CREOG Institutional Prep Exam Review Flashcards
Give 3 definitions for GTN by FIGO criteria
1) weekly hCG levels plateau over a 3 week period (+/- 10 % of the previous result)
2) hCG levels inc more than 10% across 3 values over a 2 week duration
3) persistence of detectable serum hCG levels for more than 6 months after evacuation
What are 5 Lynch - syndrome related genes
Mell 1 , Mesh 2 & 6 , PMS 2, EPCAM
(MLH 1, MSH 2 , MSH 6, PMS 2, EPCAM)
What is the most common symptom in patient with lactotroph microadenoma
Amenorrhea
Most common complication of pelvic radiation
GI toxicity
What is the most common congenital infection ?
when is the risk of severe infxn the highest?
When is the most common occurrence of vertical transmission?
CMV
1st trimester risk for severe infxn is highest
Vertical transmission is highest in third trimester
Maximum lidocaine dosing without epinephrine vs with
Without - 5 mg/kg
With Epi - 7 mg/kg
Define MTP
10 units in 24 hrs
4 units within 1 hour ( with more anticipated)
Replacement of a complete blood volume
Risks associated with massive transfusion
Hyperkalemia ( from tissue damage or hemolysis)
Hypocalcemia ( due to citrate toxicity)
Metabolic acidosis ( production of lactic acid and decreased removal of citrate)
Hypothermia ( which reduces platelet and enzymatic activity)
TRALI and transfusion associated infections
Diabetes with nephropathy ( >500 mg/day of proteinuria) is what White classification?
Class F ( for fucked up kidneys)
Class D diabetes is defined as
Diagnosed when they were dumb young (<10 yrs old) and duration > 20 years
Class B diabetes is defined as
Diagnosis in their BIG AGE (onset after age 20, duration < 10 years)
Class C diabetes is defined as
Occurring during the CONFUSING ages of 10 - 19 yrs with duration between 10 - 19 years
How is acetycholinesterase related in fetal development?
It is an enzyme present in the amniotic fluid of fetuses with an open neural tube defect
( when combined with ultrasound findings and AFP, it is diagnostic of open neural tube defect
What clinical scenarios can one find acetylcholinesterase present
Open neural tube defects
Ventral abdominal wall defects
IUFD
When do we screen for neural tube defects with MSAFP
What organs secrete MSAFP
15 - 18 weeks
Yolk sac and the liver
MSAFP levels greater than _____ MoM are concerning for a NTD
2.5
When can I deliver a patient with pregestational diabetes as early as 36 - 38+6
Poor glucose control
Hx of still birth
Vasculopathy
Nephropathy
The endometrial lining is _____ before ovulation and ____ after ovulation
Proliferation before ovulation
Secretory after ovulation
Cryoprecipitate contains ______________
VFF8-13
Vonwillebrand
Fibrinogen
Factors 8 & 13
FFP contains
All soluble plasma proteins and clotting factors
- increases level of any factor by nearly 30%*
Lifetime risk of ovarian cancer in general population is
1/70 ( 1.4%)
What are three blood disorders that indicate the need for anticoagulant in in pregnancy
Homozygous factor V Leiden
Homozygous prothrombin G20210A mutation
Antithrombin deficiency
A brand name for Low molecular weight heparin is
Lovenox
What can u give to reverse unfractionated heparin in a pregnant women who didn’t get to stop her lovenox and transition to unfractionated heparin before delivery?
Protamine sulfate
Epidural is associated with what two components of labor?
Shorter first stage when compared to systemic opioids
Also longer second stage of labor by only a few minutes
Gestational thrombocytopenia is most common at what point in pregnancy ?
When do platelet counts resolve?
Most common in 2nd and 3rd trimester
Return to normal within 1-2 months after delivery
Prevalence of ectopic pregnancy among women in ED with 1st tri bleeding
5 - 18% (~15%)
For women with hx of 2 or more ectopics, recurrence risk is ____
25%
Most common sign of uterine rupture
Fetal heart rate anomalies
Risk of uterine rupture with one prior scar
0.5 - 0.9%
What is the work up for a baby with ambiguous genitalia
Karyotype to evaluate sex chromosomes ( fetuses with CAH will usually by 46 XX)
Electrolytes
17 - hydroxyprogesterone levels
What is the dosage and management for a patient who needs stress dose steroids while in labor?
Hydrocortisone 25 mg IV q 6 hours
At time of delivery, give 100 mg IV, then taper the dose to her baseline regimen over 3 days
What 3 groups of patients don’t need stress dose steroids in labor?
A - ANY dose of steroids for <3 weeks
M - MORNING dose <5 mg/day for any length of time
E - <10 mg of prednisone EVERY other day
Progesterone inhibits what stage of lactogenesis
Stage I —> so it inhibits alpha lactalbumin which is the main stimulator of lactose synthase
What is the AFE triad for diagnosis ?
Breathing compromise + hemodynamic instability + DIC
If one twin in a monochorionic gestation dies after 14 weeks there is a ____ chance that the surviving twin also dies
15% risk of death
And almost 20 % risk of neurological injury to surviving twin
( compare to dichorionic twin where Neuro injury risk is 1% and risk of death is 3%)
When to deliver placenta accreta?
34 - 35+6 weeks via C- hyst
Risk factors for PPROM
Smoking
2nd tri bleeding
3rd tri bleeding
Previous PPROM
Short cervix
Low SES
Low BMI
Preterm birth rate in US (2019)
~10 %
Typical surgical site infxn occurs how many days after abdo surgery
4- 7 days
( Think 47 days and nights of struggle with that baby before a damn infection pops up!)
About ____ % of women with PCOS have T2 diabetes
10 %
Define periviability
20 + 0 - 25+ 6
Suspected intramniotic infection criteria are
Maternal fever AND
elevated WBC count
OR
Purple not cervical drainage
OR
Fetal tachycardia
What labs should be ordered to work up primary amenorrhea ?
UPT ( obviously rule out pregnancy )
(Testosterone, FSH, Estradiol , LH, TSH, prolactin) and 17-OHP
(Test FELT Pro) and 17-OH P
Normal testoterone levels in women
40 - 60 ng/dL
Normal follicular phase FSH
3 - 11 mIU/mL
Normal follicular phase LH
1 - 11 mIU/ml
What percent of survivors of neonatal herpes will have long term neuro issues
20% (including impairment within first 12 months of life
Layers of bladder from inner to outer
Mucosa ( transitional then lumina propia)
Submucosa
Detrusor muscle
Adventitious
By how much does breastfeeding increase material caloric requirements?
500 kcal/ day
The corpus luteum makes what kind of progesterone ?
17 alpha hydroxy progesterone
The distal (lower) one third of the vagina drains to _______
Inguinal / femoral nodes then to pelvic nodes
The upper 2/3rds of the vagina drains to what nodes?
Pelvic then para aortic
Most common cause of intracranial hemorrhage AT TERM ?
AT PRETERM?
Term - obstetric trauma
PRETERM - hypoxia and ischemia
UTI incidence in sexually active young women
0.5 - 0.7 per person-year
What is the most commonly identified mutation in women who develop VTE during pregnancy
Heterozygous Factor V Leiden
Heterozygous factor V Leiden accounts for ___ % of VTE in pregnancy
40%
Women with heterozygous factor V Leiden deficiency and no hx of VTE have what % risk of developing VTE in pregnancy
< 2%
(0.5 - 1.2%)
How do you test for factor V Leiden mutation
Protein C resistance assay ( 2nd gen)
** this can be reliable in pregnancy and acute thrombosis but is NOT RELIABLE IF THE PATIENT IS ANTOCOAGULATED**
What is the leading cause of death in pregnant women and women in the postpartum period
Cardiovascular disease (15.3%)
Serum progesterone level of ________ is a objectively indicative that ovulation occurred
> 3 ng/mL
Methimazole is associate with ___ in the ___ trimester
PTU is associated with _____
Methimazole - MESSES up your nails ( aplasia cutis) in the first trimester
PTU - pitiful liver ( hepatotoxicity)
PTU - PRIMARY hyperthyroidism med in 1st trimester, THEN Methimazole to MAINTAIN
