OB/Gyn (40) Flashcards
pain drug of choice in pregnancy
acetaminophen
Avoid bismuth salicylate and NSAIDs, aspirin during what semesters?
What category?
all (premature closure of FA)
all are category D
Warfarin, isotretinoin, FU, MTX - what pregnancy class
X - absolute CI
Tx of her2-neu positive breast cancer
trastuzumab (herceptin)
PCOS, hyperandrogenism, ovulatory dysfunction - tx with what SERM that inhibits hypothalamic E receptors, blocking E’s (-) f/b on GnRH pulse generator –> release of FSH and LH from ant pit
clomiphene
At 28wks gestation, what should be tested for and administered?
test gestational diabetes
Tdap and prophylactic dose of RhoD IgG if mom is Rh(-)
what should all pregnant women receive, in any semester?
inactivated influenza vaccine
***NEVER give active/live, MMR, zoster, varicenna
when should GBstrep test be done?
DoC?
36wk
penicillin or cefazolin
PCOS increases risk of what cancer
endometrial cancer dt unopposed estrogen
Dx and risk factor - new onset abd pain persisting bw contractions, vaginal bleeding, fetal HR changes(decrease)
urterin erupture
hx of cesarean delivery TOLAC - trial of labor after cesarean)
what happens to AFP during pregnancy?
rises in fetal plasma until 10-13
rises in maternal
Pap smear when used for cervical cancer screening should be performed every __ years in women __-__yo.
Pap smear when used for cervical cancer screening should be performed every THREE years in women 21-65 yo.
When can HPV testing be started? And what is the time interval if used with a pap smear?
after age of 30, every 5 years.
What is recommended for pregnant patients over 21y during initial OB appointment.
cervical cancer screen with Pap
If mom is Rh- and baby Rh+, when should RhoDIgG be given?
28 weeks (lasts for 12 weeks) and then 72hrs postpartum
Young F less than 30y w/ painless, well circumscribed, smooth, rubbery, mobile mass usually in UOQ unilaterally.
fibroadenoma
Young F with a bilateral breast pain in UOQs starting 1wk prior to menstruation and disappearing after. Dt hormoal factors associated with menstruation.Can have sweling and yellow greenish dischage.
US - thin walled/clusters
fibrocystic disease
Unexplained hyperthyroidism in a F, but negative TS Ig and normal radioiodine uptake) with a pelvic mass.
struma ovarii - mature (B9) thyroid follicle teratoma of ovary
Define a reactive nonstress test.
Two fetal heart accelerations within 20 minutes with or without fetal movement detecetd by patient.
This is good!
what is an acceleration in a NST?
fetal HR inc by at least 15bpm for duration of 15-120 sec.
very common cause of 3rd trimester vaginal bleeding (varies in intensity) afteer vaginal intercourse of pelvic exam. No pain or trauma. Mostly when no prenatal care.
placenta previa
placenta accreta associated wtih what type of prior delivery
hx of c section
placental villi attach to uterine myometrium no endometrium
Evaluate mastitis and breast abscess in lactating women how?
then what?
evaluate the mass with US and use to guide direct needle aspiration for drainage.
pelvic itching, pain, dyspareunia with malodorous green/yellow frothy discharge.
trichomonas
cottage cheese discharge odorless with KOH, NORMAL vaginal pH. vulvar pruritis
vaginal candidiadis
KOH, fishy odor, grey-white vaginal discharge cells covered in bacteria
bacterial vaginosis
“clue cells”
First two lines of treatment for endometriosis
- NSAIDs
2. Combination oral contraceptives
When should chlamydia screening begin?
all sexually active women and pregnant women age
Bp screening begins?
18 and older
Cervical cancer screening
Pap every 3 years 21-65
Pap+HPV every 5 years 30-65
70yo F with nipple inversiona nd discharge that appears white w/ creamy consistency. Blood tinged. Smoking and increased age are risk factors. Ductoscopy = dilated ducts filled iwth secretions and fibrotic debris.
duct ectasia
Appropriate weight gain for a normal BMI (18.5-24.9) female during pregnancy
25-35lbs
#1 DoC for vulvovaginal candidiasis #2 DoC
- topical azole (i.e. clotrimazole)
2. orgal fluconazole if pt cannot comply
DoC for bacterial vaginosis (garderella, ureaplasma, prevotella) and trichomoniasis
po metronidazole
ferning = ?
chorioamnionitis
pregnant with rise in BP >15/10 from baseline, worsening/new proteinuria, end organ damage. dx and tx
preeclampsia
Magnesium sulfate for seizure treatment and prophylaxis to prevent eclampsia.
what class of drug increases baseline fetal HR and incidence of fetal tachycardia?
beta-adrenergic agonists (terbutaline, ritodrine, albuterol)
tocolysis drugs and function
used to suppress labor - relax sm m
beta-adrenergic agonists (terbutaline, ritodrine, albuterol)
CCB (nifedipine)
NSAIDs (indomethacin)
oxytocin antagonists
Mg sulfate
pt has HTN or preeclampsia. What should be avoided if she gets uterine atony?
pt has asthma. What should be avoided if she gets uterine atony?
methylergonovine
carboprost
A woman has a surgical or surgical abortion.
a) more than two weeks followingn surgical evacuation procedure she has persistent vaginal bleeding
b) evidence of infection with foul smelling discharge and a boggy tender uterus with cervical dilation
a) retained products of conception
b) septic abortion
type of spontaneous abortion with a closed cervical os (products of conception have not been expelled). No fetal HR detected
missed abortion
type of spontaneous abortion with vacinal bleeding, pelvic pain, open cervical os with products of conception visible in cervical canal. MC after 12 weeks gestational age
incomplete abortion
type of spontaneous abortion with vaginal pink-brown to red bleeding and pelvic pain. beginning of a spontaneous abortion with dilated cervix, open cervical os, products of conception in internal os
inevitable abortion
a young female w/ unilateral breast tenderness and purulent nipple discharge. MCC? MC risk factor?
periductal mastitis, smoker.
tx periductal masttits
amoxicillin-clavulanate
50yo F annual checkup. always choose….
mammogram - the first year of screening
Dx: 12wks post partum HTN
chronic HTN
acute rise in BP from baselie, new/worsening proteinuria and/or evidence of end organ damage
preeclamspia superimposed on chronic HTN
absence of proteinuria if pt is >20wks gestation
gestational HTN
> 2 BPs>140/90 and 300mg and
mild preeclampsia
BP and prteinuria above mild ranges with evidenc of end organ damage
severe eclampsia
gran mal seizure or coma on top of preeclampsia
eclampsia
date of “confinement” math. naegele’s rule
(28 day cycle) = x days = 7
(35 day cycle) = x days = 14
(21 day cycle) = x days = 0
add x-days to first day of LMP + 9mo
MCC of genetic abnormality causing pregnancy loss
trisomy 16
wait until after this level of b-hCG (“discriminatory zone”)
1500
hypothyroid pt on levothyroxine. most appropriate management now?
increase levothyroxine (if nt, possible cretinism)
Type of abortion used to describe vaginal bleeding w/in first 20wks of gestation w/o evidence of spontaneous abortion.
Sx: presents with vaginal bleeding and pelvic pain
threatened abortion
white, hairy appearing lesions on lateral tongue. associated with immunocompromised
EBV
An infant presents with jaundice w.in first 24 hrs of life (Br>12mg/dL in first 24hrs or 5mg/dL inc in first 24hrs). Next step?
direct coomb’s test to chekc for foreign antibodies attached to infant’s RBC. often due to ABO and/or Rh incompatibility
Infant with:
-Elevated direct Br (>20% of total Br level) - do what?
-
U/S
tx of aphthous ulcers
trimcinolone (CS)
MCC of sideroblastic anemia (iron accumulates in mito, causing marrow to roduce the rnged sideroblasts)
excesive alcohol use
Threatened abortion v. inevitable abortion
btoh : vagina bleeding, cramping,
MCC of elevated AFP during wk16-18 quad screen?
MCC of decreaed AFP
- incorrect gestational dating.
- multiple gestational
- open NTD
decreased - tri21
