Ob/Gyn Flashcards
When is the serum alpha-fetoprotein screen offered?
16 weeks gestation
What does an elevated AFP indicate?
More than twice the normal
Indication of a defect in the baby’s skin. This is usually a neural tube defect.
What is the evaluation for an elevated AFP?
- 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
What is chorionic villus sampling used for?
- Fetal karyotype from a placental biopsy.
- Early detection (12 weeks) of genetic or cytogenetic abnormalities
What are the different time frames for doing an amniocentesis?
- 12-15 weeks: high suspicion or concern
- 15-18 weeks: screen for genetic or neural tube problems
- 24-40 weeks: assess fetal lung maturity
How do you determine fetal lung maturity?
- 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
What are the five different things that chlamydia trachomatis can cause?
- Urethritis
- Conjunctivitis
- PID
- Pneumonia
- Lymphogranuloma venereum serovar
What is the classic sound of a pneumonia in a neonate caused by chlamydia trachomatis?
Staccato cough
How do you test for chlamydia trachomatis?
Obligate intracellular anaerobe
PCR of cells, secretions, urine
What are the clinical features of lymphogranuloma venereum serovar?
- 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
How is chlamydia trachomatis treated?
- Azithromycin x 1
- Doxycycline x 7 days
- Conjunctivitis: oral erythromycin
What are the clinical features of neisseria gonorrhea?
- Smelly, greenish discharge
- Usually asymptomatic
- Keep in mind for adolescent patient with arthritis
How is neisseria gonorrhea treated?
- IM ceftriaxone x 1
What are the clinical features of disseminated gonorrhea?
- Rash
- Joint involvement
- Meningitis
- Endocarditis
What are the features of Fitz-Hugh Curtis syndrome?
- 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
How do you test for syphilis?
(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
When do you treat a baby born to Mom with syphilis?
- 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
What are the features of congenital syphilis?
- Maculopapular rash
- HSM
- Generalized lymphadenopathy
- Peeling skin
If untreated, baby may later develop:
- Perforated palate
- Perforated nasal septum
- Hearing loss
- Hutchinson teeth
What are the features of bacterial vaginosis?
- 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)
What are the features of trichomonas vaginalis?
- Protozoa
- Yellow-green, bubbly, frothy discharge
- pH > 4.5
- Intensely pruritic
- Strawberry cervix
- Tx: One dose of metronidazole
