First Aid for the USMLE Step 2 CK: Obstetrics Flashcards
1
Q
What is the difference between gravidity and parity?
A
- Gravidity: the number of times a woman has been pregnant
* Parity: the number of times a woman’s pregnancy has gone beyond 20 weeks
2
Q
Gestational age is measured by weeks since __________.
A
the first day of the woman’s last menstrual period
3
Q
Fetal heart tones are usually detectable by ____________.
A
10-12 weeks’ gestation
“ToNes at TeN!”
4
Q
Crown-rump length is usually done during what gestational age?
A
6 - 12 weeks
5
Q
After 12 weeks, _____________ on ultrasound can be used to determine age.
A
biparietal diameter, femur length, and abdominal circumference
6
Q
Ultrasound can most reliably determine fetal age during ___________.
A
the first trimester
7
Q
The gestational sac should be visible by ___________.
A
5 weeks’ gestation
8
Q
ß-hCG usually peaks at ___________.
A
10 weeks; it then decreases through the second trimester and levels off in the third
9
Q
The uterus usually increases in size from ________ to ___________ during pregnancy.
A
70 g; 1,200 g
10
Q
It’s recommended that pregnant women consume an additional ________ calories per day.
A
300
11
Q
Women who are breastfeeding should consume ________ more calories per day.
A
500
12
Q
What nutrients are particularly important in pregnancy?
A
- Iron: 30 mg/d
- Calcium: 1300 mg/d
- Folic acid: 0.4 mg/d
- Vitamin D: 400 IU/d
- B12: 2 µg/d
13
Q
Describe how BP changes throughout pregnancy.
A
BP gradually decreases and then around 34 weeks it increases to pre-pregnancy values.
14
Q
Both HR and ________ increase during pregnancy.
A
SV
15
Q
Which two pulmonary values change during pregnancy?
A
Tidal volume increases and expiratory reserve volume decreases.
16
Q
Although the amount of RBCs increases, _____________ actually decreases.
A
hematocrit (because of the proportionally greater increase in plasma volume)
17
Q
List the maternal infections that can pass to fetuses.
A
- Toxoplasma gondii
- Rubella
- Cytomegalovirus
- Herpes simplex virus
- Human immunodeficiency virus
- Treponema pallidum
- Listeria monocytogenes
- Varicella zoster virus
- Parvovirus B19
18
Q
From __________ to _________, it’s recommended that prenatal visits occur every four weeks.
A
fertilization; 28 weeks
19
Q
From week ________ to _________, prenatal visits should occur every two weeks.
A
29; 35
20
Q
During the last four weeks of pregnancy (36 - 40 weeks) visits should occur _________.
A
weekly
21
Q
How many prenatal visits should occur by the recommendations?
A
16, at the following weeks: •4 •8 •12 •16 •20 •24 • 28 •29 • 31 •33 • 35 •36 •37 • 38 • 39 • 40
22
Q
What tests should be done at the initial prenatal visit?
A
- Heme: CBC, Rh, type and screen
- ID: rubella, VDRL, HBV, HIV, gonorrhea, chlamydia
- If indicated: HbA1c
23
Q
Low levels of PAPP-A can indicate ___________.
A
aneuploidies
PAPP = pregnancy-associated plasma protein
24
Q
Aneuploidies can usually be detected by what weeks?
A
9 - 14 (with ß-hCG, nuchal translucency, and PAPP)
25
Quad screens are done in what pregnancy window?
15 - 22 weeks
26
The anatomic screen is done at ____________.
18 - 20 weeks
27
Glucose challenges are done at _____________.
24 - 28 weeks
28
When should Rhogam be given?
28 - 30 weeks and again within 72 hours of delivery
29
The quad screen consists of what labs?
* AFP
* ß-hCG
* Estriol
* Inhibin
30
What things can cause elevated AFP?
* Neural tube defects
* Gastroschisis
* Multiple gestations
* Incorrect dating
31
How does trisomy 18 present on the quad screen?
Low levels of all fours values
| "You're still UNDERage at 18."
32
Why is Down syndrome often caught before the quad screen?
PAPP testing and the anatomical scan are done at 9 - 14 weeks – prior to the quad screen.
33
What is one advantage of chorionic villus sampling over amniocentesis?
CVS can be done as early as 10 weeks, while amniocentesis can't be done until 15 weeks.
34
_________________ is the most common cause of second-trimester miscarriages.
Hypercoagulability
35
Toxoplamosis can be prophylactically treated in the third trimester with ___________________.
spiramycin
36
List the four symptoms associated with congenital toxomplasmosis.
- Chorioretinitis
- Hydocephalus
- Intracranial calcifications
- Deafness
37
List the six symptoms of congenital Rubella.
- PDA
- Blueberry muffin baby
- Deafness
- Jaundice
- Mental retardation
- Cataracts
38
Go through the four types of spontaneous abortions.
- Complete: bleeding, POC expelled, no POC on US, and cervix closed
- Threatened: bleeding, POC not expelled, POC on US, and cervix closed
- Incomplete: bleeding, POC expelled, POC on US, and cervix open
- Inevitable: bleeding, POC not expelled, POC on US, and cervix open
39
IUFD is defined as _________________.
loss of fetus after 20 weeks
40
Nonviable pregnancy is diagnosed by what two situations?
- Gestational sac greater than 25 mm without a fetal pole
| - No fetal cardiac activity when the crown-rump length is greater than 7 mm
41
Oral mifepristone can be used up to _______________ days' gestation.
49
42
Per official recommendations, how often should you monitor the FHR during the first and second stages of labor in an uncomplicated patient?
- First: every 30 minutes
| - Second: every 15 minutes
43
How long should the stages of labor last?
- 1st (phase I): 6-11 hours
- 1st (phase II): 4-5 hours
- 2nd: 0.5-3 hours
- 3rd: 0.5 hours
44
How frequently should you monitor FHR in a complicated patient?
- First stage: 15 minutes
| - Second stage: 5 minutes
45
What three things can cause minimal FHR variability?
- Opioids
- Magnesium
- Sleep
46
What range of variability is normal?
6-25 BPM
47
What does the "variable" in variable decelerations mean?
Variable decelerations means that the onset of deceleration sometimes occurs late and sometimes occurs early.
48
Describe the contraction stress test.
You induce contractions in a pregnant woman and monitor the FHR. If the fetus does not have late or variable decelerations, then it is considered a negative test and a healthy baby. If the fetus has late decelerations, then it is non-reassuring.
49
What is a BPP?
Biophysical profile: an ultrasound test for fetal well being; it encompasses the following:
- Fetal tone
- Fetal breathing
- Fetal movement
- Amniotic fluid depth
- Non-stress test
A score of 2 is normal. A score of 0 is abnormal. 1 is in between. Add the scores.
50
Epidurals need to be given above level _____________.
T10 (this is the level at which uterine contractions connect)
51
List three medical contraindications for regional anesthesia in labor.
- Maternal hypotension
- Maternal coagulopathy
- Maternal blood thinner use
52
Increased B-hCG and _____________ have been implicated in hyperemesis gravidarum.
estradiol
53
What categories of meds can treat hyperemesis gravidarum?
- Antihistamines: dimenhydrinate, doxylamine, promethazine
- Antipsychotics: prochlorperazine
- Antidopaminergics: metoclopramide
- Antiserotonergics: ondansetron
- Vitamins: B6
54
Diabetes during pregnancy is screened for during 24 - 28 weeks unless ____________________.
the woman has risk factors for diabetes prior to pregnancy:
- BMI greater than 25
- First-degree relative with DM
- PCOS
- Past child who weighed more than 9 lbs
- Any past labs that were suggestive of diabetes (like elevated A1c or fasting glucose)
55
1-hour glucose levels above ____________ after a challenge are abnormal.
140 mg/dL
56
Explain the utility of the 3-hour challenge.
The 3-hour challenge uses a 100 gram bolus of glucose (unlike the 50 g one used in the 1-hour challenge). Any two of the following are considered confirmatory for gestational DM:
* 1-hour greater than 180
* 2-hour greater than 155
* 3-hour greater than 140
57
How is gestational diabetes treated?
* 1st: treat with diet, exercise, and glucose monitoring
| * 2nd: treat with insulin if the first fails
58
ACOG recommends that you screen for diabetes at _______________ weeks postpartum because 50% of patients develop DM for life.
6-12
59
Normal 1- and 2-hour postprandial glucose levels are _____________.
less than 140 and 120, respectively
60
As many as ___% of those with gestational hypertension go on to develop preeclampsia.
25
61
List the antihypertensive meds that can be given in pregnancy.
- Labetalol
- Nifedipine
- Methyldopa
- Hydralazine
62
What blood pressure is diagnostic of preeclampsia?
140/90 (either/or) on two occasions at least 6 hours apart
63
List the features that define severe preeclampsia.
- BP greater than 160/110 on two occasions more than 6 hours apart
- CNS changes (e.g., AMS or HA)
- Oliguria
- Vision changes
- Hyperreflexia
- Persistent epigastric pain
64
How long is seizure prophylaxis continued after delivery?
24 hours
65
How is magnesium toxicity treated?
With calcium gluconate
66
In treating preeclampsia, aim for a diastolic BP of __________.
90 - 100 mm Hg
67
Why is asymptomatic bacteriuria treated in pregnancy only?
Because up to 40% of pregnant women with asymptomatic bacteriuria will develop a UTI.
68
What is the incidence of placental abruption?
1/100!
69
Dark vaginal bleeding is more characteristic of which late term complication?
Placental abruption
70
A very dangerous complication of placental abruption is ______________.
DIC (10% of cases)
71
Bleeding from __________ usually stops after one or two hours, while bleeding from ___________ usually continues.
placenta previa; placental abruption
72
Ultrasounds can usually rule out which causes of vaginal bleeding in pregnancy?
Previa
US are 95% sensitive for previa. Abruption sensitivity is only 50%.
73
List the management guidelines for placenta previa.
* Avoid vaginal exams except when absolutely necessary.
* Stabilize the patient with a premature baby to avoid premature delivery.
* Deliver by CS if it is 36 weeks or later.
* Delivery if mother or fetus are unstable
74
The __________ sac is within the __________ sac.
yolk; gestational
75
Intrauterine growth restriction simply means ________________.
gestational size less than 10th percentile for age
76
Betamethasone generally requires _________ hours before treatment to effectively accelerate lung maturity.
48
77
Macrosomia is defined as _______________.
gestational weight greater than 95h percentile for gestational age (generally 5000 g for nondiabetics and 4500 for diabetics)
78
AFI greater than ____ is diagnostic of polyhydramnios.
25
79
Complications of polyhydramnios include __________________.
preterm labor, cord prolapse, and fetal malpresentation
80
List three things that can cause oligohydramnios.
* ROM
* Fetal urinary tract abnormalities
* Uteroplacental insufficiency
81
How is fetal fluid measured/reported?
First, measure the depth of the fluid in each of the four quadrants. Second, sum each. If it's less than 5, then it is oligohydramnios. If the total is greater than 25, then it is polyhydramnios.
82
Hydrops fetalis is defined by fetal hemoglobin less than __________.
7
83
First-trimester uterine bleeding, hyperemesis gravidarum, and an enlarged uterus suggest ___________.
molar pregnancy
84
What percent of live births are multiple gestations?
3%
85
____ percent of deliveries have shoulder dystocia.
1%
86
The "turtle sign" -- recoil of the perineum -- is suggestive of _______________ during labor.
shoulder dystocia
87
Spontaneous rupture of membranes (SROM) occurs after the onset of _______________.
labor; PROM occurs greater than 1 hour before the onset of labor
88
Steroids are recommended in PROM cases before _____ weeks gestation.
32
89
If a term patient presents in PROM, then what should you do?
Observe for 6 hours and then induce labor if labor hasn't started
90
What is the minimum duration and frequency needed to qualify as labor?
* 3 in thirty minutes
| * Each must be at least 30 seconds
91
If a woman presents in preterm labor -- evidenced by cervical change and adequate contractions prior to 37 weeks -- how should you decide whether to deliver or not?
- First, look for signs of distress in the mother and fetus. If either is unstable, then deliver.
- Second, check to see if membranes have ruptured. If membranes have ruptured, consider delivery.
- Third, rule out infection (i.e., no fever, tachycardia).
If the mother and fetus are stable and membranes have not ruptured, then administer tocolytics.
92
Which of the three kinds of breech presentation is the most common?
Frank
93
Up to ____ percent of breech fetuses change to vertex by week 38.
75
94
What medicine is given to women prior to c-sections to decrease gastric acidity?
Sodium citrate
95
_______________ is the most common cause of postpartum hemorrhage.
Uterine atony
96
Past c-sections, placenta accreta, placenta previa, fibroids, and past D&C all raise risk for what kind of postpartum hemorrhage?
Retained placenta
97
To qualify as a true postpartum infection, the maternal temperature has to be elevated after ___________ after delivery.
24 hours
98
A woman has periodic fevers over the five days after delivery that rise and fall (the "picket-fence sign"). What is her diagnosis?
Septic embolization
The chunks of bacteria that break off cause fevers to spike. Look for an abscess on CT and then treat with antibiotics and heparin.
99
Other than failure to lactate, what does Sheehan syndrome present with?
- Weakness, lethargy, and cold intolerance (no TSH)
| - Vaginal atrophy and decreased libido (no GnRH)
100
During pregnancy, _________ inhibit prolactin and stimulate breast growth.
estrogen and progesterone
101
Infant sucking stimulates which hormone?
Oxytocin
102
What are some contraindications to breastfeeding?
- Active HIV, HBV, or HCV infection
| - Maternal use of chloramphenicol or tetracycline (or any other medicine contraindicates in newborns)
103
How should mastitis be treated?
- Continued breastfeeding (or pumping for a woman not breastfeeding) to clear infected material
- Dicloxacillin
