OB/GYN

Question 1

Treatment for uti in pregnancy

Answer 1

Cefpodoxime, amox-clav, or fosfomycin

Try to avoid nitrofurantoin or trim-sulfa esp in t1 and t3

Avoid cipro

Treat asx bacteriuria same way

Cx to guide tx and as test of cure

Question 2

Pyelo tx in preg

Answer 2

Ctx or cefepime, once af for 48 hrs switch to Orals, then daily suppressive until 6wks Pp

Question 3

Gestational thrombocytopenia

Answer 3

Benign, asx, trend and usually resolves Pp
Plts 70-150k
Hemodilution or destruction
Usually in t2 or t3

Question 4

Defn of protracted labor vs arrest of labor

Answer 4

In active phase (6-10cm), less than 1cm in 2 hours

Usually bc of inadequate contractions (less frequent than every 2-3min)

Tx is oxytocin and amniotomy

Arrest is no cervical change over four hours with adequate contractions or 6hrs with inadequate contractions —>CS

Question 5

Ddx of vaginitis

Answer 5

• bv - gardnerella, thin white dc with fishy odor and no inflamm, clue cells, pos whiff test with koh, metronid or clinda
• trich- thin, yellow green dc, malodorous with vag inflamm, 7d oral metronid
• Candida - thick white dc with inflamm, flucon

Question 6

Gastroschesis mgmt

Answer 6

No need for cs
Delivery at term if all else ok
Put lower half of body in bag
Og or ngt for decompression
Iv abx for vag flora (eg amp, gent)
Surgical repair

Question 7

Meds for postpartum hemorrhage

Answer 7

Either stimulate uterine contraction (oxytocin, other prostaglandin analogs like carbaprost (not in htn), methylergonovine (not in htn)) or stabilize clots (txa)

Question 8

Most effective contraception

Answer 8

Progestin subdermal implant

Question 9

Give antenatal steroids at labor up to

Answer 9

34 weeks

Question 10

Interventions for preterm labor at <32 weeks vs 32-34 weeks

Answer 10

<32: steroids, indometh for tocolysis, mg sulfate
32-34: steroids, nifed for tocolysis

Always pcn if gbs+ or unknown
Rho gam after delivery if mom is neg and baby is pos

Question 11

Tx for cystitis vs pyelo in pregnancy

Answer 11

Cystitis: nitrofurantoin or amox-clav
Pyelo: ivf and ctx

Question 12

PCOS treatment

Answer 12

Weight loss
Ovulation induction with clomiphene (binds estrogen rec so body sees less est and makes lh and fsh) and letrozole (aromatase inhib —> less est)

Gonadotropins are second line for ovulation

OCPs to protect endometrium

Spiro to decrease androgens

Question 13

Tx for intrapartum intraamniotic infxn vs PP endometritis

Answer 13

Inteaamniotic - amp/gent
Endo - clinda/gent for more anaerobes

Question 14

When to give abx to unknown gbs?

Answer 14

Preterm (<37 weeks)
Fever
Prolonged rom (over 18 hours)

Question 15

First trimester routine screening

Answer 15

Anemia, rh, pap, ua for asx bacteriuria (always treat with cephalosporin or amox and test of cure), hep b and rubella, syph, hiv, chlam/gon, bv, trich, tb, trisomy 21 (optional - papp, hcg, nuchal translucency, or cell free)

Question 16

Second trimester tests

Answer 16

Quad screen - afp, hcg, estriol, inhibin a

AFP up in ntd etc

AFP low in trisomies - 21 hcg and inhibin high; 18 all low

Can start with afp and then if abnormal confirm dates with us, if correct do amnio

Question 17

Third trimester tests

Answer 17

Diabetes (wk 24-28), anemia, indirect Coombs if rh neg (if they have anti d ig don’t give rhogam), gbs screen at 35-37 wks

Question 18

What do do with hiv in pregnancy

Answer 18

Triple therapy for mom
Zdv at delivery if viral load
No invasive stuff (eg fse, arom)
Vag delivery ok unless load high
6 wks zdv for baby for ppx
No BF

Question 19

Immediately deliver in hellp if

Answer 19

> 34 wks or severe maternal or fetal distress (eg placental abrupto on, liver infarction)

Question 20

FHR tracings

Answer 20

Normal hr 110-160
Accels with mvmt are normal
Early decels with contractions are normal
Late decels = uteroplac insuff
Variable decels = cord compression

Question 21

Meds for uterine atony

Answer 21

Carboprost (pg analog, ci in htn)
Miso (pg analog —> contractions)
Methylergo —> vasospasm (ci htn)

Question 22

What ocp can you use while breastfeeding?

Answer 22

Progestin only (estrogen decreases lactation plus increases hypercoag state so can’t use within three weeks of labor)

Question 23

Letrozole
Clomiphene
Leuprolide

Answer 23

-letrozole - inhibit androgen to est conversion —> less estrogen —> increased lh and fsh
- clomiphene binds est receptors in ht and pit —> receptor depletion and release from neg feedback —> release more lh and fsh
- leuprolide when given continuously down regulates pit gnrh receptors (it’s a gnrh agonist) —> low lh and fsh (menopause)

Question 24

Lcis vs dcis management

Answer 24

Dcis lumpectomy, radiation, tamox for five years to prevent invasive disease

Lcis just tamox for five years or surveillance, low malig potl

Question 25

Endometrial lining should be <__mm in postmen

Answer 25

4mm Endometrial bx—> if cancer, do surgery staging (tah with bso, ln dissection and peritoneal washings)—> if mets etc add radiation and chemo

Question 26

Cervical cancer screening guidelines

Answer 26

Start at 21 regardless If <30, every three years Then every three with just cytology or every 5 with Hpv cotesting

Question 27

Contraindications to use of MTX

Answer 27

Renal or hepatic failure, high likelihood, treatment, failure, if high, hCG, or fetal heartbeat, breast-feeding, peptic ulcers, immuno deficiency, pulmonary disease

Question 28

Intrahepatic cholestasis of preg tx

Answer 28

Ursodeoxycholic acid, antihist, deliver at 37 weeks

Question 29

Ovarian hyperstim sx and cause

Answer 29

Cause - increased hcg from injection for induction causes vascular perm and fluid shifts S/s- n/v/abd pain, ascites, resp distress, hemoconc, hypercoag, electrolyte imbalances, multi organ failure, doc

Question 30

Ruptured ovarian cyst presentation

Answer 30

Sudden onset, pelvic pain, following strenuous activity, with free fluid on ultrasound from hemoperitoneum, which also causes acute abdomen and anemia

Question 31

Ulipristal

Answer 31

Most effective oral emergency contraception Copper iud most effective overall

Question 32

Granulosa cell tumor

Answer 32

Ovarian cancer that releases extra estrogen and inhibin, estrogen causes prolif of endometrium and can increase risk of endometrial cancer and cause bleeding etc

Question 33

Abnormal uterine bleeding after menopause, what do you do?

Answer 33

Endometrial bx for cancer

Question 34

Cephalohematoma vs caput succedaneum

Answer 34

Cephalo is subperiosteal and doesn’t cross sutures, often see with vacuum etc, resolves within weeks CS is superior to periosteum and crosses sutures, usually at vertex and resolves over few days

Question 35

Interstitial cystitis

Answer 35

Bladder pain with filling, increased frequency, etc, assoc with psych and pain disorders Normal ua No curative tx

Question 36

Risk of postponing delivery after IUFD

Answer 36

DIC not infection!

Question 37

Afi for oligo vs polyhydramnios

Answer 37

Poly >=24 Oligo<5