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Step3 > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

Treatment for uti in pregnancy

A

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

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2
Q

Pyelo tx in preg

A

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

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3
Q

Gestational thrombocytopenia

A

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

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4
Q

Defn of protracted labor vs arrest of labor

A

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

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5
Q

Ddx of vaginitis

A
  • 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
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6
Q

Gastroschesis mgmt

A

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

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7
Q

Meds for postpartum hemorrhage

A

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

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8
Q

Most effective contraception

A

Progestin subdermal implant

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9
Q

Give antenatal steroids at labor up to

A

34 weeks

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10
Q

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

A

<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

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11
Q

Tx for cystitis vs pyelo in pregnancy

A

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

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12
Q

PCOS treatment

A

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

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13
Q

Tx for intrapartum intraamniotic infxn vs PP endometritis

A

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

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14
Q

When to give abx to unknown gbs?

A

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

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15
Q

First trimester routine screening

A

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)

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16
Q

Second trimester tests

A

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

17
Q

Third trimester tests

A

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

18
Q

What do do with hiv in pregnancy

A

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

19
Q

Immediately deliver in hellp if

A

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

20
Q

FHR tracings

A

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

21
Q

Meds for uterine atony

A

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

22
Q

What ocp can you use while breastfeeding?

A

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

23
Q

Letrozole
Clomiphene
Leuprolide

A

-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)

24
Q

Lcis vs dcis management

A

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

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

25
Q

Endometrial lining should be <__mm in postmen

A

4mm

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

26
Q

Cervical cancer screening guidelines

A

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

27
Q

Contraindications to use of MTX

A

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

28
Q

Intrahepatic cholestasis of preg tx

A

Ursodeoxycholic acid, antihist, deliver at 37 weeks

29
Q

Ovarian hyperstim sx and cause

A

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

30
Q

Ruptured ovarian cyst presentation

A

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

31
Q

Ulipristal

A

Most effective oral emergency contraception

Copper iud most effective overall

32
Q

Granulosa cell tumor

A

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

33
Q

Abnormal uterine bleeding after menopause, what do you do?

A

Endometrial bx for cancer

34
Q

Cephalohematoma vs caput succedaneum

A

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

35
Q

Interstitial cystitis

A

Bladder pain with filling, increased frequency, etc, assoc with psych and pain disorders

Normal ua

No curative tx

36
Q

Risk of postponing delivery after IUFD

A

DIC not infection!

37
Q

Afi for oligo vs polyhydramnios

A

Poly >=24
Oligo<5

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