OB/GYN Flashcards
First line test for gonorrhea/chlamydia
NAAT
First line test for gonorrhea/chlamydia
NAAT
Less than 25, frequency of STD testing
Q annual STD testing
Do we screen for HPV in women under 30 years old?
No; in most women, this is transient
Pap frequency: Women 21-30 years old
q3 years with cytology only
Pap frequency: Women 30-65
q5 years w/ HPV
q3 years alone
Do we screen for HPV in women under 30 years old?
No; in most women, this is transient
Pap frequency: Women 21-30 years old
q3 years
Pap frequency: Women 30-65
q5 years w/ HPV
q3 years alone
Who doesn’t need a Pap?
Women > 65 years old; h/o hysterectomy
Most significant risk factor for BRCA
Age (FH, genetics, early (before 12, after 55), nulliparity, radiation exposure, first child after 30), dense breasts
Mammo screening recommendations
Mammo at 40 q yearly (or 1-2 years)
USPTF: 50-74 biannual
RF cervical cancer
No screening (inadequate screening), immunosuppression, early coitarche
HPV vaccine age guidelines for females
9-26
DEXA begins at age
65 (less than 65 h/o fragility fx, positive family history, smoking, RA, EtOH)
Low bone mass
Osteopenia
First day of LMP to EDD is how long?
40 weeks (0-13, 14-27, 28-40)
Why does T4 rise in early pregnancy?
Thyroid: beta-HCG peak at 10 weeks (stimulates maternal T4)
Estrogen: TBG increased, total T4, T3 up, but free is unchanged
CL secretes large volumes of…
Why GERD and gallstones in pregnancy?
Progesterone (placenta takes over)
- Relaxes smooth muscles, including LES and gb contractility, GI motility
N/V in 1st trimester 2/2
Progresterone, beta-HCG
Severe n/v in pgx
Hyperemesis gravidarum (related to high beta-HCG)
T/F Female body needs more blood in pgx.
T
Does CO increase in pgx?
Yes! Increased CO (30-50%),
- First half: SV; Second half: HR
Supine postural hypotension syndrome in pgx
Decreased BP 2/2 progesterone
- Don’t lay flat on back; sleep w/ left tilt (IVC obstruction)
T/F O2 consumption increases in pgx.
T (Development of respiratory alkalosis 2/2 increased minute ventilation)
T/F Hypercoagulable state in pregnancy?
Yes: Increase fibrinogen, decreased protein C/S
Blood flow in fetus
2 umbilical arteries, 1 umbilical vein (in)
- Portal –> liver/ductus venous –> IVC –> RA –> FO (RA–> LA) –> LV –> Aorta (RA–>RV–>Pulm arteries–>Ductus arteriosus)–> Aorta) Aorta –> Iliacs -> Internal –> Umbilical arteries
Three shunts of fetal circulation
DV, FO, DA
Describe the placenta
Placenta has pools of maternal blood, fetus inserts trophoblastic cells/capillaries into pools; sites of intersection (simple diffusion)
T/F High A1C results in high fetal malformation rate
True! And a high miscarriage rate
-CV, CNS, GI/GU, Skeletal
HTN agents contraindicated in pregnancy
Normal: 160/>90
No ACEi
Anti-HTN agents in pgx
Methyldopa, labetalol
HTN in pgx a/w
Placental abruption, pre-eclampsia, FGR
Guidelines for folate in pregnancy, and for folate for women with a h/o baby with NTD
0.4 mg Folate
4 g qd if prior NTD
GDM is generally screened for at what week? What about obese women?
1 hour GTT 24-28 weeks; obese: first visit
Triple screen; quad screen consists of…
AFP, estriol, HCG, (Inhibin)
NST consists of…
Fetal HR, accelerations, 20 minutes (2 accels)
- 5 movements 1 hour; 10 in 2 hours
Decreased AFI means
Decreased fetal shunting of blood to kidneys, more to the brain
Fetal lung maturity…
Amnio/ markers of lung maturity
Guidelines for weight gain in pregnancy by BMI
BMI 20: 11 lbs
Definition of labor
Painful uterine contractions, cervical dilation
No dilation with contractions is called
Braxton-Hicks
4 Most IMPORTANT questions to ask a laboring woman
- LOF
- Vaginal bleeding
- Painful contractions q 5 minutes/hr
- Decreased fetal movement
Define dilation, effacement, station
Dilation: internal os opening (10 cm)
Effacement: thinning out int-ext os (non = 4 cm)
Station: presenting part to ischial spines 0–>+5
The four stages of labor
Stage 1: Latent (dilation to 4 cm–days), Active (4 cm, more rapid 1.2-1.5 cm/hr)
Stage 2: complete dilation –> infant
Stage 3: infant –> placenta
Stage 4: 2 hours post-partum
An external tocometer is used to assess …
Uterine activity
Signs of immenent placental delivery
-Gush blood, lengthening of cord
Fundal massage, gentle cord traction, IV oxytocin
Heavy peripartum blood loss complicated by hypotension
Sheehan syndrome; post-partum pituitary infarction
Maternal and fetal risk factors for fetal macrosomia
Mat: Age, DM, obesity, multiparity
Fetal: AA/Hispanic, male, post-term
Waiter’s tip posture
Erb-Duchenne palsy (C5-7)
Definition of pre-eclampsia
New onset hypertension (>140/90 at 20 weeks) plus proteinuria or end-organ damage (Severe: TBOpenia, Cr, transaminases, pulmonary edema, visual)
Patients with pre-eclampsia at risk for…
Seizures, abruption, hepatic rupture, DIC
Drugs for HTN treatment in preeclampsia
Hydralazine, Labetalol, Nifedipine
T/F MS can present in pregnancy as CHF/AF-RVR
True (PPCM usually >36 weeks without AF/RVR)
Immediate management of hemorrhage from placental abruption
IVF resuscitation, uterine displacement (LL deQ)
Role of corpus luteum
Maintain and preserve the corpus luteum during early pregnancy
Thin, off white discharge with fishy odor, pH > 4.5; clue cells
BV; Flagyl/Clinda
Thin, yellow-green frothy discharge with vaginal inflammation with motile pear-shaped
Trichomonas (Flagyl, treat partner)
Low pH vaginosis
Candida
Universal screening for GBS infection includes…
Rectovaginal culture at 35-37 weeks gestation
Indications for PCN in a pregnant patient with unknown GBS status
18 hours rupture
Excessive fundal pressure and traction on the umbilical cord before placental separation can lead to…
Uterine inversion (“A smooth round mass protruding through the cervix/vagina)
Severe antenatal pain, loss of station, plpable fetal parts
Uterine rupture
Management of Eclampsia
Administer Mg, administer anti-HTN, deliver the fetus
Shoulder dislocation: posterior or anterior. More common?
Anterior: blow/fall outstretched arm; abducted, externally rotated
Posterior: adducted, internally rotated
Risk factor for clear cell vaginal cancer
In utero exposure to DES
Vaginal cancer histologic subtypes posterior vs. anterior
Posterior: SCC
Anterior: Clear cell
Most common cause of post-partum hemorrhage; a soft and boggy uterus
Atony
Treatment of uterine atony
Bumanual uterine massage, IVF/O2, Oxytocin/Methylergonovine, carboprost, misoprostol
What is common about Tetracyclines, FQ, and Bactrim in pregnancy?
Contraindicated
Unilateral bloody nipple discharge with no associated mass or LAD
Intraductal papilloma
First line treatment for atrophic vaginiits
Vaginal moisturizer/lubricant
Second line: Topical vaginal estrogen
Subareolar, mobile, well-circumscribed, nontender mass
Galactocele
T/F Mastitis p/w a fever
True
Tumor marker for ovarian ca
CA-125
Evaluation of secondary amenorrhea with blood tests includes…
Prolactin (brain), TSH (hypothyroid), FSH (premature ovarian failure)
When is an external cephalic version performed?
37 weeks to gestation
OCP use can decrease risk of which cancers?
Ovarian and endometrial
What is the well-known AE of Lithium in pregnancy?
Ebstein anomaly: atrialization of RV
AE of OCP’s
VTE, HTN, hepatic adenoma
Does Klumpke palsy result in Horner syndrome?
Yes
Maternal/Asymmetric factors IUGR/FGR; Symmetric/fetal
Vascular disease, Lupus AC, AI, substance abuse
Genetics, congenital heart, infections
Painless third trimester bleeding
Placenta previa
Hypoxemic respiratory failure immediately following delivery leading to cardiogenic shock, DIC
AF embolism
Treatment for sudden, overwhelming, or frequent need to empty the bladder
Urge; Anti-muscarinic (oxybutinin_
Treatment for constant involuntary dribbling of urine and incomplete emptying
Overflow; Cholinergic agonists (intermittent cath)
Test for urtheral hypermobility
Q-tip test; angle of >=30 degrees signals hypermobility with coughing
Management of BRBPV at 36-37 weeks 2/2 placenta previa
C-section
AIS vs. Mullerian agenesis karyotype
AIS: 46 XY (functioning testes secrete anti-Mullerian)
Mullerian: 46 XX
Boggy, tender, globular, freely mobile uterus
Adenomyosis
When is doppler sonography of the umbilical artery used?
Evaluation of umbilical artery flow in fetal IUGR
A noreactive NST requires further evaluation with…
A biophysical profile or contraction stress test
Contraindications to contraction stress test
Placenta previa, prior myomectomy
Excess LH in PCOS?
Yes
Pathophysiology of PCOS
Abnormal GnRH results in too much LH, not enough FSH, androgen excess
Most common organism in lactational mastitis
Staph
Maternal thyroid hormone requirement goes up or down during pregnancy
Goes up: increased beta-HCG increases T3/4, increased TBG
When is a TOL contraindicated?
Myomectomy with entry into uertus, classical C-section (vertical incision)
Trisomy 21 vs. 18 on quad screen
21: increased beta-hcg and inhibin
18: nl inhibin
Indications for C-section
Fetal distress, breech, multiple prior C-sections
Should HAV/HBV vaccines be given in pregnancy?
Yes
Lactational amenorrhea is 2/2
High levels of prolactin
HTN in pgx is a/w oligo or poly-hydramnios
Oligo
Paget disease is a/w what type of BRCA?
Adenoca
Complication of late-term delivery
Oligo
AE Herceptin (Trastuzumab)
Cardiac; must get pre-treatment echo
