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Step 2 > OB > Flashcards

OB Flashcards

1
Q

Goodell Sign

A

Softening of the cerix

4 weeks

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2
Q

Ladin sign

A

Softening of the midline of the uterus

6 weeks

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3
Q

Chadwick sign

A

Blue discoloration of vagina and cervix

6-8 weeks

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4
Q

Telangiectasias/ palmar erythema

A

First trimester

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5
Q

Chloasma

A

Pregnancy mask

16 weeks

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6
Q

Linea nigra

A

Second trimester

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7
Q

1st trimester prenatal care

A

Visit every 4-6 weeks
US at 11-14 weeks to confirm gestation age and check nuchal lucency
Blood work, pap smear, G/C

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8
Q

2nd trimester prenatal care

A

15 to 20 weeks- triple/quad screen
Auscultation of fetal heart
16-20wk- quickening
18-20wk- US for malformation

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9
Q

3rd trimster prenatal care

A

Every 2-3 week visits, until 36wk and then weekly visits
37 week- weekly cervical check
27 week- CBC check, supplement iron if Hb<11
24-26week glucose tolerance test
36 week- cervical culture for G/C and rectovaginal swab for GBS

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10
Q

Chorionic villus sampling

A

10-13wk: advanced maternal age or known genetic disease
Catheter into intrauterine cavity and aspirate chorionic villi from placenta
Obtains fetal karyotype

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11
Q

Amniocentesis

A

16-18wk: advanced maternal age or known genetic disease
Transabdominal needle into amniotic sac and withdraw amniotic fluid
Obtains fetal karyotype

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12
Q

Fetal blood sampling

A

Transabdominal need into uterus to get blood from the umbilical cord

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13
Q

Exclusion criteria for methotrexate

A 
Immunodeficiency 
Noncompliant patient- needs to follow up in 4-7 days
Liver disease- MTX is hepatotoxic 
Ectopic >3.5cm 
Fetal heartbeat auscultated
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14
Q

Cramping abdominal pain, vaginal bleeding

No products of conception found on US

A

Complete abortion

Tx: follow up in office

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15
Q

Cramping abdominal pain, vaginal bleeding

Some products of conception found on US

A

Incomplete aborton

Tx: D&C or medical

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16
Q

Cramping abdominal pain, vaginal bleeding

Products of conception intact, but intrauterine bleeding present and dilatation of cervix

A

Inevitable abortion

Tx: D&C or medical

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17
Q

Cramping abdominal pain, vaginal bleeding
Products of conception intact and intrauterine bleeding
No dilatation of cervix

A

Threatened abortion

Tx: bed and pelvic rest

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18
Q

Cramping abdominal pain, vaginal bleeding

Death of fetus, but all products of conception present in uterus

A

Missed abortion

Tx: D&C or medical

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19
Q

Cramping abdominal pain, vaginal bleeding

Infection of uterus and the surrounding area

A

Septic abortion

Tx: D&C and IV abx: levofloxacin and metronidazole

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20
Q

Circumstances when preterm labor should not be stopped with tocolytic and delivery should occur

A 
Maternal severe hypertension 
Maternal cardiac disease 
Maternal cervical dilation >4cm 
Maternal hemorrhage 
Fetal death 
Chorioamnonitis
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21
Q

Placental Previa

A

Presentation:
Painless vaginal bleeding

Dx: transabdominal US showing where placenta lying in uterus

Tx: Placenta may move so…strict pelvic rest!
Immediate C-section if: unstoppable labor, severe hemorrhage, fetal distress

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22
Q

Complete placenta previa

A

Complete covering of internal os

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23
Q

Partial placental previa

A

Partial covering of internal os

24
Q

Marginal placental previa

A

Placental is adjacent to internal os

25
Q

Vasa previa

A

Fetal vessels present over internal os

26
Q

Low-lying placenta

A

Placenta implanted on lower segment of the uterus, 0-2cm away from os

27
Q

Placenta accreta

A

Abnormally adheres to superficial uterine wall

28
Q

Placenta increta

A

Placenta attached to myometrium

29
Q

Placena percreta

A

placenta invades into the uterine serosa, bladder wall, or rectal wall

30
Q

Risk factors for placental abruption

A 
HTN 
prior placental abruption
cocaine use 
external trauma 
smoking
31
Q

Chronic HTN

A

BP >140/90 before patients becomes pregnant

Tx: methyldopa, labetalol, nifedipine

32
Q

Gestatoinal HTN

A

BP > 140/90 starting at 20 weeks gestation
No other symptoms
Tx: methyldopa, labetalol, nifedipine only during pregnancy

33
Q

Mild Pre-eclampsia

A 
HTN >140/90
Proteinuria: 1-2+, >3g in 24 hour urine
Edema: hands, feet, face 
No mental status change 
No vision change 
No liver function impairment
34
Q

Severe Pre-eclampsia

A 
HTN >160/110
Proteinuria: 3+, >5g in 24 hour urine
Edema: generalized 
Mental status changes 
Vision changes 
Impaired liver function
35
Q

Risk of pre-gestational diabetes

A 
Maternal:
Pre-eclampsia 
Spontaneous abortion 
Increased infection 
Post-partum hemorrhage

Fetal
Congenital anomalies- heart and neural tube defects
Macrosomia
Preterm labor

36
Q

Fetal testing schedule for gestational diabetes

A

32-26 week- weekly NST and US to assess fetal well being and size

> 36 week- twice weekly: one NST (fetal well being) and one BPP (amniotic fluid and fetal well being)

37 week- L/S ratio (assess fetal lung maturity) >2 is mature, if mature delivery

38-39 weeks: if pt refused L/S deliver now

37
Q

Nonstress test

A

Detect 2 fetal movements
Acceleration of HR > 15bpm lasting 20 seconds.

Nonreactive stress test, baby may be sleeping- vibroacoustic stimulation

38
Q

Biophysical Profile

A 
Fetal HR
Fetal chest expansion- 1 breath 30 min
Fetal movement: 3 movement in 30 min 
Fetal muscle tone: flex an extremity 
Amniotic fluid index

Normal 8-10
Abnormal <4

39
Q

Stage 1 of labor

A

Onset of labor to full cervical dilation
P: 6-18 hours
M: 2-10 hours

40
Q

Latent labor

A

Part of Stage 1
Onset of labor until 4cm dilated
P: 6-7 hours
M: 4-5 hours

41
Q

Active labor

A

Part of Stage 1
4cm dilated to fully dilated
P: 1cm/hr
M: 1.2cm/hr

42
Q

Stage 2 of labor

A

Full dilation of the cervix to delivery of neonate
P: 30min-3hr
M: 5-30min

43
Q

Stage 3 of labor

A

Delivery of neonate to delivery of placenta

30 minutes

44
Q

Steps of Stage 2

A 
Engagement 
Descent 
Flexion 
Internal rotation 
Extension 
External rotation
45
Q

Signs of placental delivery readiness

A
  1. gush of blood
  2. umbillical cord lengthening
  3. globular uterus
46
Q

Arrest of dilation

A

No cervical dilation for >2 hours during active labor

47
Q

Arrest of descent

A

No change in station for >1 hour during active labor

48
Q

Lichen Sclerosus

A

Any age-if post menopausal increased risk of cancer

White thin skin extending from labia to perianal area, clinical diagnosis but do a punch bx if concerned about cancer

Tx: Topical steriods

49
Q

Squamous cell hyperplasia

A

Any age- particularly in patients that have chronic vulvar pruritus.

Chronic irritation develop hyperkeratosis- raised white lesions

Tx: Sitz baths or lubricants

50
Q

Linchen planus

A

30-60 yo women

Violet flat papules

Tx: topical steroids

51
Q

Vaginal discharge with fishy odor

Grey-white

A

Bacterial vaginosis- gardnerella

Saline wet mount shows clue cells

Tx: metronidazole or clindamycin

52
Q

White cheesy vaginal discharge

ph: 4-5

A

Candidiasis- Candida albicans

KOH shows pseudohyphate

Tx: with -azole

53
Q

Profuse green-grey frothy vaginal discharge

Vulvar pruritus, dysuria, pain

ph: 5-6

A

Trichamonas vaginalis

Saline wet mount shows motile flagellates

Tx: both patient and partner with metronidazole

54
Q

Paget’s disease

A

Intraepithelial neoplasm
Postmenopausal women

Vulvar soreness and pruritus
Red lesion with superficial white coating

Bilateral: radical vulvectomy
Unilateral: modified vulvectomy

55
Q

SCC

A

Pruritus, bloody vaginal discharge, and post menopausal bleeding

Dx: with bx

Tx: vulvectomy

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