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Residency > OB Floor > Flashcards

OB Floor Flashcards

1
Q

Def of postpartum hemorrhage (vaginal and section)

A

> 499 ml of blood loss at time of vaginal delivery or >999 ml at cesarean

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2
Q

Risk factors for PPH

A 
Grand multiparity
Multiple gestation
Prolonged labor
Prolonged oxytocin augmentation 
Chorioamnionitis
Tocolytics
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3
Q

Most common cause of PPH

A

Uterine atony

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4
Q

Main medications for postpartum hemorrhage

A 
Oxytocin
Methylergonovine (Methergine)
Hemabate
Misoprostol (Cytotec)
TXA
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5
Q

Oxytocin dosage for PPH

A

10-40 unites in 1,000 ml LR or NS IV infusion

10 units IM or into uterus through abdomen or cervix if IV line is unavailable

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6
Q

Side effects and contraindications of oxytocin when used of PPH

A

Water intoxication and hyponatremia

Hypotension if given in IV bolus

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7
Q

Dosing for Methergine in PPH

A

0.2 mg IM or 0.2 mg tablet PO x 1

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8
Q

Dosing for Hemabate in PPH

A

0.25 mg IM or intramyometrial injection every 15 minutes up to 8 doses

Usually stop after 3 injections

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9
Q

Dosing of Misoprostol in PPH

A

800-1000 ug per rectum

600 ug PO or sublingual

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10
Q

Side effects and contraindications of Methergine for PPH

A

Nausea, vomiting and chest pain

Contraindicated in HTN or vascular disease

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11
Q

Side effects and contraindications Hemabate in PPH

A

N/V, diarrhea, fever, bronchospasm and HTN

Contraindicated in ASTHMA, active heart, lung, renal or liver disease

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12
Q

Side effects and contraindications Misoprostol (Cytotec) in PPH

A

Diarrhea, shivering and fever that can be confused with endometritis

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13
Q

Uterine tamponade device name

A

Bakri Tamponade Balloon

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14
Q

When is Bakri Tamponade Balloon removed

A

Within 24 hours

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15
Q

How much fluid in filling Bakri Tamponade Balloon

A

500 ml of NS, may apply gentle traction to the balloon with a weight of <501 grams

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16
Q

Potential surgical procedures with laparotomy for uterine hemorrhage

A

Artery Ligation
Uterine Compression Suture
Hysterectomy

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17
Q

What artery ligations for PPH

A

Bilateral uterine artery ligation (O’Leary stitch) and bilateral utero-ovarian artery ligation

Internal iliac arteries- difficult and risky

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18
Q

Procedure for uterine compression suture

A

B-Lynch suture

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19
Q

Short term complication of B-Lynch suture used for PPH

A

Uterine necrosis
Pyometra
Myometrial defects

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20
Q

What is the B-Lynch suture

A
  • First suture is like closing incision (in on one side out on other)
  • Wrap suture around back side and drive needle on back side opposite of opening.
  • Then throw suture back in of back and wrap suture over top coming from the other side
  • Drive needle through other corner of incision line.
  • Tie two together.
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21
Q

When to give packed RBC (PRBC) in postpartum hemorrhage

A

Based on clinical assessment:

  • EBL >1,500
  • HR >/= 110
  • BP = 85/45
  • O2 saturations <95%

Do not rely on H&H

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22
Q

Dosing for TXA (Tranexamic acid) in postpartum hemorrhage

A

1 g (10 mL of a 100 mg/mL solution) is infused over 10-20 minutes

If bleeding persists after 30 minutes, a second 1 g dose is administered

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23
Q

Difference in accelerations by gestational age

A

> /= 32 weeks: >/= 15 bpm above baseline, with a duration of >/=15 seconds

<32 weeks: >/=10 bpm above baseline, with duration >/= 10 seconds

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24
Q

Define variable decelerations

A

Drop >/=15 bpm, last >/= 15 sec and <2 minutes in duration

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25
Q

Numbers for moderate variability

A

6-25 bpm

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26
Q

Fentanyl dose for labor pain

A

50-100 ug IV q1h

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27
Q

Butorphanol (Stadol) dose for labor pain

A

1-2 mg IV or IM q4h

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28
Q

Morphine dose for labor pain

A

2-5 mg IV or 10 mg IM q4h

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29
Q

Nalbuphine (Nubain) dose for labor pain

A

10 mg IV q3h

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30
Q

Meperidine (Demerol) dose for labor pain

A

25-50 mg IV q1-2 hours
OR
50-100 mg IM q2-4

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31
Q

Timing before delivery for prophylactic antibiotics in Group B Strep mother

A

> /= 4 hours

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32
Q

Management of Group B strep mother’s infant with inadequate GBS prophylaxis

A
  1. > /= 37 weeks and ROM <18 hours observe 48 hours
  2. If no to either of the above get:
    - CBC
    - Blood culture
    - Observation for 48 hours
33
Q

When to treat a mother with unknown GBS status

A
  • Peterm (<37 weeks)
  • Intrapartum fever
  • ROM >/= 18 hours
34
Q

Mnemonic for approach to shoulder dystocia

A 
HELPERR
H = call for Help
E = Evaluate for Episiotomy
L = Legs - McRoberts Maneuver
P = Suprapubic Pressure
E = Enter - rotational maneuvers
R = Remove the posterior arm
R = Roll the patient to her hands and knees
35
Q

When to consider cesarean delivery for fear of shoulder dystocia

A

EFW >5,000 grams in women without diabetes

and >4,500 grams in women with diabetes

36
Q

Intrapartum risk factors for shoulder dystocia

A
  • Abnormal first-stage labor
  • Arrest disorder
  • Labor augmentation with oxytocin
  • Instrument delivery
  • Epidural anesthesia
37
Q

Antepartum risk factors for shoulder dystocia

A

FAM MAPPED

  • Fetal macrosomia
  • Abnormal pelvis
  • Male fetus
  • Multiparity
  • Advanced maternal age (AMA)
  • Prior shoulder dystocia
  • Post-term
  • Excessive weight gain
  • Diabetes
38
Q

Internal maneuvers for shoulder dystocia

A

Woods maneuver

Rubin maneuver

39
Q

Woods maneuver in shoulder dystocia

A

insert a hand into the posterior vagina and rotate posterior shoulder clockwise or counterclockwise

40
Q

Rubin maneuver in shoulder dystocia

A

Push posterior or anterior shoulder toward fetal chest to adduct shoulders

41
Q

Neurologic examination criteria of brain death:

A

absence of:

  • papillary
  • oculocephalic
  • oculovestibular (caloric)
  • corneal
  • gag
  • sucking
  • swallowing reflexes
  • extensor posturing
42
Q

Gestational age (weeks) for administration of betamethasone:

43
Q

Main treatment for postpartum endometritis:

A

Clindamycin and gentamicin

44
Q

Routine prenatal labs test for initial visit:

A 
Rh(D) type, antibody screen
Rubella and varicella immunity
VDRL/RPR, HBsAg, HIV
Hemoglobin/hematocrit, MCV
Chlamydia PCR
Urine culture
Dipstick for urine protein
Pap test (if screening indicated)
45
Q

Routine prenatal lab test at 24-28 weeks:

A

Hemoglobin/hematocrit
Antibody screen if Rh(D) negative
50-g 1-hour GCT

46
Q

Routine prenatal lab test at 35-37 weeks:

A

Group B streptococcus (Streptococcus agalactiae)culture

47
Q

Main side effects of Valproic acid:

A

Thrombocytopenia and hepatotoxicity. Neuro tube defects in pregnant women.

48
Q

What are the 4 pre-birth questions to ask the obstetric provider before every birth?

A
  1. What is the expected gestational age?
  2. Is the amniotic fluid clear?
  3. How many babies are expected?
  4. Are there any additional risk factors?
49
Q

You have provided warmth, positioned the head and neck, cleared the airway, dried, and stimulated a newborn. It is now 60 seconds after birth and she is still apneic and limp. Your next actions is to:

A

Start positive-pressure ventilation

50
Q

When (time) is positive-pressure ventilation started if baby has not responded to the initial steps and continues to be apneic or limp

51
Q

How long should you listen for newborns baby’s heartbeat during resuscitation?

A

6 seconds, then multiply by 10 to get rate

52
Q

How long may a healthy newborn take (time) to achieve oxygen saturation of greater than 90%, when on room?

A

More than 10 minutes

53
Q

Concerning symptoms for headache

A 
SNOOP
Systemic symptoms: weight changes, fever, cancer HIV
Neurologic: including recent trauma
Sudden Onset: 
Older age: 
Change from previous:
54
Q

Oral medication for severe itching

A

Doxepin - antidepressant but suppresses itchiness.

55
Q

Life threatening DDx for chest discomfort

A 
Acute coronary syndrome
Pulmonary Embolus
Thoracic aortic dissection
Tension Pneumothorax
Esophageal Rupture
Pericarditis with potential tamponade
56
Q

Key historical and key exam features of ACS

A

Chest pain, weakness, nausea, and fatigue

Variable: possible diaphoresis, ill appearance, or rales

57
Q

Key historical and key exam features of PE

A

Pleuritic chest pain, SOB, risk factors

Tachycardia, clear lungs, unilateral leg swelling

58
Q

Criteria to use for PE rule out

A

PERC Criteria

59
Q

Key historical and key exam features of Aortic Dissection

A

Sudden onset sever ripping pain to back with paresthesia or paralysis

Unequal blood pressure, abnormal pulses, neurologic deficits

60
Q

Key historical and key exam features of tension pneumothorax

A

Sudden onset severe unilateral pleuritic chest pain

Hypotension, unequal breath sounds, tracheal deviation

61
Q

Key historical and key exam features of Esophageal rupture

A

Intense SSCP after vomiting or endoscopic procedure

Hamman’s crunch (crackle sounds heard or felt in time w/ heart beat)

62
Q

What are the main ligaments to injured with inversion ankle injury

A
  1. Anterior talofibular ligament (ATFL), which is just anterior to lateral malleolus
  2. Calcaneofibular ligament (CFL), which is inferior posterior to malleolus
  3. Posterior talofibular ligament (PTFL), posterior to malleolus
63
Q

Key historical and key exam features of Pericarditis/Tamponade

A

Pleuritic chest pain and dyspnea

Muffled heart sounds, distended neck veins, hypotension

64
Q

Monitor what when starting patients on Metformin

A

Yearly B12 check, 20% have deficiency at 5 years

Neuropathy could be related to B12???

65
Q

Warfarin goal INR for aortic valve replacement if no risk factor are present

66
Q

Warfarin goal INR for mitral valve replacement

67
Q

Warfarin goal INR for aortic valve replacement with presence of risk factors (eg A fib, severe LV dysfunction, prior thromboembolism, or presence of hypercoagulable state)

68
Q

Cardiac condition associated with classic Ehlers-Danlos

A

Mitral valve prolapse

69
Q

Cardiac condition associated with Marfan’s

A

Progressive aortic root dilation

Mitral valve prolapse

70
Q

Initial treatment of patient with regular, narrow complex tachycardia

A

Vagal maneuvers and/or IV adenosine

71
Q

Initial treatment of patient with persistent tachyarrhythmia (narrow or wide) causing hemodynamic instability, altered mental status, ischemic chest discomfort or acute heart failure

A

Immediate synchronized direct-current cardioversion

72
Q

Oxygen protocol for inpatient child with bronchiolitis/asthma

A

Continuous O2 monitoring for 6 hours with a deep sleep

73
Q

Oxygen protocol for inpatient child with pneumonia

A

Continuous O2 monitoring for 12 hours with a deep sleep

74
Q

Ibuprofen administration in children

A
  • Don’t give less than 6 months of age
  • Synergistic potential kidney damage if given same time as Tylenol.
  • Dosing 10 mg/kg
75
Q

Tylenol administration in children

A
  • Parents do not give <2 months of age, due to concern for masking fever.
  • May give inpatient is known cause of fever
  • Dosing 10-15 mg/kg
76
Q

Major initial interventions to reduce the risk of sepsis-related mortality:

A

Aggressive IV fluids and early broad-spectrum antibiotic therapy (within 1 hour)

77
Q

Examples of broad-spectrum antibiotics to be used as an initial intervention to reduce the risk of sepsis-related mortality:

A
  • If pseudomonas is unlikely: Use IV Vancomycin (MRSA) plus will need to cover G+ and G- bugs with:
  • carbapenem or piperacillin-tazobactam or ceftriaxone or cefepime
  • May need to add another antibiotic if concern about pseudomonas
78
Q

Aggressive IV fluids to be used to reduce the risk of sepsis-related mortality:

A

Typically, 30 mL/kg of NS, which is given over the first 3 hours of treatment in 500-mL boluses.

Residency (5 decks)

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