OB/GYN Flashcards
Initial prenatal visit tests
Rh(D) type, Ab screen, Hgb/Hct, MCV, HIV, VRDL/RPR, HBsAg, reubella and varicella immunity, pap, chlamydia, urine culture, dipstick for urine protein
- influenza vaccine
Active phase arrest
no cervical change in 4 or more hours with adequate contractions (>200) or 6 or more hours with inadequate contractions
- tx with c section
secondary amenorrhea with increased FSH in a pt <40
Primary ovarian insufficiency
- accelerate ovarian follicle depletion
- leads to decreased estrogen with thin endometrium and vaginal atrophy
Fetal sinusoidal heart rate tracing is associated with
fetal anemia (ruptured vasa previa)
Risk factors for hyperemesis gravidarum
Hydatidiform mole
multifetal gestation
hx of previous hyperemesis
Post menopausal woman with endometrial cells on pap smear
Requires endometrial biopsy
increased AFP during pregnancy most commonly related to
open neural tube defects
ventral wall defects
multiple gestations
Target blood glucose levels and tx options in gestational diabetes
fasting glucose: <95
1 hour PP: <140
2 hour PP: 120
Tx: dietary modifications (first line), insulin and metformin (second line)
Management of shoulder dystocia
BE CALM
B: Breath; do not push
E: Elevate the legs and flex hips (McRoberts)
C: Call for help
A: Apply suprapubic pressure
L: enLarge vaginal opening with episiotomy
M: Maneuvers: deliver posterior arm, rotate posterior shoulder (Wood’s screw), adduct posterior shoulder (Rubin), mother on hands and knees (Gaskin), replace fetal head into pelvis for cesarean (Zavanelli)
Lady at 28 weeks gestation has high grade squamous intraepithelial lesion on pap smear. Next best step?
Immediate colposcopy
tx for preterm labor
<32 weeks: betamethasone, tocolytics (indomethacin), mag sulf, penecillin if GBS + or unknown
32-33 6/7: betamethasone, tocolytics, penecillin if GBS + or unknow
34-36 6/7: betamethasone, penecillin
Management of pregnant patient with past HSV infection
Antiviral suppression beginning at 36 weeks
- Lesions at time of delivery: C-section
- no lesions: vaginal
When is an endometrial biopsy necessary
On TVUS if endometrium in >4 mm
Next best step in management of patient with mullerian agenesis?
Renal ultrasound
- uterus comes from paramesonephric ducts
- primitive kidneys come from mesonephric ducts
When to progress to c-section during arrest of labor
if no cervical change in 4 or more hours with adequate contractions
if no cervical change in 6 or more hours with inadequate contractions
*if cervix is not progressing as fast as it should (1.2cm/hr or 1.5cm/hr) give oxytocin
58 year old female presents with glazed, brightly erythematous vulvar erosions with a border of serpentine-appearing white striae. She also has serosanguinous vaginal discharge and lace like reticular erosions on the gingiva and palate
vulvar lichen planus
Side effect of OCPs on liver
hepatic adenoma
- well demarcated hyperechoic lesion
pregnant women with bilateral dilation of renal pelvis and proximal ureters
physiologic hydronephrosis of pregnancy
- no additional management
Young male with persistent cough and dull back pain. CXR shows retroperitoneal LAD and multiple pulmonary nodules
Metastatic testicular cancer
28 year old male with left testicular mass that has increased in size. Ultrasounds shows hypoechoic, 5 cm left testicular mass
Testicular cancer
- requires radical inguinal orchiectomy for confirmation of dx and tx
- will also have elevated tumor markers: Bhcg, afp, and LDH
Second stage labor arrest
10 cm and pushing for 4 or more hours in primigravid or 3 in multiple with lack of fetal descent
- move to operative vaginal delivery
Pt is 10 days post partum and still having low back pain. She had a c-section due to failure to progress. She now has fever, weakness, and decreased sensation in her leg
epidural abscess
- needs urgent MRI
Next step if atypical glandular cells are found on pap smear
colposcopy, endocervical curettage, and endometrial biopsy
Follow up for a 29 year old after draining simple cyst
repeat breast exam in 2 months
Pt in her third trimester with twin gestation presents with hepatic inflammation and fulminant liver failure
Acute fatty liver of pregnancy - deliver now
Management of chorioamnionitis
Antibiotics
Delivery
premature rupture of membranes at 34-37 weeks
deliver, give penicillin if GBS status unknown
Pregnant patient in third trimester develops palmar erythema and pruritis. AST, ALT and bile acids are elevated.
Intrahepatic cholestasis of pregnancy
- bile acids
- tx with delivery at 37 weeks
- ursodeoxycholic acid
- antihistamines
Genital and oral ulcers with uveitis
Behcet syndrome
- tx acute exacerbations with prednisone
Pt with 2 prior miscarriages with + VDRL, thrombocytopenia and elevated PTT
Antiphospholipid syndrome - give LMWH
Cause of primary dysmenorrhea
Increased endometrial prostaglandin production
How to measure gestational age before and after 14 weeks with US
Before: crown-rump length
After: head circumference, femur length, abdominal circumference, biparietal diameter
How to dx lichen sclerosis
punch biopsy
tx: potent topical steroids
pregnancy is a hypercoagulable state because
decreased protein S activity, increased fibrinogen, and increased levels of factors II/VII/VIII/X.
oligohydraminos
AFI < 5cm
Fever, abdominal pain in RLQ, complex multi-loculated adnexal mass with thickened walls and internal debris
tubo-ovarian abscess
Liver failure (hypoglycemia, thrombocytopenia and elevated LFTs) with severe RUQ pain and elevated bilirubin
Acute fatty liver of pregnancy
- immediate delivery
Complications of PPROM
preterm labor
intraamniotic infection
placental abruption
umbilical cord prolapse
intrapartum GBS tx
penicillin
- if allergic: cefazolin
short interpregnancy interval puts you at risk for
maternal anemia
PPROM
preterm delivery
low birth weight
generalized tonic-clonic seizure after delivery with hyponatremia
oxytocin toxicity
- causes water retention
tx of asx bacteruria
beta-lactams (such as ampicillin), nitrofurantoin (macrobid), and fosfomycin (single dose)
Bisphosphonates cannot be given when GFR is ___
30-35
must give denosumab
Indications for starting bisphosphonate tx
- DEXA (T-score ≤ -2.5) or the presence of a fragility fracture.
- Patients with osteopenia (T-score between -1.0 and -2.5) should also be treated if they have a 10-year probability for hip fracture of ≥ 3%
postpartum endometritis
IV gentamicin and clindamycin
Tx of Toxic shock syndrome
IV fluids
IV Abx given to prevent recurrence but not as important in the acute setting
How to detect semen on a vaginal sample
Alk Phos assay for up to 72 hours
