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Shelf Exams > OB > Flashcards

OB Flashcards

1
Q

3 signs of placental separation after delivery of baby

A

Gush of blood
Lengthening of cord
Uterine changes: hardening

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2
Q

Stages of labor

A
  1. Cervical dilation and effacement
    Ends when cervical is fully dilated (10 cm)
  2. Delivery of fetus
  3. Delivery of placenta
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3
Q

What is the role of hCG?

A

Maintenance of the corpus luteum in order to maintain progesterone secretion until the placenta is able to produce progesterone on its own

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4
Q

Premature rupture of membranes can cause what type of decelerations?

A

Variable – cord compression due to lack of amniotic fluid

Treat with amnioinfusion!

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5
Q

What does the progesterone challenge test look for?

A

Presence of estrogen

If there is withdrawal bleeding - pt has estrogen (PCOS)

If there is no withdrawal bleeding- pt does not have enough estrogen or has an anatomic condition (Ashermans syndrome)

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6
Q

When can you start to hear fetal heart tones?

A

12 weeks via Doppler

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7
Q

Erb palsy vs Klumpke

A

Erb: 5th and 6th cervical nerves

Klumpke: 8th cervical nerve and 1st thoracic nerve

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8
Q

Symmetric vs asymmetric IUGR

A

Symmetric IUGR
o Chromosomal abnormalities, congenital anomalies, fetal infections

Asymmetric IUGR
- Low abd circumference, normal biparietal diameter
o When fetal access to nutrients is compromised
o Maternal nutritional deficiency, HTN, uteroplacental insufficiency

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9
Q

What imaging should be done after a patient has an ultrasound-confirmed molar pregnancy?

A

CXR: most likely to metastasize to the lungs

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10
Q

Recommendation for seizure meds in pregnancy

A

High dose folic acid and stay on seizure meds

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11
Q

Treatment of dysmenorrhea

A
  1. NSAIDs

2. OCPs

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12
Q

Medical management of ectopic pregnancy

A

Methotrexate

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13
Q

Thyroid hormones changes in pregnancy

A

Free T3 and T4 levels = unchanged
TBG = increased
Total T4 = increased

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14
Q

Acid base status in pregnancy

A

Chronic respiratory alalosis with metabilic compensation

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15
Q

Why should asymptomatic UTIs be treated in all pregnant women?

A

Progsterone levels cause smooth muscle relaxation and ureteral dilation – increases risk of ascending infection (acute pyelonephritis)

Need to do a test of cure after antibiotic to make sure the infection has cleared

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16
Q

Twin twin tranfusion syndrome is seen in most in what type of twins

A

Monochorionic diamniotic

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17
Q

Most common cause of postpartum hemorrhage

A

Uterine Atony

Other causes:
Tone: atony
Tissue: retained placenta
Trauma: laceration
Thrombin: underlying coagulopathy
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18
Q

Protein level in 24 hours seen in severe preeclampsia

A

> 5000 mg (5 g)

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19
Q

The ovarian artery runs through which structure?

A

The suspensory ligament

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20
Q

Causes of fetal tachycardia

A

Maternal fever (chorio), maternal hyperthyroidism, medication use, placental abruption

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21
Q

Obesity is a risk factor for what type of cancer?

A

Endometrial: excess adipose tissue causes unopposed estrogen

Aromatase in adipose cells converts androgens into estrogens

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22
Q

What is the most effective screening test for Down Syndrome?

A

Cell free DNA

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23
Q

Treatment of early decels

A

Nothing. Related to head compression

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24
Q

What is the most accurate way of assessing gestational age?

A

First trimester US with crown-rump length

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25
Q

Atypical glandular cells on Pap test may be due to?

A

Cervical or endometrial adenocarcinoma

Colposcopy, endocervical curettage, endometrial biopsy

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26
Q

When, during pregnancy, are steroids no longer indicated?

A

After 34 weeks gestation

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27
Q

What antidepressant should not be used in pregnancy?

A

Paroxetine

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28
Q

Branches of the anterior division of the internal iliac artery

A 
Obturator
Inferior vesicle
Internal pudendal
Inferior gluteal
Vaginal 
Uterine
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29
Q

What tests to order in secondary amenorrhea

A

1 = pregnancy test!

IF negative then order FSH, TSH , prolactin

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30
Q

Definitive diagnosis of endometriosis

A

Diagnostic laparoscopy

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31
Q

Most common congenital defect in maternal diabetes?

A

Cardiac defect

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32
Q

Treatment of lichen sclerosis and atrophic vaginitis

A

Lichen sclerosis: high dose topical steroids

Atrophic vaginitis: topical estrogen

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33
Q

What size cystic adnexal mass should be explored surgically in the reproductive age perido

A

10 cm

8cm if solid

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34
Q

Inc bhCG (in terms of cancer)

A

Choriocarcinoma

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35
Q

Cardinal movements of labor

A

Every Decent Family In Europe Eats Eggs

Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
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36
Q

Oxytocin

A

Produced in hypothalamus and is secreted from the posterior pituitary gland

Stimulates uterine contractions

Pitocin is the synthetic form

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37
Q

Drugs used to control postpartum hemorrhage

A

Oxytocin
Methergine (contraindicated in HTN)
Hemabate (contraindicated in asthma)
Misoprostol

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38
Q

Painless vaginal bleeding after 20 weeks gestation

A

Placenta previa: the presence of placental tissue overlying or proximate to the internal cervical os

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39
Q

SUdden onset of pelvic pain in a woman with a known ovarian cyst should make you suspect?

A

Ovarian torsion

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40
Q

Glucose screening prenatal care

A

24-28 weeks

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41
Q

Sheehan Syndrome

A

When a patient experiences a significant blood loss during delivery, this can result in anterior pituitary necrosis (loss of prolactin, TSH, ACTH, gonadotropin, LH)

Slow mental function
Weight gain
Fatigue
Difficulty staying warm
No milk production
Hypotension
Amenorrhea
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42
Q 
Down syndrome quad screen
MSAFP
Estriol
hCG
Inhibin
A

MSAFP low
Estriol low
bhCG high
Inhibin high

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43
Q

Treatment of late decels

A

Rotate mom

Give mom fluids, O2, tranfusion (if there is a hemorrhage)

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44
Q

OCPs post pregnancy

A

Non breastfeeding women
Can initiate progestin only products (micronor) right away
Initiate combined OCPs 3-4 weeks postpartum after hypercoagulability resolves

Breastfeeding women
Start progestin only pills 2-3 weeks postpartum
Wait to start combined OCPs for at least 6 weeks when lactation is well established

45
Q

treatment of variable decels

A

Amnioinfusion

46
Q

Antihypertensives in pregnancy

A

Labetalol
Hydralazine
Nifedipine

47
Q

Treatment of postpartum endometritis

A

Clindamycin and gentamicin

48
Q

Corticosteroids have what benefits on premature infants?

A

Protects against NEC and intraventricular hemorrhage

Increases surfactant production (lung maturation)

49
Q

What hormone suppresses lactation during pregnancy

A

Estrogen

50
Q

Inc inhibin

A

Ovarian cancer: granulosa cell tumor

51
Q

When is anti-D immune globulin given to an Rh negative mother?

A

28-32 weeks gestation

52
Q

GBS prophylaxis

A

<37 weeks unknown GBS status = everyone gets antibiotics

> 37 weeks unknown GBS status, treat all of the following

  • GBS UTI during pregnancy
  • previous infant with GBS sepsis
  • maternal fever
  • prolonged rupture of membranes >18 hours
53
Q

When is tocolysis indicated

A

Before 35 weeks gestation

54
Q

Where is a baby if they are at zero station?

A

At the level of the ischial spines

55
Q

What is the threshold bHCG level for visualizing pregnancy on transvaginal US?

A

2000

56
Q

Pelvic inflammatory disease antibiotics

A

Ceftriaxone + doxycycline

or

Ceftriaxone + azithromycin

57
Q

Where does the ovarian artery branch from

A

Aorta

58
Q

Inc LDH

A

Ovarian cancer: dysgerminoma

59
Q

Why is renal insufficiency a risk factor for magnesium toxicity?

How do you treat magnesium toxicity

A

Magnesium is SOLELY excreted by the kidneys

Treat toxicity with calcium gluconate

60
Q

Hormone levels in primary ovarian insufficiency

A

Dec estrogen, inc GnRH, inc FSH

Decreased ovarian function –> dec estrogen –> dec negative feeback on hypothalamus –> inc GnRH –> inc FSH –> infertility

61
Q

How can you differentiate between hyperemesis gravidarum and typical nausea/vomiting of pregnancy?

A

Presence of ketones in urine

Hypokalemic hypochloremic metabolic alkalosis

62
Q

PCOS increases risk of what cancer?

A

Endometrial (due to chronic unopposed estrogen)

63
Q

1st trimester spontaneous abortions are seen in what chronic disease

A

DM

64
Q

In utero exposure to DES can lead to what?

A

Clear cell adenocarcinoma of the vagina and cervix

65
Q

Hydrops

Presentation and treatment

A

Abnormal fluid accumulation in 2+ sites: thorax, abdomen, skin
Tx with fetal transfusion

66
Q

what part of the colposcopy is not performed in pregnancy?

A

ECC (endocervical curettage)

67
Q

How does pyelonephritis lead to ARDS in pregnancy? (Pulmonary edema)

A

Endotoxin release!

68
Q

Phases of delivery

A

Phase 0: uterine quiescence
Phase 1: preparation for labor
Phase 2: labor
Phase 3: post party

69
Q

In someone who is less than 20 weeks pregnant and presents with signs of preeclampsia, what should you suspect?

A

Hydatidiform mole

70
Q

What medical management can prevent preterm deliver

A

Weekly progesterone injections

71
Q

Cervical diameter at active phase of labor

A

6 cm

72
Q

Why should Bactrim be avoided in the third trimester of pregnancy? What other trimester(s) should it be avoided in?

A

It can cause kernicterus

Should also be avoided in the 1st trimester as it interferes with folate metabolism

73
Q

Paget disease is associated with what type of breast cancer?

A

Adenocarcinoma

74
Q

Enlarged placenta and a fetus with abnormalities, suspect…

A

Congenital syphilis

75
Q

Branches of the posterior division of the internal iliac artery

A

Iliolumbar
Lateral sacral
Superior gluteal

76
Q

Anatomical difference between atrophic vaginitis and lichen sclerosis

A

In lichen sclerosis, the vagina is not involved

77
Q

What should you suspect in a post partum patient who is being treated for endometritis but has a fever that is unresponsive to antibiotics? How should you proceed?

A

Septic pelvic thrombophlebitis

Treat with anticoagulation and broad spectrum antibiotics

78
Q

Inc AFP

A

Ovarian cancer: endodermal sinus tumor

79
Q

Cerclage

A

Indicated in a patient with a history of >1 2nd trimester pregnancy loss related to cervical incompetence

80
Q

Magnesium sulfate in preterm labor

A

Administered for fetal neuroprotection before 32 weeks

81
Q

Medical treatment of uterine leiomyoma

A

GnRH agonist

82
Q

When is rhogam given during prenatal care

A

24-28 weeks

83
Q

Naegele’s Rule

A

Estimated day of delivery

Add seven to the date of the 1st day of the LMP and count back 3 months

84
Q

Baby size in T1DM vs gestational diabetes

A

T1: small babies

Gestation: large babies

Babies can be hypoglycemic at birth

85
Q

Drugs used to induce labor

A

Cervical ripening:
Dinoprostone (cervidil) – intravaginal, lasts 12 hours
Misoprostol (cytotec) – oral

After cervical dilation:
Oxytocin

86
Q

Which choices of contraception have a <1% pregnancy rate?

A

Depo provera
Sterilization
LARCs (IUD or Nexplanon)

87
Q

Adverse effects of oxytocin

A

Hyponatremia
Hypotension
Tachysystole (abnormally frequent uterine contractions)

88
Q

When is Mg sulfate given in preterm labor? How about steroids?

A

Mg: less than 32 weeks
Steroids: less than 34 weeks

89
Q

First trimester bleeding differential

A

Physiologic
Ectopic
Miscarriage
Structural pathology (cervical, vaginal, etc)

90
Q

Minimum diagnostic criteria for PID

A
  1. Pelvic or lower abdominal pain
  2. Uterine tenderness or cervical motion tenderness or adnexal tenderness
    (Chandelier sign)
91
Q

Kleihauer Beck test

A

Used to determine if there has been fetal to maternal hemorrhage

92
Q

Genetic screening timing

A

15-20 weeks

93
Q

What is the most common karyotype in a spontaneous abortion

A

Autosomal trisomy (trisomy 16)

94
Q

When should you repeat bHCG if you suspect miscarriage?

A

After 48 hours

95
Q

How can you tell if someone has chronic HTN vs Gestational HTN?

A

Chronic HTN = before 20 weeks gestation

Gestational HTN = after 20 weeks gestation

96
Q

What is the most common cause of sepsis in pregnancy?

A

Pyelonephritis

97
Q

Cervical mucus prior to ovulation is due to what hormone?

A

Due to the surge of LH

98
Q

Postpartum hemorrhage

A

500 cc in vaginal delivery

1000 cc in C section

99
Q

What is a normal finding in urine in pregnancy that is abnormal otherwise?

A

Glucosuria

100
Q

Magnesium mechanism as a tocolytic agent

A

Competes with Ca for entry into cells

101
Q

Apt test

A

Used to dx vasa previa

102
Q

Condyloma acuminata is caused by which strains of HPV

A

HPV 6/11

103
Q

Fundal height

A

20 weeks = umbilicus

Above 20 weeks, fundus will be gestational age in cm

104
Q

Indomethacin is contraindicated in….

A

Oligohydramnios

105
Q

Treatment of chorioamnionitis

A

Broad spectrum antibiotics (ampicillin and gentamicin)\

Induction of delivery

106
Q

Painful vaginal bleeding after 20 weeks gestation

A

Placenta abruptio: decidual hemorrhage leading to the premature separation of the placenta prior to delivery of the fetus

107
Q

Managment of preeclampsia

A

W/o severe features: delivery after 37 weeks
W/ severe features: delivery after 34 weeks

Mg Sulfate
Antihypertensives

108
Q

How do OCPS help with hirsutism in PCOS?

A

Inc the amount of sex hormone binding globulin, which will lower circulating free testosterone

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