Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB general (from oral boards) > General 8-23 > Flashcards

General 8-23 Flashcards

1
Q

Rh negative and testing

A

1) Rosette: qualitative test to assess but can have false negatives
2) KB: acid elution test, with ghost cells (maternal)
3) Flow cytometry (radio labeled Ab to cells)

For increased volumes, you can give increased amount by IV, 600ug q8hours until dose is achieved.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Thyroid nodule

A

Goal is to rule out malignancy
>/= 1cm -> FNA
Other indications for FNA (if the size is smaller than 1cm) is risks for cancer such as radiation to the neck history or family history

Radionucleotide thyroid scan- hot nodule is less likely to be malignancy

Obtain TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

General screening (non pregnancy) for DM

A

45 yo w/o risk factors, or 25 years old if BMI>25 with risk factors. Screen q3 years
Dx FBG >126 mg/dL
2hour 75g OGTT >= 200 mg/dL
random >/= 200 with symptoms
hub a1c >/= 6.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Methimazole

A

Anti thyroid medication blocking t3 to t4 synthesis
Risks for fetus of aplasia cutis- :PTU [referred in the first trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cesarean delivery under local

A

0.5% lidocaine (4mg/kg) or with epinephritis (7mg/kg) (max 60cc) or w/o
O2 and EKG monitor with increased doses
midline vertical, minimal retraction?
skin. subcutaneous, viscera, parietal peritoneum
supportive care for lidocaine toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Chorio treatment (during and postpartum)

A

Ampgent 2g q6h and gentamicin 1.5mg/kg q8 hour OR 5-7 mg/kg q24hour

PP: gentamicin, clindamycin 900 mg q8h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mechanism of ursodiol

A

increases bile flow, competes for intestinal absorption

300mg q8hou

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mechanism of glyburide

A

sulfonylurea- increase insulin sensitivity and release
max 20mg/day
1.25-2.5-5-10mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Risk of cord prolapse based on fetal presentation

A

cephalic/frank breech: 0.4-0.55
complete breech: 5%
footling breach: 15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Thyroid storm

A

Admit to the ICU
1) Thioamide: PTU 100mg -> 200mg
2) Iodide (lugol’s, KI)
3) Steroids, block T4-> t3
4) B-blockers: decreased sympathetic effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Inflixamab

A

Anti TNF alpha, monoclonal Ab, -> q8 week dosing usually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

breast candidiasis

A

Infant should be treated by peds
topical: miconazole
oral: diflucan 400mg PO x1 -> 200mg qd for 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

KCL for cardioplegia

A

5-15cc of KCl (2meq/mL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cysto procedure

A

30 or 70 degree score (esp for trigone)
5ml of indigo carmine 10-15 min prior

Insert - identify interureteric ridge, water for efflux, remove slowly to inspect uretrha

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

alpha thal types

A

aa/aa normal
a-/aa asymptomatic carrier

a-/a- (African Am/African) - mild anemia
aa/– (cis) southeast asian

a-/–HbH
–/–Hb Barts hydrops. IUFD

Chromosome 16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PPROM

A

Azithromycin 1mg PO x1
ampicillin 2g q6h -> 48 hours
amoxicillin 500mg q8h for 5 days

PCN allergic: (mild)
cefazoline 1g q8h x48 hours -0> reflex 500mg PO q6h x 5days
azithromycin 1gPO x1

PCN allergic (severe)
clindamycin 900mg q8h x 48h -> 300q8h x5da
gentamicin 7mg/kg x2 doses
azithromycin 1mg PO x1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CMV and pregnancy:

A

0.2-2.2% of all neonates- the most common congenital infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

HSV in pregnancy
treatment and suppression
transmission risk
neonatal HSV

A

tx valtrex 100mg BID x 10 days
suppression: valtrex 500mg BID starting at 36 weeks

transmission: 1’ near delivery 30-60%
2’ with lesions 3%, w/o 2/10K
neonatal: skin/eye/mouth, CNS, worst is disseminated CNS DIC and skin. can be trans placental but much more rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

LSIL in pregnancy

A

Preferential: colposcopy in pregnancy (mostly to rule out high grade lesions or cancer)
can defer colposcopy for 6 wks PP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

types of cerclages

A

history: prior cerclage, cervical insufficiency, >/= 2 trimester losses
US: <25mm at 24 weeks (with prior history)
exam: <10mm OR cervical dilations- usually with no history of PTB
C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Classical CD indications

A

preterm- can be up to 32 weeks if the LUS is not developed (such as FGR)
dense, extensive adhesions
Fibroids
+/- transverse with back down
post-mortem c/s (for maternal death)
3-7% rupture in the next pregnancy (possibly even up to 10%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Posplacental IUD

A

Ideally within 10 minutes of delivery of the placenta
20-35ry% of expulsions
Contraindications: endometritis, PAS

23
Q

Therapeutic anticoagulation
- dose antepartum
- intrapartum management

A

Lovenox 1mg/kg q12H
heparin: goal aPTT 1.5 2.5 (q12h dosing)
consider UFH at 36-37 weeks
- Lovenox d/c i 24 hours and then plan for delivery
if high risk (prosthetic heart valve, fib, PE), consider IV UFH in labor -< stopped for epidural (4-6) and before delivery

In labor:
24 hours stop Lovenox before epidural
UFH: 12 hours stopped before an epidural

Postpartum:
Resuming Lovenox dose:
4-6-12 VD
6-12 CD
Resuming UFD dose:
4-6-12 VD
12-24 CD

24
Q

Home birth

A

2-3x increased risk of neonatal death
no recommended by ACOG

25
Q

Respiratory disease:
Flu
TB
CPAP (PNA)
Asthma

A

Flu: PCR testing and treatment with oseltamivir (neuramidase inhibitor) in 48 hours within for symptoms 75mg PO for 5 days
TB: LTBI for 3-4 months, postpartum treatment if the CXR is negative
CPAP/PNA: S. pneumo, viruses, PO2>70, IV abx with ceftriaxone, aziithromycin- avoid fluroquinolones

Asthma: acute
keep O2>95%, if <90%, get an ABG
albuterol q20minjutes and IV methyprednisone
Long term meds:
Budesonide: ICS
Fluticason: ICS
Advairr: fluticasone + salmeterol
Symbicord: budesonide + formetrol

26
Q

cervical pregnancy or corneal pregnancy

A

cervical:
asymmetrical distention of the cervix, US will show hourglass shaped uterus and ballooning of the cervical canal
Treatment: excision of the mass, possible hysterectomy, placement of sutures, packing, UAE
+/- med management but if medical management ,then needs to be managed inpatient for high risk of bleeding

CORNUAL
- XLAP, excision and uterine reconstruction (possible laparoscopically but will need a specialist)
- NO ROOM FOR MED MANAGEMENT

27
Q

Gardasil vaccine

A

Covers HPV 6, 11, 16, 18, 31, 33 45, 52, 58 (9 subtypes)
Ages 9-26(female) and males 13-21) - although ages have been now extended

3 months (0, 2, 6 months)
14-16 years old- only need 2 doses 0, 6, months

Covers 10% HPV related cancers, 15% of cervical cancers
does NOT cover condylomata - should be treated with TCA, imiquimod

28
Q

Molar pregnancy
Imaging
High risk factors for poor prognosis

A

Additional imaging:
CT chest, pelvis, head

Poor prognosis risk factors:
HCG >40K before treatment
>4 months from last pregnancy
last pregnancy full term
brain/liver mets
prior chemo treatment for molar pregnancy

TREATMENT
a) no mets: Hysterectomy if childbearing is complete or MTX IM weekly until there are 2 negative readings
b) Low risk mets: hysterectomy, single MTX +/- actinomycin
c) High risk: EMA/CO treatment chemo

29
Q

FGR delivery timing

A

FGR 39 weeks
Severe FGR: 37
FGR with elevated UAD 37 weeks
sFGR with elevated UAD 36 weeks
FGR absent 33-34
FGR reversed 30-32

30
Q

Maternal cardiac disease management
- ante/intra/post

A

Ante: ECHO, WHO category, consultations
Intra: strict I/O monitoring, L Lateral positioning, early epidural to prevent catecholamine surge with pain, +/- operative delivery, +/- telemetry
Postpartum: telemetry, +/- diuresis

31
Q

Vesicovaginal fistula- non surgical initial managemen t

A

Foley catheter to decompress the bladder first
If there is a small or high fistulae, this may spontaneously heal with a cathether
keep the catheter in for 4-6 weeks

If still draining despite conservative management -> give it a longer time to 12 weeks (to wait for all suture material to dissolve) and go for OR management with 3 layer closure technique:
1) excise the fistula
2) bladder submucosa
3) bladder muscularis
4) vaginal mucosa

32
Q

Lidocaine doses and side effects

A

LEEP: <10cc with 1% lidocaine

c/s: 30cc of 1% w/o epi
60cc of 1% w/ api
or double if 0.5% lidocaine
7mg/kg is the rough estimate

side effects: metallic taste, oral numbness, tinnitus, speech changes, vision changes, AMS, seizures, arrhythmia, cardiac arrest

33
Q

Respiratory parameters intubation in the ICU(for asthma and other respiratory conditions)

A

PO2 <50
Pco2 >45
Ph <7.35
maternal exhaustion altered mental status

34
Q

steroids for mag neuroprotection

A

steroids: increase surfactant production
max effect 2-7 days after BMZ
BMZ more definitive effect on IVH
improves: mortality, RDS, IVH, necrotizing enterocolitis

Mag: stablizes blood pressure in the fetus and cerebral blood flow
stabilized neuronal membranes
6-12 hours before birth
improves: mortality, cerebral palsy

35
Q

twin breech extraction- inclusion criteria

A

Twin A must be cephalic
32 -39 weeks (or 28 weeks, pending 1500g cutoff)
SVD does not have higher composite risk of adverse neonatal outcomes
<20% weight discordance between the twins (namely, Twin B being larger than twin 1)
at least 1500mg/28 weeks

Give nitro 50-200mcg for uterine relaxation for breech extraction

36
Q

post term pregnancy

A

definition: >/= 42 weeks, 0.25% of pregnancy
morbidity/mortalitiy
- macrosomia risk
- risk of dysmaturity and uteroplacental insufficiency
- risk of meconium
- seizures, CP, hypoglycemia
mortality rate is increased by 2x

37
Q

Fetal OP and manual rotation

A

AP diameter
occiput to town: 9.5 (ideal)
occiput to front (11.5)
occiput to mentum (13.5) -> OP

Occurs 25% of the time in labor, of these 80-90% will spontaneously become OA
5-12% will be born OP without any intervention (and persistence)

Management:
Stage 2:
Nullip: 1.5-2 hours
multiple: 1 hours

38
Q

Fetal T21 and tests sen for NIPT

A

Extra chromosome 21
cfDNA sens 99.3%, spec 99.8%
PPV: age 25: 33%, age 40 87%
dysmorphia features, developmental delay
findings: nuchal thickening, bowel, short humerus/femur, pyelectasis, duodenal atresia

39
Q

IV iron dosing

A

10-20cc/100mL NS -> do EFM for risk of anaphylaxis
20mg Fe/ML

Required iron dose (mg) = (2.4 × (target Hb-actual Hb) × pre-pregnancy weight (kg)) + 1000 mg for replenishment of stores

Equations :

Total body iron deficit (mg) = body weight (kg) x (target Hb – actual Hb in g/dL) x 2.4 + iron depot (mg)** [1, 2]
Iron depot:
15 mg/kg for body weight less than 35 kg
500 mg for those with a body weight greater than or equal to 35 kg

Ideal Body Weight (kg) =45.5 +2.3 * (height inches - 60 inches) [3]

40
Q

SCD risks and treatment for SC crisis

A

Risks: PTL, PPROM, FGR, IUFD, infections, crisis, folate deficiency
Crisis treatment: O2 sat >95%, IVF, pain medication (will need opioids), Hgb >10, HgA>40%, may need exchange transfusion

41
Q

Nephrotic syndrome and pregnancy and AC

A

Definition: >300mg protein/day (increased dues to increased FGR)
glomerular dz treatment:
- immunosuppression +/-
- start LDA
- limit Na intake 1.5g/day
- +/- AC due to low albumin
Risks: PEC, thrombosis in pregnancy or postpartum

42
Q

Vasa previa
- types
- % resolution
- fetal blood volume
- admission and delivery

A

Admission +/- 30 weeks
Delivery at 34-35 weeks
Types:
I: velamentous
II: bilobed
III: branded out and returns (most rare)
15% may resolve by the 3TM

there can be up to 60% perinatal mortality due to hemorrhage if undiagnosed
Fetal blood volume: <100cc/kg
clues on ultrasound: multi lobed, succenturiate, velamentous placental
TVUS: FHR/doppler

43
Q

IgA nephropathy

A

most common cause of primary/idiopathic/ glomerulonephritis
slow progression to ESRD
Risks in pregnancy: HTN, age, proteinuria, race, ACEi
Tx: optimized supportive care, HTN control, RAAS.ACEI , may. need immunosuppression with high risk

Types: IgA with minimal change -> usually goes into remission
IgA with AKI
IgA with rapidly progressive glomerulonephritis

Pregnancy: usually well tolerated if not rapidly progressing

44
Q

Rheumatic heart disease
Mitral valve (bio prosthetic)

A

RHD
- fever with group A strep (usually highest risk ages 5-15)
- Sx present as JONES (2 major and 1 minor): joints, cardiac, nodules, erythema marginatum, syndeham chorea (hypotonia and movement)
- cardiditis with MV damage, 10-20 years after and turns into MV stenosis
- presenting symptoms: dyspnea, fib (causing thrombosis), WHO Class IV, can turn into increased L atrial pressure, dyspnea, pulmonary edema
***50% in pregnancy will progress to pulmonary edema and heart failure

Tx:
beta blockers
diuretics
AC (fib, thrombosis, prosthetic valve)
Lovenox (mitral) Xa 1.0-1.2
Lovenox (aortic) Xa 0.8-1.0
UFH: 2-2.5 PTT

45
Q

Non-OB surgery in pregnancy

A

optimize for 2nd trimester
<24 weeks needs FHR before and after
>24 hours, EFM during surgery
LSC consideration

Fundal height, alternative port placement, LL til, 10-15mm Hg for abdominal pressure, +/- BMZ depending on the sickness of the patient and surgery needs

46
Q

Chronic hepatitis B

A

sAg +, hepbcag +, E ab (if positive- then high risk of transmission)
Plan:
- check VL, LFTs, GI and other hepatitis
- check HIV
- tenofovir 300mg -> 2x10^5 Vl copies
- increased fetal risk of FGR, PtD, IUFD
- Ensure there is no cirrhosis or varicose
- okay for breastfeeding
- HBIg +N vaccine for the newborn

47
Q

Maternal hydrocephalus
- causes
management and delivery

A

NPH: normal pressure hydrocephalus- increased ventricular size can affect dementia, gait, incontinence and may need a VP shunt

Shunt complications: 25-50% (shunt occlusion) -> enlarging uterus -> increased ICP

VD +/- shorten second stage with operative delivery

consult neurology

48
Q

cardinal movements of labor

A

Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
restitution
expulsion

49
Q

hidradenitis suppurativa

A

it is a chronic inflammatory disease of apocrine glands (pelvic, axillary)
- can have a secondary bacterial infection: S aureus, s pyrogens, gram negatives
- can cause extensive scarring and formation of draining sinus

Treatment:
Clindamycin, orał micocyclie, tetracycline
steroids (intralesional)
Retinoinds
cyclosporine

Surgical: wide local excision

50
Q

Toxo

A

Toxoplasmosis
- parasite from raw meat and cat feces
- 1TM 10-15% transmission
- 2TM 25%
- 3TM: 60% or more

Dx IgG /IgM
Amnio PCR

TX: spiramycin

findings: ventriculomegaly, microcephaly, calcifications, hepatomeglaly, FGR

51
Q

CMV

A

30-40% with increased tramission in the 3TM

IgG/M with PCR

Findings of microcephaly, chorioretinitis

52
Q

VZV

A

treatment with Vz/ig
FEtal findings of FGR, hydros, echogenic bowel, microcephaly

53
Q

Fetal weights
24
28
32
36 weeks

A

24 - 670g
28- 1210g
32 2000g
36 2800
40 3600

OB general (from oral boards) (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions