Hinjke Flashcards

1
Q

What is a tier 1 contraceptives?

A

Progestin implants and IUD
Implanon
Copper IUD
Mirena

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2
Q

What are tier 2 contraceptives?

A

DMPA, rings, patches, OCP

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3
Q

What is a tier 3?

A

Condoms, diaphragms, caps, shield, spermicides, withdrawal, fertility awareness, natural family planning

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4
Q

What is the mechanism of action of implanon?

A

Negative feedback on hypothalamus decreasing GnRH
Thickens cervical mucus
Thins endometrium

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5
Q

What is a contraindication to using implanon?

A

Breast cancer

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6
Q

What drugs may decrease the efficacy of implanon?

A

Phenobarbital
Dilantin
St. John’s Wort

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7
Q

What are the emergency contraceptions?

A

Combo OCPs with 100 mcg of ethinyl estradiol and .5 mcg levonorgestrel twice 12 hours apart
Copper IUD
Plan B

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8
Q

How does a copper IUD work?

A

Immobilizes and kills sperm

Prevents implantation if fertilization

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9
Q

How long does a copper IUD last?

A

10-20 years

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10
Q

What is a contraindication in copper IUD?

A

Wilson’s disease and PID

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11
Q

How is a copper IUD used for contraception?

A

Can use for up to 5 days after

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12
Q

What do you worry about when your perforate laterally?

A

Bleeding through uterine artery

If patient feels pain immediately afterward - think perforation

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13
Q

How does levonorgestrel work?

A

Thickens cervical mucous
Thins endometrium
Does NOT prevent ovulation

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14
Q

How long does levonorgestrel work?

A

5 years

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15
Q

What are the contraindications to levonorgestrel?

A

Breast cancer

PID

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16
Q

How do tier 2 contraceptives work?

A

Thicken cervical mucous

Preventing ovulation by suppressing LH surge

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17
Q

What is a contraindication to OCPs?

A
Aura or hx of migraines
Hx of uncontrolled HTN
Hx of TE, stroke, MI, breast cancer
Advanced DM 
Unexplained dysfunctional uterine bleeding - could have cancer
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18
Q

If someone on OCPs comes in with RUQ pain, what should you be thinking?

A

Cholelithiasis or benign hepatic tumor

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19
Q

What is the downside to ortho evra patch?

A

Skin irritation
Must be under 198 pounds
Higher risk of DVT!

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20
Q

What do you give to milking mothers for contraception?

A

The progesterone only pill - micronor

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21
Q

How does progestin only work as a contraceptive?

A

Thickens cervical mucous

Inhibits ovulation

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22
Q

Who cannot use progestin only?

A

Women who have had breast cancer in the last 5 years

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23
Q

What do progesterone and estrogen do to triglycerides?

A

They make them go up so don’t use for someone with hyperlipidemia

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24
Q

What is DMPA?

A

An IM injection every 3 months

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25
Q

What is the biggest problem with the DMPA?

A

Weight gain

Return to fertility may be prolonged

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26
Q

What is a contraindication for using DMPA?

A

If the patient has asthma

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27
Q

What is the Yuzpe method?

A

Using OCPs for emergency contraception

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28
Q

What is plan B?

A

Progestin only
.75 mg of levonorgestrel
Can take up to 5 days after
89% effective

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29
Q

What female sterilization method is good for patients who aren’t good with anesthesia?

A

Hysteroscopic - can be done in office.
Put little stainless steel coils in the Fallopian tubes — inflammatory reaction causes closure of the tubes.
Do a hysterosalpingogram afterward to make sure the tubes closed

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30
Q

What is the Texas law in abortion?

A

Legal up to 20 weeks
After 16 - must happen in a hospital
Under 18 must have parental consent
Info on alternatives must be provided 24 hours before
Descriptions of US findings must be given
Must offer to view US

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31
Q

What can be used for abortions before 7 weeks?

A

Mifepristone - anti progesterone

Misopristol - prostaglandin that causes uterine contractions

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32
Q

What is placental abruption?

A

Premature separation of normally implanted placenta

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33
Q

What are the risk factors for placental abruption?

A

HTN, hx of abruption, trauma, short umbilical cord (less than 30 cm), tobacco use, PROM

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34
Q

What is a succenturiate placenta?

A

An accessory placenta

Associated with postpartum hemorrhage or infection

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35
Q

What is velamentous cord insertion?

A

Vessels only surrounded by fetal membranes, no Wharton’s jelly

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36
Q

What is vasa previa?

A

When vessels course over the cervical os.

Associated with perinatal mortality

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37
Q

What is a complication of velamentous cord insertion?

A

Fetal exsanguination

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38
Q

What is the Apt test?

A

When you are trying to figure out who is bleeding - mom or baby.

Take blood from vag, put in water and add KOH. RBCS will lyse. Mom’s Hb will be brown and baby’s will be red

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39
Q

What is the greatest risk factor for velamentous cord insertion?

A

Multiples

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40
Q

What is the management for velamentous cord insertion?

A

Immediat abdominal delivery

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41
Q

Woman comes in at 30 weeks with painless vaginal bleeding and no contractions. Her vital signs are stable and is afebrile. What is the dx?

A

Placenta previa

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42
Q

A girl comes in with light vaginal bleeding after intercourse. Everything else is good. Cervix is friable. What is the dx?

A

Ectropion of pregnancy

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43
Q

What is cervical ectropion?

A

When the endocervical columnar epithelium is exposed to the vaginal milieu by eversion.

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44
Q

Preggers Patient comes in with heavy bleeding, ab pain, firm uterus. What is the dx?

A

Placental abruption

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45
Q

What does a normal placenta look like?

A

Diameter = 22 cm
Thickness = 2-2.5 cm
Cord length = 55-60 cm
Gray wrinkled shiny and translucent

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46
Q

Pregger patient comes in with bright vag bleeding and no pain or contractions. How do you dx placenta previa?

A

Pelvic US

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47
Q

What is placenta accreta?

A

Deep attachment of the placenta through the endometrium and myometrium of the uterus due to defective desidual formation.
Lots of hemorrhage and often leads to a hysterectomy
Accreta - superior
Increta - invades partially into the myometrium
Percreta - extends to the serosa of uterus

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48
Q

What are the risk factors for placenta accreta?

A

Prior c-section!!!!!

Scar tissue - asherman’s

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49
Q

What is a good method for determining the cause of third semester bleeding?

A

Pelvic US

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50
Q

What is a low lying placenta?

A

When the placenta is with 2 cm of the cervical os

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51
Q

What are the signs for placental abruption?

A

Painful vaginal bleeding
Increased uterine tone and activity
Uterine tenderness
If fibrinogen is down

52
Q

What are the risk factors for a ruptured placenta?

A
Maternal HTN
Trauma
Prior abruption
PROM
Short umbilical cord
Tobacco use
Folate deficiency
53
Q

What is the most common cause of DIC in pregnancy?

A

Placental abruption

54
Q

What is the best way to manage a placental abruption?

A

A vaginal delivery

55
Q

What are the consequences of placental abruption?

A

Fetal demise
Hypovolemic shock
Acute renal failure
Sheehan’s syndrome

56
Q

What are the signs of uterine rupture?

A

Sudden onset of intense abdominal pain and some vaginal bleeding
No longer feel fetal parts
Mother has hx of C-section

57
Q

What is the most consistent clinical finding with a uterine rupture?

A

Abnormal fetal heart rate

58
Q

What is the treatment for uterine rupture?

A

If you can’t fix it - hysterectomy

59
Q

What does uterine inversion cause?

A

HTN and postpartum hemorrhage

60
Q

What is postpartum hemorrhage?

A

Blood loss of over 500 ml in vag delivery

Over 1000 ml in c-section

61
Q

Patient with multiple different delivery attempts with fever and ok bp - had a c-section. what is dx?

A

Endometritis

62
Q

What is uterine atony?

A

Loss of uterine muscle tone

63
Q

What are the risk factors for uterine atony?

A

Multiples
Macrosomia
Prolonged labor
Over distention

64
Q

How does trichomonas present?

A
Itchy
Odor
White, greenish discharge that pools in the fornix and has bubbles in it. 
Strawberry cervix 
Will see WBCs
65
Q

How do BV present?

A
Odorous discharge
Milky white
Fishy
Usually just see in the walls
Presence of clue cells = Gardernella 
No WBCs
66
Q

How does Candida present?

A

Itching
No odor
Clumpy white
Will see WBCs

67
Q

What is the treatment for trich?

A

Metronidazole - 2 g

68
Q

What is the treatment for candida?

A

Oral fluconazole
Vaginal miconazole
Boric acid suppositories

69
Q

How do you diagnose a tuboovarian abscess?

A

US or CT

70
Q

When do you hospitalize a patient when they have PID?

A

Pregnant
Unsure about the dx
Tuboovarian abscess
Sepsis

71
Q

What is the protocol for PID?

A

Test for all STDs

Broad spectrum antibiotics because PID is a polymicrobial infection

72
Q

What is Fitzhugh-Curtis syndrome?

A

Perihepatic adhesions presenting with RUQ pain

73
Q

What are the clinical pearls for herpes?

A

Do not biopsy - too painful
Start tx immediately
Start suppressive tx at 36 weeks and consider c-section

74
Q

What do you do for condyloma acuminatum?

A
Tx with TCA - chemical burn
Surgical removal
Antiviral - cidofovir
Anti proliferation - podophyllotoxin
Immunomodulatory - imiquimod
75
Q

Is condyloma an indication for a c-section?

A

No, infection rate is low

76
Q

What happens in lichen sclerosis?

A

You lose anatomical distinction between the labia minora and majora. Introitus is small

77
Q

How does lichen sclerosis present?

A

Usually older woman with severe itching, especially at night who is not sexually active with husband because it is too painful

78
Q

What is the tx for lichen sclerosis?

A

High dose steroids

79
Q

When do you biopsy condyloma acuminatum?

A

If the lesions haven’t gotten better

80
Q

What do you do to confirm diagnosis of lichen sclerosis?

A

Office punch biopsy

81
Q

How does lichen planus present?

A

Older woman with vulvar itching, not having sex, burning

82
Q

What is lichen sclerosis a risk factor for?

A

Vulvar SCC

83
Q

What is the most common form of mental retardation?

A

Down’s syndrome

84
Q

What are the sex-linked disorders mentioned?

A

Fragile X - triple repeat expansion on long arm of X

Duchenne’s muscular dystrophy

85
Q

What are some multifactorial disorders?

A

Cleft palate
Spina bifida
Anencephaly
Pyloric stenosis

86
Q

What is the recommendation is the patient has a history of babies with NT defects?

A

4mg of frolic acid daily

87
Q

What is a triple marker screen?

A

Offered at 16-18 weeks

Tracks alpha fetoprotein, hCG, unconjugated estriol

88
Q

What does an elevated MSAFP mean?

A

You need to do a sonogram because there are higher rates of NT defects associated with this
Can also do amniocentesis

89
Q

What problem is associated with low MSAFP, UE3, and hCG?

A

Trisomy 18

90
Q

What problem is associated with low MSAFP, UE3, and high hCG?

A

Down’s

91
Q

When do you do a cordocentesis?

A

When there is rh factor problems to see how anemic the baby is and figure out when it’s time to get the baby out

92
Q

What are the screening tests in the first trimester?

A

Serum hCG
Sono + Pregnancy associated plasma protein a
Thickened nuchal translucency
Chorionic villus sampling

93
Q

What is the screening in the second trimester?

A

Quad screen: AFP, HCG UE3, inhibit a

94
Q

When is the fetus most susceptible to teratogens?

A

3-8weeks

95
Q

What does an FAH baby look like?

A
Low nasal bridge
Thin upper lip
Small chin
Flat midface
Short nose
96
Q

What are the anxiolytics that can be teratogens?

A

Meprobamate and chlordiazepoxide

97
Q

What are the anti neoplasticism agents?

A

MTX, amionopterin

Busulfan, chlorambucil, cyclophosphamide, nitrogen mustard

98
Q

What is warfarin syndrome?

A

Stipples epiphysis
Nasal hypoplasia

Use heparin instead because it doesn’t cross the placenta as readily

99
Q

What are the anticonvulsants?

A

Dilantin
Trimethadione
Valproic acid - NT defects
Carbamazepine - spina bifida

100
Q

What is the problem with phenobarbital in pregnancy?

A

Low teratogenicity but baby goes through withdrawal

101
Q

What do retinoids cause?

A

Ear defects, blindness,

102
Q

What is preterm labor?

A

Contractions with cervical change prior to 37 weeks

103
Q

What are the risk factors for preterm labor?

A
Infection
Vascular problems (SLE) 
Placental problems 
Stress/strain
Uterine stretch
Hx of preterm
Multiples
104
Q

What are the two leading factors for preterm?

A

Multiples and hx

105
Q

What is the most concerning diagnostic finding for preterm labor?

A

Cervical length less than 2.5 cm

106
Q

What does the fetal fibronectin tell you?

A

If positive - you have a 50% chance of going into labor within the next 2 weeks

107
Q

How do you treat preterm labor?

A

Give antibiotics
Give steroids prior to 34 weeks
Recommend hydration, bed rest

108
Q

When do we use magnesium sulfate?

A

When they are having contractions - tocolytic

109
Q

How does magnesium sulfate work?

A

It competes with calcium so it decreases contractions.

Makes you feel crummy

110
Q

What else is mgso4 used for?

A

Neuroprotection

111
Q

What is nifedipine?

A

It is a calcium channel blocker

Tocolytic and anti hypertensive

112
Q

What is indomethacin?

A

Prostaglandin synthetics inhibitor - tocolytic

113
Q

What is atosiban?

A

Oxytocin receptor antagonist

Tocolytic

114
Q

What is PROM?

A

Rupture of membranes without other signs of labor.

Don’t induce until after 34 weeks

115
Q

How do you diagnose PROM?

A

Pooling - fluid in the vault
Ferning - take liquid and dry it - if amniotic fluid, will see crystals
Nitrazine - paper that turns blue
Amnisure- detects alpha microtglobulin

116
Q

What are the markers for fetal lung maturity?

A

Lecithin/sphingomyelin ratio is 2/1
Presence of phosphatidylglycerol with the ratio = great sign
Lamellar body density count

117
Q

What is IUGR?

A

When fetus is below 10th percentile

118
Q

What is symmetrical IUGR?

A

When head to abdominal ratio is normal. The whole fetus is small

119
Q

What is symmetrical IUGR due to?

A

Infection

120
Q

What is asymmetrical IUGR?

A

When the head is larger than the rest of the body

121
Q

What is asymmetrical IUGR due to?

A

Vascular problems - HTN, SLE, DM

122
Q

What is the screening test for gestational growth?

A

Fundal height

123
Q

What is used to diagnose fetal IUGR?

A

US

124
Q

What is fetal post aridity syndrome?

A

When the placenta functions poorly, SC fat loss, long fingernails and dry peeling skin on baby

125
Q

What do you worry about in a mother who has been carrying a dead fetus for several weeks?

A

DIC - check fibrinogen

126
Q

What is IUFD?

A

Death of the fetus past 20 weeks and before th onset of labor