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*****ObGYN > Kaplan Q's > Flashcards

Kaplan Q's Flashcards

1
Q

What is the benefit of using LMWH compared to unfractionated heparin in a pregnant pt w/ DVT?

A

longer half life
more predictable dose-response relationship
less likely to cause thrombocytopenia and hem. complications* (most important)
(NEITHER cross placenta or cause teratogenesis)

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2
Q

Warfarin embryopathy sx?

A

nasal hypoplasia

stippled vertebral/femoral epiphyses

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3
Q

2nd and 3rd T exposure to warfarin can cause what sxs?

A

hydrocephaly, microcephaly, ophtho abnormalities, IUGR, developmental delay

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4
Q

What are the complications of overt hypothyroidism in pregnancy?

A

inc risk of pre-eclampsia, LBW, preterm labor, placental abruption, MR

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5
Q

dx of primary amenhorrhea?

A

absence of menses at age 14 without secondary sex characteristics; or at 16 w/ secondary sex char.

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6
Q

another name for Mullerian agenesis?

A

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome

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7
Q

What is absent w/ Mullerian agenesis?

A
  • fallopian tubes, uterus, cervix, upper vagina
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8
Q

What is present w/ Mullerian agenesis?

A

normal external genitalia/sex characteristics (tanner stage IV: breasts/pubic hair because ovaries do NOT originate from Mullerian duct)
- lower vagina (comes from urogenital sinus) ends in blind pouch

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9
Q

primary amenorrhea w/ bulging membranes b/w labia and hematocolpos. dx?

A

imperforate hymen. usually requires sx

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10
Q

inability to produce GnRH?

A

Kallman syndrome

(neurons fail to migrate) -> anosmia; no breast development. DO have uterus

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11
Q

Criteria for discharge of a post-op pt?

A
  • alert
  • ambulatory
  • tolerate PO
  • VSS
  • adequate bowel/urinary tract fxn
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12
Q

Indications for neurosurgery for prolactinoma?

A
  • failure of medical managment after 1-3 months
  • persistent vf defects despite tx
  • large cystic or hem tumors
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13
Q

Contraindications for tolterodine use for urge incontinence?

A
  • it is antichol

- CI in urinary retention, gastric retention, narrow angle glaucoma or allergy

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14
Q

Contrast PID with TOA

A

both have ascending infxn from upper gential tract

  • PID: infxn of epithelial cells lining tubes
  • TOA: adnexal abscess
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15
Q

TOA tx

A

IV clindamycin and gentamycin

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16
Q

other indications for inpt IV clinda/gent

A

indications for inpatient:

  • preg
  • T >39 (102)
  • IUD
  • pelvic abscess
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17
Q

DOC for acute PID without TOA?

A

oral ofloxacin for 14 days

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18
Q

what is pseudocyesis and how do you dx it?

A

woman convinced she is pregnant when she is not

  • negligible BhCG
  • no IUP on TV/US
  • may have symptoms of preg
  • can last for a few weeks up to 9 months
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19
Q

When to give Rhogam?

A
  • to ALL Rh negative moms: at 28 weeks, with bleeding, at delivery (300 mcg standard ppx dose)
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20
Q

How to determine Rhogam dose w/ fetomaternal hemorrhage?

A
  1. Rosette test to screen
    (if neg -> 300 mcg dose)
  2. If positive, do Kelihauer-Betke stain
  3. for every 15mL fetal blood in maternal serum, give 300 mcg dose IM to a max of 5 doses
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21
Q

What should be given before an epidural is placed?

A

antacid to increase the stomach pH (help prevent aspiration pneumonitis should aspiration occur w. general anesthesia)

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22
Q

persistent scaling, eczematous, ulcerated lesion of nipple/areolar complex. dx?

A

paget disease of the breast;

often coexists w/ DCIS

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23
Q

what is expected microscopically w/ pagets of breast?

A

individual adenocarcinoma cells of the epidermis

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24
Q

Causes of face presentation (instead of normal occiput pres)

A
  • anencephaly
  • pelvic contraction
  • high parity

can continue w/ normal vaginal delivery

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25
when to deliver term or later preterm IUGR fetus?
- maternal HTN - growth failure of 2-4 wks - low BPP - absence/reversed flow on umbilical arterial doppler velocimetry
26
when would you do SIS (saline-infused sonohysterogram)
work up of RPL to assess uterine cavity
27
other tests to work up RPL?
IgG and IgM anticardiolipin antibody, lupus anticoag, TSH, thyroid peroxidase; parental/abortus karyotype (if all else normal)
28
when is oral fluconazole contraindicated for vulvovaginal candidiasis?
``` first trimester (due to potential for embryopathies) -> use miconazole cream instead ```
29
Who should undergo yearly mammography screening?
women age 50-70
30
Safe abx for UTI in preg?
nitrofurantoin, keflex
31
what is the max safe radiation dose in preg?
5 RAD
32
malodorous (fish) greenish-gray "frothy discharge" erythematous/edematous vulva/vaginal epithelium petechial cervical lesions
"strawberry cervix" "motile flagellated protozoa" | dx = trichomonas vaginalis
33
how to interpret ph of fetal scalp sampling?
pH > 7.25 -> expectant management pH 7.20-7.25 - repeat in 15-30 min pH <7.2 take steps to bring about delivery (damage if pH <7.0) (choose b/w forceps, vacuum, C-section depending on station, dliation etc)
34
When do you see physiologic leukorrhea?
- female neonate shortly after birth (maternal estrogens stim newborn endocervical glands & vag epithelium -> gray/gelatinous d/c) - months preceding menarche (inc. estrogen levels -> whitish d/c_
35
tx for heme stable pts w known hxDUB?
Ocp w high dose E+P qidx7 days
36
when do you give IV estrogen for vaginal bleeding?
profuse and pt is unresp to ivf
37
when do you give progestins alone?
anovulatory dub when dx is clear
38
tx of endometrial cancer?
TAH, bilateral adnexectomy, possilbe LN sampling
39
def and cause of early decels?
gradual dec in FHR directly correlated w/ uterine contractions; cause: fetal head compression and vagal nerve stim
40
pattern seen w umbilical cord compression?
``` variable decels (abrupt, not related to ctx) if >60/min, may indicate fetal jeopardy ```
41
magnesium sulfate: - excretion method - contraindications - SE - signs of toxicity - antidote
- excreted by kidneys (adjust dose) - CI in MG - SE: flushing, diaphoresis - toxicity: loss of DTR, resp paralysis, cardiac arrest - antidote: calcium gluconate
42
how do you define variable decelerations?
abrupt FHR decrease of at least 15 below baseline with no relationship to uterine contractions
43
what causes variable decelerations?
umbilical cord compression
44
how do you define accelerations?
increases in FHR above baseline | if >32 wks: >15 increase in FHR lasting >15s
45
what do late decelerations indicate?
uteroplacental insufficiency - most concerning! | -> transient hypoxemia or myocardial depression
46
criteria for dx of precocious puberty
development of secondary sex char and accelerated growth in age: <8 if girl (usually thelarche -> adrenarche ->growth) <9 if boy (usually testicular->penile-> adrenarche -> growth spurt)
47
enlarged, symmetric, tender uterus. not pregnant. | dx?
adenomyosis (presence of endometrial glands/stroma in myometrium)
48
enlarged, asymmetric, nontender uterus. not pregnant.
leiomyoma (benign smooth muscle growth of myometrium aka fibroids)
49
what is the only breech presentation that can be delivered potentially safely vaginally?
frank breech (thighs flexed, legs extended)
50
what is compound presentation?
presentation of more than one anatomic part (e.g. both fetal head and an arm)
51
in evaluation of fertility, what is next step if sperm is abnormal?
- repeat semen analysis in days to weeks b/c of sig. variability; THEN investigated FSH, LH, testosterone
52
what is the most common symptom of PMDD?
abdominal bloating
53
tx for granuloma inguinale?
bactrim or doxy for 3 weeks
54
how do you characterize placental abruption?
mild - minimal vag bleed w/ normal FHT and localized pain/tenderness moderate - mod bleed/pain w/ fetal tachy with decreased variability and/or mild late decels severe - continuous "knife-like" uterine pain w/ fetal brady, severe late decels, or fetal death. +/- DIC
55
when should you test for GDM?
week 24-28
56
when should you test for GBS?
week 35-37
57
what to use for GBS if PCN allergy and no time to desensitize?
cefazolin, clindamycin, or vanc
58
germ cell tumor assoc w/ increased LDH, normal-increased BhCG?
dysgerminoma
59
GCT assoc w/ increased LDH and AFP?
yolk sac tumor (endodermal sinus(
60
GCT assoc w/ increase of all 3 markers (AFP, BhCG, LDH)
mixed germ cell
61
GCT assoc w/ increased B-hCG and LDH?
choriocarcinoma
62
tx of choice for endometritis following a C section?
clindmycin and gentamicin (add ampicillin if patient still spiking a fever; flagyl if pcn allergy)
63
what kind of IUGR does chronic maternal dz cause?
Asymmetric (normal head, small abdominal circumference)
64
what can cause symmetric IUGR?
aneuploidy, early infxn, gross anatomic anomaly
65
what is another common cause of anovulation besides PCOS?
hypothyroidism
66
what is incomplete isosexual precocious puberty?
change in only ONE of thelarche, adrenarche, or menarche
67
what cancer does OCPs decrease your risk for?
endometrial
68
what is a pt at risk for with placenta previa and a hx of prior C-sections?
placenta accreta
69
why are ocps contraindicated immediately after delivery?
ESTROGEN- bad for baby if breastfeeding; bad for mom for up to 3 months due to hypercoag state
70
classic triad of vasa previa
1. fetal brady 2. ruptured membranes 3. painless vaginal bleed
71
what is lochia?
normal discharge after pregnancy; due to normal shedding of endometrium after delivery of placenta
72
normal lochia progression?
mean 4 weeks | bright red blood -> pinkish brown -> yellowish white
73
definition of arrest of labor?
no change in cervical dilation for >4 hrs if adequate contractions (>6hrs if inadequate)
74
how is the active phase of labor definied?
after 3 cm dilation
75
latent phase of labor?
onset of contractions up until rapid cervical dilation
76
what sonographic findings are consistent with retained products of conception?
endometrial thickness >10mm, intrauterine mass
77
AFI - definition of oligohydramnios
AFI <5cm
78
rate of HIV vertical xmission WITHOUT haart?
25%
79
What is an indication for forceps delivery?
mitral stenosis
80
what are the levels of SHBG like in PCOS?
decreased! (due to increased androgens)
81
what is the LH;FSH ratio like?
greater than 1:1; more LH -> stim theca cells -> more androgens -> decreased SHBG by liver
82
What are signs of infection that would cause you to be concerned for chorioamnionitis?
uterine tenderness, maternal fever, fetal tachy
83
when is beta unnecessary in prom/pprom?
if fetus if 34 weeks or greater
84
What does bleeding gums while pregnant indicate?
NORMAL physiologic change caused by hypervascularity and increased circ blood volume
85
what is the next step in evaluation of a pregnant woman with low TSH?
look at free T4 - if high, indicates hyperthyroidism - give (propanolol) or PTU if moderated/severe
86
tx of lichen sclerosis?
clobetasol or halobetasol topical corticosteroid
87
when do you treat persistent chronic HTN in pregnancy?
systolic >= 160, diastolic >= 105
88
what should you do after a pregnant woman gets her 2nd uti during pregnancy?
put her on abx ppx for the remainder of the pregnancy
89
triad of dysuria, dyspareunia, and postvoid dribbling. dx?
urethral diverticulum
90
mild pre-eclampsia criteria
bp >= 140/90 after 20 wks gestation, proteinuria >300 mg/24 hr or 1+
91
severe pre-eclampsia findings
bp >=160/110, proteinura >5g/24 hrs, HA, vision changes, upper abdominal pain, oliguria, inc. creatinine, increased LFTs, thrombocytopenia, IUGR, pulmonary edema
92
IUD absolute contraindications
current/suspected pregnancy, gross uterine abnormalities, abnormal uterine bleeding of unknown cause, acute pelvic infxn, current breast cancer (copper IUD also contraindicated in wilsons' dz and in those w/ copper allergy)
93
dx criteria for hyperemesis gravidarum?
hx of vomiting, plus loss of 5% pre-preg wt
94
tx for HG?
1. pyridoxine-doxylamine 2. promethazine 3. IVF if signs of dehydration, lyte abnormalities, ketonuria/acid base
95
components of BPP?
1. NST 2. AFI 3. gross fetal movements 4. extremity tone of fetus 5. fetal breathing **important to obtain if NST equivocal or non-reassuring
96
cancer treatment differences in pregnant women
1. no chemo in T1 | 2. no radiation during preg
97
management of PID in pregnancy?
admit and IV abx: clinda, gent

*****ObGYN (3 decks)

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