhogam

Question 12

Dx w/ amnio and PCR

Answer 12

Toxo and CMV

Question 13

Dx with liver fxn and HBSAg. e ag has higher viral load. Key to tx is vax

Answer 13

HBV

Question 14

Late sxs of syphilis. How to dx?

Answer 14

Hutch teeth, mulberry molar, saddle nose, saber shins. VDRL and TPA b/c first test can be false pos

Question 15

Which dx to Doppler MCA for fetal anemia?

Answer 15

Parvo

Question 16

Describe listeria. Key thing?

Answer 16

No specific foods, most infectious in 3rd trim, tx w/ PCN/Bactrim/gentamicin. PREVENTION

Question 17

VZV. Rubella. CMV

Answer 17

1st half of preg -> congen; 5d before/2d after-> mild rash or disseminated. Oral acyclovir if rash, IVIG to baby, live vax to household contacts. Limb hypoplasia
blueberry, 3ad of sensorineural hearing loss/glaucoma or cataract/PDA, enlged lat v. dx w/ igM. Tx w/ vax
coven hearing loss, petechiae, calcifications in brain. Dx w/ amino/cx/PCR. Tx w/ antivirals

Question 18

HIV in preg. Zika

Answer 18

Preg won’t affect HIV or vice versa, don’t BF. dx w/ ELISA & Western blot (both need be pos). Tx w/ zivoludine, don’t BF, C/S 38wks if viral load >1000
Microencephaly, dec brain parenchyma, cortical atrophy; rpt US to chk those. Dx w/ PCR of NAAT. Tx w/ prevention, no unprotected sex after 8 wks of last exposure

Question 19

Biochemical hyperthyroidism vs pp thyroiditis. When does peripartum cardiomyopathy occur and w/u?

Answer 19

Hyperthyroid, HG, undetectable TSH, spont resolve by 18 wks vs hypothyroid, spont resolve. Last month of preg or 6mo pp; bed rest, digoxin, diuretics, possible anticoagulant; 6mo pp = marker for heart transplant; future prevention by sterilization

Question 20

Acute fatty liver in pregnancy

Answer 20

Persistent N/V, inc liver enzymes & bili & lactic acidosis, PTL @ 35wks; tx supportive or liver transplant

Question 21

How to predict PTL? Def?

Answer 21

Pos fetal fibronectin and cvx < 25. Ctx + cvx dil in 20-37wks