GU 3

Question 1

pregnancy - take hx of
7

Answer 1

1. LMP
2. delivery date
3. prior pregnancies
4. new vaginal discharge
5. bleeding
6. prenatal care, vitamines
7. fetal movement

Question 2

pregnancy - if BP elevated consider
2

Answer 2

preeclampsia, eclampsia

Question 3

pregnancy - PE might reveal
3

Answer 3

1. enlarged uterus
2. Chadwick sign - cervical changes of softening, bluish discoloration
3. increased vaginal discharge (leukorrhea)

Question 4

pregnancy - img/testing
3

Answer 4

1. pregnancy test
2. fetal heart tones - 2nd and 3rd trimester
3. POC urine

Question 5

pregnancy - refer to who for f/u care

Answer 5

gyno

Question 6

pregnancy - recommend daily vitamin that contains what
2

Answer 6

folic acid and DHA

Question 7

NV in pregnancy - non pharm info
4

Answer 7

1. recommend frequent, small meals
2. small sips of water
3. changing positions slowly
4. consider ginger products

Question 8

NV in pregnancy - rx options
2

Answer 8

1. pyridoxine (vitamin B6) 10-25 mg PO q8h plus doxylamine succinate 25 mg PO up to q8h
2. persistent vomiting despite above tx - metoclopramide or ondansetron but discuss why gyno before

Question 9

pregnancy - when to refer to ER

Answer 9

1. all suspected obstetrical emergencies - pain, bleeding, or ruptured membarnes

Question 10

suspect ectopic pregnancy

Answer 10

unilateral pelvic pain and positive urine hCG - send to ER

Question 11

hyperemesis gravidarum

Answer 11

excessive vomiting, send to er - can check urine for ketones but send to ER

Question 12

premature prelabor ruptue of membranes (PPROM)

Answer 12

< 37 weeks gestation - sterile speculum exam may confirm pooling of amniotic fluid; nitrazine paper will stain dark blue; send to L/D in ER

Question 13

cord prolapse

Answer 13

umbilical cord slides through cervix and may be compressed w/ contractions, resulting in fetal hypoxia, anoxia or death

Question 14

cord prolapse tx
3

Answer 14

1. call 911
2. place oxygen on mother, place in Trendelenburg position
3. try to decompress cord w/ hand by elevating fetal presenting part

Question 15

placenta previa

Answer 15

implantation of placenta over cervical os

Question 16

placenta previa - pt may present with

Answer 16

painless vaginal bleeding in 2nd half of pregnancy

Question 17

painless vaginal bleeding in 2nd half of pregnancy

Answer 17

placenta previa - major risk for PP hemorrhage

Question 17

placenta previa tx

Answer 17

911
if suspected, do not attempt bimanual or speculum exam

Question 18

placental abruption

Answer 18

premature separation of placenta from wall of uterus, resulting in bleeding and pain secondary to uterine contractions

Question 19

premature separation of placenta from wall of uterus, resulting in bleeding and pain secondary to uterine contractions

Answer 19

placental abruption

Question 20

placental abruption tx

Answer 20

911
if suspected, do not attempt bimanual or speculum exam

Question 21

HTN in pregnancy

Answer 21

BP reading 140 or 90 lasting >15 min

Question 22

HTN in pregnancy - urine neg for proteinuria and asymptomatic do what

Answer 22

consult OB

Question 23

HTN in pregnancy - urine + proteinuria or symptomatic (HTN, HA, visual disturbances, HELLP syndrome, abd pain RUQ epigastric)

Answer 23

refer to ER, consider EMS transport

Question 24

severe HTN dx and tx

Answer 24

160 or DBP 110 15 min or more
911

Question 25

ovarian torsion

Answer 25

sudden onset of unilateral pelvic pain because of complete or partial rotation of the ovary on its ligamentous supports and vascular pedicle, resulting in ischemia

Question 26

ovarian torsion pain
2

Answer 26

1. acute onset of unilateral pelvic pain, often described as “sharp/stabbing” pain
2. referred pain to groin or flank

Question 27

ovarian torsion s/sx
2

Answer 27

1. acute pain
2. NV

Question 28

ovarian torsion - chronic or recurring

Answer 28

may be chronic or recurring w/ torsion/detorsion phenomenon

Question 29

ovarian torsion - primary risk factors
6

Answer 29

1. hx of ovarian cyst/mass - 5 cm or greater in diameter increases risk; greatest when cyst/mass is 8-12 cm
2. prior pelvic surgery
3. hx of PID
4. recent vigorous physical activity
5. reproductive age
6. undergoing fertility tx

Question 30

ovarian torsion - PE findings may include (although no PE findings definitively r/o torsion)

Answer 30

moderate to significant abd/pelvic tenderness +/- palpable adnexal mass

Question 31

ovarian torsion - img/testing
1

Answer 31

1. pregnancy test

Question 32

ovarian torsion - tx

Answer 32

emergency, send to ER