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Final review for Step 2 Ck > OB/gyn > Flashcards

OB/gyn Flashcards

1
Q

When is gest sac able to be seen (bchg level)

A

1500

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2
Q

What does BhCG do early in pregnancy?

A

BhCG needs to rise right away because it maintains the pregnancy with progesteroner until the placenta can make its own

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3
Q

How is viable pregnancy confirmed?

A

Viable pregnancy confirmed with FHT by 10 weeks on U/S

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4
Q

Do Braxton Hick’s change the cervix?

A

No, braxton Hicks are irregular and in the lower back and don’t increases in intenseity or amount and do NOT change the cervix

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5
Q

What is PUPP

A

Pruritic papules and palques, plaques on trunks and legs

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6
Q

How is PUPP treated

A

Topical steroids for PUPP

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7
Q

Mortality of PUPP

A

No mortality associated with PUPP

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8
Q

How is intrahepatic choelstasis (high prog) treated inpregnancy

A

High prog in pregnancy causes cholestasis which also causes itching and can result in still birth, give ursodeoxycholic acid and monitor fetus

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9
Q

Why is edema in pregnancy

A

Increased fluid volume and venous pressure due to gravid uterus compressing IVC

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10
Q

Why do women in pregnancy have a low Hg?

A

It is dilutional due to increase in plasma volume, they actually have increaed reticuloctye count with normal MCV, it is a normoctyic anemia without hemolysis due to diluation, plasma osmo is decreased

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11
Q

What type of respiratory changes are present in pregnancy?

A

Less FRC and less RV due to high diaphragm frmo uterine compression and increased RR to compensate causing a respiratory alkalosis

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12
Q

What urinary infection complication do women commonly get

A

They get high risk for pyelo due to urinary stasis from right hydroureter/gravid compression and need tx if they have asyx bacteriuria

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13
Q

What happens to Cr and BUn in pregnancy?

A

They get a physiologic increase in GFR due to high blood volume resulting in more clearance and drop of Cr and BUN

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14
Q

Why does x2 NST start at 41 w

A

women at 41 weeks have higher risk morbidity/mortality and so 2x weekly NST is done

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15
Q

After 41w with x2 NST tests, what is an indication for delivery

A

After 41 weeks delivery is indicated with oligohydramnios or fetal demise

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16
Q

what is most reliable way of dating?

A

most reliable way of dating is CRL at 10w via U/S

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17
Q

When is GBS testing done ?

A

35-7w

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18
Q

When is a CST done

A

CST is done after nonreactive NST, but do not do at women high risk for preterm delivery

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19
Q

How is IUGR measured?

A

Measure IUGR with serial U/S

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20
Q

What is modified BPP

A

modified BPP is NST + AFI starting 2x at 41 weeks, oligohydramnios is indication for delivery

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21
Q

What is one way to assess IUGR

A

IGUR can be assessed with doppler to look at MCA

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22
Q

When do you use doppler to look at MCA

A

use doppler to look at MCA in IUGR which shows flow absence, reversal/low flow

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23
Q

MCC og abnormal quad screen?

A

wrong dates

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24
Q

What should you do if someone has an abnormal quad screen?

A

The MCC of abnormal quad screen is wrong dates, get a U?S

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25
Q

What is unique to NTD

A

Unique to NTD is high AFP, it is normal or low in other aneuplodies

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26
Q

high AFP what do you think of first?

A

NTD for high AFP

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27
Q

What is diagnostic alrogithm for abnormal quad?

A

Abn quad (likely wrong dates) –> U/S–> U/S Abn –> amniocentesis

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28
Q

When is amniocentesis used?

A

Amniocentesis is used after U/S when a quad screen is abn (quad – us – amnio) has risk of 0.5% fetal loss

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29
Q

What has higher risk CVS or amniocenteiss

A

CVS has higher risk because you punture villi as opposed to just getting amniotic fluid in AFI

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30
Q

When is CVS done

A

CVS is done BEFORE amniocentesis at 10-13 weeks, it only tells genetic issues, not NTD or omphalocele

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31
Q

What does CVS increase risk of if it doesnt kill fetus or cause limb injury

A

Isoimmunization

32
Q

When is labor protracted in phase 1?

A

over 20 hours null 14 hours multi

33
Q

when is labor protracted phase 2?

A

4cm starts phase 2 and should be 1.2 nulli or 1.5/hr multi

34
Q

When do you do a sterile digital exam vs SPE on labor presentation

A

do SPE on presentation when ROM is suspected as it can show you ferning, do nitrzine or pH testing (basic), do digital sterile exam when RoM has not happened yet

35
Q

When do you attempt external cephalic reversion

A

When there is breech present at 37w, often corrects its own, just monitor until then

36
Q

What is the risk of delivering breech baby?

A

Umbilical cord prolapse

37
Q

Should you attempt cephalic reversion during labor?

A

NO. Go to OR

38
Q

MCC of PPH

A

uterine atony, tx with pitocin/methergine/hemabate, misoprostol

39
Q

When is amnioinfusion used

A

Amnioinfusion is used in VARIABLE due to cord compression, not due to late decels that have oligo

40
Q

Why is amnioinfusion only used for variable and not for late decels with oligohydramnios?

A

Amnioinfusion is used in variable to prevent cord compression and not in late decels which are uteroplacental in which amniotic fluid does nothing, even if they have oligohyrdamnios

41
Q

What is fetal tachycardia

A

Fetal tachycardia is >160 for 10m likely due to maternal infection and chorioamnionits

42
Q

What hormone is pitocin/oxy like

A

Oxytocin is made and similar to ADH

43
Q

what can oxy cause as an AE?

A

It looks like ADH and can cause hyponatremia dn seizure and daeth

44
Q

What is used to ripen cervix

A

PGE1

45
Q

What does PGE1 do and when is it used?

A

pGE1 is a cervical ripening agent used at 41w in a posterior cervix for induction

46
Q

What is a C/I to cervical ripening?

A

Classic cesarean delivery

47
Q

What is placenta previa an indication for?

A

Pelvic rest, no digital vaginal exam and cesarean section

48
Q

When are forceps used

A

If used, presenting part must be fully engaged

49
Q

What is diff between vacuum and forceps

A

More room in canal and less injury to vaginal canal

50
Q

What is caput succedaneum

A

Swelling of fetal head due to prolonged engagement crossing suture lines, resolves on its own

51
Q

Why is caput succ formed?

A

Prolonged engagement

52
Q

What is cephalohematoma?

A

blood under periosteum not crossing suture lines that resolves in weeks

53
Q

What is a way to prevent hypotension with nerve blocks in obstetrics

A

Prior infusion of 1L saline to increase CO

54
Q

What mal-effects does epidurals have on delivery overall?

A

Epidurals prolong labor and can result in chorioamnionitis, more forcep deliviries and high Csxn rate and may result in maternal meningitis

55
Q

What does a boggy uterus after birth mean?

A

PPH is coming due to uterine atony

56
Q

Why do women get distended baldder after birth and wha tis tx?

A

Cath them. It is paralytic due to epidural or from trauma and need immediate cath with urinary retention PP, even though it resolves. Cath.

57
Q

What is the KB test

A

The KB test detects fetal maternal hemorrhage in Rh- mothers, you have 72 hours to administer RhoGam

58
Q

What is a huge risk for endometritis

A

A big risk for endometritis is Csxn

59
Q

What are other risks of endometritis other than Csxn

A

prolonged RoM, multiplle vaginal exams and internal monitors

60
Q

What is 5-10x more likely after Cxn

A

Endometritis is 5-10x more likely after Csxn

61
Q

When does endometritis occr

A

endometritis occurs 2-3D PP

62
Q

How is endometritis treated?

A

Endometritis is treated for polymicrobial infection with amp, gent (gent for gram -)

63
Q

what bugs causes endometritis

A

endometritis is polymicrobial so it is treated with amp and gent

64
Q

What is the s/s of septic thrombophlebitis

A

septic thrombophlebitis is spiking fever WITHOUT s/s of endoemtritis

65
Q

how is a spiking fever with s/s of endometritis treated?

A

thrombophlebitis is spiking fever w/o s/s of endometritis treated with heparin

66
Q

how is septic thrombophlebitis treated?

A

septic thrombophlebitis is treated with heparin

67
Q

What hormone for contraception can be used in lactation?

A

Progesterone. Not breast milk excreted and does not decrease amount of breast milk

68
Q

When is digital exam indicated with RoM

A

when there is fetal brady cardia with RoM it is likely due to cord prolapse - digital exam is then INDICATED even witih RoM ro r/o polapse

69
Q

When prolapse is felt, what medicine given?

A

Tocolytic like magnesium or terbutaline as contractions decrease blood flow

70
Q

What are AE of nifedipine tocolysis?

A

nifedipine causes pulmonary edema and respiratory depression, as does b2 agonist agents like terbutrine

71
Q

what does tocolysis in general often cause

A

tocolysis causes PPH beacuse the uterus cannot contract on itself

72
Q

How is bronchiectasis picked out

A

extremely frequent lung infection in setting of COPD + a lot more sputum production and often hemoptysis with no masses found on XR/CT. Get a CT to diagnose.

73
Q

cause of goodpasture syndrome?

A

Ab to GBM collagen a3 type IV with linear Ig deposition

74
Q

Linear Ig - Ab on the GBM?

A

Goodpasture, look for hemoptysis due to a3 type IV collagen

75
Q

When don’t you do a tap of an effusion

A

Do NOT tap an effusion in clear-cut CHF

Final review for Step 2 Ck (12 decks)

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