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Oral Boards > OB - 1 > Flashcards

OB - 1 Flashcards

1
Q

What are the muscles of the anterior abdominal wall?

A

Internal Oblique, External Oblique, Transversalis, Rectus

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2
Q

What dermatome is the nipple?

A

T4

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3
Q

What dermatome is the sternum?

A

T8

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4
Q

What dermatome is the umbilicus?

A

T10

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5
Q

What dermatome is the pubis?

A

T12

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6
Q

What are the nerve roots of the pudendal?

A

S2,3,4

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7
Q

What nerves innervate labor pain felt in the first stage?

A

T11-12

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8
Q

What nerves innervate labor pain felt in the second stage?

A

S2-4 (Pudendal N.)

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9
Q

Nerve roots and palsy of: iliohypogastric n.

A

T12-L1; sensory loss of skin over pubic symphysis down to labia majora

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10
Q

Nerve roots and palsy of: ilioinguinal n.

A

T12-L1; sensory loss of medial aspect of labia majora

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11
Q

Nerve roots and palsy of: femoral n.

A

L2-4; sensory loss of anterior medial leg and thigh, motor loss of quadriceps, unable to lift knee

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12
Q

Nerve roots and palsy of: lateral peroneal n.

A

L4-S2; motor loss: foot drop, foot inversion

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13
Q

Nerve roots and palsy of: sciatic n.

A

L4-S3; motor loss: weak hamstring, leg flexion compromised

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14
Q

Nerve roots and palsy of: Erb’s.

A

C5-6; waiter’s tip

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15
Q

Nerve roots and palsy of: Klumpke’s.

A

C8-T1: hand and wrist paralysis, arm hangs flaccid at side, grasp reflex lost

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16
Q

What are the (3) parameters of the: pelvic inlet?

A

Diagonal conjugate, retropubic space, pectineal line

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17
Q

What are the (3) parameters of the: mid pelvis?

A

Hollow of sacrum, ischial spines, sacrospinous ligaments

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18
Q

What are the (3) parameters of the: pelvic outlet?

A

Coccyx, infrapubic angle, inter tuberous diameter

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19
Q

What muscles are cut in an episiotomy?

A

Bulbospongiosis, superficial transverse perineal, deep transverse perineal

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20
Q

What are the cardinal movements of labor?

A

Engagement
Descent
Flexion
Internal rotation
Extension
Restitution
External rotation
Expulsion

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21
Q

What are the elements of an Apgar score?

A

HR, RR, Tone, Reflex, Color

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22
Q

What are the elements of a Bishop score?

A

Position, Consistency, Dilation, Effacement, Station

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23
Q

What are the 4Ts etiologies of PPH?

A

Tone (Atony)
Tissue (Placenta)
Tears (Lacs)
Thrombus (Coagulopathy/DIC)

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24
Q

What factors does Wafarin/Coumadin act upon?

A

Factors 2, 7, 9, 10 (extrinsic and intrinsic)

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25
Q

What factors does heparin act upon?

A

Inhibits factor 10a and acts as a co-factor for antithrombin III

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26
Q

What are normal changes in the clotting system for pregnancy?

A

Increased factor 5, 7, 9 , 10 , 12, fibrinogen
Mild resistance to protein C and S
Increased plasminogen activator type 1+2

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27
Q

What are risk factors for fetal macrosomia?

A

History of macrosomia
Excessive weight gain in pregnancy
Positive 1h GCT but neg 3h GTT
Diabetes
Obesity
GA > 40w

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28
Q

What interventions have been shown to reduce the risk of fetal macrosomia?

A

Low glycemic index diet
Exercise in pregnancy
Bariatric surgery prior to pregnancy

29
Q

What factors are associated with decreased success of ECV?

A

Obesity
Fetal macrosomia
Oligohydramnios
Anterior placenta
Short/nuchal cord
Frank breech

30
Q

What are contraindications (relative or absolute) for ECV?

A

Maternal: cardiac disease
Fetal: multiple gestation, IUGR, fetal anomalies, NRFHT
Placenta: Placenta previa, PROM
Indication for CS: prior classical, congenital uterine malformations

31
Q

What is the background risk of uterine rupture in TOLAC?

A

1%

32
Q

What is the risk of uterine rupture with undocumented scar in TOLAC?

A

1%

33
Q

What is the risk of uterine rupture with twins TOLAC?

A

1%

34
Q

What is the risk of uterine rupture with prior lower segment uterine rupture?

A

6%

35
Q

What is the risk of uterine rupture with prior upper segment uterine rupture?

A

32%

36
Q

What is the risk of uterine rupture with prior classical CS?

A

10%

37
Q

What is the risk of uterine rupture with misoprostol?

A

15%

38
Q

What is the risk of uterine rupture with miso induction for 2nd tri loss?

A

< 1%

39
Q

What is the overall success rate of TOLAC?

A

60-80%
- 60% if prior CD for CPD
- 80% if not

40
Q

What factors lower the success rate of TOLAC?

A

Recurrent indication for initial CD
AMA
GA > 40w
Maternal obesity
PEC
Short interval pregnancy
EFW > 4000g
IOL

41
Q

What is the definition of cHTN?

A

HTN dx < 20w GA or persists > 12w PP
> 140/90 on 2 occ at least 4 hrs apart

42
Q

What is the definition of gHTN?

A

HTN dx > 20w GA, normal at 12w PP
No proteinuria

43
Q

What is the definition of PEC?

A

gHTN + proteinuria
- P/C >= 0.30
- 24h protein > 300mg
- Spot protein > 30 (2+)

44
Q

What are the severe features of PEC?

A
  • Cerebral: HA and visual disturbances
  • Vascular: BP > 160/110 or pulm edema
  • Heme: Hemolysis, Plt > 100k
  • Hepatic: LFTs twice normal, RUQ pain
  • Renal: Cr > 1.1 or doubling of Cr
45
Q

What are high risk factors that require ASA for prevention of PEC?

A

Hx PEC
CHTN
Renal disease
Multiple gestation
GDM
Autoimmune disease (APLS, lupus)

46
Q

What are mod risk factors that require ASA for prevention of PEC (presence of 2 or more)?

A

Family hx of PEC
Hx of low birth weight or SGA
Nulliparity or > 10yrs since last pregnancy
AMA
Obesity
AA race
Low SES

47
Q

What is the therapeutic range for Mag?

A

4.8-8.4

48
Q

Describe aspects of Mag toxicity at various levels:

A

Mag 10 - loss of reflexes
Mag 16 - respiratory distress
Mag 22 - cardiac arrest

49
Q

What to use instead of Mag in pts with Myasthenia Gravis?

A

Phenytoin (monitor with EKG), or
Diazepam (need to be able ot intubate)

50
Q

What are causes of cHTN?

A

Essential HTN, rcoarctation of aorta, Cushing’s, renal disease, renal artery stenosis, primary hyperaldosteronism, sleep apnea, cocaine or meth use

51
Q

When to deliver: cHTN not on meds?

A

38-40w

52
Q

When to deliver: cHTN on meds?

A

37-40w

53
Q

When to deliver: cHTN uncontrolled?

A

36-38w

54
Q

When to deliver: gHTN?

A

37w or at dx if later

55
Q

When to deliver: PEC?

A

37w or at dx if later

56
Q

When to deliver: sPEC?

A

34-37w or at dx if later

57
Q

What are the Carpenter/Coustan criteria for 3h GTT cut offs?

A

95/180/155/140

58
Q

White classification: A1

A

gestational, diet controlled

59
Q

White classification: A2

A

gestational, medicine controlled

60
Q

White classification: B

A

onset > 20yo, duration < 10y

61
Q

White classification: C

A

onset 10-20yo, duration 10-20y

62
Q

White classification: D

A

onset < 10yo, duration > 20y

63
Q

White classification: F

A

Nephropathy

64
Q

White classification: H

A

Heart dz (CAD)

65
Q

White classification: R

A

Retinopathy

66
Q

Fetal effects of diabetes: 1st tri

A

SAB
Fetal malformations
- Cardiac: ASD, VSD, TGA
- Skeletal
- CNS: NTD, holoprosencephaly
- Caudal regression

67
Q

Fetal effects of diabetes: 3rd tri

A

Fetal macrosomia or IUGR, IUFD

68
Q

Neonatal effects of diabetes:

A

RDS, Hypoglycemia, HypoCa/Mg, Hyperbili, Polycythemia, Cardiomyopathy, Hypothermia

69
Q

Calculate insulin for pre-gestational diabetic:

A

0.7u/kg x weight in kg

2/3 in AM
- 2/3 NPH, 1/3 short acting
1/3 in PM
- 1/2 NPH, 1/2 short acting

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