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OB/GYN 8% Flashcards

1
Q

___ predominates in Phase 1 (a.k.a. ___)

Day:

A

Estrogen predominates
Follicular phase

Day 1-12

Follicular

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2
Q

Causes follicle and egg maturation in ___phase

A

FSH

Follicular (phase 1)

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3
Q

Stimulates maturing follicle ___ production

A

LH

Estrogen production

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4
Q

___ causes a sudden ___ surge causes ovulation

Days:

A

Estrogen causes a sudden LH surge

Day 12-14

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5
Q

Phase 3 (a.k.a. ___, a.k.a. ____)

___ surge causes ruptured follicle to become ___, which secretes ___ to ___.

A

Luteal, Secretory phase

LH
corpus luteum
progesterone
maintain endometrial lining and secretion

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6
Q

If pregnancy occurs, ___ keeps the corpus luteum functional until placenta can support itself

A

blastocyst

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7
Q

Estrogen is produced by ____

Provides (positive/negative) feedback on ___.

A

granulosa cells of follicle

Positive feedback on LH –> LH surge to cause ovulation

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8
Q

Inhibins is produced by ___.

Provides (positive/negative) feedback on ____.

Inhibin B levels rise during ___, highest during ___. Increase again during ___.

Inhibin A levels decrease during ___.

A

granulosa cells of follicle

Negative feedback for FSH

  • luteal-follicular transition
  • highest during mid follicular phase
  • LH peak

late luteal phase

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9
Q

Chronic anovulation is caused by ___.

A

Unopposed estrogen, no corpus luteum –> no ovulation, no progesterone –> continuous estrogen production and stimulation of endometrium w/o progesterone stabilization/induced bleeding

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10
Q

Ovulatory dysfunctional uterine bleeding caused by ___.

A

ovulation with prolonged progesterone secretion d/t low estrogen –> blood loss from endometrial vessel dilation and prostaglandins –> metrorrhagia

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11
Q

Tx of acute severe uterine bleed

A

High dose IV estrogens

D&C if IV estrogen fails

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12
Q

Tx of anovulatory dysfunctional uterine bleeding

A

OCPs
Medroxyprogesterone acetate
Leuprolide

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13
Q

Tx of ovulatory dysfunctional uterine bleeding

A

OCPs
Medroxyprogesterone acetate
Leuprolide
NSAIDs*

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14
Q

MC/most important diagnostic for DUB

A

Endometrial bx

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15
Q

Primary amenorrhea = failure of onset of menarche by ___.

A

15 y/o

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16
Q

High FSH in setting of primary amenorrhea suggests problem with ___

A

ovaries. FSH screaming at unresponsive ovaries

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17
Q

Low FSH in setting of primary amenorrhea suggests problem with ___

A

H-P axis problem. Ovaries don’t know what to do without FSH.

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18
Q

Breasts that are present, with absent uterus, 46, XX suggests ____

A

Mullerian agenesis = congenital absence of vagina, uterine agenesis

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19
Q

Breasts that are present, with absent uterus, 46, XY suggests ____

A

Androgen insensitivity = female phenotype d/t testosterone resistance

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20
Q

Kallmann’s Syndrome =

Hallmark symptom:

A

Hypogonadotropic hypogonadism –> pituitary secretion of FSH and LH VERY low

Anosmia (lack of smell)

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21
Q

Low stature, webbed neck, edema, low hairline, low ears, widely set nipples =

Tx w/:

A

Turner Syndrome (45, XO)

Tx: estrogen

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22
Q

Most common form of secondary amenorrhea

Induces a hypothalamic state in which reduced secretion of ___–> low ___ –> no stimulation of ____ –> ____ is not produced by follicles

A

Stress related

GnRH
LH and FSH
ovulation
estrogen

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23
Q

Progesterone challenge test used for ____

Result interpretation:

A

determining ovarian disorders in secondary amenorrhea

If withdrawal bleeding = ovarian cause –> anovulatory. Estrogen present to build up the endometrial lining.

If no bleeding = Hypoestrogenic (Hypothalamus-Pituitary failure OR uterine disorder

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24
Q

Hypothalamus dysfunction causing amenorrhea occurs when ____

Causes:

Tx:

A

disruption of pulsatile GnRH –> low FSH and/or LH from pituitary

Causes: Anorexia, weight loss, exercise**
Stress, nutritional deficiency, systemic disease

Tx:
Clomiphene = estrogen agonist/antagonist actions to stimulate gonadotropin release and ovulation
Menotropin = gonadotropin secretion

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25
Q

Ovarian disorders causing amenorrhea will show (high/low) FSH, (high/low) LH, (high/low) (Estradiol/Prolactin).

A

High FSH and LH

Low Estradiol

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26
Q

Pituitary disorders causing amenorrhea will show (high/low) FSH, (high/low) LH, (high/low) (Estradiol/Prolactin).

Tx:

A

Low FSH and LH
High Prolactin

Tx:
OCP
Bromocriptine (Dopamine agonists to inhibit prolactin)

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27
Q

Asherman’s Syndrome =

Dx:

Tx:

A

Acquired endometrial scarring (overaggressive D and C)

“A”dhesions + “A”menorrhea

Pelvic US showing absence of normal uterine stripe

Tx: Estrogen

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28
Q

Primary dysmenorrhea is caused by ___

A

High prostaglandins = painful uterine muscular wall

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29
Q

Premenstrual Syndrome diagnostic criteria:
Minimum of ___ symptoms need to begin ___.
Must be in ____ (prior/during/after) menstruation.
Must be symptom free for ____ in ____ of cycle.
Must occur in ___ cycles.

A

Minimum of FIVE symptoms need to begin THE WEEK PRIOR TO MENSES.
Must be in 2 WEEKS PRIOR menstruation.
Must be symptom free FOR 7 DAYS in FIRST HALF of cycle.
Must occur in 2 CONSECUTIVE cycles.

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30
Q

Severe PMS w/ FUNCTIONAL impairment

A

Premenstrual Dysphoric Disorder (PMDD)

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31
Q

Menopause: increased ___ levels, decreased ___ levels.

A

Increased FSH >25 (confirms dx)

Decreased estradiol

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32
Q

Most effective tx for menopausal vasomotor symptoms (hot flashes/night sweats)

Tx of mood symptoms?

A

Estrogen

SSRI/SNRI

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33
Q 
Which of the following is NOT a risk factor for uterine/endometrial polyps?
A. Obesity
B. Cervical polyps
C. HTN
D. Methotrexate
A

D. Tamoxifen (tx of breast cancer) is a RF

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34
Q

Medication tx of uterine/endometrial polyps

A

Progestins

Leuprolide (GnRH inhibitor)

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35
Q

Polycystic Ovarian Syndrome has unknown etiology but possibly d/t ____, which results in ___

A

Elevated LH:FSH ratio

Suppression of pituitary FSH, constant LH stimulation, anovulation, multiple cysts, theca cell hyperplasia, excess androgens

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36
Q

LH stimulates ___ to produce ___, which are shunt to ___, which aromatize into ___.

A
  • theca cells
  • androstenedione and testosterone
  • granulosa cells
  • estrone and estradiol
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37
Q

Presentation of Polycystic Ovarian Syndrome

A

Hirsutism*
Obesity*
Amenorrhea*
Signs of hyperandrogenism (hair, deep voice)

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38
Q

“String of pearls” on TVUS

Other dx:

A

PCOS

LH:FSH > 2 or 3:1

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39
Q

Tx of PCOS

A
  • Metformin: restore ovulatory menses
  • Clomiphene: stimulate ovulation
  • Low dose OCP or spironolactone: hirsutism and acne
  • Weight loss
  • Dexamethasone?
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40
Q

MC pathogen of bacterial vaginosis

A

Gardnerella

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41
Q

T/F: Candida vaginitis has acidic pH <4.5.

A

True. BV and Trichomonas have basic pH >4.5

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42
Q

Lymphogranuloma Venereum (LGV) is caused by ___.

Dx:

Tx:

A

Chlamydia Trachomatis

Dx:

  • Complement fixation test >1:16
  • Bubo aspiration and culture for chlamydia

Tx: Doxycycline, tetracycline or erythromycin

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43
Q

PAP smear for women age ___ Q ___.

PAP + HPV for age ___ Q ___.

A

21-65, Q 3 years

30-65, Q 5 years

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44
Q

What to do if PAP shows ASCUS?

When do you do colposcopy?

When do you redo pap in 1 year?

What do you do if negative HPV?

A

HPV reflex testing

If + HPV >24 y/o –> colposcopy

If + HPV and 21-24 y/o –> redo pap in 1 year

If - HPV –> back to routine schedule

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45
Q

Chancroid caused by what pathogen?

Co-infection?

Presentation?

Tx?

A

Haemophilus ducreyi

Co-infect: HSV, T. pallidum

Presentation: EXTREMELY painful ulcers w/ soft, ragged edges
Malaise, HA, anorexia

Tx: Azithromycin*
Cetriaxone, Cipro

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46
Q

Leading cause of infertility and ectopic pregnancy in young, Nulliparous, sexually active women

Tx:

A

Pelvic Inflammatory Disease (PID)

Broad spectrum abx, at least 2: Cetriaxone + doxycycline

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47
Q

Condyloma Acuminata caused by ____

Dx:

Tx:

A

HPV strain 6, 11

Dx: Acetic acid –> appear white raised plaques

Tx:
Cryotherapy
Podofilox (CI in pregnancy)
Imiquimod

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48
Q

Syphilis is caused by ____

Presentation of each stage:

A

Treponema pallidum

Initial (10-60 days):
Chancre
Secondary (1-3 months):
- Condylomata lata = soft, flat, moist papules scattered on perineum
- scattered discrete coppery papules on palms of hand/feet
Tertiary:
Gummas: granulomas of skin

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49
Q

Dx of Syphilis

A

Dark field microscopy
+
Direct fluoresecent antibody tests
- Screening: VDRL, RPR (rapid plasma reagent)
- Confirm: TPPA (Treponema pallidum particle agglutination assay), FTA-ABS (Fluorescent treponemal antibody absorption test )

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50
Q

Screening for syphilis during pregnancy with ___

A

RPR antibody

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51
Q

Tx of syphilis

A

Benzathine Penicillin G
PCN allergy: Doxycycline

F/u w/ VRDL titers at 3, 6, 12 months

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52
Q

Genital herpes most commonly caused by ___.

Viral shedding occurs for ___.

Time it takes to heal?

A

HSV-2

3 weeks

10-22 days

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53
Q

Dx of genital herpes

A

Tzanck smear*

PCR testing

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54
Q

Precaution for pregnant women w/ active genital herpes lesions

Disseminated infection in neonates

A

Require C-section delivery

Encephalitis, eyes, skin, mucosa

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55
Q

Thinning of epidermis and fibrosis of dermis –> leukoplakia, thinning (parchment-like) vulvar skin

T/F: It causes increased risk for vulvar basal cell carcinoma.

A

Vulvar Lichen Sclerosus

False. Squamous carcinoma

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56
Q

Hyperplasia of vulvar squamous epithelium associated w/ chronic itching and irritation causing thicker, leathery skin

T/F: No risk of cancer development

A

Lichen Simplex Chronicus

True

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57
Q

Fetal complications of Erythema infectiosum (5th’s dz)

A

Fetal loss
Fetal hydrops
Fetal viral myocarditis

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58
Q

Adults with 5th’s dz present w/

A

Rash, fever, lymphadenopathy, arthritis

Acute transient aplastic crisis*

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59
Q 
All of the following are risks of Ovarian Neoplasms EXCEPT:
A. Early menarche
B. Nulliparity
C. Late menopause
D. OCPs
A

D. OCPs are protective.

Risk = uninterrupted ovulation. Infertility

Protective = multiparity, breastfeeding, hysterectomy, chronic anovulation

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60
Q

Tumor marker used to monitor Ovarian Neoplasms

A

CA-125

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61
Q

MC type of Ovarian neoplasm

A

Epithelial

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62
Q

Highest mortality of all gynecological cancers

A

Ovarian cancer

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63
Q

T/F:OCPs are protective against breast cancer.

A

FALSE: unopposed estrogen is a risk factor of breast cancer.
Other risk factors: AGE ***, nulliparity, early menarche, late menopause

OCP is protective in Ovarian Cancer.

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64
Q

MC type of breast cancer

A

Invasive ductal carinoma

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65
Q

Most common gynecological cancer

A

Endometrial cancer

66
Q

Gynecological cancer that is ESTROGEN dependent

A

Endometrial cancer

Biggest risk factor = high estrogen exposure

67
Q

MC site of metastasis in endometrial cancer

A

Lungs

Do CXR

68
Q

90% of vulvar cancers are ____.

Develop from 2 pathways:

A

squamous cell carcinoma

  1. HPV 16 and 18
  2. Long standing lichen sclerosus
69
Q

T/F: You should stop breastfeeding if you have mastitis.

A

False. Stop breastfeeding w/ breast abscess. Continue breastfeeding in mastitis.

70
Q

T/F: Fibroadenomas may fluctuate with menstrual cycle.

A

False. Fibroadenomas do NOT change. Fibrocystic breast changes fluctuate w/ menstrual cycle.

71
Q

Cystocele presents with ____

A

Stress urinary incontinence

Feeling of vaginal fullness

72
Q

Procidentia

A

Cervix extends beyond vulva

73
Q

Definitive dx of ovarian torsion

A

Laparoscopy

US can’t r/o

74
Q 
All of the following are ABSOLUTE CI for estrogen EXCEPT:
A. DVT/PE
B. Stroke
C. CAD
D. Thromboembolic d/o
E. Breast/endometrial cancer
A

D. Thromboembolic d/o is a RELATIVE CI

75
Q

1st line tx for endometriosis

A

Combination OCPs + NSAIDs

–> severe cases: Depot Leuprolide injections (GnRH agonist) –> decrease pituitary, no LH and FSH

76
Q

Decreased pelvic organ mobility, endometrium proliferates outside of uterus and leads to pain, eventual scar tissue development in pelvis =

A

Endometriosis

77
Q

Ectopic endometrial tissue within myometrium (muscle layer of uterine wall) =

Presentation:

A

Adenomyosis

Tender symmetrically, “boggy uterus”

78
Q

Tx of Adenomyosis:

A

Total Abdominal Hysterectomy (TAH) = only effective treatment

79
Q

1 risk factor of Leiomyomas/fibroids:

A

ESTROGEN:
multiparity, late/menopause/early menarche, oral estrogen

Menorrhagia

80
Q 
All of the following are charcteristics of Leiomyomas EXCEPT:
A. Nontender
B. Irregular
C. Firm
D. Symmetric
A

D. Asymmetric. Adenomyosis is symmetric, soft, tender.

81
Q

Leiomyomas are differentiated from adenomyosis by ____ seen on MRI/US

A

pseudocapsule

82
Q

Treatment of Leiomyomas

Definitive tx?

A
  • Observation if asymptomatic other than menorrhagia
  • Saline infusion sonohysterography
  • Progestins, Leuprolide, Mifepristone
  • NO estrogen

Definitive: Hypsterectomy

83
Q 
Causes of ovarian cysts include all EXCEPT:
A. Hyperthyroidism
B. Early Menarche
C. Use of Tamoxifen
D. Early menopause
A

A, D.

HYPOthyroidism

84
Q

Detrusor muscle is under ___ control.

Internal sphincter is under ___ control.

External sphincter is under ___ control.

A

Detrusor muscle is under PARAsympathetic (Beta-adrenergic) control.

Internal sphincter is under ALPHA-adrenergic control.

External sphincter is under ___ control.

85
Q

History of Imipramine use for postpartum depression may cause ___

A

Hyperprolactinemia –> infertility

and visual changes

86
Q

Most common cause of infertility

A

Polycystic Ovarian Syndrome –> causes increased levels of estrogen production –> inhibit FSH and LH

87
Q

Criteria for PCOS dx:

A

2 of 3:

  • Oligo and/or anovulation
  • Hyperandrogenism –> test Testosterone
  • Polycystic ovaries on US –> “string of pearls”
88
Q

Tx of Polycystic Ovarian Syndrome (PCOS)

A
  • METFORMIN: lowers glucose, insulin, testosterone levels –> spontaneous ovulation
  • Estrogen receptor modifiers
  • Clomiphene (Clomid) –> inhibit negative feedback of estrogen on release of gonadotropin
89
Q

Ladin’s Sign =

Piscacek’s Sign =

Goodell’s or Hagar Sign =

Chadwick’s Sign =

A

Ladin’s Sign = uterus softening at 6 weeks

Piscacek’s Sign = palpable uterus lateral bulge at 7-8 weeks

Goodell’s or Hagar Sign = cervical softening at 4-5 weeks

Chadwick’s Sign = Cervix/vulvar bluish at 8-12 weeks

90
Q

G4P1123 =

A 
G = # of times women has been pregnant
P = number of pregnancies that resulted in birth at or beyond 20 weeks
TPAL = Term, Preterm, Abortuses, Living children

Woman gave birth to set of preterm twins, 1 38 week infant, 2 miscarriages

91
Q

Expected Due Date =

A

1st day of LMP - 3 months + 1 week, + 1 year

92
Q

Fundal height:
___ weeks = pubic symphysis
___ weeks = umbilicus
___ weeks = elevates ~ 1 cm above umbilicus for each week of pregnancy

A

12 weeks = pubic symphysis
20 weeks = umbilicus
After 20 weeks = elevates ~ 1 cm above umbilicus for each week of pregnancy

93
Q

Preterm =

Term =

A

24-37 weeks = preterm

37-42 weeks = term

94
Q

Triple Screening at ___ weeks

What is tested?

A

15-20 weeks

alpha Fetoprotein (a-FP), b-HCG, Estradiol

95
Q

low a-FP, HIGH b-HCG, low estradiol suggests ___

A

Trisomy 21

96
Q

HIGH a-FP suggests ___

A

Open neural tube defect
OR
multiple gestation

97
Q

low a-FP, low b-HCG, low estradiol suggests ___

A

Trisomy 18 –> stillborn or die w/i 1 year

98
Q

Fetal imaging start at ____ weeks.

GBS screening at ___.

A

18-22 weeks

32-37 weeks

99
Q

Chorionic VIllus Sampling can be performed at ___.

Amniocentesis can be performed at ____.

A

9-12 weeks (earlier than amniocentesis)

> 15 weeks

100
Q

Macrocytic anemia, tongue soreness, numbness/tingling of feet, impaired cognitive function suggests ___ deficiency

A

Cobalamin (B12) deficiency

101
Q

Quad screen includes:

A

alpha Fetoprotein (a-FP), b-HCG, Estradiol AND Inhibin-A

Detects Down Syndrome 81%, 5% false positive

102
Q

Gestational diabetes screen performed at ___ weeks with ____. If elevated > ____, f/u w/ ____. Diagnosis established when ___.

A 
27 weeks
1 hr glucose tolerance test
>135
3 hr GTT
2 or more of 4 tests are abnormal
103
Q

Sex of fetus determined at ___ weeks via US.

104
Q

1 tx of Hyperemesis gravidarum

A

Pyridoxine (vit B6) +/- doxylamine (Unisom)

105
Q

hCG levels double every ____, peaks at ____ in normal pregnancy

A

48 hrs

10-12 weeks

106
Q

PUPPP =

A

pruritic urticarial papules and plaques of pregnancy = papulovesicular lesions on trunk and extremities

107
Q

T/F: Mother is considered G1P2 if she is pregnant with twins

A

False: Still G1P1

108
Q

APGAR scoring evaluated at ____ after birth.

Score and meaning:

A 
7-10 = good
4-6 = assist, stimulate
<4 = resuscitate
109
Q

APGAR stands for? How is each category scored?

A

Appearance: 2 = pink all over; 1 = pink w/ blue extremities; 0 = blue/pale

Pulse: 2 = > 100 bpm, 1 = <100 bpm, 0 = absent

Grimace: 2 = cough/sneeze/vigorous cry; 1 = grimace/slight cry, 0 = no response

Activity: 2= active movement, 1 = some movement/flexed extremities, 0 = limp

Respiration: 2 = slow/crying, 1 = slow, irregular, 0 = absent

110
Q

What type of abortion?

Bleeding before 20 weeks gestation

A

Threatened abortion. “Catch-all” dx

111
Q

What type of abortion?

Some but not all intrauterine contents expelled

A

Incomplete abortion

Tx: D and C

112
Q

What type of abortion?

Dilated cervical os, cramping, +/- bleeding

A

Inevitable abortion

113
Q

What type of abortion?

POCs have been completely expelled from uterus

A

Complete abortion

114
Q

What type of abortion?
Fetal demise w/o cervical dilatation
Asymptomatic

A

Missed abortion

115
Q

What type of abortion?

With intrauterine infection

A

Septic abortion

116
Q

Medical abortion most commonly use ____.

Time limits?

A

Mifepristone + Misoprostol

24-48 hrs –> up to 9 weeks gestation

117
Q

Spontaneous abortion = loss of pregnancy without outside intervention before ___.

A

20 weeks gestation

118
Q

Placenta previa =

Tx:

A

PainLESS uterine bleeding 27-32 weeks

C section if 37 weeks OR unstable
Otherwise: observe, hgb checks, steroids

119
Q

Premature placenta separation from uterine wall with hemorrhage =

Presentation:

Dx:

Risks:

A

Placental abruption (abruption placentae)

PainFUL bleeding**

US is NOT HELPFUL in dx. Pelvic exam and hx ONLY.

Risk: TRAUMA**

120
Q

Toxoplasmosis during pregnancy can cause ___ in newborn.

A

hepatosplenomegaly

121
Q

T/F: Rubella vaccine is administered at 16 weeks of pregnancy to prevent congenital disease.

A

FALSE: DO NOT give vaccine during pregnancy

122
Q

Most common congenital infection =

A

Cytomegalovirus

123
Q

Women with 1-2 prior second-trimester pregnancy losses or preterm births + cervical length < 25 mm on TVUS or advanced cervical changed on PE before 24 weeks =

A

Incompetent cervix

124
Q

Tx of incompetent cervix for
Previable fetus:
Viable fetus:

A

Previable fetus:
elective termination OR
Cerclage placement (suture cervix to hold it closed)

Viable fetus:
Betamethasone (glucocorticoid to enhance fetal lung maturity) + strict bed rest
Tocolytics (Ritodrine) = prevent contractions and progression of labor if there is preterm labor contractions

125
Q

Universal Gestational Diabetes screening is recommended for all pregnant women at ____ weeks.

Screening =

Definitive diagnosis =

A

24-28 weeks

Screening:

  • Random blood sugar >200 OR fasting glucose >126 on 2 occasions = diagnostic
  • Non-fasting 50 gm oral glucose challenge test > 140 = positive

Definitive:
3 hour glucose tolerance test

126
Q

Tx of choice for gestational diabetes

If fasting blood glucose is high, use ___
If postprandial glucose is high, use ___
If both fasting and postprandial glucose are high, then ___

A

Insulin

Fasting: NPH insulin at bedtime
Postprandial: regular insulin before meals
Both: NPH before breakfast and bedtime + regular insulin before each meal

127
Q

Gestational HTN = Persistent ___ mmHg, (with/without) proteinuria, at or after ___ weeks.

Tx:

A

> 140/>90
WITHOUT
20 weeks

Tx: methyldopa

128
Q

Preeclampsia = ___ mmHg + ____

Tx:

A

> 140/>90
Porteinuria of 0.3 gm or greater in 24 hr urine

Tx: bedrest, Methyldopa

129
Q

HELLP syndrome =

Seen in ___

A

Hemolysis, Elevated Liver enzyme, Low Platelet

Severe preeclampsia (>160/110, >5 gm protein in 24 hrs)

130
Q

Tx of severe preeclampsia

A

-Antihypertensive
-Mg sulfate = seizure prophylaxis
-Betamethasone x2 24 hrs apart = speed up lung development if under 33 weeks
Induce delivery

131
Q

Occurrence of 1 or more conuslions in presence of preeclampsia =

Tx:

A

Eclampsia

Tx: Mg sulfate for seizures –> may cause hyporeflexia –> Ca gluconate

132
Q

Painless, abnormal vaginal bleeding, preeclampsia, tachycardia, tachypnea is presentation of ___.

A

Molar pregnancy

133
Q

Dx of molar pregnancy:
hCG =
US shows ___

A

hCG >100,000

US: cluster of grapes, snowstorm appearance

134
Q

Complete mole =
karyotype:

Partial mole =
karyotype:

A

Complete: 46XX
Fertilization of egg that had no chromosomes

Partial: 69XXY
Fertilization of ovum by 2 sperms

135
Q

Complete moles have a 2 % chance of developing into ___.

A

Choriocarcinoma

136
Q

Sheets of anaplastic cytotrophoblasts and syncytiotrophoblasts w/o chorionic villi =

A

Choriocarcinoma

137
Q

Choriocarcinoma tx

A

Methotrexate

Actinomycin D

138
Q

Tx of Rh-Incompatibility

A

300 mg Rh immunoglobulin given to Rh - mother at 28 weeks and within 72 hours of delivery

139
Q

Erb palsy

A

Fetal brachial plexus injury

Complication d/t shoulder dystocia

140
Q

Tocolytics =

Examples:

A

medication that suppresses premature labor

  • Betaminmetics* (ritodrine, terbutaline)
  • Magnesium sulfate
  • Nifedipine (CCB)
  • Indomethacin (anti-prostaglandins)
  • Oxytocin ANTAgonists
141
Q

Tx of preterm labor =

A
  • Tocolytics
  • Dexamethasone/betamethasone (stimulate fetal lung development)
  • GBS prophylaxis: PCN
142
Q

Prenatal screening for vaginal and rectal GBS at ____ weeks.

143
Q

MC cause of life-threatening infections in newborns.

A

GBS

Sepsis, meningitis, newborn pneumonia

144
Q

Prolapsed umbilical cord will cause ____ after membrane rupture

A

severe variable deceleration or bradycardia

145
Q

Abnormal accumulation of fluid in fetal tissue =

A

Hydrops fetalis (fetal hydrops)

146
Q

All of the following are reassuring fetal status EXCEPT:
A. Minimal variability
B. Active fetal movement
C. 2 accelerations in 20 minute period

A

A. Moderate variability (6-20 bpm) is good. Minimal (<5 bpm), marked (>20 bpm) or absent variability is bad.

Reactive strip = 2 accelerations of >15 seconds w/ peak of >15 bpm in 20 min period

147
Q

Uterine myometrium fails to contract following delivery =

Tx:

A

Uterine atony

Tx:
- Bimanual uterine massage*
- Uterotonic agents =
IV oxytocin*
Prostaglandins (CI in asthma)
Methylergonovine (CI HTN/pre-eclampsia)
Bakri Balloon (good for HTN)
148
Q

Bloody mass seen near introitus after delivery =

Tx:

A

Uterine inversion

Tx: ** Steps

  1. Uterine relaxants/tocolytics (Mg sulfate, terbutaline)
  2. Replace proper position (place fist inside uterus)
  3. Uterotonics agents (oxytocin)
149
Q

Sheehan Syndrome

Tx:

A

Pituitary infarct d/t hypovolemia and hypotension
–> absence of lactation d/t loss of prolactin OR no restart of menstruation d/t loss of gonadotropins

Tx: find cause, fluid resuscitation, blood transfusion

150
Q

Tx of endometritis
Prophylaxis:
W/ C-section:
W/ vaginal delivery:

A

Prophylaxis: 1st gen cephalosporin during C-section

W/ C-section: Clindamycin + gentamicin
W/ vaginal delivery: Ampicillin + gentamicin

151
Q

What congenital disorder?

Rocker bottom feet

A

Trisomy 18

152
Q

Klinefelter syndrome = ___ karyotype

(high/low) testosterone, (high/low) FSH/LH

Phenotype:

A

47, XXY

low testosterone, high FSH/LH

Male, hypogonadism
Long extremities
Decreased intelligence, behavioral problems

153
Q

Low birth weight, poor muscle tone, microcephaly, language difficulties, profound retardation =

Results from ___.

A

Cri Du Chat

Deletion of long arm of chromosome 5

154
Q

Diagnosis of Premature Rupture of Membranes (PROM)

A

Direct visualization

Fern test OR nitrazine paper: pH >6.5

155
Q

MC cause of infertility

A

Endometriosis

156
Q

Classic triad presentation of Endometriosis

A

Premenstrual pelvic pain
Dysmenorrhea
Dyspareunia (pain w/ sex)

157
Q

Definitive diagnosis of Endometriosis

A

Laparoscopy

158
Q

Premature labor = Regular uterine contractions w/ progressive cervical changes before ___ weeks gestation.
Cervical dilation =
Effacement =

A

37 weeks

> 3 cm cervical dilation
80% effacement

159
Q

Tx of choice of chronic HTN in pregnancy

What meds should be avoided?

A

Methyldopa if BP > 150/100

Avoid ACEI** and diuretics

160
Q

BP med should be started if BP > ____ in preeclampsia

A

> 180/110

Hydralazine**, Labetalol, Nifedipine

161
Q

Schiller Test

A

Evaluates cervix after abnormal Pap smear. Iodine staining highlights areas of rapid cell turnover.

PANCE (20 decks)

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