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OBGYN, PSYCH, PEDS > OB 2 > Flashcards

OB 2 Flashcards

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1
Q

3 things that cause elevated AFP in pregnancy

A

open NT defects, ventral well defects, multiple gestation

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2
Q

Is AFP up or down in aneuploidies

A

down

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3
Q

You get lab results with elevated AFP, what next?

A

fetal anatomy US

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4
Q

deltaF508 mutation

A

CF

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5
Q

Quad screen profile for Down Syndrome

A

low MSAFP and estradiol, elevated BHCG and inhibin A levels

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6
Q

sudden-onset, severe, unilateral lower abdominal pain with N/V

A

ovarian torsion

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7
Q

after sx pt develops fever, tachycardia and tachypnea, muscle rigidity

A

malignant hyperthermia, stop anesthesia and give DANTROLENE

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8
Q

difference between NMS and MH

A

NMS = neuroleptic agents (haloperidol, promethazine) and develops over course of DAYS

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9
Q

you suspect a gynecological tumor, what imaging to do first?

A

US

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10
Q

why do endometrial biopsy?

A

when suspect hyperplasia or carcinoma

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11
Q

with what gynecological problems do we use diagnostic laparoscopy?

A

endometriosis or pelvic adhesions

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12
Q

what is pseudocyesis

A

cond’n in which a nonpsychotic woman presents with signs and symptoms of early pregnancy and the belief that she is pregnant but evaluation excludes prenancy

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13
Q

N/V, uterine size larger than dates, markedly elevated BhCG, uterus filled with a heterogeneous cystic mass

A

hydatidiform mole

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14
Q

irregular menses, unable to get pregnant and low FSH and low Estradiol

A

hypogonadotropic hypogonadism - loss of pulsatile GnRH secretion previptated by weight loss, stress, chronic illnes

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15
Q

GDM target blood glucose levels

A

Fasting < 95
1 hr post-prandia < 140
2 hr post-prandial < 120

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16
Q

Woman presents in labor at 34 weeks, do you do tocolysis or proceed?

A

proceed when > 34 wks

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17
Q

Who gets external cephalic version?

A

> 37 weeks, breech, no CI to vaginal delivery

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18
Q

unilateral pelivc pain precipitated by strenuous activity or sex, free fluid in pelvis

A

ruptured ovarian cyst

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19
Q

complex multilocular adnexal mass, fever, leukocytosis,

A

tubo-ovarian abscess

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20
Q

bright, glazed, red-purple plaques and papules with an overlying white, lacy pattern, pruritus, pain, dyspareunia, other mucosal lesions (mouth)

A

lichen planus

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21
Q

hypopigmented skin, thin wrinkled appearance, pruritus, vaginal introitus stenosis

A

vulvar lichen sclerosus (post menopausal and young girls)

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22
Q

painless vaginal bleeding > 20 weeks

A

placenta previa - FHR tracing will look good, blood is maternal

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23
Q

risk factors for placenta previa

A

prior PP or c-section, multiple gestation

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24
Q

this causes second trimester pregnancy loss

A

cervical insufficiency (look for previous conization)

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25
Q

bleeding, abdominal pain, fetal decelerations, smokers

A

placental abruption - stabilize mom with aggressive fluid resuscitation and have mom on left lateral decubitas for uterine displacement

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26
Q

dx and tx or lichen planus

A

vulvar punch biopsy, high-potency corticosteroids

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27
Q

postcoital bleeding, mucopurulent d/c friable cervix

A

acute cervicitis

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28
Q

thin, grey d/c, fishey odor

A

BV

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29
Q

indications for vacuum/forceps

A

protracted second stage of labor, fetal HR abnormalities, maternal CI to pushing

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30
Q

Signs for Sertoli-Leydig tumor

A

frank virilization - voice deepening, male-pattern baldness, increased mucle bulk, clitoromegaly; and estrogen deficiency (breast atropy, vulvovaginal atrophy)

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31
Q

mgmt of labor < 32 wks

A

mag sulfate and indomethacin

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32
Q

when is indomethacin CI

A

> 32 wkns due to risk of premature fetal ductus arterosus closure

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33
Q

what can be prescribed to adolescents with irregular heavy menstrual bleeding

A

progesterone - stabilizes unregulated endometrial proliferation

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34
Q

post-partum hemorrhage, lactation failure, hypotension, anorexia

A

sheehan - piturity ischemic necrosis

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35
Q

endometrial glands within the myometrium bulky, tender uterus that is UNIFORMLY enlarged

A

adenomyosis

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36
Q

proliferation of smooth muscle cells within the myometrium, heavy menstural bleeding, IRREGULARLY enlarged uterus

A

leiomyomata uteri (fibroids)

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37
Q

When do you give Rhogam to Rh - mom

A

28-32 weeks and after delivery of baby is Rh + (do a test to determine amount of dose; inadeqate dose = alloimmunization)

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38
Q

mgmt of IUFD 20-23 wks

A

Dilation and evacuation or vaginal delivery

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39
Q

mgmt of IUFG >24 wks

A

vaginal delivery

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40
Q

critical elements of IUFD evluation

A

fetal autopsy, karyotype, placental examination, maternal lab testing for fetomaternal hemorrhage and APS

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41
Q

at what hBCG level should pregnancy be visible by US

A

1500-2000

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42
Q

raloxifene

A

antagonist in breast and uterus, agonist in bone; CI in pt with hx of thromboembolism

(tamoxifene = antag of breast and agonist of uterus, risk of endometrial proliferation)

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43
Q

what are SAB tx options

A

expectant mgmt, medical induction (misoprostol), suction curretage if infxn or hemodynamic instability

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44
Q

tamsulosin

A

a-blocker used for tx of overflow inctoninence by BPH

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45
Q

deafness, cardiac defects, hepatosplenomegaly, micocephaly, cataracts

A

congenital rubella syndrome

46
Q

> 60 with new vaginal bleeding, malodorous discharge, irregular vaginal lesions

A

r/o vaginal cancer with biopsy

47
Q

5 complications of shoulder dystocia

A 
fractured clavicle
fracture humerus
erb-duchenne palsy
klumpke palsy
asphyxia
48
Q

shoulder dystocia, decreased moro and biceps reflex on right side, righ arm with extended elbow, pronated forearm, flexed wrist and fingers, intact grap reflex

A

erb duchenne palsy

49
Q

describe presentation of klumpke palsy

A

claw hand with extended wrist, hyperextended MCP, flexed interphalangeal, absent grasp, horner syndrome, intact moro and biceps

50
Q

which nerves are injured in klumpke palsy

A

C8 and T1

51
Q

waiters tip, 5th and 6th cervical nerves

A

erb-duchenne palsy

52
Q

lab findings consistent with POI

A

elevated FSH

53
Q

secondary amenorrhea, elevated FSH, vaginal atrophy, thin endometrium

A

POI

54
Q

absolute CI to combined hormone contraceptives

A 
migraine with aura
> 15 cigarettes/day + age > 35 
HTN
heart disease
DM with end-organ damage
hx of TE disease or stroke
APS
Breast CA
Cirrhosis and liver CA
Major sx with prolonged immobilization
use < 3 wks post partum
55
Q

GnRH, FSH and Estrogen for POI

A

GnRH high, FSH high, Estrogen low

56
Q

GnRH, FSH, and Estrogen for Hypothalamic hypogonadism

A

GnRH low, FSH low, Estrogen low

57
Q

who gets hypothalamic hypogonadism

A

eating disorders or strenuous exercise (GnRH is low, and so is FSH and estrogen)

58
Q

When start pregnant lady of acyclovir ppx for delivery

A

> 36 weeks

59
Q

pH > 4.5, clue cells, positive whiff test, metronidazole or clindamycin

A

BV

60
Q

pH > 4.5 in both of these causes of vaginal symptoms

A

BV and trichomoniasis

61
Q

thin, yellow-green, malodorous, motile trichomonad, tx pt and sexual partner with metronidazole

A

trichomoniasis

62
Q

pH < 4.5 (normal)

A

candid vaginitis

63
Q

eclampsia tx

A

mag sulfate for seizure recurrence prevention, BP control, expedient delivery

64
Q

normal cervical length?

A

> 2.5 cm

65
Q

mgmt of pregnant lady with hx of preterm delivery

A

progesterone supplementation + serial cervical length measurements

66
Q

impaired virilization during embryogenesis and testosterone to DHT conversion

A

5 alpha reductase deficiency

67
Q

intrahepatic cholestasis of pregnancy

A

third trimester pruritus, elevated total bile acids, manage with ursodeoxycholic acid and delivery at 37 weeks

68
Q

empiric tx of acute cervicitis

A

ceftriaxone + azithromycin

69
Q

PID tx

A

cefoxitin + doxycycline

70
Q

when to use progesterone withdrawal test

A

evalute secondary amenorrhea

71
Q

most common cause of second stage arrest

A

cephalopelvic disproportion

72
Q

what is adequate contractions?

A

> 200 mV unites average over 10 minutes

73
Q

unilateral bloody nipple d/c without co-existing breast mass

A

intraductal papilloma

74
Q

redness, ulceration, scaling and flaking of nipple

A

mammary paget disease

75
Q

active phase arrest

A

no cervical change for > 4 hrs with adquate contractions OR > 6 hrs with inadequate contractions –> c-section

76
Q

risk with short interpregnancy intervals

A

preterm labor, preterm prelabor ROM, low birth weight

77
Q

epithelial cells coated with bacteria

A

clue cells of BV - tx = metronidazole or clindamycin

78
Q

is labor and vaginal delivery CI after classical c-section (vertical incision) and myomectomy with uterine cavity entry?

A

YES due to significant risk of uterine rupture

79
Q

placenta accreta risk factors

A

prio c-section, dilation and curretage, advaced maternal age

80
Q

pt with secondary amenorrhea, elevated FSH levels, low estrogen (lack of withdawal bleeding after a progesterone stimulation challenge)

A

POI

81
Q

can choriocarcinoma occur after hydatidiform mole, normal gestation and spontaneous abortion?

A

yes

82
Q

where does choriocarcinoma metastasize?

A

the lungs; check bHCG

83
Q

intrauterine synechiae

A

Asherman syndrome ; complication of intrauterine surgeries (myomectomy, curettage)

84
Q

undercooked meat, cat feces, unwashed produce + bilateral ventriculomegaly, diffuse intracranial calcifications, fetal growth restriction + chorioretinitis, hearing loss, seizures

A

congenital toxoplasmosis

85
Q

struma ovarii

A

teratoma composed of mature thyroid tissue

86
Q

QUAD screen results for Trisomy 21

A

elevated BHCG and Inhibin A, low AFP

87
Q

BhCG and Inhibin A are elevated in what abnormality?

A

Trisomy 21

88
Q

These 3 values are decreased in Trisomy 18

A

MSAFP, BhCG, Estriol (afp is low in aneuploidy)

89
Q

This value is increased in neural tube or abdominal wall defects and multiple gestation

A

MSAFP

90
Q

Combined OCPs can be used in patients > X week pp while breastfeeding

A

6 weeks

91
Q

vaginal bleeding, abdominal/pelvic pain that is excrutiating, uterine tenderness/rigidity

A

abruptio placenta (contrast to placental previa which is painless bleeding)

92
Q

HSP tx

A

doxycycline

93
Q

RUQ pain, leukocytosis, mildly elevated LFTs, hypoglyemcia, hyperbilirubinemai, thrombocytopenia

A

AFLP

94
Q

> 40, dysmenorrhea, heavy bleeding, progressive chronic pelvic pain, boggy, tender and symmetrically enlarged uterus

A

adenomyosis

95
Q

genotypically male pt that appears phenotypically female with primary amenorrhea, normal breast and female external genitalia development, and minimal or no axillary and pubic hair

A

androgen insensitivy syndrome (contrast to 5 alpha reductase deficiency where external genitalia is ambiguous)

96
Q

how to differentiate AIS from mullerian agenesis

A

AIS = elevated testosterone and no hair

Mullerian agenesis = normal testosterone, normal female development with pubic and axillary hair

97
Q

condyloma acuminata

A

HPV 6 and 11, nontender, verrucous genital lesions, tx = tricholoacetic acid or surgical excision

98
Q

condyloma acuminata vs lata

A 
acuminata = HPV, cauliflower shaped and raised
lata = secondary syphillis, broad smooth base
99
Q

first line HTN tx in pregnancy

A

labetaolol and methyldopa

100
Q

what does early rupture of membranes put a pt at risk of

A

placental abruption, intraamniotic infection, umbilical cord prolapse, preterm labor

101
Q

female pt with normal internal genitalia but ambiguous external genitalia

A

congenital aromatase deficiency; blocks conversion of androgens to estrogens

102
Q

severe microcephaly, thin cerebral cortices, multiple intracranial calcification, craniosynostosis, multiple contractures, hypertonicitiy

A

zika

103
Q

intracranial calcifications, hydrocephalus, chorioretinitis

A

toxo

104
Q

what do these ovarian US findings suggest: solid mass with thick septations and the presence of ascites

A

malignancy - epithelial ovarian carcinoma

105
Q

dysmenorrhea, deep dyspareunia, dyschezia

A

endometriosis, start on OCP

106
Q

Describe thyroid function in pregnancy

A

T hormone prodxn + during pregnancy to cope with metabolic demands; estrogen causes + TBG, leading to increased total (but not free) T levels; hCG directly stimulates TSH receptors, causing + T prodxn

107
Q

how to differentiate hyperemesis gravidarum from typical nausea and vomiting of pregnancy?

A

urinary ketones

108
Q

presentation of vWD in pregnancy

A

PPH and prolonged bleeding - a PTT may be normal or prolonged

109
Q

severe unilateral pain + abdominal mass

A

ovarian torsion

110
Q

uterine tachysystole

A

> 5 contractions in 10 minutes

OBGYN, PSYCH, PEDS (8 decks)

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