OB/Gyn

Question 1

tx of ectopic >3.5cm?

Answer 1

> 3.5cm: laproscopic

Question 2

mc tocolytic

Answer 2

MgSO4 (not just used for preeclampsia)

tocolytics slow progression of cervical dilation and contraction

Question 3

first sign of pregnancy

Answer 3

Goodell sign

cervical softening, around 4 wks

Question 4

Virchow’s triad elements occur in pregnancy. What are they?

Answer 4

Venous stasis
endothelial injury
hypercoaguability

Question 5

Term lengths

Answer 5

Preterm: 25-37 weeks
Term: 38-42
Postterm: after 42weeks

Question 6

Nagele rule for estimated day of delivery

Answer 6

LMP - 3mo + 7 days = estimated delivery day

Question 7

mc site for ectopic pregnancy specifically?

Answer 7

ampulla of the fallopian tube

Question 8

methotrexate MOA?

Answer 8

it is a folate receptor antagonist

can be used on ectopic preg

Question 9

how do you know methotrexate is knocking out that ectopic preg?

Answer 9

Want to see a 15% decrease in bHCG in 4-7d

follow every week until bHCG levels are 0

Question 10

granulosa cell tumor

Answer 10

ovarian solid tumor, malignant
produced excess estrogen
see: precocious puberty, or postmeno bleeding (bimodal age distribution)

Question 11

missed vs threatened abortion

Answer 11

missed: nonviable fetus
threatened: viable fetus

do: fetal heart tones, pelvic exam (asses cervix, fluids), then US
(i picked bHCG over US; wrong)

Question 12

HELLP syndrome

Answer 12

Hemolysis (schistocytes, etc)
Elevated Liver enzymes
Low platelets

Question 13

elevated alk phos in pregnant woman

Answer 13

normal

Question 14

preg pt with HELLP syndrome has pitting LE edema, rales , and oliguria. What is happening?

Answer 14

pulmonary edema (a rare complication of preeclampsia) (HELLP is a variant of preeclampsia)

Question 15

tx for magnesium toxicity?

Answer 15

obvi stop mag

then give calcium gluconate

Question 16

gestational HTN is when?

Answer 16

only after 20wk gestation!

Question 17

After diet and excercise, what 3 treatments are safe for gestational DM?

Answer 17

insulin
metformin
glyburide

Question 18

placenta previa vs vasa previa antepartum hemorrhage

Answer 18

both cause painless vaginal bleeding upon ROM; however, vasa previa you see rapid fetal distress

Question 19

What are the 5 elements of the Biophysical Profile?

Answer 19

Nonstress test
Fetal chest expansions (1+ in 30min)
Fetal movement (3+ in 30min)
Fetal muscle tone (1 flex)
Amniotic fluid

Question 20

Fetal tachycardia

Answer 20

> 160bpm

Question 21

What is the nonstress tests?

Answer 21

external fetal HR monitoring for ~30 min
good results: > or = 2 accelerations
bad: multiple variable or late decels

Question 22

External cephalic version

Answer 22

can be done between 37weeks - labor
to turn breech baby around
CI: placental abnormalities, oligohydramnios, multiple gestation

Question 23

Meconium aspiration syndrome looks like? assc with? at risk for?

Answer 23

see low APGARs, resp distress, and CXR with patchy b/l infiltrates

associated with advanced gestational age

at risk for persistent pulm HTN

Question 24

Testing at first prenatal visit? (8 things)

Answer 24

CBC
ABO & Rh status
Hep B 
Syphilis
Rubella 
HIV
UA 
Gonorrhea
Chlamydia

Question 25

itchy white plaques in the anogenital region

Answer 25

(vulvular) lichen sclerosis
tx: topical steroids, or tacrolimus (calcineurin inhib) if steroids aren’t enough
dx: biopsy
at risk for developing squamous cell CA

biopsy to tell this from Paget’s disease. tx for Pagets is b/l vulvectomy

Question 26

post partum hemorrhage

Answer 26

needs to be >500mL of blood (can be up to 6 wk later)

do: 1. examine the uterus for rupture, retained stuff
2. compression and massage
3. administer uterotonic agents (oxytocin, methylergonovine, caraboprost tromethamine(this is a PGF2a analog))

Question 27

Avoid these drugs in pregnancy

Answer 27

ACEi
valproic acid, carbamazepine, Li
warfarin
aminoglycosides, tetracyclines, fluoroquinolones, TMP-SMX

Question 28

Non-cancerous condition where the endometrium invades the myometrium

Answer 28

Adenomyosis

uterus feels boggy on exam

dx&tx: hysterectomy

Question 29

Drugs to tx prolactinoma

Answer 29

1.Bromocriptine 2. Cabergoline

these are dopamine receptor agonists. Dopamine inhibits prolactin release

(note: in order to treat with drugs, needs to not be causing visual disturbances)

Question 30

intraurterine adhesions

Answer 30

Asherman’s syndrome

secondary to D&C

Question 31

mc site for ureteral injury after a hysterectomy?

Answer 31

cardinal ligament
it attaches the cervix to the pelvic wall and houses the uterine arteries

The ureter run just lateral and below the uterine arteries “water under the bridge”

Question 32

assessment of amenorrhea:

Answer 32

1. bHCG preg test
2. TFT
3. prolactin levels
4. progestin challenge test

Question 33

What is a cerclage?

Answer 33

Stitches to hold in place an incompetent cervix

ex: a patient who had several abortions in their youth is now ready for a serious pregnancy

Question 34

Third trimester testing (5)

Answer 34

1. 27wk CBC (did this at visit 1, Hg less than 11, give PO Fe)
2. 24-28 do glucose load
   3/4. 36wk: Chlamydia, gonorrhea testing
3. Group B strep rectovaginal swab

Question 35

motile flagellates on saline wet mount
is?
tx?

Answer 35

trichomonas

tx pt AND partner with metronidazole

Question 36

mild vs. severe preeclampsia?

Answer 36

mild: BP more than 140/90, 24H protein of more than 300mg
severe: more than 160/110, 24H protein of more than 5g