Ob/Gyn Flashcards

1
Q
Term lengths: 
Previable - 
Preterm - 
Term -
 Early -
 Full - 
 Late - 
Postterm -
A
Term lengths: 
Previable - <24 w
Preterm - 25-37 w
Term - 37 w
 Early - 37 to 38 and 6 
 Full - 39 to 40 and 6 
 Late - 41 to 41 and 6 
Postterm - >42 w
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2
Q

Beta hCG >1500 or 5 weeks =

A

gestational sac on U/S

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3
Q

Fibrinogen is _ in pregnancy

A

increased

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4
Q

Routine prenatal labs

  • Initial prenatal visit
  • 24-28 weeks
  • 35-37 weeks
A

Routine prenatal labs

  • Initial prenatal visit: Rh(D) type, ab screen, Hb/Hct/MCV*, HIV, VDRL/RPR, HBsAg, Rubella and Varicella immunity, Chlamydia, urine culture, urine protein
  • 24-28 weeks: Hb/Hct, ab screen if Rh(D) negative, 50 g 1-h oral glucose challenge test**
  • 35-37 weeks: GBS culture
  • treat iron deficiency anemia with iron + stool softener
  • *if positive, perform glucose tolerance test
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5
Q

what labs do you need for someone taking methotrexate?

A

liver enzymes

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6
Q

medical tx of ectopic pregnancy

A

1) get baseline exams: CBC, blood type/screen, LFTs, and beta-hCG
2) give methotrexate and recheck beta-hCG in 4-7 days
3) if <15% drop in beta-hCG, give second dose
4) if persistently high levels –> surgery

ectopics >3.5 cm are at greater risk of failure with MTX

if surgery is performed, Rh negative mothers should receive RhoGAM

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7
Q

types of abortion

  • complete
  • incomplete
  • inevitable
  • threatened
  • missed
  • septic
A

types of abortion

  • complete - no products of conception left
  • incomplete - some products
  • inevitable - products intact, bleeding, cervix dilated
  • threatened - same as above, but cervix closed
  • missed - intact but dead
  • septic - infection
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8
Q

Late and postterm pregnancy complications for the fetus and the mother

A

fetus - oligohydramnios, meconium aspiration, stillbirth, macrosomia, convulsions

mother - cesarean delivery, infection, postpartum hemorrhage, perineal trauma

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9
Q

circumstances in which preterm labor should not be stopped with tocolytics and delivery should occur

A
  • severe hypertension (preeclampsia, eclampsia)
  • cardiac disease
  • cervical dilation >4 cm
  • hemorrhage
  • fetal death
  • chorioamnionitis
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10
Q

if preterm labor is occurring (contractions + cervical dilation), when do you stop and when do you deliver?

A

stop if 24-33 w (or 600-2500 g) –> give betamethasone*, tocolytics, if <32 w –> add magnesium sulfate**

deliver if >34 weeks (or >2500 g)

*steroids need 24 h for full effect (beta completion), peak at 48 h, and last 7 days; must give tocolytic to allow then time to work

** magnesium tox can lead to respiratory depression and cardiac arrest, so check DTRs often

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11
Q

what to do with patient with PROM and term fetus? preterm fetus?

A

PROM + term fetus –> wait 6-12 hours for spontaneous delivery –> none –> induce labor

PROM + preterm fetus –> give betamethasone, tocolytics, and antibiotics (to lower risk of chorioamnionitis)

  • no allergies - ampicillin + azithromycin
  • penicillin allergy - cefazolin + azithro
  • anaphylaxis risk - clindamycin + azithro
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12
Q

third trimester vaginal bleeding? imaging and digital exam

A

digital vaginal exam is C/I in 3rd trimester vaginal bleeding, do transabdominal U/S first (may do TVUS after)

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13
Q

tx of placenta previa

A

strict pelvic rest (no sex, nothing in the vagina)

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14
Q

placenta previa presents with pain_ vaginal bleeding

placental abruption presents with pain_ vaginal bleeding

A

placenta previa presents with painLESS vaginal bleeding

placental abruption presents with painFULL vaginal bleeding

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15
Q

mgmt of Rh incompatibility

A

at initial prenatal visit, do Rh ab screen –> if negative, check titers –> if unsensitized, repeat test again at 28 weeks and if patient continues to be unsensitized, we try to keep her unsensitized by given her RhoGAM (which binds any fetal Rh that may enter mother’s circulation and keeps her from mounting immune response) –> if at any point sensitized and titers are high (>1:16), do amniocentesis at 16-20 weeks to look at fetal Rh and bilirubin levels –> if bili levels are high, check fetal Hct and if low do intrauterine transfusion

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16
Q

how does U/S confirm gestational age?

A

femur length, abdominal circumference, and head diameter

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17
Q

tx of hyperemesis gravidarum

A

1st non pharmacological (diet, avoid triggers, etc) then diphenhydramine (H1) then metoclopramide (DA) finally ondansetron (H2)

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18
Q

asx bacteriuria in pregnancy

A

we treat it, other can result in preterm birth, low birth weight, and perinatal morbidity

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19
Q

acute pyelo in pregnancy warrants

A

hospitalization and IV ceftriaxone

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20
Q

antibiotics to avoid in pregnancy

A

TMP-SMX in first trimester (folic acid antagonism)
Aminoglycosides (amikacin, gentamicin, kanamycin, streptomycin, tobramycin) - ototoxicity
Tetracyclines and fluoroquinolones

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21
Q

Tx of pruritic urticarial papule and plaques of pregnancy

A

topical steroids

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22
Q

severe preeclampsia <20 weeks gestation

A

can be a manifestation of hydatiform mole

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23
Q

HTN during pregnancy with edema, joint pain, malar rash, and proteinuria and RBC casts likely

A

SLE complicated by nephritis

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24
Q

fetal nonstress test

A

detection of 2 fetal movements and acceleration of HR >15 bmp lasting 12-20 seconds in a 20 minute period

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25
Q

biophysical profile

A
B - breathing (chest expansions) 
A - amniotic fluid index (volume) 
T - fetal Tone (flexing) 
M - movement (3 in 30 mins) 
A -------------------------------------
N - Nonstress test 

each one is assigned 2 points
8-10 = normal
4-8 = inconclusive
<4 = abnormal

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26
Q

do not give _ to asthma patients

A

prostaglandins (e.g. for cervical ripening or to stop bleeding)

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27
Q

most common cause of prolonged or arrested 2nd stage of labor is

A

fetal malposition (head not engaged with pelvis properly; optima = occiput anterior)

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28
Q

arrest of cervical dilation is when …

A

there is no dilation for more than 2 hours

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29
Q

causes of protracted dilation (i.e. cervix is too slow to dilate during the active phase)

A

the 3 P’s: power, passenger, and passage (–> cephalopelvic disproportion)

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30
Q

Leopold maneuver does what?

A

set of 4 maneuvers that estimate the fetal wight and presenting part of the fetus

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31
Q

fetus can maneuver itself into cephalic (vertex) presentation by

A

36 weeks; after that –> external rotation

32
Q

neonatal clavicular fx prognosis

A

spontaneous healing

33
Q

mgmt of postpartum hemorrhage

A

1) bimanual massage
2) oxytocin
3) other uterotonics
- methylergovine - do not use in HTN
- carboprost - do not use in asthma

34
Q

pubic symphysis diastisis

A

can occur after traumatic delivery; radiating supra public pain and point tenderness; exacerbated by ambulation or weight bearing

35
Q

bulk-related sxs, size-date discrepancy, irregular contours

A

fibroids

36
Q

what kind of sports should be avoided in pregnancy

A

contact sports and activities with high fall risk

37
Q

contraindications to breastfeeding

A

active and untreated TB, varicella infection, herpetic breast lesion, current chemo, illicit drug use

38
Q

marijuana use during breastfeeding

A

THC is concentrated in breast milk, asso with decreased muscle tone, poor sucking, sedation, and delayed motor development at 1 year of age

39
Q

second trimester quad screen

A

trisomy 18 - low AFP, beta-hCG and estriol, normal inhibin A

trisomy 21 - low AFP and estriol, high beta-hCG and inhibin A (if put in alphabetical order: low low high high)

NT or abdominal wall defect - high AFP

40
Q

fetus with multiple limb fx’s

A

osteogenesis imperfecta

41
Q

bladder atony with urinary retention and inability to void/dribbling results from

A

prolonged labor, perineal trama, and regional analgesia

42
Q

newborns with fetal growth restriction typically have

A

loose skin, thin umbilical cord, and wide anterior fontanelle; assess placenta for signs of infection or infarction

43
Q

patient with persistent postop/partum fever unresponsive no antibiotics

A

not endometritis (which is response to abx) but septic pelvic thrombophlebitis –> tx with anticoagulation and broad-spectrum abx

44
Q

side effect of epidural

A

vasodilation/venous pooling –> hypoTN

45
Q

preeclampsia + signs of end organ damage

A

preeclampsia with severe features

46
Q

should not use this medication to tx preeclampsia in woman who presents with HTN and bradycardia

A

labetalol - will slow down the heart even further

use hydralazine

47
Q

In patients with FH of breast cancer, start screening at

A

40 years of age

48
Q

what is the most important consideration in the tx of breast cancer?

A

tumor burden (TNM)

49
Q

EtOH’s has a dose-dependent effect on

A

breast cancer

50
Q

OCP use lowers risk of ____ cancer but has no effect on incidence of ____ cancer

A

ovarian

breast

51
Q

s/e’s that all the SERMs share

A

hot flashes and risk of VTE

tamoxifen - increased risk of endometrial hyperplasia/CA

52
Q

trastuzumab major s/e

A

cardiotoxic, must do baseline Echo

53
Q

patients with primary ovarian insufficiency have a hx of

A

autoimmune disease of Turner syndrome

54
Q

evaluation of primary amenorrhea

A

1- first thing you do is check if there’s an uterus
2- if uterus present, check FSH levels
- high –> do karyotyping
- low –> get cranial MRI
- if no uterus, do karyotyping and serum testosterone levels

55
Q

most common cause of secondary amenorrhea

A

pregnancy

56
Q

PMS vs PMDD

A

PMDD is a more severe version of PMS; disrupts patients daily activities; ask patient to chart her sxs
tx: lower caffeine, EtOH, cigarette and chocolate consumption; if sxs are severe: SSRI

57
Q

Lichen simplex chronicus

A

hyperplastic response to repetitive scratching and irritation

58
Q

Lichen sclerosis

A

usually coexists with autoimmune conditions

59
Q

in postmenopausal woman, may mimic UTI…

A

atrophic vaginitis

60
Q

neonatal vaginal bleeding d/t

A

maternal estrogen w/drawal

61
Q

any patient >35 with abnormal bleeding should endergo

A

endometrial bx to r/o cancer

62
Q

postmenopausal bleeding consider ___ until proven otherwise

A

endometrial cancer

63
Q

labial fusion occurs with …

A

androgen excess

64
Q

tx of sx vs asx bartholin cyst

A

I&D if sx; obs if asx

65
Q

tx of PID

A

IV ceftriaxone or cefotetan plus oral doxy

OR clindamycin plus gentamicin

66
Q

if trichomonas if diagnosed, tx….

A

patient and partner

67
Q

vaginal discharge with fishy odor, gray-white

A

BV (Gardnerella - clue cells)

68
Q

white, cheesy vaginal discharge

A

Candidiasis (pseudohyphae)

69
Q

profuse green, frothy vaginal discharge

A

Trichomonas (motile flagellates)

70
Q

best way to dx HSV ulcer infectious etiology

A

PCR

71
Q

postmenopausal woman with vulvar soreness and pruritus appearing as a red lesion with superficial white coating

A

Paget disease - an intraepithelial neoplasia, tx with vulvectomy

72
Q

HPV vaccine ages

A

males - 11 - 21, if risk factors –> up to 26

females - 11 - 26

73
Q

fixed, immobile uterus

A

endometriosis

74
Q

endometriosis tx

A

NSAIDs, OCPs, danazole (–>androgenism) or leuprolide (–> hot flashes, osteoporosis)

75
Q

choricarcinoma likes to metastasize to

A

the lungs

76
Q

Magnesium sulfate toxicity

A

common adverse effects include HA, nausea, fatigue, diaphoresis

signs of toxicity include loss of DTRs, somnolence, and respiratory depression

solely excreted by the kidneys, so renal insufficiency is a risk factor for toxicity

tx with calcium gluconate

77
Q

homogenous cystic ovarian mass

A

endometrioma