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Peds Boards > Ob/Gyn > Flashcards

Ob/Gyn Flashcards

1
Q

When is the serum alpha-fetoprotein screen offered?

A

16 weeks gestation

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2
Q

What does an elevated AFP indicate?

A

More than twice the normal

Indication of a defect in the baby’s skin. This is usually a neural tube defect.

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3
Q

What is the evaluation for an elevated AFP?

A
  • If elevated, get a fetal ultrasound
  • If ultrasound is negative, get an amniocentesis for amniotic AFP level
  • Low serum AFP is associated with Down syndrome
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4
Q

What is chorionic villus sampling used for?

A
  • Fetal karyotype from a placental biopsy.

- Early detection (12 weeks) of genetic or cytogenetic abnormalities

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5
Q

What are the different time frames for doing an amniocentesis?

A
  • 12-15 weeks: high suspicion or concern
  • 15-18 weeks: screen for genetic or neural tube problems
  • 24-40 weeks: assess fetal lung maturity
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6
Q

How do you determine fetal lung maturity?

A
  • Phosphatidylglycerol: Best predictor, not made until after the 35th week of gestation
  • Lecithin-Sphingomyelin ratio: L/S ratio > 2 (from amniotic fluid) indicates fetal lung maturity
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7
Q

What are the five different things that chlamydia trachomatis can cause?

A
  1. Urethritis
  2. Conjunctivitis
  3. PID
  4. Pneumonia
  5. Lymphogranuloma venereum serovar
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8
Q

What is the classic sound of a pneumonia in a neonate caused by chlamydia trachomatis?

A

Staccato cough

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9
Q

How do you test for chlamydia trachomatis?

A

Obligate intracellular anaerobe

PCR of cells, secretions, urine

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10
Q

What are the clinical features of lymphogranuloma venereum serovar?

A
  • Starts as small nontender papules or shallow ulcers that resolve
  • Followed by a tender unilateral inguinal lymph node
  • Pain is relieved when lymph node ruptures
  • Ruptured lymph node can drain for months
  • Treat with doxycycline or erythromycin
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11
Q

How is chlamydia trachomatis treated?

A
  • Azithromycin x 1
  • Doxycycline x 7 days
  • Conjunctivitis: oral erythromycin
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12
Q

What are the clinical features of neisseria gonorrhea?

A
  • Smelly, greenish discharge
  • Usually asymptomatic
  • Keep in mind for adolescent patient with arthritis
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13
Q

How is neisseria gonorrhea treated?

A
  • IM ceftriaxone x 1
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14
Q

What are the clinical features of disseminated gonorrhea?

A
  • Rash
  • Joint involvement
  • Meningitis
  • Endocarditis
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15
Q

What are the features of Fitz-Hugh Curtis syndrome?

A
  • Peri-hepatitis
  • Due to gonorrhea or chlamydia
  • Occurs after an episode of PID
  • Symptoms: sudden right upper quadrant abdominal pain aggravated by breathing, coughing, movement
  • LFTs are normal
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16
Q

How do you test for syphilis?

A

(Treponema pallidum)

  • Non-treponemal tests (RPR, VDRL) can be false positive’s, so need to do a confirmatory treponemal test (FTA)
  • Non-treponemal tests (titers) correlate w/ dz activity
  • If mom is RPR+, get FTA in baby to confirm disease presence
17
Q

When do you treat a baby born to Mom with syphilis?

A
  • If mom was treated and baby’s titers are lower than hers, no need to treat
    • Titers are from mom’s IgGs crossing placenta
    • Follow titers
  • If mom was treated <1 month ago, TREAT
  • If mom was given erythromycin, TREAT
    • Erythromycin doesn’t cross placenta
18
Q

What are the features of congenital syphilis?

A
  • Maculopapular rash
  • HSM
  • Generalized lymphadenopathy
  • Peeling skin

If untreated, baby may later develop:

  • Perforated palate
  • Perforated nasal septum
  • Hearing loss
  • Hutchinson teeth
19
Q

What are the features of bacterial vaginosis?

A
  • Gardnerella vaginalis
  • Homogenous, smelly/fishy odor
  • Discharge: white, yellow, or gray
  • Associated with anything that changes the usual flora
  • Clue cells
  • Vaginal fluid has alkaline pH (>4.5)
20
Q

What are the features of trichomonas vaginalis?

A
  • Protozoa
  • Yellow-green, bubbly, frothy discharge
  • pH > 4.5
  • Intensely pruritic
  • Strawberry cervix
  • Tx: One dose of metronidazole

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