Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SHELF Exams > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

H/o DVT rules out what contraception options?

A

anything containing combination of estrogen and progestin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define typical use effectiveness and perfect use effectiveness

A

Typical use effectiveness- overall effectiveness in actual use when forgetfulness and misuse occur

Perfect use effectiveness- efficacy when used correctly, consistently and reliably

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the yuppie method?

A

OCP regimen consisting of 2 tablets of 100-120 mug of ethinyl estradiol and 500-600 mug of levonorgosterol at time zero and 2 tablets after 12 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is plan B?

A

Levonorgestrel 0.75 mg PO at time 0 and the same dose after 12 hrs (method used within 72 hours of unprotected sex)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Plan B one-step

A

levonergosterol 1.5 mg taken as one pill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most effective contraception to protects against STDs?

A

male condoms; this is the second most common form of contraception used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the disadvantages with a vaginal diaphragm?

A

it must be fitted by a physician; placed 1-2 hours before sex and left in 8 hours afterwards

There is an increased rate of UTIs and increased risk of ulceration of the vagina with prolonged use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cervical caps are limited in use because women with ____ should not use them.

A

abnormal cervical cytology; due to fear of traumatizing the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the function of the progestin and estrogen in OCPS?

A

progestin- thickens the cervical mucous and inhibits ovulation
Estrogen- maintain the endometrium, prevent unscheduled bleeding, and prevent follicular development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What risks are involved with OCPs (primarily due to estrogen)?

A

Venous thromboembolism
Stroke in pts with migraines with aura
MI in heavy smokers (>15 cigarettes per day) and who are 35 or older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the non-contraception benefits of OCPs?

A

Decreased risk of ovarian, colon, or endometrial cancer
Shortened duration of menses
Decreased bleeding during menses
Improved pain from dysmenorrhea and endometriosis
Decreased abnormal uterine bleeding
Improving acnes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

T/F: Depot (DMPA) is just as effective as LARCs.

A

F- depot has a higher pregnancy rate than LARC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What medication is in the contraceptive patch?

A

norelgestromin and ethinyl estradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What medication is in the contraceptive arm implant?

A

etonogestrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the time period after stopping contraception needed to regain fertility?

A

Pills, patches, rings- 2 weeks

Injectables-9-10 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

postpill amenorrhea may persist for ____ amount of time

A

6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How long can the IUDs be in place for?

A

Cooper T380A- 10 yrs
Mirena- 5 years
Skyla- 3 years
Liletta- 3 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the non contraceptive uses for levonorgestrel IUDs?

A

tx pts with menorrhagia, dysmenorrhea, and pain due to endometriosis, and adenomyosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What risks are there with IUD insertion?

A

uterine perforation in 1:1000

transient increase in upper GU infection (1:1000) due to endometrial contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Contraindication to IUD insertion

A

current pregnancy, current STD, PID currently or within the past 3 months, unexplained vaginal bleeding, malignant gestational trophoblastic disease, untreated cervical cancer, untreated endometrial cancer, uterine fibroids distorting the endometrial cavity, current breast cancer (for levonorgestrel IUDs), anatomical distortions of the uterine cavity, known pelvic TB, allergy to IUD component, Wilson’s dx (Copper IUD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the forms of emergency contraception?

A

Progestin Plan B, Plan B One-Step, ulipristal are the three most common forms. Also includes the copper IUD and the Yuzpe method

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

True/false – there are no medical conditions were the risk of emergency contraception outweighs the benefits.

A

True-woman with cardiovascular disease, migraines, liver disease, or who are breast-feeding may use emergency contraception.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the major side effect of emergency contraception?

A

Nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When is emergency contraception contra indicated?

A

In women with suspected or known pregnancy, are those with abnormal vaginal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What effect does Depot have on bones in adolescence?

A

Depot Is associated with the loss of bone mineral density particularly in adolescence. If it is the best type of contraception for the patient, the loss and bone mineral density should not discourage the use of the agent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

True/false – oral contraceptives decrease the risk of benign breast disease

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

OCPs may cause a slight increase in ____ and ______.

A

Risk of breast cancer and incidence of gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What birth control method is best suited for breast-feeding females?

A

Progestin only pill- e.g. Minipill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What birth control method is best suited for patients with sickle cell disease or epilepsy?

A

Injectables like Depot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What form of contraception may lead to more bleeding or dysmenorrhea?

A

Copper IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Of the three most common causes of infectious vaginal discharge, which etiology is not inflammatory?

A

Bacterial vaginosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the treatment of bacterial vaginosis?

A

Antibiotic therapy targeting anaerobes such as metronidazole are clindamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the diagnostic criteria for a bacterial vaginosis?

A

Three out of four Amsel’s criteria are indicative of bacterial vaginosis: 1. Homogeneous gray white discharge 2. Vaginal pH greater than 4.5
3. Positive whiff test 4. Clue cells on wet mount

Gram stain is considered the gold standard for diagnosis, but is rarely used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Bacterial vaginosis is associated with what genital tract infections and pregnancy complications?

A

Endometriosis, PID, preterm delivery, and preterm premature rupture of membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What STD can survive for up to six hours on a wet surface?

A

Trichomonas vaginalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the most common symptom associated with trichomoniasis?

A

Profuse frothy Yellow– Green to gray vaginal discharge or vaginal irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What can cause trichomonads on a wet mount to have decreased movement?

A

If the wet mount is cold or there are excess leukocytes present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the treatment for trichomoniasis?

A

A fairly high dose of metronidazole (2 g) as a one time dose, with the partner treated as well.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Why is vaginal metronidazole not effective in the treatment of trichomoniasis?

A

Vaginal metronidazole results in low therapeutic levels of the drug in the urethra or Skene’s glands were trichomonads may reside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

In a healthy vagina what prevents the growth of fungus?

A

The native lactobacilli; this explains why anabiotic therapy may result in Candida overgrowth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Typical presentation: intense vulvar or vaginal burning, irritation and swelling

A

Candidal vaginitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Candidal vaginitis treatment

A

Oral fluconazole/Diflucan or topical imidazoles such as Terconazole/terazol, miconazole/ Monistat, and clotrimazole/ lotrimin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the most common side effects with metronidazole?

A

G.I. including nausea, abdominal discomfort, bloating or diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which forms of vaginitis are associated with alkaline pH and positive whiff test?

A

Bacterial vaginosis and trichomoniasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Uncomplicated cystitis treatment

A

Three day course of trimethoprim/sulfa (Bactrium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

If a patient with UTI symptoms has a urine culture that demonstrates no growth of organisms, but symptoms persist what is the most likely diagnosis?

A

Urethritis often caused by chlamydia, candidalvulvovaginitis, or urethral syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is urethral syndrome?

A

Recurrent episodes of urgency and dysuria caused by urethral inflammation of unknown cause; Urine cultures are persistently negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Gross hematuria should raise the suspicion of _____

A

Nephrolithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

True/False – fever is common with a UTI

A

False- fever is uncommon unless there is upper urinary tract/kidney involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the definition of bacteriuria?

A

More than 100,000 colony forming units per milliliter of a single uropathogen obtained from a midstream voided clean catch urine culture

If the patient is symptomatic, as few as 1000 colony forming units per milliliter may be significant.

On a catheterized patient, 10,000 colony forming units per milliliter is considered bacteriuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the most common form of UTI?

A

Simple cystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

List the antibiotics that are effective in treating simple cystitis

A

(Trimethoprim/sulfa) Bactrim, nitrofurantoin, ciprofloxacin, norfloxacin, fosfomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the three most common causes of urethritis?

A

Chlamydia, gonorrhea, trichomoniasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How should urethritis be diagnosed?

A

Gram stain and culture of the urethra for gonococcus and chlamydia, with confirmatory nucleic acid amplification testing (NAAT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Urethritis treatment

A

Empiric treatment for chlamydia with doxycycline; if gonorrhea is suspected, intramuscular ceftriaxone with oral doxycycline is usually curative. If treating a pregnant woman azithromycin should be substituted for doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Typical presentation: nausea, vomiting, fever, chills, flank pain

A

Pyleonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Mild Pyelonephritis in non pregnant woman treatment

A

Oral Bactrim or a fluroquinolone for 14 day course; women should be re-examined within 48 to 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

When should a woman with Pyelonephritis be hospitalized?

A

Those who are not beginning to clinically improved, are more toxic, unable to take oral medications, pregnant, or immunocompromise should be hospitalized and treated with IV anabiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Treatment of pyleonephritis in a hospitalized patient

A

Treatment and patience bad enough to warrant hospitalization – IV anabiotic’s such as ampicillin and gentamicin, third generation cephalosporin such as ceftriaxone, fluroquinolones, the carbapenems, or piperacillin – tazobactam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Management of a pregnant patient following resolution of fever and symptoms from acute Pyelonephritis

A

Suppressive antibiotic therapy for the remainder of the pregnancy– Such as nitrofurantoin Macrocrystals 100 mg once daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Upper UTIs increase the risk of _____ in pregnant women

A

septicemia, kidney dysfunction, or preterm labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Asymptomatic bacteriuria has a high incidence in women with ______

A

Sickle cell trait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the hCG threshold at which a intrauterine pregnancy should be seen with transvaginal sonography?

A

1500 to 2000 mIU/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

In a normal pregnancy what should happen to the hCG levels in 48 hours?

A

Follow up hCG at 48 hours should rise at least by 66%. If the follow up hCG does not rise by 66% particularly if it rises by only 20% then the patient most likely has an abnormal pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

True/false – a subnormal rise in hCG indicates that an abnormal pregnancy exist outside of the uterus

A

False – a subnormal rise in hCG does not indicate whether the abnormal pregnancy is in the uterus or the tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Following a complete abortion what should happen to the hCG levels?

A

HCG level should be cut in half every 48 to 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Following a complete abortion what does a hCG plateau indicate?

A

If the hCG level plateaus rather than falling, then the patient has residual pregnancy tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

True/false – spontaneous abortions are more common in older patients.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is the most common identifiable cause for spontaneous abortion?

A

Chromosomal abnormality of the embryo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Define. Threatened abortion

A

Pregnancy with vaginal spotting during the first half of pregnancy; this does not delineate the viability of the pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Define: inevitable abortion

A

Cramping, bleeding, and cervical dilation without passage of tissue in a pregnancy less than 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Define: incomplete abortion

A

Cramping, vaginal bleeding, and open cervical os, and some passage of tissue per vagina with remaining tissue in utero in a pregnancy less than 20 weeks. The cervix remains open and the uterus continues to contract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Define: completed abortion

A

A pregnancy less than 20 weeks in which all the products of conception have passed and the cervix is generally closed. Because all of the tissue has been passed, the uterus no longer contracts, and the cervix closes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Define: missed abortion

A

My pregnancy less than 20 weeks with embryonic demise no symptoms such as a bleeding or cramping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What percentage of threatened abortions result in viable intrauterine pregnancy?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

A single progesterone level more than ____ almost always indicates a normal intrauterine gestation

A

25 ng/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

A single progesterone level less than ____usually correlates with a non-viable gestation

A

5ng/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

True/false –Abnormal hCG rise or single progesterone less than five means a non-viable pregnancy is diagnosed; however, it is still unclear whether the patient has a spontaneous abortion ectopic pregnancy

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

When a non-viable pregnancy is diagnosed either by abnormal rising hCG or a single progesterone less than five, what is the next step in distinguishing miscarriage from ectopic pregnancy?

A

Most physicians perform a uterine curettage; if chorionic villi are present the patient had a miscarriage. If chorionic villi are absent the patient had an ectopic pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is the treatment for small ectopic pregnancies?

A

Asymptomatic, small (less than 3.5 cm) ectopic pregnancies are ideal candidates for intramuscular methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is the management of a non-viable intrauterine pregnancy?

A

Manage expectantly, surgically via dilation and curettage or medically with vaginal misoprostol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Rh negative women with ____, _____, or ______ should receive RhoGAM to prevent isoimmunization

A

Threatened abortion, spontaneous abortion, or ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

How can an inevitable abortion be differentiated from an incompetent cervix?

A

With an insufficient cervix, the cervix opens spontaneously without uterine contractions. However, in inevitable abortion uterine contractions lead to cervical dilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Incompetent cervix treatment

A

Cerclage – a surgical suture at the level of the internal cervical os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Missed or incomplete abortion treatment

A

Expectant management for passage of tissue, medical management with mifepristone misoprostol, and surgical management with dilation and curettage of the uterus for immediate definitive treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is the primary complication of retained tissue from an incomplete abortion?

A

Bleeding and infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Management of a patient with threatened abortion, hypotension/volume depletion, severe abdominal/pelvic pain or adnexal mass

A

Consider a laparoscopy or laparotomy due to high possibility of ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Management of a patient with threatened abortion, HCG more than 1500, no interuterine pregnancy seen on transvaginal ultrasound

A

Consider a laparoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Management of a patient with threatened abortion, hCG less than 1500

A

Ultrasound is optional and repeat hCG in 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Management of a patient with threatened abortion, no acute signs of ectopic pregnancy, hCG less than 1500, Repeat hCG reveals abnormal rise

A

Diagnosis: probable non-viable pregnancy; uterine curettage – chorionic villi seen versus no villi seen

No villi seen -diagnosis ectopic pregnancy; consider methotrexate
Chorionic villi seen- diagnosis miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Typical presentation: vaginal spotting, absence of fetal heart tones, size greater than dates, and markedly elevated hCG levels

A

Molar pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Molar pregnancy treatment

A

Uterine suction curettage; patients followed with weekly hCG levels because sometimes gestational trophoblastic disease persist after evacuation of the molar pregnancy. In this case chemotherapy is used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Incompetent cervix risk factors

A

Cervical conization, congenital (short cervix or collagen disorder), trauma to the cervix, prolonged second stage of labor, and uterine overdistention as with a multiple gestation pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

List the two most common causes of antepartum bleeding

A

Placenta previa and placenta abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is the most common cause of a first trimester miscarriage?

A

Fetal karyotypic abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

True/false – enlarged uterus does not exclude the diagnosis of an ectopic pregnancy

A

True – hCG has an affect on the uterus regardless if the pregnancy is interuterine or ectopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Define: heterotopic pregnancy

A

When both and interuterine pregnancy and an act topic pregnancy exist at the same time; risk 1:10,000

this is why the proof of an interuterine pregnancy decreases the likelihood of an ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Management of a patient with hCG more than 1500, no intrauterine pregnancy seen on transvaginal ultrasound

A

The risk of extra uterine pregnancy is high but it is not 100%. Therefore, laparoscopy is indicated and not methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is the location of the majority of ectopic pregnancies?

A

97% involve the Fallopian tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is the most common reason for maternal mortality in the first 20 weeks of pregnancy?

A

Hemorrhage from ectopic gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Typical presentation: abdominal pain, amenorrhea of 4 to 6 weeks, irregular vaginal spotting

A

Ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Typical presentation: acute worsening of Abdominal pain, syncope, shoulder pain, tachycardia, hypertension, orthostasis, hemoperitoneum

A

Ruptured ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Risk factors for ectopic pregnancy

A

Salpingitis particularly with chlamydia, tubal adhesive disease, infertility, progesterone secreting IUD, tubal surgery, prior ectopic pregnancy, ovulation induction, congenital abnormalities of the tube, assisted reproductive technology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Which is more sensitive transvaginal sonography or trans abdominal sonography?

A

Transvaginal sonography – can detect pregnancies as early as 5.5 to 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Define: pseudo gestational sac

A

irregularly shaped fluid collection in the midline of the uterine cavity seen in some ectopic pregnancies

Distinguished from a normal gestational sack because these or eccentrically located and have a decidual sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

When is a salpingectomy performed for ectopic pregnancies?

A

Gestations too large for conservative therapy, when rupture has occurred, or for those women who do not want future fertility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

During a salpingostomy, why is the incision on the tube not reapproximated?

A

Suturing may lead to structure formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Follow up after salpingostomy

A

There is a 10 to 15% chance of persistent ectopic pregnancy. Therefore, serial hCG levels should be followed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

When is methotrexate used for ectopic pregnancy?

A

Ectopic Pregnancy is less than 3.5 cm in diameter, without fetal cardiac activity, and hCG levels less than 5000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Following one dose of methotrexate, what should be done if the hCG level does not fall?

A

Methotrexate leads to resolution in 85 to 90% of cases. However, a second dose is required if the hCG level does not fall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Hypotension, worsening or persistent pain, or a falling hematocrit after methotrexate treatment may indicate what?

A

Tubal rupture which will necessitate surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What is indicated when hCG levels plateau in the first eight weeks of pregnancy?

A

An abnormal pregnancy – may be either a miscarriage or an ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

True/false – spotting and lower abdominal pain can be a normal occurrence in pregnancy especially very early in the first trimester

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Define: latent phase of labor

A

The initial part of labor where the cervix mainly effaces/thins rather than dilates. Cervical dilation less than 6 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Define: active phase of labor

A

The portion of labor were dilation occurs more rapidly; cervix is more than 6 cm dilated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Define: arrest of active phase of labor

A

No progress in the active phase of labor with ruptured membranes for four hours with adequate contractions, or six hours of inadequate contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What are the stages of labor?

A

First stage: onset of labor through the complete dilation of cervix

Second stage: complete cervical dilation through the delivery of infant

Third stage: delivery of infant through delivery of placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Define: normal fetal heart rate, fetal bradycardia, fetal tachycardia

A

Normal: between 110 and 160 bpm

Fetal bradycardia: baseline less than 110 bpm

Fetal tachycardia: heart rate exceeding 160 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What are the three types of Decelerations?

A

Early: mirror image of uterine contraction due to compression of fetal head

Late: Deceleration offset following the uterine contraction that indicate fetal hypoxia

Variable: abrupt jagged dips below the baseline caused by cord compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Define: acceleration

A

Episodes of the fetal heart rate increasing above the baseline for at least 15 bpm and last for at least 15 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Normal labor parameters in a nullipara Woman

A

Latent phase: less than or equal to 18 to 20 hours
Active phase: continued progress
Second stage of labor: less than or equal to three hours or less than or equal to four hours if epidural used
Third stage of labor: less than or equal to 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Normal labor parameters a multipara woman

A

Latent phase: less than or equal to 14 hours
Active phase: continued progress
Second stage of labor: less than or equal to two hours or less than or equal to three hours if epidural used
Third stage of labor: less than or equal to 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

When an abnormal labor is diagnosed what three categories should be considered?

A

Powers, pelvis, and passenger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

When it is determined that the power is the issue, what is the treatment?

A

Oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Define: clinically adequate uterine contractions

A

Contractions every 2 to 3 minutes, firm on palpation, and lasting for at least 40 to 60 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

How can the adequacy of the powers be assessed?

A

Internal ureter catheters can evaluate the adequacy of the powers. One common assessment tool is to examine a 10 minute window and add each contraction’s rise above baseline (each mm Hg rise is called a Montevideo unit); 200 Montevideo units is commonly accepted as an adequate uterine contraction pattern.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What are the most common decelerations?

A

Variable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What can late decelerations occurring in more than 50% of uterine contractions indicate?

A

Fetal acidemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

When late decelerations occur together with decreased variability, then _____ is strongly suspected.

A

Acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Define: category I, category II, and category III fetal heart rate patterns

A

Category I: Reassuring – normal baseline and variability, no late or variable decelerations

Category II: needs watching – may have some aspect that is concerning but not Ominous; for example Fetal tachycardia without decelerations

Category III: ominous and indicates a high likelihood of severe fetal hypoxia or acidosis– examples include absent baseline variability with recurrent late or variable decelerations or bradycardia, or sinusoidal heart pattern (this requires prompt delivery if no improvement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Management of arrest disorder (no change in active phase of labor for four hours)

A

Assess three Ps; if adequate contractions for four hours with rupture of membranes and cervix is dilated more than 6 cm OR inadequate contractions for six hours with rupture of membranes and cervix dilated more than 6 cm–> c-section

If the above criteria are not met, give oxytocin and reassess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What are the two most common reasons for a C-section?

A

Labor dystocia in 34% of cases and an abnormal fetal heart rate in 23% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

How does the safety of a C-section compare to vaginal delivery?

A

C-section has a higher overall severe morbidity or mortality rate, and a 3.5 fold increase risk of mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Management of category III tracings

A

Require prompt intervention – if prompt interuterine resuscitation maneuvers are not curative, imminent delivery is prudent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What conditions are associated with category III tracings?

A

these tracings are associated with low pH, hypoxia, and encephalopathy, and cerebral palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Most fetal heart rate tracings fall in which category?

A

II – which can span from reassuring fetal heart rate tracing versus a tracing that is worrisome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Scalp stimulation inducing ____ highly correlates to a normal umbilical cord pH (greater than or equal to 7.2).

A

An acceleration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

What are the 6 causes for prolonged decelerations?

A

Tachysystole, hypotension, rapid cervical dilation, umbilical cord prolapse, placental abruption, uterine rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Define: prolonged decelerations

A

Decelerations lasting between 2 and 10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Define tachysystole. What is the intervention?

A

More than 5 contractions per 10 minutes averaged over 30 minutes; decrease or stop oxytocin, or administer beta-mimetic agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

If hypotension following anesthesia or epidural causes prolong decelerations, how should this be managed?

A

IV fluid bolus, or administer vasopressor agents such as ephedrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

If rapid cervical dilation is causing prolonged decelerations, how should this be managed?

A

Positional changes and observation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Management of umbilical cord prolapse

A

Elevate presenting part and emergency C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

If placental abruption is causing prolonged decelerations, how should this be managed?

A

Support BP, stabilize patient, consider C-section if progressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

If uterine rupture is causing prolonged decelerations, how should this be managed?

A

Emergency C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

True/false – IV oxytocin aids in cervical dilation, and enhances contraction strength and/or frequency

A

False – IV oxytocin does not affect cervical dilation. It does however enhance contraction strength and/or frequency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Define: anthropoid pelvis

A

A pelvis with an anterioposterior diameter greater than the transverse diameter with prominent ischial spines and a narrow anterior segment, which predisposes to the persistent fetal occiput posterior position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Define: station

A

Refers to the relationship of the presenting bony part of the fetal head in relation to the ischial spines, and not the pelvic inlet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Define: engagement

A

Refers to the relationship of the widest diameter of the presenting part and its location with reference to the pelvic inlet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Define bloody show

A

Loss of the cervical mucus plug; a sign of impending labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Delivery before 39 weeks gestation is associated with an increased risk of neonatal complications including…

A

Increased incidence of NICU admission, respiratory difficulties, sepsis, hyperbilirubinemia, Ventilator use, and hospital stay exceeding five days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Management of prolonged latent phase of labor

A

Observation and Oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Management of repetitive deep variable decelerations

A

Amnioinfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

What is the most common abnormal karyotype encountered in spontaneous abortions?

A

Autosomal trisomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

What can be given for pregnancy is less than 32 weeks for Neuroprotection?

A

Magnesium sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

A single examination revealing _________ and _______ in a nulliparous woman would be sufficient to diagnose preterm labor.

A

2 cm dilation and 80% effacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Explain what a positive and negative result on fetal fibronectin indicates.

A

A positive result indicates risk of preterm birth whereas a negative result is strongly associated with no delivery within one week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Treatment for Preterm labor

A

Intramuscular antenatal steroids to enhance fetal pulmonary maturity in a pregnancy less than 34 weeks

Tocolysis unless there is a contraindication such as inter-amniotic infection or severe preeclampsia

IV antibiotics such as penicillin in the case that delivery cannot be prolonged to help reduce the likelihood of GBS sepsis

Magnesium sulfate in pregnancies less than 31 weeks and six days for neurodevelopment, Reducing cases of cerebral palsy in preterm infant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Define: preterm labor

A

Cervical change associated with uterine contractions prior to 37 weeks and after 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

What are the four most common tocolysis agents used?

A

Indomethacin, nifidepine, terbutaline, ritodrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Cervical length of less than ____ millimeters results in an increased risk of preterm delivery

A

25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Define: late preterm gestation

A

Delivery that occurs between 34w0d and 36w6d

This category comprises most preterm deliveries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

What is the most significant risk factor for preterm delivery?

A

History of a prior spontaneous preterm birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Symptoms of preterm labor

A

Uterine contractions, abdominal tightening, pelvic pressure, increased vaginal discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What is the most serious side effect of nifidipine?

A

Pulmonary Edema

166
Q

What is a complication of indomethacin?

A

Closure of the ductus arteriosus, leading to severe neonatal pulmonary hypertension; oligohydramnios may also be seen

167
Q

If a patient who previously entered preterm labor was given one course of corticosteroids, and 7 to 14 days afterwards reenters preterm labor (before 34 weeks), what is the management?

A

One additional rescue course of corticosteroids: repeat rescue doses are contraindicated

168
Q

Risk factors for preterm labor

A

Preterm premature rupture of membranes, multiple gestations, previous preterm labor and birth, hydramnios, uterine anomaly, history of cervical cone biopsy, cocaine abuse, African-American race, abdominal trauma, pyleonephritis, abdominal surgery in pregnancy

169
Q

What can be used to reduce the incidence of preterm birth in women at high-risk?

A

Weekly 17 alpha hydroxyprogesteronecaprotate (makena) from 16 to 36 weeks

170
Q

Contraindication for nifidepine use

A

Hypotension

171
Q

Side effects terbutaline and ritodrine

A

Pulmonary edema, increased pulse pressure, hyperglycemia, hypokalemia, and tachycardia

172
Q

Which is more strongly associated with preterm delivery, gonococcal cervicitis or chlamydial cervicitis?

A

Gonococcal

173
Q

Why is tocolysis contraindicated in suspected placental abruption?

A

If given, it would increase the chance of hemorrhage and mothers after delivery because it will be more difficult to get the uterus to contract on itself, since tocolytics also act as uterine relaxants

174
Q

What might cause a sudden worsening in the frequency and/or severity of variable decelerations?

A

Oligohydramnios, rupture of membranes, or dissent of the fetal head, such as in labor, so that I nuchal cord may tighten

175
Q

What is the most common cause of neonatal morbidity in a preterm infant?

A

Respiratory distress syndrome

176
Q

Mekena used weekly from week 16 to 36 in women with history of prior spontaneous preterm birth decreases the risk of preterm birth by ____

A

1/3rd

177
Q

What is the most common cause of preterm labor?

A

Idiopathic

178
Q

What tocolytic agents are contraindicated in diabetic patients?

A

Terbutaline and ritodrine

179
Q

What are the long-term complications of salpingitis?

A

Infertility, topic pregnancy, chronic pelvic pain

180
Q

What most commonly causes salpingitis?

A

Pathogenic bacteria of the endocervix that accends to the tubes

181
Q

The pain of salpingitis occurs _____

A

Around the time of menses

182
Q

When does the ascending infection leading to salpingitis occur?

A

At the time of menses during endometrial break down

183
Q

What is included in the differential diagnosis of Salpingitis?

A

Pyleonephritis, appendicitis, Cholecystitis, diverticulitis, pancreatitis, ovarian torsion, gastroenteritis

184
Q

Why is a pelvic alter sound typically performed on patients with suspected PID?

A

Tubo-ovarian abscesses are difficult to diagnose on physical exam and can present without fever; a pelvic ultrasound is used to assess for tubo-ovarian abscess

185
Q

Define: Fitzhugh Curtis

A

Perihepatitis caused by purulent tubal discharge which ascends to the right upper quadrant area.

186
Q

Define: Mucopurulent cervicitis

A

Yellow exudative discharge arising from the endocervix with 10 or more PMNs per high-powered field on microscopy

187
Q

Define pelvic inflammatory disease

A

Synonymous with salpingitis or infection of the fallopian tube

188
Q

Define: tubo – ovarian abscess

A

Collection of Purulent material around the distal tube and ovary

189
Q

Gonoccocal and chlamydial organisms have a propensity for _____ cells

A

Columnar cells of the endocervix

190
Q

What is the most common organism implicated in mucopurulent cervical discharge?

A

Trichomonas

191
Q

What are the Gram stain findings from cervical discharge caused by gonorrhea?

A

Intracellular gram-negative diplococci

192
Q

What is the treatment of gonococcal disease?

A

Ceftriaxone 125 to 215 mg IM and because of the frequency of coexisting chlamydial infection, Azithromycin 1 g or orally or doxycycline 100 milligrams orally b.i.d. for 7 to 10 days

193
Q

If the Gram stain of the cervical discharge is negative, what should be done?

A

Antimicrobial therapy directed at chlamydia should be used

194
Q

Other than sampling the endocervix directly, what is another diagnostic approach to confirming infection with gonococcus or chlamydia?

A

Urine nucleic acid amplification test (NAAT)

195
Q

Describe the arthritis associated with gonococcus.

A

Usually involves the large joints and is classically migratory

196
Q

What is the most common cause of septic arthritis in young women?

A

Gonorrhea

197
Q

What is a possible skin finding and disseminated gonorrhea?

A

Irruption of painful pustules with an erythematous base on the skin

198
Q

Classic presentation: young, nulliparous female complaining of lower abdominal or pelvic pain and vaginal discharge; fever and nausea and vomiting may be present; cervix is inflamed and patient complains of dyspareunia

A

PID

199
Q

How is PID diagnosed?

A

Clinically – abdominal tenderness, cervical motion tenderness, and/or adnexal tenderness

200
Q

True/false – most episodes of PID are asymptomatic or have mild symptoms.

A

True

201
Q

Mucopurulent cervicitis with exacerbation of symptoms during and after menstruation is classically caused by _____

A

Gonorrhea

202
Q

Findings highly suggestive of PID

A

Endometrial biopsy showing endometritis or transvaginal ultrasound or MRI showing thickened or fluid filled tubes

203
Q

When the diagnosis of PID is in doubt, what is the best method for confirmation?

A

Laparoscopy-look for discharge from the fimbria

204
Q

What are the criteria for outpatient management of PID?

A

Low-grade fever, tolerance of oral medication, and the absence of peritoneal signs. The woman must also be compliant. The patient should be reevaluated in 48 hours for improvement.

205
Q

What are the criteria for inpatient management of P ID?

A

Failure of outpatient therapy after 48 hours, pregnancy, extremes of age, cannot tolerate oral medications, Surgical emergencies cannot be ruled out, tubo-ovarian abscess, Severe illness, upper peritoneal signs, fever greater than 102°F

206
Q

What is the outpatient regimen for PID treatment?

A

IM ceftriaxone 250 mg as a single injection and oral doxycycline 100 mg twice a day for 14 days, with or without metronidazole twice a day for 14 days

207
Q

What is the inpatient regimen for treatment of PID?

A

IV cefotetan 2 g IV every 12 hours and oral or IV doxycycline 100 mg twice daily to continue 24 hours after clinical improvement, then discharge on doxycycline 100 mg twice daily for 14 days

208
Q

If be patient with P ID does not improve within 48 to 72 hours, what should be considered?

A

Laparoscopy to assess the disease

209
Q

What is the treatment of Tubo-ovarian abscess?

A

This disorder generally has anaerobic predominance and is treated with clindamycin or metronidazole. Unlike other abscesses these do not require surgical drainage

210
Q

The risk of infertility due to tuple damage is directly related to…

A

The number of episodes of PID

211
Q

____ form of contraception places the patient had a greater risk for PID, whereas ____ form of contraception decreases the risk of PID.

A

IUD; oral contraceptive agents (progestin thickens the cervical mucus)

212
Q

What are the two most common organisms involved in PID?

A

Gonorrhea and trichomonas

213
Q

What is considered the gold standard for diagnosing Salpingitis?

A

Laparoscopy

214
Q

What imaging modality is most helpful when appendicitis is suspected?

A

CT

215
Q

Actinomyces involvement in PID is more common with _____

A

IUDs

216
Q

True/false – Nulliparity is associated with an increased risk of PID.

A

True

217
Q

Which is most commonly associated with mucopurulent cervical discharge, gonorrhea or chlamydia?

A

Chlamydia is more common than gonorrhea

218
Q

Which work causes pharyngitis associated with world sex, chlamydia or gonorrhea?

A

Gonorrhea. Chlamydia is not a common causes because it lacks the pili the gonorrhea has that allows it to adhere to the surface of the columnar epithelium at the back of the throat

219
Q

What is the most common reason for hysterectomy in the US?

A

Symptomatic uterine fibroids

220
Q

What is the most common symptom of uterine Leiomyomata?

A

Menorrhagia

221
Q

What medical treatments are available for uterine fibroids?

A

NSAIDs, Provera, gonadotropin releasing hormone agonist ( causes temporary shrinkage of fibroids after three months of therapy; after therapy has stopped, fibroids will regrow), Levonorgestrel IUD, selective progesterone receptor antagonist, or oral contraceptives.

222
Q

What are the various types of uterine fibroid based on their location?

A

Subserosal, intramural, submucosal, cervical, prolapsed

223
Q

Define: carneous degeneration

A

Changes of the fibroid due to rapid growth; the center of the fibroid becomes red, causing pain; this is also known as red degeneration

224
Q

What is the most common tumors of the pelvis?

A

Uterine fibroids

225
Q

What causes menorrhagia in women with fibroids?

A

May be due to an increased endometrial surface area or the disruption of hemostatic mechanisms during menses

226
Q

Leiomyomata rarely degenerate into leiomyosarcomas. What are some signs of this progression?

A

Rapid growth such as an increase of more than six weeks gestational size in one year

227
Q

Fibroids causing labor like uterine contraction pain indicate what?

A

That a submucosal fibroid has prolapsed through the cervix

228
Q

Physical exam findings: irregular, midline, firm, nontender mass that moves contiguously with the cervix

A

Uterine fibroid; this presentation is approximately 95% accurate and most of the time ultrasound is used to confirm the diagnosis

229
Q

What is the best conservative treatment option for submucosal fibroid’s?

A

Hysteroscopic resection

230
Q

What is the procedure of choice for women with symptomatic fibroids who desire pregnancy?

A

Myomectomy; is not indicated in women who have uterine fibroids unless there have been pregnancy complications due to the fibroids in the past

231
Q

Explain the technique of uterine artery embolization.

A

Both uterine arteries are catheterized and infused with embolization particles that preferentially float to the fibroid vessels. Fibroid infarction and subsequent hyalinization and fibrosis results

232
Q

Uterine artery embolization should not be used in women who want to be pregnant in the future because…

A

There is an increased risk of placentation abnormalities

233
Q

What are the Contra indications for uterine artery embolization?

A

Pregnancy, suspected gynecologic malignancy, history of PID, or renal failure

234
Q

What type of fibroid is most likely to be associated with recurrent abortions?

A

Submucosal because of their affect on the uterine cavity- changes in the contours of the endometrium and insufficient vasculature

235
Q

Impingement of the ureters is most likely to occur with what type of fibroids?

A

Subserosal

236
Q

Extensive myomectomies sometimes necessitate cesarean delivery because of…

A

Risk of uterine rupture

237
Q

What is the best treatment for leiomyosarcoma?

A

The diagnosis and treatment is surgical – laparoscopy with possible hysterectomy

238
Q

What are the best ways to diagnose Leiomyosarcoma?

A

MRI usually reveals a large heterogenous mass in the uterus with areas of both hyper and hypo enhancement; percutaneous biopsy or even better surgical resection and pathologic examination are the best ways to assess for Leiomyosarcoma

239
Q

How is endometrial cancer staged?

A

Surgically

240
Q

What are the risk factors for endometrial cancer?

A

Obesity, diabetes, hypertension, prior anovulation, late menopause, Unopposed estrogen replacement therapy and nulliparity

241
Q

What are the initial diagnostic test acceptable for assessing for endometrial cancer?

A

Endometrial biopsy or transvaginal ultrasound

242
Q

What is the most common cause of postmenopausal bleeding?

A

Atrophic endometrium– Friable tissue of the endometrium or vagina due to low estrogen levels causes postmenopausal bleeding

243
Q

Define endometrial stripe:

A

Transvaginal sonographic assessment of the endometrial thickness; a thickness greater than 4 mm is abnormal in a post menopausal woman

244
Q

Define: type one endometrial cancer

A

Typical endometrioid cell type which is estrogen dependent, occurring in the perimenopausal or early menopause patient with the classic risk factors of unopposed estrogen. This type of cancer is typically lower grade and not as aggressive

245
Q

Define: type two endometrial cancer

A

Usually an aggressive disease with cell types of papillary serous or clear-cell, and is estrogen independent/ER negative. These cancers involve late menopausal women, thin patients, are those with regular menses

246
Q

Complex hyperplasia with atypia is associated with endometrial carcinoma in __% to ___% of cases

A

30-50

247
Q

Women over the age of ____ with abnormal uterine bleeding should have assessment for endometrial cancer and those women Younger than this with ____ should also be considered for a diagnostic procedure.

A

40 to 45

Risk factors

248
Q

What is the most common female genital tract malignancy?

A

Endometrial carcinoma

249
Q

Women with Lynch syndrome or an increased risk of developing…

A

Colon cancer, ovarian cancer, and type one endometrial cancer

250
Q

What is the inheritance of Lynch syndrome?

A

Autosomal dominant disorder associated with mutations of one of the mismatch repair genes

251
Q

True/false – smoking increases a patient’s risk for endometrial cancer.

A

Force – smoking is associated with the lower estrogenic state which would therefore also decrease a patient’s risk for endometrial cancer

252
Q

And a woman with normal endometrial sampling and continued postmenopausal bleeding, what should be done?

A

Further investigation such as a hysteroscopy

253
Q

What is the most common source of fever on the first postpartum day after a csection, especially if done under general anesthesia?

A

The lungs

254
Q

What conditions are associated with breech presentation of the infant?

A

Prematurity, multiple gestation, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, placenta previa, uterine anomalies and uterine fibroids

255
Q

What conditions are associated with an increased incidence of shoulder dystocia?

A

Fetal macrosomia, maternal obesity, diabetes mellitus, post term pregnancy, a prior delivery complicated by a shoulder dystocia, and a prolonged second stage of labor

256
Q

True/false –Ambulation is contraindicated in the presence of a nonreassuring fetal heart tracing’s

A

True

257
Q

What are the different categories a breech presentation? What is the most common type of breech?

A

Frank breech – the buttocks is the presenting part
Complete breech –
Incomplete breech – footling breech

Frank breach is the most common type

258
Q

True/false – SSRIs are safe during breast-feeding

A

True – the drug is passed through breastmilk but there is not a detectable amount of drug in the baby’s serum

259
Q

What is caused by third trimester use of SSRIs?

A

Abnormal muscle movement/extraparametal signs and withdraw symptoms, which may include agitation, abnormally increased or decreased muscle tone, tremor, sleepiness, severe difficulty breathing and difficulty in feeding.

260
Q

What are the symptoms of postpartum blues?

A

Postpartum blues occur within 2 to 3 days postpartum and resolve within two weeks. Symptoms include insomnia, easy crying, depression, poor concentration, irritability or labile affect and anxiety. Symptoms often last a few hours per day and they are mild and transient.

261
Q

What is the biggest risk factor for the development of postpartum depression?

A

A history of depression whether that be major depression or postpartum depression

262
Q

What is the typical rate of progression in the active phase of labor?

A

1 cm dilation per hour; multiparous women 1-2 cm/h

263
Q

What is contained in fresh frozen plasma?

A

Fibrinogen, clotting factors five and eight

264
Q

Classic presentation: abdominal pain, bleeding, uterine hypertonus and fetal distress

A

Placental abruption

265
Q

What are the risk factors for placental abruption?

A

Smoking, cocaine use, chronic hypertension, trauma, prolonged premature rupture of membranes, and prior history of abruption

266
Q

Classic presentation: vaginal bleeding, fever, dilated cervix

A

Septic abortion

267
Q

What is the treatment of septic abortion?

A

Uterine evacuation and broad-spectrum antibiotics

268
Q

What is the treatment for antiphospholipid antibody syndrome causing a recurrent pregnancy loss?

A

Aspirin plus heparin

269
Q

____ is increased in women undergoing medical abortion versus surgical abortion.

A

Blood loss

270
Q

What are the surgical treatment options for endometriosis?

A

The definitive treatment is hysterectomy/BSO. In young patients, in order to preserve fertility laser ablation is preferred.

271
Q

How can anorexia nervosa cause amenorrhea?

A

Significant weight loss may cause hypothalamic pituitary dysfunction- lack of the normal pulsatile secretion of GnRH leads to a decrease stimulation of the pituitary gland to produce FSH and LH. This leads to anovulation and amenorrhea.

272
Q

How does hormone replacement therapy affect cholesterol profiles?

A

Decrease LDL and increase HDL- increase triglycerides and increase LDL catabolism, as well as lipoprotein receptor numbers activity therefore causing decreased LDL levels

273
Q

What is the normal sequence of sexual maturation in puberty for females?

A

Breast-feeding/thelarche, then hair growth/adrenarche, a growth spurt, and then menarche

274
Q

What bodyweight is needed before menses begins?

A

85 to 106 pounds

275
Q

What is the treatment of Kallmann syndrome?

A

Pulsatile GnRH therapy

276
Q

Define: true precocious puberty

A

diagnosis of exclusion were the sex steroids are increased by the hypothalamic-pituitary-gonadal axis with increased pulsatile GnRH secretion

277
Q

Explain the reason for postpartum hair loss/ telogen effluvium.

A

High estrogen levels during pregnancy increase the synchrony of hair growth. Therefore hair grows in the same phase and is shed at the same time. This can affect 40 to 50% of women postpartum. This can result in significant postpartum hair loss at 1 to 5 months postpartum, with three months after delivery being the most common time.

278
Q

Classic presentation: rapid onset of acne, hirsutism, amenorrhea, clitoral hypertrophy and deepening of the voice, unilateral adnexal mass

A

Sertoli Leydig cell tumor

279
Q

Define: hyperthecosis

A

A more severe form of polycystic ovarian syndrome; it is associated with virilization due to the high androstenedione production and testosterone levels. In addition to Temporel balding, other signs of virilization include clitoral enlargement and deepening of the voice.

280
Q

When should mammography screening begin? What is the screening schedule?

A

ACOG recommends women beginning at the age of 40 to receive annual mammogram

281
Q

What are the risk factors of osteoporosis?

A

FH, age > 50, female, small framed, petite and thin women, heavy alcohol use

282
Q

What is the best way to prevent osteoporosis?

A

regular weight bearing exercise 3-4 times per week

283
Q

Physiologic dyspnea is present in __% of women by the 3rd trimester.

A

75

284
Q

What respiratory physiologic changes are seen in pregnancy?

A

Inspiratory capacity increases by 15% during the third trimester b/c of increase in tidal volume and inspiratory reserve volume. The respiratory rate is unchanged, but because TV increases, minute ventilation increases as well. This causes a respiratory alkalosis. FRC is reduced to 80% of the non pregnant volume by term. Combined, these effects lead to subjective SOB.

285
Q

What are the common causes of acute pulmonary edema in pregnancy?

A

tocolytic use, cardiac disease, fluid overload and pre-E

286
Q

What change in CO is seen in pregnancy?

A

increase by 33% CO due to increase in HR and Stroke volume

287
Q

Explain why some degree of dilation of the ureters and renal pelvis is seen in pregnancy.

A

The uterus causes compression which is asymmetrical due to the cushioning of the L ureter by the sigmoid colon and the dextrorotation of the uterus.. Also the R ovarian vein complex dilates in pregnancy and lays obliquely over the R ureter.

288
Q

Explain the effects of pregnancy on the thyroid.

A

TBG increases due to estrogens with a concomitant increase in total thyroxine. Free T4 remains relatively constant. Total T3 increase while free T3 levels do not change.

289
Q

What is the most common location of metastatic disease in patients with gestational trophoblastic disease?

A

the lungs

290
Q

What are the recommendations for weight gain in pregnancy?

A

Underweight–> 28-40 lbs
normal weight–> 25-35 lbs
Overweight–>15-25 lbs
Obese–> 11-20 lbs

291
Q

What autosomal recessive diseases are more common in Jews of Ashkenazi descent?

A

Fanconi anemia, Tay-sachs, CF, and Niemann-Pick

292
Q

What are the teratogenic effects of valproic acid?

A

increased risk of NTD, hydrocephalus and craniofacial malformations

293
Q

What are the effects of uncontrolled diabetes during conception and organogenesis?

A

4-8 fold increase in fetal structural anomalies- majority involving the CNS (like NTD) and cardiovascular system

294
Q

What screening test has the highest detection rate for Trisomy 21?

A

Cell-free DNA

295
Q

What is the risk of fetal loss with chorionic villus sampling?

A

1%; not related to miscarriage history

296
Q

What is the most common form of mental retardation?

A

Fragile X syndrome

297
Q

Define: twin-twin transfusion syndrome

A

complication of monochorionic pregnancies characterized by an imbalance in th blood flow communicating vessels across a shared placenta, leading to undwrperfusion of the donor twin. The donor twin becomes anemic and the recipient becomes polycythemia. The donor ten often develops IUGR and oligohydramnios and the recipient experiences volume overload and polyhydramnios that may lead to heart failure and hydrops

298
Q

What are the risk to infants born to diabetic mothers?

A

increased risk of developing hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia, and RDS.

299
Q

Management of an infant born to a HIV+ mom

A

start zidovudine immediately after delivery; HIV testing begins at 24 hours

300
Q

What are signs that a baby that is breastfed is getting enough milk?

A

3-4 stools in 24 hours, six wet diapers in 24 hours, weight gain and sounds of swallowing

301
Q

T/F- Prostaglandins are contraindicated in patients with h/o csection

A

T- increased risk of uterine rupture

302
Q

What conditions are associated with post-term pregnancies?

A

placental sulfatase deficiency, fetal adrenal hypoplasia, anencephaly and inaccurate or unknown dates. Macrosomia, olgio, meconium aspiration , uteroplacental insufficiency and dysmaturity

303
Q

What is the most common cause of sepsis in pregnancy?

A

pyleonehritis

304
Q

A woman with pulmonary hypertension has a __% mortality rate during pregnancy.

A

25%

305
Q

Define: fetal hydrops

A

collection of fluid in at least 2 body cavities

306
Q

300 micrograms of RhoGAM neutralizes __cc of fetal blood or __cc of fetal RBCs

A

30

15

307
Q

What ultrasound markers are suggestive of dizygotic twins?

A

dividing membrane thickness greater than 2mm, twin peal (lambda) sign, different feta genders and two separate placentas (anterior and posterior)

308
Q

The twin infant death rate is __ times higher than singletones

A

5

309
Q

Twin-twin transfusion syndrome occurs most often in what type of twins?

A

monochorionic, diamniotic

310
Q

Define: superfecundation

A

fertilization of two different ova at two separate acts of intercourse in the same cycle

311
Q

What is the most common aneuploidy encountered in abortuses?

A

Trisomy 16

312
Q

What gestational age is the fetus most susceptible to developing intellectual disability with sufficient doses of radiation?

A

8-15 weeks

313
Q

What are the ultrasound criteria for a missed abortion?

A

Crown-rump length > 7 mm with no cardiac activity

314
Q

What is the most reliable way to date a pregnancy in the first trimester?

A

ultrasound measurement of crown-rump length

315
Q

A fetal head greater than __cm could benefit from c-section.

A

12

316
Q

Macrosomia is defined as greater than ____ grams.

A

4000

317
Q

Chorionic villi sampling is done at __ weeks and amniocentesis is done at ___ weeks

A

10-12

after 15

318
Q

Define: advanced maternal age

A

Age 35 or greater at estimated time of delivery

319
Q

Fundal height at the level of the umbilicus corresponds to ____ weeks gestational age

A

20

320
Q

What defines anemia in pregnancy?

A

Hemoglobin less than 10.5

321
Q

Explain the cardiovascular physiologic changes in pregnancy.

A

Cardiac output increases due to an increase in heart rate and stroke volume. Plasma volume increases by 50%; systemic vascular resistance decreases; mean arterial pressure is unchanged or slightly lowered

322
Q

Explain the respiratory physiologic changes in pregnancy.

A

Respiratory rate unchanged; tidal volume increased; minute ventilation increased; ventilation exceeds needs causing primary respiratory alkalosis

323
Q

What are the physiologic changes and arterial blood gases in pregnancy?

A

PH is increased, PCO2 is decreased, HCO3 is decreased. Primary respiratory alkalosis and partial metabolic compensation

324
Q

What are the renal physiologic changes in pregnancy?

A

GFR is increased by 50% (reason for glucosuria); serum creatinine is decreased due to increased clearance; ureteral caliper dilated

325
Q

Describe the hematologic physiologic changes in pregnancy.

A

Hemoglobin is decreased slightly; platelets are decreased slightly; leukocyte count is slightly increased; physiologic anemia due to plasma volume increased more than red blood cell mass

326
Q

Describe the gastrointestinal physiologic changes in pregnancy.

A

Delayed stomach emptying, decreased lower esophageal sphincter tone, decreased gut motility

327
Q

Cystic fibrosis gene frequency is ___ in Caucasian patients

A

1:40

328
Q

Define: asymptomatic bacteriuria

A

Urine culture of 100,000 CFU per milliliter or more of a pure pathogen of a midstream voided specimen

329
Q

The fundal height in centimeters corresponds to the gestational age from ___ to ___ weeks.

A

20-34

330
Q

What is a reasonable approach in a patient with a history of abruption in a prior pregnancy?

A

Induction at or slightly before the time of abruption with the fetal loss if at term is a reasonable approach to avoid repeat abruption

331
Q

What are the ramifications of anti-Lewis antibodies?

A

Anti-Lewis antibodies do not cause hemolytic disease of the newborn; these antibodies are IgM and do not cross the placenta

332
Q

If a worrisome antibody is identified from a positive comes test, the tighter should be evaluated. In general, fetal risk is not great unless the titer is ____ or higher.

A

1:8

333
Q

How can chronic carrier status versus active hepatitis be differentiated?

A

Chronic carriers have normal LFTs versus active hepatitis with elevated LFTs

334
Q

Management of an infant born to a mother with positive hepatitis B surface antigen.

A

When born should receive hepatitis B immune globulin to protect against immediate exposure and then the active hepatitis B vaccine for lifelong immunity

335
Q

What can result from hepatitis B infections in infants?

A

Often this infection leads to cirrhosis and hepatocellular carcinoma

336
Q

What are the recommendations for the TdaP vaccine in pregnancy?

A

This vaccine is a killed vaccine and is therefore safe in pregnancy. It should be given between 28 and 36 weeks regardless of whether it has been given in prior pregnancies.

337
Q

Define: chronic hypertension

A

Blood pressure is greater than 140/90 before pregnancy or at less than 20 weeks, or persisting more than 12 weeks postpartum

338
Q

Define: gestational hypertension

A

Hypertension at greater than 20 weeks persisting for at least four hours

339
Q

Define:preeclampsia

A

Blood pressure greater than 140 systolic or 90 diastolic measured twice six hours apart with the new onset of proteinuria usually at 20 weeks or greater. Proteinuria equals greater than 300 mg over 24 hours or a urine protein to creatinine ratio of 0.3 or greater

In the absence of proteinuria, hypertension and any one of the following findings may suffice: thrombocytopenia, impaired liver function test, renal insufficiency he, pulmonary edema, cerebral disturbances, or visual impairment

340
Q

Define: posterior reversible encephalopathy syndrome

A

Syndrome consisting of headache, encephalopathy, seizures, cortical visual disturbances diagnosed with clinical features and MRI showing enhancement in the posterior parietal areas

341
Q

Treatment of posterior reversible encephalopathy syndrome

A

Antihypertensives, antiepileptics, and intensive care unit monitoring

342
Q

Define: severe feature of preeclampsia

A

Vasospasm associated with preeclampsia of such extent that maternal end organs are threatened; usually necessitating delivery of the baby regardless of gestational age

Severe features: systolic greater than or equal to 160, diastolic greater than or equal to 110, platelets less than 100,000, impaired LFTs (2X normal), severe persistent epigastric pain, RUQ pain, progressive renal insufficiency (Cr less than or equal to 1.1), pulmonary edema, New onset cerebral or visual disturbances

343
Q

Define: superimpose preeclampsia

A

Development of preeclampsia in a patient with chronic hypertension often diagnosed by an increase in blood pressure and/or new onset proteinuria

344
Q

What risks to the pregnancy does chronic hypertension and bows?

A

IUGR, fetal demise, placental abruption, Preeclampsia

345
Q

True/false – eclampsia can occur without elevated blood pressure or proteinuria

A

True

346
Q

What are they hematologic changes seen in preeclampsia?

A

Vasospasm leads to an increase of systemic vascular resistance, decreased intravascular volume, and decreased oncotic pressure. Vasospasm and endothelial damage result in leakage of serum between the endothelial cells and cause local hypoxemia of tissue

347
Q

What are the complications of preeclampsia?

A

Placental abruption, eclampsia, coagulopathies, renal failure, hepatic subcapsular hematoma, hepatic rupture, Uteroplacental insufficiency, Fetal growth restriction, poor Apgar scores, and fetal acidosis

348
Q

Where are the rest factors for preeclampsia?

A

Nuliparity, extremes of age, African-American, personal history of severe preeclampsia, family history of preeclampsia, chronic hypertension, chronic renal disease, obesity, antiphospholipid syndrome, diabetes, and multifetal gestation

349
Q

Management of just stational hypertension or preeclampsia without severe features

A

Deliver at 37 weeks 0 days; magnesium sulfate use is individualized

350
Q

How should a mother with gestational hypertension or preeclampsia without severe features be assessed?

A
  1. Check for symptoms
  2. check blood pressure two times per week,
  3. check platelet count, LFT, and creatinine 1 time per week
  4. Check serial ultrasound for fetal growth
  5. BPP once a week for fetal well-being
351
Q

Where is the assessment of a mother with chronic hypertension?

A
  1. Check blood pressure and urine protein at prenatal visits
  2. Serial ultrasounds to assess for fetal growth
  3. BPP starting at 30 to 32 weeks
352
Q

Management of chronic hypertension

A

Delivery at 38 to 39 weeks

353
Q

What is the management of preeclampsia with severe features at or greater than 34 weeks?

A

Administer magnesium sulfate and deliver

354
Q

Who is the management of preeclampsia with severe features at less than 34 weeks?

A

Give corticosteroids magnesium sulfate and assess the maternal and fetal stability.

If the maternal/field status is stable, wait at least 48 hours than deliver with magnesium sulfate.
With greater prematurity, if delivery is delayed, Monitor carefully and reassess daily in a tertiary care center.
If fetal or maternal status is unstable, deliver immediately with magnesium sulfate.

355
Q

What circumstances in preeclampsia with severe features necessitate delivery regardless of gestational age?

A

Uncontrollable severe hypertension despite max meds, eclampsia, pulmonary Edema, abruption, DIC, nonreassuring fetal status

356
Q

Management of acutely elevated blood pressure in pregnancy

A

Use IV labetalol, IV hydralazine, or oral nifidepine immediately and reassess 20 minutes later; escalate dose or alternate agent to bring the BP to a safe level

357
Q

_____ maybe elevate the blood pressure and postpartum preeclampsia and patients and should be avoided.

A

NSAIDs

358
Q

When is the greatest risk for eclampsia to occur?

A

Just prior to delivery, during labor, and within the first 24 hours postpartum

359
Q

What monitoring is needed for a patient on magnesium?

A

Monitor urine output, respiratory depression, dyspnea, abolition of the deep tendon reflexes

360
Q

What can be done to reduce the reoccurrence of preeclampsia?

A

Low-dose aspirin started in the late first trimester may slightly reduce the reoccurrence of preeclampsia. Women who have had one or more pregnancies complicated by severe features at less than 34 weeks are candidates.

361
Q

Women with preeclampsia have an increased risk of ______ later in life.

A

Cardiovascular disease

362
Q

What is the most common cause of maternal death due to eclampsia?

A

Intracerebral hemorrhage

363
Q

What are the two most common acute complications of preterm premature rupture of membranes?

A

Infection and labor

364
Q

Define: preterm premature rupture of membranes

A

Rupture of membranes prior to 37 weeks and before the onset of labor

365
Q

When PPROM has been detected causes should be looked into. Test should include:

A

Urine culture, assay for chlamydia and gonorrhea, fetal weight, fetal presentation, and amniotic fluid volume, GBS cultures

366
Q

Approximately ____% of patients with PPROM will go into labor within 48 hours and ____% within one week.

A

50

90

367
Q

What are the complications of preterm delivery?

A

Respiratory distress syndrome, chorioamnionitis, placental abruption, necrotizing enterocolitis

368
Q

What are signs and symptoms of Chorioamnionitis?

A

Maternal fever, maternal tachycardia, uterine tenderness ,malodorous vaginal discharge, fetal tachycardia is an early sign

369
Q

What is the treatment of PPROM?

A

Prior to 34 weeks steroids are given in the absence of overt infection. Broad-spectrum antibiotics therapy, usually ampicillin and erythromycin, initially IV for 48 hours and then orally for five days to complete a seven day course. Antibiotics have been shown to delay the delivery and decrease the incidence of chorioamnionitis. If the risk of infection is thought to be less than the risk of prematurity, patients are placed on bed rest and expectantly managed.

If membranes reseal – discharge home

If before 22 weeks corticosteroids and anabiotic’s are not recommended; patient should be given informed consent about the risk of pulmonary hypoplasia and outcomes

After 34 to 35 weeks – the treatment is usually delivery

370
Q

In ____% patients with PPROM resealing of membranes may occur demonstrated by absence of the fluid leakage, several negative speculum examinations and normal amniotic fluid volume.

A

10

371
Q

What are the risk factors for PPROM?

A

Lower social economic status, sexually transmitted diseases, cigarette smoking, cervical conization, emergency cerclage, multiple gestations, hydramnios, placental abruption

372
Q

What can be given in pregnancies before 32 weeks for Neuroprotection?

A

Magnesium sulfate

373
Q

What is the most accurate method to confirm an intra-amniotic infection?

A

Amniocentesis revealing organisms on Gram stain

374
Q

______ may induce chorioamnionitis without rupture of membranes due to transplacental spread.

A

Listeria

375
Q

What is the treatment for chorioamnionitis?

A

Broad-spectrum antibiotics such as IV ampicillin and gentamicin and labor should be induced

376
Q

What are the prenatal wrist factors for shoulder dystocia in order of significance?

A
  1. prior shoulder dystocia
  2. fetal macrosomia
  3. maternal gestational diabetes
377
Q

Define: shoulder dystocia

A

Inability of the fetal shoulders to deliver spontaneously, usually due to the impaction of the anterior shoulder behind the maternal symphysis pubis

378
Q

Define: McRoberts maneuver

A

The maternal thighs are sharply flexed against the maternal abdomen to straighten the sacrum relative to the lumbar spine and rotate the symphysis pubis anteriorly toward the maternal head

379
Q

Define: erb palsy

A

A brachioplexus injury involving the C5 – C6 nerve roots which may result from the downward traction of the anterior shoulder; the baby usually has weakness of the deltoid and infraspinatus muscles as well as the flexor muscles of the forearm. The arm often hangs limply by the side and is internally rotated

380
Q

What are The maternal complications of shoulder dystocia?

A

Postpartum hemorrhage and vaginal/perineal lacerations

381
Q

___% of the time, brachioplexus injury will improve with physical therapy

A

80

382
Q

True/false-artificial rupture of membranes should be avoided with an unengaged fetal part

A

True – this increases the likelihood of umbilical cord prolapse

383
Q

What situations predispose to cord prolapse?

A

Transverse fetal lie, footling breach presentation, unengaged fetal part

384
Q

What is the first step in the evaluation of the fetal bradycardia in the face of rupture of membranes?

A

Vaginal exam to assess for the umbilical cord

385
Q

Management of cord prolapse

A

Place the patient in Trendelenburg position, physician should keep his or her hand in the vagina to elevate the presenting part, emergent C-section

386
Q

Define: engagement

A

The largest transverse diameter of the fetal head has negotiated the bony pelvic inlet

387
Q

Define: fetal bradycardia

A

Baseline fetal heart rate less than 110 for greater than 10 minutes

388
Q

Management of fetal bradycardia

A

Confirm fetal heart rate versus maternal heart rate, vaginal examination to assess for cord prolapse, Placement of the patient on her side to improve blood return to the heart, intravenous fluid bolus if the patient is possibly volume depleted, administration of 100% oxygen by facemask, and stopping oxytocin if it has been given

389
Q

And women with prior C-section, uterine rupture made manifest as _____

A

Fetal bradycardia

390
Q

Why does epidural administration lead to hypotension in the mother?

A

The epidural cause a sympathetic blockade leading to vasodilation

391
Q

What is the treatment for hypotension caused by an epidural?

A

Intravenous fluids and a vasopressor of agents such as ephedrine if late decelerations persist

392
Q

What is the most common cause of uterine inversion?

A

undue traction of the cord before placenta detachment

393
Q

What are the 4 signs of placental detachment?

A

Gus of blood, lengthening of the cord, globular and firm shape of the uterus, and the uterus rises up to the anterior abdominal wall

394
Q

What is the difference between active management and physiologic management of the third stage of labor?

A

Active- maneuvers that attempt to facilitate the 3rd stage of labor
Physiologic- no interventions are done until the natural separation of the placenta

395
Q

What is the function of delayed cord clamping?

A

Delayed cord clamping of 30-60 seconds is beneficial for the preterm infant due to increasing total iron stores and hemoglobin levels, and decreasing the risk of intraventricular hemorrhage. delayed cord clamping in a term infant also improves the iron stores but may lead to a higher risk of hyperbilirubinemia

396
Q

What is the explanation for hypercoaugable states in pregnancy?

A

venous stasis and mechanical obstruction by the uterus; high estrogen also increase coagulation factors particularly fibrinogen

397
Q

Tx for confirmed PE in pregnancy

A

Full IV anticoagulation for 5-7 days then switched to subcutaneous therapy to maintain aPTT at 1.5 to 2.5 times control for at least 3 months after the acute event. After 3 months, either full heparinization or prophylactic heparization doses can be utilized for the remainder of the pregnancy and for 6 weeks postpartum

Both unfractioned and LMWH are safe to use in pregnancy because they do not cross the placenta

398
Q

What is the tx for antiphospholipid syndrome in pregnancy?

A

aspirin and heparin

399
Q

What hypercoaguable states in pregnancy need prophylactic anticoagulation?

A

homozygogus FVL or a previous h/o VTE

400
Q

DVT is associated with PE in __% of untreated cases

A

40

401
Q

signs and symptoms of DVT

A

deep leg pain, linear cords palpated along the calf, tenderness and swelling in the lower extremity, 2 cm difference in leg circumference; the examination is normal in 50% of cases

402
Q

What is the tx for DVT?

A

anticoagulation with bed rest and elevation of involved extremity

Anticoagulation the same as PE: Full IV anticoagulation for 5-7 days then switched to subcutaneous therapy to maintain aPTT at 1.5 to 2.5 times control for at least 3 months after the acute event. After 3 months, either full heparinization or prophylactic heparization doses can be utilized for the remainder of the pregnancy and for 6 weeks postpartum

403
Q

When is the most common time for amniotic fluid embolism to occur?

A

during labor or immediately postpartum

404
Q

Explain the mechanism of amniotic fluid embolism.

A

amniotic fluid enters the maternal circulation and subsequently causes obstruction and vasoconstriction of the pulmonary vessels due to fetal debris and vasoactive substances in the fluid

405
Q

What are risk factors for amniotic fluid embolism?

A

c-section, instrumental vaginal delivery, induction of labor, traumatic delivery, placental abruption, placental accreta, advanced maternal age, grandmultipartiy

406
Q

What is the tx for amniotic fluid embolism?

A

supportive and immediate delivery if there is rapid maternal or fetal decompensation

407
Q

What is the most common cause of maternal mortality?

A

embolism of all types, followed by CV and infections

408
Q

hypercoaguable state of pregnancy persists for __ weeks postpartum

A

6

409
Q

What is the most common side effect of long-term heparin in pregnancy?

A

osteoporosis- thought to be due to overactive osteoclasts

410
Q

A PO2 of less than ___ is abnormal in a pregnant woman.

A

80

411
Q

What is the anatomical problem of genuine stress incontinence (GSUI)?

A

the bladder neck is below the abdominal cavity

412
Q

Tx of GSUI

A

initially pelvic floor exercises (kegel exercises). If these are unsuccessful, then pessary or surgical tx is considered

SHELF Exams (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions