comat wrongs

Question 1

how do you diagnose appendicitis in a pregnant woman?

Answer 1

Exploratory laparotomy; basically pretend she isn’t pregnant, bc if she dies, there will be no baby anyway.

Question 2

how do you induce someone with a Bishop score less than 5?

Answer 2

PGE2 or PGE1M (misoprostol)

Question 3

how do you induce someone with a Bishop score more than 5?

Answer 3

oxytocin/pitocin

Question 4

what are the contraindications for using prostaglandins in labor induction?

Answer 4

Maternal reasons= asthma and glaucoma Obstetric reasons= prior C-section and nonreassuring fetal testing

Question 5

name some non-pharma ways of easing labor pains?

Answer 5

lamaze/breathing and relaxation techniques

Question 6

what is an absolute contraindication for Trial of Labor After Cesarean?

Answer 6

prior classical hysterotomy or other VERTICAL uterine incision

Question 7

what is required for forceps delivery?

Answer 7

adequate anesthesia, full dilation of the cervix, station 2 or lower with engaged head, knowledge of fetal position

Question 8

what is a contraindication for use of forceps?

Answer 8

evidence of cephalopelvic disproportion

Question 9

when giving methotrexate therapy for ectopic pregnancy, why should you wait longer than 48 hours to get B-hCG levels?

Answer 9

the B-hCG level commonly rises in the first few days after methotrexate therapy with a fall to 10-15% between days 4-7 after administration. Wait to check the levels in this 4-7 day period to see if you need to add more methotrexate or not

Question 10

a patient with a known uterine scar (previous c-section) is having painful contractions but is not showing signs of labor. What do you do?

Answer 10

she is at risk for uterine rupture. continue close observation with continuous fetal monitoring, and reevaluate in 2-4 hours

Question 11

severe abdominal pains with loss of station of the fetal head on vaginal exam are classic findings of what?

Answer 11

uterine rupture

Question 12

how do you proceed with delivery of a baby when placental abruption occurs during labor?

Answer 12

emergent c-section

Question 13

what do you give to a pregnant woman with eclampsia and active seizure?

Answer 13

magnesium sulfate

Question 14

Patients in 1st trimester with high risk of aneuploidy and advanced maternal age should undergo which diagnostic test?

Answer 14

chorionic villus sampling

Question 15

Patients in 2nd trimester with high risk of aneuploidy and advanced maternal age should undergo which diagnostic test?

Answer 15

amniocentesis

Question 16

What classifies as “fetal growth restriction”?

Answer 16

estimated birth weight on US is less than the 10th percentile expected for gestational age

Question 17

At 20 weeks gestational age and up, how many grams does a fetus gain per day?

Answer 17

10 grams

Question 18

what should you convey to a patient considering tubal ligation?

Answer 18

it is considered an irreversible form of contraception

Question 19

which antiviral medication is used to treat hep B in pregnancy?

Answer 19

tenofovir

Question 20

what is the most common cause of postpartum hemorrhage?

Answer 20

uterine atony

Question 21

name the risk factors for uterine atony:

Answer 21

increased uterine distension (multiple gestation, macrosomia, or polyhydramnios), chorioamnionitis, a long induction of labor from prolonged exposure to oxytocin, magnesium sulfate for preeclampsia, uterine inversion, or retained placenta

Question 22

what are the sx of congenital varicella?

Answer 22

infant: growth restriction, cicatrical disseminated rash/ scarred skin lesions, limb hypoplasia, chorioretinits

Mom: pruritic vesicles on trunk and extremities, fever

Question 23

What are the sx of congenital parvovirus B19?

Answer 23

• Infant: aplastic anemia, high-output congestive heart failure, and cardiomyopathy
  
  • hydrops fetalis=fetal anemia leading to high output cardiac failure
• Mom: fever, myalgias, arthralgias, lymphadenopathy, lacy erythematous rash

Question 24

what are the sx of congenital toxoplasmosis?

Answer 24

infant: diffuse intracranial calcifications, chorioretinitis, hydrocephaly (large head)

Question 25

what are the sx of congenital cytomegalovirus?

Answer 25

infant: low birth weight, ventriculomegaly, hearing impairment, periventricular calcifications

Question 26

What are the sx of congenital rubella?

Answer 26

infant: patent ductus arteriosus, hearing impairment, ptechial purpural rash (blueberry muffin baby)

Question 27

how long should you wait before doing an infertility workup on a patient below the age of 35?

Answer 27

12 months of trying to concieve without birth control

Question 28

how long should you wait before doing an infertility workup on a patient above the age of 35?

Answer 28

6 months of trying to concieve without birth control

Question 29

what is considered pre-term pregnancy?

Answer 29

<37 weeks and 0 days

Question 30

What is considered early term?

Answer 30

37 weeks and 0 days — 38 weeks and 6 days

Question 31

What is considered full term pregnancy?

Answer 31

3 weeks and 0 days — 40 weeks and 6 days

Question 32

What is considered late term pregnancy?

Answer 32

41 weeks and 0 days—41 weeks and 6 days

Induce!

Question 33

What is considered post-term pregnancy?

Answer 33

after 42 weeks and 0 days

Question 34

what are fetal effects of antenatal steroids?

Answer 34

abnormality in fetal heart rate (usually decreased), decreased movement, and decreased breathing patterns 2-3 days after steroid administration

Question 35

what are the maternal effects of antenatal steroids?

Answer 35

hyperglycemia and leukocytosis

decreasesed lymphocytes

Question 36

how does pregnancy affect GFR?

Answer 36

• GFR increases, meaning that creatinine levels will decrease
• normal creatinine in a pregnant woman means renal failure

Question 37

how does pregnancy affect hemoglobin?

Answer 37

• hemoglobin decreases (around 10)

Question 38

signs and sx of HELLP syndrome

Answer 38

epigastric and RUQ pain with HTN, anemia, thrombocytopenia, and transaminitis, schistocytes

Question 39

Turner’s syndrome

Answer 39

45, X

primary ameonrrhea (non-functional “streak” ovaries), low-set ears, aortic coarctation, webbed neck, wide-spaced nipples, shield chest, absent breast development

Question 40

kleinfelter syndrome

Answer 40

male with extra “X” cromosome; 47 XXY

small firm testes, low sperm counts, low testosterone levels, tall stature

Question 41

has a classic bleeding pattern of metrorrhagia or intermenstrual spotting

Answer 41

endometrial polyp

Question 42

classical physical exam finding of tender, boggy, and enlarged uterus

Answer 42

adenomyosis

Question 43

what are some anticholinergics that can help treat urge incontinence?

Answer 43

darifenacin, tolterodine, oxybutynin