OB/GYN

Question 1

At what gestational age can you see gestational sac with yolk sac

Answer 1

4-6 weeks

Question 2

CCS: what should we order in newly diagnosed pregnant patients?

Answer 2

Pregnancy counseling… order icon, “counsel patient, pregnancy

Question 3

what does parity mean?

Answer 3

of births with a gestational age >20wk

Question 4

What are the first trimest routine tests?

Answer 4

CBC, type and screen, direct and indirect coombs, PAP, UA and UC, Rubella antibody, HepBs Ag, VDRL or RPR, ELISA for HIV, Cervical cx for chlamydia/gonorrhea, TB with Quant gold, Trisomy 21 testing

Question 5

What do you confirm a + ELISA screen with?

Answer 5

Western blot: presence of HIV core and envelope Ag’s

Question 6

What do you confirm +VDRL/RPR with?

Answer 6

FTA

Question 7

How do you manage Anemia with low MCV in early preggo?

Answer 7

give iron, test for thalassemia if anemia does not improve

Question 8

How do you manage anemia with high MCV in early preggo?

Answer 8

give folate

Question 9

What does Trisomy 21 Early testing consist of?

Answer 9

B-hCG, Pregnancy associated plasma protein A (PAPP-A), Fetal nuchal translucency

Question 10

What is a Trisomy 21 positive screening test confirmed with in 1st trimester?

Answer 10

Chorionic villus sampling or amniocentesis

Question 11

What is Anemia in pregnancy caused by?

Answer 11

increased levels of hepcidin, which inhibits iron transport… preggo increases iron demand, but hepcidin prevents absorption

Question 12

What are some unique features of Chlamydia and gonorrhea

Answer 12

Chlamydia is an obligate intracellular parsite that needs a host cell to survive
Neisseria is a gram-negative diplococcus that grows on chocolate agar… NAAT is the test of choice

Question 13

If a mom has negative rubella antibody titer, what do you do?

Answer 13

DONT IMMUNIZE HER!, wait until after pregnancy to do that

Question 14

How do we manage HIV positive moms

Answer 14

antiretrovirals are recommended in pregnancy, give zidovudine in labor

Question 15

Tx for chlamydia/gonorrhea

Answer 15

PO azithromycin + IM ceftriaxone

Question 16

Tx for bacterial vaginitis

Answer 16

PO or vaginal metronidazole or clindamycin

Question 17

Tx for trichomonas vaginalis

Answer 17

PO metronidazole for mother and partner

Question 18

What to do with Rh negative moms

Answer 18

give rhogam at 28 weeks AFTER first rescreening for absence of anti-D antibodies
-give it to Rh negative mothers after any procedure and after delivery (including CVS, amniocentesis)

Question 19

why do we always treat asymptomatic bacteriuria in pregnancy?

Answer 19

30% risk of pyelonephritis

-use cephalosporins or amoxicillin

Question 20

If there is increased levels of Inhibin A, what does the fetus have?

Answer 20

Down syndrome

Question 21

What is the most common cause of an abnormal maternal serum alpha fetoprotein (MS-AFP)

Answer 21

gestational error

-so get an obstetric U/S to confirm getstational date

Question 22

What does the second trimester Quad screen consist of? (btw, this is the only thing we do in 2nd trimester

Answer 22

• MS-AFP
• B-hCG
• Estriol
• add Inhibin A in high-risk women (otherwise it is a triple screen)

Question 23

what does increased MS-AFP mean?

Answer 23

NTD, Ventral wall defect, twin preggo, placental bleeding, renal disease, sacrococcygeal teratoma

Question 24

What is the quad screen look like for down syndrome?

Answer 24

decreased MS-AFP, Estriol

incrased B-hCG, Inhibin A

Question 25

Quad screen results indicative of trisomy 18 (edwards)

Answer 25

everything is down

Question 26

First thing we do in an abnormal MS-AFP

Answer 26

perform U/S to confirm dating

• (increased MS-AFP)amniocentesis for amniotic fluis AF-AFP (amniotic fluid) level and acetylcholinesterase activity
• (decrased MS-AFP) amniocentesis for karyotyping

Question 27

What are elevated levels of amniotic fluid acetylcholinesterase activity specific for?

Answer 27

Neural tube defects

Question 28

How do you work up gestational diabetes?

Answer 28

first step is 1 hr 50g OGTT at 24-28 wks

-then, if positive, do the 3hr 100g OGTT to confirm

Question 29

What are all the screening things we do in 3rd trimester screening?

Answer 29

• 1 hr 50g OGTT 24-28 wks
• CBC at 24-28 wks
• Indirect coombs test
• Vaginal and rectal cx and GBS at 35-37 wks

Question 30

Mom is GBS positive and in labor, what do you do?

Answer 30

IV penicillin G

• IV clinda or eryth if allergic AND we have sensitivities
• if no sensitivities: IV Vanc

Question 31

what is a positive 1 hr OGTT?

Answer 31

blood glc >130-140

Question 32

What is a positive 3 hr OGTT?

Answer 32

> 180 at 1 hr
155 at 2 hr
140 at 3 hr

Question 33

How do you interpret a 3 hr OGTT?

Answer 33

if 1 postflc load measurement is abnormal, dx is impaired glc tolerance
-if 2 or more of the postglucose loads are abnormal, the dx is gestational diabetes

Question 34

Why do we screen everyone for gestational diabetes?

Answer 34

because the symptoms are not always there, and if they are, they are usually not the “classic” diabetes symptoms

Question 35

What is the threshold of radiation exposure that the infant will start to see adverse effects from it?

Answer 35

50mGy (milligrays)

Question 36

What are the components of the Bishop score?

Answer 36

DESPC

• dilation
• effacement
• station
• postition
• consistency

Question 37

What is a Bishop’s score?

Answer 37

tells us whether it’s a good idea to induce a mom!

• total score= 13
• threshold of being ok to induce: 6

Question 38

When treating an ectopic pregnancy, when should you give another dose of methotrexate?

Answer 38

if the B-hCG has not decreased by 15% from days 4-7

-this is why it’s super important to follow their B-hCG!