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OBGYN Clerkship > Divine Intervention > Flashcards

Divine Intervention Flashcards

1
Q

Most important risk factor for endometritis

A

Cesarean delivery

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2
Q

Most important risk factor for chorioamnionitis

A

Prolonged rupture of membranes (>18 hr)

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3
Q

Baby was stillborn. Abscesses found in multiple parts of the body on autopsy.

What is the likely etiology?

A

Granulomatosis infantiseptica

Congenital lysteriosis

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4
Q

If a patient has been ROMed for ~18 hours, you may to go ahead and give ___ if she has not already received it

A

Penicillin

Just incase GBS finds its way in there

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5
Q

“Mask of pregnancy”

A

Blotchy pigmentation of the face

Physical exam sign of pregnancy, like Chadwick’s sign

Shown in the R on this picture

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6
Q

Why are pregnant women at increased risk of UTI?

A

Mostly due to urinary stasis induced by progesterone

Maybe a slight argument for increased glycosuria, but it is not that significant

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7
Q

Only serum protein that decreases in pregnancy

A

Albumin

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8
Q

In the case of intrauterine fetal demise at term, ___ is NEVER worth it

A

In the case of intrauterine fetal demise at term, C section is NEVER worth it

You can NEVER justify this, the surgery is too dangerous for mom. But, you also can’t leave the fetus in there as it will cause DIC.

Vaginal delivery is the correct treatment here. Labor may need to be induced with oxytocin or misoprostol the same way it is for a live infant.

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9
Q

Why is urinalysis part of the standard first prenatal visit?

A

Screening for asymptomatic bacteriuria

If present, treat w/ amoxicillin or nitrofurantoin

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10
Q

Treatment of pyelonephritis in the pregnant patient

A

IV ceftriaxone, then repeat urinalysis (to ensure clearance) and suppressive nitrofurantoin for the rest of pregnancy

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11
Q

Timing for RhD Ig in an Rh- female

A

28 weeks

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12
Q

Timing for GBS vaginal swave

A

35-37 wks

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13
Q

Timing for 50g OGTT

A

24-28 wks

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14
Q

Timing for chorionic villus sampling

A

10-13 wks

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15
Q

Timing for screening ultrasound for NTDs

A

18-20 wks

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16
Q

Timing for amniocentesis quad screen

A

15 weeks and beyond, usually before 20 weeks

Remember, amniotic fluid isn’t even produced until about 15 weeks

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17
Q

Timing for cfDNA screen

A

Any time after 10 weeks

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18
Q

When performing amniocentesis or villus biopsy, you may want to give mom. . .

A

. . . Rhogam

These invasive procedures may sensitize her to RhD if present.

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19
Q

L:C ratio

A

If lecitin:sphingomyelin is >2, fetal lungs are mature

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20
Q

Having a cerclage is a contraindication to __ in a pregnant woman

A

Having a cerclage is a contraindication to exercise in a pregnant woman

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21
Q

Gestational diabetes complications vs Chronic diabetes complications

A
  • Chronic* diabetes complications: Cardiac problems (HOCM), sacrum anomalies, lower limb anomalies (sirenomelia, aka fusion of the legs), caudal regression syndrome + Gestational diabetes complications
  • Gestational* diabetes complications: Preeclampsia, neonatal hypoglycemia, neonatal hypocalcemia, neonatal polycythemia, macrosomia, polyhydrmanios
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22
Q

Idiopathic premtaure ovarian failure is . . .

A

. . . autoimmune

It may be associated with Hashimoto’s, T1DM, Addison’s, etc

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23
Q

pH cutoff for the vagina

A

4.5

Less than 4.5, and vaginitis is probably Candida

More than 4.5, and vaginitis is probably BV or Trichomonas vaginalis

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24
Q

Obesity increases the risk of osteo___, but decreases the risk of osteo___.

A

Obesity increases the risk of osteoarthritis, but decreases the risk of osteoporosis.

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25
Q

Treatments for hyperemesis gravidarum

A
  1. Ondansetron
  2. Metoclopramide
  3. Doxylamine-pyridoxine

Plus fluids if necessary

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26
Q

Hypertensive Moms Love Nifedipine

A

Hydralazine

Methyldopa

Labetalol

Nifedipine

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27
Q

Most important risk factor for preeclampsia

A

Prior history of preeclampsia

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28
Q

“Severe features” in preeclampsia

A

BP: >160/110

Signs of end organ dysfunction

(as opposed to >140/90 and proteinuria for just plain-old preeclampsia)

This is when you begin prophylaxis with magnesium sulfate

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29
Q

Magnesium and immediate delivery is the 100% first-line agent for eclamptic seizures. But, if magnesium alone fails, what do you add?

A

A benzodiazepine

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30
Q

Cartilage damage in an infant suggests teratogenicity with. . .

A

. . . fluoroquinolone

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31
Q

Stippling of the epiphyses in an infant suggests teratogenicity with. . .

A

. . . warfarin

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32
Q

Gray baby syndrome suggests teratogenicity with. . .

A

. . . chloramphenicol

An antibiotic effective in treating ocular infections such as conjunctivitis, blepharitis etc.

33
Q

Kernicterus in the absence of late-preterm delivery or Criggler-Najjar syndrome suggests teratogenicity with. . .

A

. . . Bactrim

34
Q

Smooth philtrum, microcephaly, thin upper lip

A

Fetal alcohol syndrome

35
Q

IUGR, hypoplastic nails, microcephaly, cleft lip suggests teratogenicity with. . .

A

. . . phenytoin

36
Q

Tdap vaccine in pregnancy

A

All pregnant women should receive a single dose of Tdap between the 27th and 36th week of pregnancy

37
Q

Serology for all pregnant women at first prenatal visit

A
  • HIV ELISA
  • RPR
  • HBsAg

Also, test for Chlamydia and Gonorrheae if in a high prevalence area!

38
Q

“Atrialized right ventricle”

A

Buzz word for lithium teratogenicity, aka the Ebstein anomaly

39
Q

Ways of getting staphylococcal toxic shock syndrome

A
  • Infection of a wound
  • Using something to pack a mucous membrane
    • Tampons
    • Nose packing
    • Vaginal packing
40
Q

Treating candida in pregnancy

A

Topical clotrimazole is the way to go

Oral azoles are contraindicated in pregnancy

41
Q

Chancre lesion vs chancroid lesion

A

Chancres have raised, indurated borders

Chancroid has thin borders, but a very necrotic base

42
Q

Rules for preeclampsia magnesium

A
  • Loading of 6g, then maintenance of 2g
  • Give if there are severe features OR depending on local guidelines without severe features
  • Continue for 24 hours postpartum (including for cesarean section)
43
Q

“Beta complete”

A

One dose of betamethasone, 24 hours later another, then 24 hours later for that one to have its full effect

~48 hours in total from start

44
Q

Breast mass with leaf-like projections on histology

A

Phyllodes tumor

45
Q

Trastuzumab may induce this cardiac problem

A

Dilated cardiomyopathy

A reversible form of it!!!! Just stop taking trastuzumab.

46
Q

x-year old female presenst with palpable breast mass. What is the next step?

A

If x < 30, breast ultrasound

If x > 30, mammogram

47
Q

You palpate a mass on breast exam of a patient. Mammogram is negative. What is the next step?

A

Core needle biopsy

48
Q

Next step if ultrasound of a breast mass in a young patient reveals a solid mass vs a cystic mass

A

Solid mass: Core needle biopsy (high likelihood cancer)

Cystic mass: Fine needle aspirate (low likelihood cancer)

49
Q

Things that might lead you to do core needle biopsy of a cystic breast mass following FNA

A
  • Concerning cytology
  • Blood observed in FNA
  • Recurrence of cystic mass on followup ultrasound
50
Q

Ways of communicating that a patient has uterine rupture in ACOG exam land

A
  1. Loss of fetal station
  2. Palpation of unusual abdominal masses (fetal parts outside of the uterus)
51
Q

Things that may cause uterine atony by the mechanism of overstretching the uterus

A

Multiple gestations

Macromsomia

Polyhydramnios

52
Q

Dinoprost for uterine atony is contraindicated in. . .

A

. . . hypotension

53
Q

Sheehan syndrome vs pituitary apoplexy

A

Think of Sheehan syndrome as ischemic stroke of the pituitary and apoplexy as hemorrhagic stroke of the pituitary

54
Q

Adjuvant to utertonics in treating PPH

A

IV Estrogen

Estrogen can sensitize uterine tissue to uterotonics

55
Q

Next best step in management PCOS question

A

NBME loves to ask this question.

Routine care of a PCOS patient in late 30’s to 40’s includes a screening endometrial biopsy.

The question will be framed as routine care for someone with PCOS who is asymptomatic.

56
Q

If an NST is non-reactive in prenatal care, the next step is. . .

A

. . . biophysical profile

NST, amniotic fluid volume, fetal breathing, movement, fetal tone

57
Q

You see a sinusoidal pattern on FHRT. What is the next step?

A

Percutaneous umbilical blood sampling to check hematocrit and O2 sat of the fetus

58
Q

Presentation and treatment of choriocarcinoma

A

Often presents with either pulmonary symptoms (due to high pulmonary metastasis rate) or hyperthyroidism (due to extremely high bHCG)

May follow molar pregnancy

Methotrexate is highly effective as treatment

59
Q

Woman comes to first prenatal visit and is found to be Rh- and anti-RhD positive. What is the next step?

A

Check dad’s Rh status

If he is Rh-, you are all set.

If he is Rh+, you will need to check the fetus. If it is Rh+, regular MCA flow screenings are indicated to assess fetal status. May require intrauterine transfusions to prevent hydrops fetalis.

60
Q

Management of detected placenta previa prior to 32 weeks

A

No need for immediate delivery as it may change position, however we should administer drugs to hedge our bets against prematurity now. So, give betamethasone and Mg.

Plan to deliver ~34 weeks if it persists by this time.

An obviously, mom needs pelvic rest – nothing in the vagina.

61
Q

What is the downside of indomethacin as a tocolytic?

A

Possibility of premature ductus arteriosus closure

NBME loves to test this fact.

62
Q

Highly tested risk factors for preterm labor

A

Perineal Infection (BV, UTI)

Bicornuate uterus

63
Q

Polyhydramnios associations

A

Maternal diabetes

Duodenal atresia (double bubble sign)

Anencephaly (no swallowing center)

Esophageal atresia

64
Q

Spontaneous abortion vs IUFD

A

Spontaneous abortion is before 20 wks gestation and is treated with D&C

IUFD is after 20 weeks and is treated with D&E (induce labor, effectively)

65
Q

After you place a cerclage, the patient should not. . .

A

. . . exercise

66
Q

“Machine like murmur in a newborn” along with features of teratogenciity should make you think. . .

A

. . . Rubella

67
Q

CMV can present very similarly to Toxo, but in CMV the calcifications will be. . .

A

. . . periventricular

68
Q

Meningitis, pneumonia, or sepsis in the month of life

A

Group B strep

69
Q

Ovarian cancer with Psammoma bodies

A

Serous cystadenocarcinoma

70
Q

“Anterior mediastinal masses”

A

Often dermoid cysts / mature teratomas

71
Q

Amniotomy

A

Fancy word for artificial rupture of membranes

May be performed prior to moving to pitocin if a patient is arrested in the active phase of labor and has not SROMed.

If AROM and pitocin fails to induce progression, Cesarean delivery is indicated.

72
Q

Blood per vagina and signs of fetal distress following ROM indicates. . .

A

. . . vasa previa or placental abruption

If mom has symptoms too (particularly pain), abruption is likely, especially if she had polyhydramnios.

If mom has no symptoms, vasa previa is likely.

73
Q

“Bloody show”

A

Small amount of mucousy vaginal bleeding that may occur with onset of labor due to cervical irritation

Not clinically significant, very common

74
Q

Most frequent cause of preterm labor

A

Idiopathic

Don’t be fooled when they put “cervical insufficiency” or “infection” as answers.

75
Q

Contraindications to tocolytics

A

Magnesium sulfate: Mysasthenia gravis

Terbutaline: Diabetes (causes hyperglycemia)

Indomethacin: EGA >/= 33 wks (premature ductus closure)

Nifedipine: Hypotension

76
Q

Preterm labor with chorioamnionitis is an indication for. . .

A

. . . augmentation of labor (oxytocin)

77
Q

If fibronectin is negative, you don’t need to give ___

A

If fibronectin is negative, you don’t need to give steroids

78
Q

___ decelerations may be amenable to amnioinfusion, but ___ decelerations will not be

A

Variable decelerations may be amenable to amnioinfusion, but late decelerations will not be

79
Q

Fetal stimulation

A

Can be performed simply by rubbing the crown of baby’s head

Done to elicit an acceleration in a fetus with minimal variability and no accelerations. If elicitable, this indicates a normal fetal blood pH and no further testing is required unless FHT changes further.

If this fails, allis clamp stimulation or fetal scalp pH are indicated.

OBGYN Clerkship (30 decks)

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