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Step 2k > Ob/gyn > Flashcards

Ob/gyn Flashcards

1
Q

Guide for abnormal fetal heart tracings. VEAL CHOP

A

Variable decels, early decels, accelerations, late decels

(Cord compression/prolapse; oligohydroamnios), head compression, Ok/normal, placental insufficiency

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2
Q

In what phase of menstrual cycle in the mucus, abundant, basic pH, clear, and stretchy?

A

In the ovulatory phase. Think evolutionarily, this allows for a friendly environment for sperm.
In all other phases, the mucus is acidic (

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3
Q

little vulva inflammatio. thin, off-white malodorous (fishy) vaginal discharge. pH>4.5

A

bacterial vaginiosis. Caused by Gardenerella vaginialis. You see clue cells. treat with metronidazole

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4
Q

yellow-green, malodours, thin, frothy and purulent vaginal discharge. Severe vulva inflammation
pH >4.5

A

Trichomonas vaginitis. You see highly motile pear shaped organisms. treat with metronidazole

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5
Q

Cottage cheesy vaginal discharge. Significant vulva inflammation. Normal pH

A

Candida vulvovaginitis

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6
Q

Hyperemesis gravida definition and treatment

A

Persistent vomiting, acute starvation (large ketouria and weight loss of at least 5%). Must first rule out molar pregnancy with US + b hCg. Treat by Vit B6, doxylamine (antihistamine for mild) or promethazine or dimenhydrinate. Support with IV if dehydrated and unable to PO.

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7
Q

7 Ws of post partum fever

A

Same as other 5 + weaning (mastitis, engorgement) and womb

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8
Q

Treatment for postpartum endometritis

A

Broad coverage. Clindamycin and gentamicin. Due to polymicrobial.
Chorioamniotis is amp gent.

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9
Q

Pseudocyesis

A

Seen in women with a strong desire for pregnancy. Present with amenorrhea, breast enlargement, abdominal enlargement but empty uterus on US and neg office pregnancy test

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10
Q

21 hydroxylase deficiency

A

Most severe classic form of CAH. Presents as new born femal with ambitious genitalia and life threatening salt wasting.
17 hydroxyprogesterone will be elevated

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11
Q

11 b-hydroxylase deficency

A

Less common cause of CAH

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12
Q

Elevated DHEAS

A

Suggests adrenal source

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13
Q

Normal female phenotype, normal ovaries, abnormal vagina and absent uterus precluding menstruation is consistent with.

A

Mullerian agenesis

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14
Q

Contraindication to Raloxifene

A

Venous thromboembolism
Raloxifene is a selective estrogen receptor modulator (SERM) that increases bone mineral density and is used to prevent osteoporosis

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15
Q

Amber one cause of postpartum hemorrhage

A

Uterine atony

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16
Q

At what beta hCG level and gestational age should a one see an interuterine growth on ultrasound

A

Five weeks gestational age or better hCG 1500

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17
Q

Treatment for urinary retention after epidural anesthesia with a post void residual greater than 500

A

Indwelling catheter allow decompression and recovery

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18
Q

Acceptable antihypertensives in pregnancy

A

Preferred: hydralazine, labetalol (Particularly in hypertensive crisis or preeclampsia)
First line:Methyldopa, hydralazine, beta blockers (labetalol), calcium channel blocker’s (Amlodipine)
Second line: clonidine, thiazides .

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19
Q

Contraindicated antihypertensives in pregnancy

A

ACEi/ARB, Lasix, Aldosterone blockers, direct renin inhibitor

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20
Q

Vasa previa versus placenta previa

A

Bleeding after rupture of membrane can be seen both however the baby does not experienced rapid deterioration after placenta previa.

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21
Q

kleihauer betke test or apt test

A

Differentiates Fetalfrom maternal blood

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22
Q

Early decelerations signify

A

Head compression. Can be normal

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23
Q

Late decelerations signify

A

Uteroplacetal insufficiency, Fetal hypoxia, fetal acidosis

24
Q

Variable decelerations signify

A

Cord compression
Oligohydroamnios
Cord prolapse

25
Q

Amsel criteria for diagnosis of bacterial vaginosis

A

Whitish grey discharge
pH >4.5
Positive whiff test with addition of amine to discharge
Clue cells

26
Q

Severe postpartum hemorrhage and inability to lactate several days after delivery

A

Sheenan syndrome

Pituitary hypoperfusion leading to anterior pituitary infarction

27
Q

Women taking metronidazole should avoid

A

alcohol because it is a disulfiram like reaction

28
Q

How do you edit levothyroxin in pregnancy

A

You must increase the dose

Total T3 and T4 are elevated in pregnancy because of an increase in thyroid binding globulin levels

29
Q

Small teardrop like growths the results with trichloroacetic acid

A

HPV associated genital warts

30
Q

What form of birth control is associated with weight gain

A

MeDoxyprogesterone is associated with increased body fat and reduce lean muscle which can lead to weight gain

31
Q

Cause of symmetric growth restriction

A

Growth lag begins at the first or second trimester (before at 28 weeks gestation) do to fetal factors. These include chromosomal abnormalities congenital infections (toxoplasmosis, cytomegalovirus, rubella, malaria) and congenital anomalies (cardiac Abnormalities, Gastroschisis)

32
Q

Causes of asymmetric growth restriction

A

Usually due to sub optimal maternal factors such as vascular insults from things such as hypertension, diabetes mellitus, preeclampsia, cigarette smoking, drug use

33
Q

What stage of the menstrual cycle is the cervical mucus clear profuse and thin

A

Ovulatory phase. This is in contrast to the mucus of pre-and post ovulatory phase which are scant, opaque and thick

34
Q

Folate supplementation in pregnancy

A

0.4 mg/day

Or 4 mg/day in people with a history of neural tube defects

35
Q

Screening at 9-14 weeks

A

PAPP-a + Michael transparency + free b-hCG +/- CVS

(PAPP-A can be done before CVS and can be good for the diagnosis of

36
Q

15-22 weeks screening

A

Maternal serum a-fetoprotein MSAFP or quad screen (AFP, estriol, b-hCG, and Inhibin A) +/- amniocentesis

37
Q

Trisomy 18 vs trisomy 21

A

All 4 are reduced in trisomy 18

Trisomy : Inhibin A and b-hcg are increased ; MSAFP and estriol are decreased

38
Q

How to assess lung maturity

A

Lecithin:sphingomyelin > 2.5

Or presence of phosphatidylglycerol in the 3rd trimester

39
Q

Intracranial calcifications, chorioretinitis, hydrocephalus, ring enhancing lesions on MRI

A

Congenital toxoplasmosis
Avoid cat feces during pregnancy
Treat with pyrite thiamine +sulfadiazine

40
Q

Blueberry muffin rash, cataracts, hearing loss, patent ductus arteriosus

A

Congenital rubella

Immunize prior to pregnancy. Cannot be nice during pregnancy because it’s a live vaccine

41
Q

Peri ventricular calcifications, petechia rash

A

Congenital CMV.

Treat with postpartum ganciclovir

42
Q

Maculopapular skin rash, hepatomegaly, sniffles ( mucho purulent Rhinitis), saber shins, saddle nose

A

Congenital syphilis

Treated with penicillin

43
Q

Elective termination of pregnancy in the first trimester

A

49 days : oral mifepristone + oral/vaginal misoprostol; IM/oral methotrexate +oral/vaginal misoprostol
59 days: vaginal or sublingual or buccal misoprostol
Surgical management up to 13 weeks

44
Q

Elective termination of pregnancy in second trimester

A

13-24 wks : induction of labor or D&E

45
Q

Timing of first stage of labor

A

Latent: onset to 3-4 cm dilation
Active: 4cm to complete cervical dilation: four hours with adequate contractions or six hours without adequate contractions

46
Q

Second stage of labor

A

Complete cervical dilation to delivery of infant

.5 to 3 hours

47
Q

Third stage of labor

A

Delivery of the infants to delivery of placenta

0-0.5 hrs

48
Q

What should you not do if you expect rupture of membranes

A

Do not do a digital exam instead do a sterile speculum exam

49
Q

What nerve is responsible for pain during childbirth

A

Uterine contractions and cervical dilation result in visceral pain T 10 to L1
Descent of the fetal head and pressure on the vagina and Perineum result in somatic pain (pudendal nerve, S2 to S4)

50
Q

Contra indications to regional anesthesia during childbirth

A

Hypotension, maternal coagulatopathy, use of low molecular weight heparin, maternal bacteremia, skin infection over site of needle placement, increased intracranial pressure

51
Q

Clothes of hyperemesis gravidarum

A

If morning sickness persists after the first trimester.
Persistent vomiting, acute starvation (usually large ketouria), weight loss (at least 5% decrease in body weight)
The first step is to rule out molar pregnancy with ultrasound

52
Q

Treatment for hyperemesis gravidrum

A

Vit B6, antiemetics

53
Q

Work up for pelvic mass in post menopausal woman

A

Pelvic ultrasound and CA125 (only marker that is useful)

54
Q

What constitutes severe features of preeclampsia

A 
Blood pressure above 160
thrombocytopenia less than 100,000
renal dysfunction: creatinine greater than 1.1
Elevated transaminases
Pulmonary edema
Neurological signs
55
Q

Relationship between thyroid hormone and prolactin

A

TRH stimulate prolactin

56
Q

OCPs and hypertension

A

OCPs can sometimes worsen and hypertension

57
Q

Testing for CIN 1 by age

A

21-24 : usually regresses; repeat in one year
25-29: should have colpo and biopsy
>30: should be tested for HPV (16 and 18). If negative then cytology plus HPv testing in a year is preferred; if positive or hpv status unknown then perform colpo and biopsy

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