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ABOG Written Exam > OB > Flashcards

OB Flashcards

1
Q

dx and mgmt of chorio

A

one 39F or 38.9F x2 fever, PLUS, fetal tachycardia, cervical purulence, maternal leukocytosis

  • mgmt= amp, gent for SVD, add clinda for c/s, postpartum continue clinda but dc amp/gent
  • remember that chorio neonates have increased risk of espsis and 4x higher risk of CP compared to similar aged infants
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2
Q

how much do GFR and RPF increase in pregnancy?

A

50 and 80 % respectively

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3
Q

at what level of meaternal anemia is there associated direct fetal morbidity?

A

<6 g/dl

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4
Q

rpt c/s timing after classical?

A

36-37 wk

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5
Q

mechanism of action for PTU and methimazole?

A

blocks peripheral conversion of T4 to T3

  • graves MC cause hyperT in preg
  • fetus makes own thyroid hormone @ 12 wk
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6
Q

MC cause of PPH? what percentage of all PPH is it responsible for?

A

atony, 80%

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7
Q

u/s definition of pregnancy loss

A
  1. CRL >7 w/o cardiac activity
  2. gestational sac >25 mm w/o embryo
  3. no cardiac activty 11 days after u/s shows gest sac w/ yolk sac
  4. no cardiac activity 14 days after u/s shows gest sac w/o yolk sac
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8
Q

what is the only MEC1 contraception for breastfeeding moms?

A

copper IUD

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9
Q

most sensitive finding for abruption?

A

uterine ctx. Coag changes is late change bc at that point 50% of products have been consumed

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10
Q

how often do you need to scan monochorionic twins?

A

q2wk for fluid (r/o TTTS)

q4wk for growth

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11
Q

contraindication for late preterm steroids?

A

chorio, diabetes(??), previous course (rescue), other conditions prompting del (don’t delay for steroids)

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12
Q

what are the #1 and #2 MC causes of thrombocytopenia in pregnancy?

A
  1. GTP (80%)
  2. PreE (15%)
  3. all others combined (5%)
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13
Q

what is PAPP-A an independent marker for?

A

FGR, IUFD

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14
Q

what is considered an abnormal nuchal translucency measurement? what are euploid fetuses at risk for w/ increased nuchal translucency?

A

> 3.0mm. increased risk for cardiac defect

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15
Q

what percentage of GDM pts will have impaired glucose control postpartum? when do you test them?

A

up to 33%. 2GTT 75 g between 6 and `12 wk

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16
Q

vaccines for pregnant HIV pts?

A

influenza, Tdap, pneumococcus, hep B

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17
Q

what medications are affected by changes in pregnancy metabolism?

A

anything metabolized by P450. These include synthroid, some antihypertensives (beta blockers), SSRIs, seizure meds. N/V can exacerbate these effects too. Pregnancy itself may also lower seizure threshold.

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18
Q

what do gastric bypass pts need supplementation of during pregnancy?

A

Fe, B12, protein, vit D, folic acid, Ca. Worst w/ roux en y but still possible w/ restrictive procedures

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19
Q

what is the greatest infection risk to physicians w/ needle stick (highest rate of transmission)

A

Hep C

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20
Q

Describe the mgmt of rhesus dz during pregnancy

A

W/ first affected pregnancy, perform titers q 2 wks until 24 wks, if 1:32 or worse, MCA doppler q 1-2 wk, if 1.5 MoM or greater, cordocentesis, if fetal hematocrit 30% or worse, intrauterine infusion, antenatal testing 32 wk, deliver 37-38 wk

W/ previously affect pregnancy, don’t do titers. At 18 wks, start 1-2 wk MCA dopplers, mgmt per above

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21
Q

what percentage of couples will experience recurrent pregnancy loss. What is mgmt for pts w/ antiphospholipid syndrome and how much does it improve pregnancy outcomes

A

1%. ASA 81 mg + heparin, reduces AB by 50%. Only 3-15% of couples w/ recurrent early pregnancy loss have antiphospholipid syndrome

22
Q

what is the most common bug in chorio? what bug is transmitted via hemogenous spread? What categories of bugs do the tx for chorio cover?

A

“polymicrobial”. Listeria can be spread by hematogenous spread. Amp covers gram pos, gent gram neg.

23
Q

findings of ICP. Recurrence rates in subsequent gestations. Delivery timing. Recommend tx and MOA. What bile acid level denotes higher risk?

A

Pruritis w/ transaminitis w/o derm findings. Recurrence = 40-60% subs pregnancies. Tx= ursodeoxycholic acid (ursodiol). Deliver @ 36-37 wks. Anything over 40 is higher risk for adverse outocme.

24
Q

Triplets percentage of PreE? What should you do to minimize risk?

A

10%. Add ASA 81 mg qd fo multiples.

25
Q

what findings are c/w neonatal encephalopathy? what neonatal tx should they receive and what is its benefit? what intrapartum finding also increases this risk

A
  • apgars <5 @ 5 and 10 min, cord pH <7, base deficit >12, MRI c/w hypoxic changes, multisystemic failure
  • tx= therapeutic cooling (hypothermia) reduces rates of mortality and severe disabilitiy @ 18-24 mo
  • fever associated w/ neonatal encephalopathy when acidosis is present: OR 93.9!
26
Q

in increasing severity, what are asthma rx

A

SABA -> inhaled CS -> LABA -> PO CS

27
Q

define autonomy, beneficience, justice, nonmaleficience

A
  • autonomy- patient’s self-determination
  • beneficence- obligation to help, do good
  • justice- obligation to consider fair distribution of resources/costs
  • nonmaleficence- obligation to do no harm
28
Q

What is mgmt of syphilis findings in pregnancy?

A

If RPR is pos, do VDRL. If VDRL is pos, do titers. If 1’ or 2’ dz, PCN G IM x1. If asx, presume latenet sx PCN G x3. If HIV pos/immunocompromised, PCN G qw x 3 IV.

29
Q

Ddx postpartum fever?

A

UTI, breast engorgement, mastitis, wound infection, endometritis, sptic pelvic thrombophlebitis, epidural fever, PNA. Ddx narrowed w/ timing and sx.

30
Q

peripartum cardiomyophathy dx and mgmt.

A

Dx- new onset cardiac failure w/in last month pregnancy or 5 mo postpartum, absence of another cause of dz, echo <45%
Mgmt- ace, diuretic, O2, then when stable, beta blocker

31
Q

mgmt listeria exposure (gram pos bacteria)

A

If pt is sx, then tx only if febrile (ampicillin)
If pt is sx, expectant mgmt if afebrile
If no sx, no testing/tx

32
Q

when can cesarean delivery be indicated in context of failed IOL?

A

24 hr pit or 12 hr pit after ruptured membranes.

33
Q

pre-pregnancy PrEP for HIV couple? how long of tx is needed before risk is minimized?

A

emtricitabine/tenofovir. 20 days for vaginal sex. these are also safe during pregnancy

34
Q

description of appendicitis on u/s. If inconclusive, best test?

A

“non-compressible tubular structure more than 6 mm in diameter” warrants surgical intervention. CT abd/pelvis is best if inconclusive. Consider MRI if immediately available.

35
Q

which fetal structural abnormality is most highly attributable to obesity?

A

neural tube defect, spina bifida. anorectal atresia, cardiac anomaly, limb anomaly, orofacial clefting are also associated but not as directly.

36
Q

when to report a patient w/ opiate use to state authorities?

A

only if mandated by the state

37
Q

what interventions at what wk for periviability?

A

20-21 wk abx for PPROM, 22 wk NICU, 23 consider everything, 24 do everything except fetal c/s 25 do everything

38
Q

dx of alpha, beta thal?

A

both are microcytic anemias w/ normal Fe labs. alpha thal requires DNA testing and will appear normal on hgb electrophoresis. Beta thal can be dx’d w/ electrophoresis (elevated A2 >3.5%)

39
Q

at what age should steroids be avoided for NVP? if need nutrition, how to feed?

A

associated w/ clef palate before 10 wk gestation. if need nutrition, an NG tube should be used for feeding (not TPN)

40
Q

what type of diet should PKU pts be on during pregnancy?

A

low protein diet. high rates of developmental delay, microcephaly, congenital heart defect. metabolic control later in pregnancy may not help cardiac defect as it develops so early.

41
Q

breast ca tx during pregnancy? modality and timing

A

Chemotx is used in 2nd and 3rd TM. Should be d/c 3 wk prior to delivery if possible d/t possibility of neonatal immunosuppresion. IUGR and PTD have been reported sfx. Tamoxifen use contraindicated

42
Q

mgmt of hep B during pregnancy

A

hep B greater than 6-8 log10 copies/mil should receive antiviral tx, usually tenofovir. amnio, breastfeeding are ok.

43
Q

mgmt and delivery timing for HIV pts

A

if viral load is <1000 can undergo vaginal labor w/o antiviral tx. For these pts, amnio and prolonged ROM have not been associated w/ greater transmission. If viral load is >1000 should have cesarean delivery @ 38 wks to avoid vertical transmission and receive zidovudine before surgery. Even w/ undetectable viral load should not breastfeed in resource rich settings.

44
Q

what is the most common cause of fetal bradycardia in a non-laboring pt?

A

heart block- consider quick u/s(?)

45
Q

what is the definition of polyhydramnios and severe polyhydramnios?

A

25 and 35 AFI respectively. When greater than 35, congenital abnormalities are the most common cause.. Otherwise, nearly 50% of cases are idiopathic.

46
Q

why is TDAP and flu vaccine so important during pregnancy

A

neonates depend on passive immunity from mom until 2 mo for pertussis vaccination.

47
Q

timing of anticoag restarting for SVD and c/s

A

4-6 hr, 6-12 hr respectively

48
Q

IUGR timing by doppler

A

REDF 32 wk
AEDF 34 wk
elevated 37 wk

49
Q

what u/s finding is most strongly associated w/ down syndrome

A

thickened nuchal fold

50
Q

selection of GBS abx w/o sensitivity known and mild PCN allergy?

A

ancef. if anaphylaxis hx, clinda or vanc depending on sensitivities

51
Q

what baseline evaluation is always most helpful for IUFD?

A

placental histology, fetal autopsy, fetal karyotype

52
Q

most important risk factor for postpartum infection?

A

c/s. Ppx abx decrease risk by 60-70%

ABOG Written Exam (5 decks)

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