Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Uworld/shelf > OB/Gyn > Flashcards

OB/Gyn Flashcards

1
Q

external cephalic version can be performed at __ weeks

A

> =37 weeks
to decrease risk of prematurity if complication occurs (eg contractions, fetal distress, premature rupture of membranes- all would require immediate delivery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

contraindications to external cephalic version

A

Contraindications to vaginal delivery

  • previous classical cesarean delivery
  • extensive myomectomy (fibroid removal)
  • placenta previa

These patients will undergo Cesarean at 37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

choriocarcinoma most commonly metastasizes to the __

A

lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

presentation of choriocarcinoma

A
  • amenorrhea or abnormal uterine bleeding
  • pelvic pain/pressure
  • sxs from mets (lung, vagina)
  • uterine mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

diagnosis of choriocarcinoma is confirmed by __

A

elevated b-hCG level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

treatment for postpartum endometritis

A

clindamycin + gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

clinical features of acute fatty liver of pregnancy

A

n/v
RUQ/epigastric pain
fulminant liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

lab findings of acute fatty liver of pregnancy

A
  • profound hypoglycemia (liver can’t convert glycogen to glucose)
  • elevated aminotrnsferases (2-3x normal)
  • elev bilirubin
  • thrombocytopenia (dt fulminant liver failure)
  • possible DIC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

management of acute fatty liver of pregnancy

A

immediate delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

when is it considered preterm prelabor rupture of membranes

A

<37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

risk factors for preterm prelabor rupture of membranes

A

anything that distends or weakens the membranes

  • polyhydramnions
  • GU infection
  • antepartum bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

management of uncomplicated preterm prelabor rupture of membranes <34 weeks

A

inpatient expectant management with:
-prophylactic latency antibiotics (to prevent intraamniotic infection thereby increasing time between rupture and delivery)

  • corticosteroids eg betamethasone (decr risk of neonatal respiratory distress syndrome)
  • fetal surveillance (nonstress tests, fetal growth ultrasounds)
  • tocolysis contraindicated as contraction often indicate complication that requires delivery or intervention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

magnesium sulfate needed for preterm deliveries __ weeks and why?

A

<32 weeks if imminent delivery

fetal neuroprotection - reduce risk of cerebral palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

time of onset postpartum blues vs depression vs psychossi

A

blues- 2-3 days (resolves within 2 weeks)

depression- within 4-6 weeks (can be up to 1 year)

psychosis - days to weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

risk factors amniotic fluid embolism

A 
advanced maternal age
gravida >=5
cesarean or instrumental delivery
placenta previa or abruption 
preeclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

2 main causes of cutaneous SCC

A

HPV infection

frequent sun exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mammary paget disease is associated w what condition

A

adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

appearance of mammary paget disease

A

persistent, eczematous and/or ulcerating rash at nipple and spreads to areola

pain, itching, burning, no relief with corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

why might pt with von willebrand disease have normal PTT?

A
  • mild to moderate vwf deficiency, may have enough factor 8 to maintain PTT levels
  • stress or inflammation; vWF and factor 8 are acute phase reactants
  • (pregnancy, OCP), thyroid hormone replacement increase vWF synthesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how is the first stage of labor divided?

A

latent (0-6cm)

active (>=6-10cm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

normal labor progression in active phase

A

cervix dilates at least 1cm per hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when is cesearean delivery needed during labor?

A

active labor arrest- no cervical change for 4 or more hours with adequate contractions / 6 hours or more with inadequate contractions; or category III Fetal heart tracing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

when is an intrauterine pressure catheter placed?

A

when labor hasn’t completely arrested but cervical change slows to <1cm/2 hr (labor protraction)

if inadequate contractions, labor is augmented with oxytocin to incr contraction frequency and force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

definition uterine tachysystole

A

> 5 contractions every 10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

criteria of gestational hypertension (as opposed to chronic htn)

A

systolic pressure >= 140 or diastolic >=90 prior to conception OR 20 weeks

no proteinuria or end organ damage (otherwise preeclampsia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

maternal complications/risks of HTN

A
  • superimposed preeclampsia
  • postpartum hemorrhage
  • gest diabetes
  • abruptio placentae
  • cesarean delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

fetal risks when mom has HTN

A
  • fetal growth restriction
  • perinatal mortality
  • preterm delivery
  • oligohydramnios
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

fetal bradycardia rate? tachycardia?

A

<110 brady

>160 tachy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

causes of fetal tachycardia

A

(>160)

  • maternal fever
  • med side effect (eg beta agonists)
  • fetal hyperthyroidism
  • fetal tachyarrythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

causes of fetal bradycardia

A
  • maternal hypothermia
  • med side effect (eg beta blockers)
  • fetal hypothyroid
  • fetal heart block (eg anti Ro/SSA, anti-La/SSB)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

signs and symptoms of chorioamnionitis/intraamniotic infection

A
  • maternal fever >= 39C without another clear cause
  • leukocytosis >15
  • and/or purulent amniotic fluid

risk of developing IAI increases as labor progresses and after membrane rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

complex ovarian cyst with calcified and hyperechoic areas

A

mature cystic teratoma (dermoid cyst)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

explain hydrops fetalis in alpha thalassemia major

A

fetus makes hemoglobin barts (4 gamma chains) which have extremely high O2 affinity, doesn’t release O2 to tissues –> severe fetal hypoxrmia –> high output heart failure –> hydrops fetalis (eg skin edema, ascities) and fetal demise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

friable cervix, yellow discharge in young female

most likely microscopic finding?

A

n gonorrhea or
chlamydia

no organisms (both are intracellular)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

initial workup of recurrent pregnancy loss

A
  • pelvic u/s
  • karyotype
  • thrombophilia testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is placenta previa

A

placenta covers the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

risk factors placenta previa

A
  • previous placenta previa
  • prior c-section
  • multi gestation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

how does placenta previa present

A

painLESS vaginal bleeding >20 weeks gestation
(eg nontender uterus, painless ireggular contractions)

*note bleeding is mostly maternal origin so many pts have reassuring fetal monitoring initially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

management placenta previa

A
  • no sex
  • no digital cervical exam
  • inpatient admission for bleeding episodes

most previas resolved by 3rd trimester
if persistent previa, undergo c-section at 36-37 weeks (prior to onset of labor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is placental abruption, how does it present?

A

(separation of placenta from uterus prior to fetal delivery

  • vaginal bleeding
  • uterine contractions
  • constain abdominal PAIN
  • fetal decels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

definition preterm labor

A

cervical dilation 3cm or more, or effacement (length <2cm) with regular painful contractions at <37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

pathognomonic finding ovarian torsion

A

lack of doppler flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

indications for giving anti-D immunoglobulin for Rh(D) negative patients

A
  • at 28-32 weeks gestation
  • within 72h of delivering Rh+ baby
  • within 72h after spontaneous abortion
  • ectopic preg
  • threattened abortion
  • hydatidiform mole
  • chorionic villous sampling, amniocentesis
  • abdominal trauma
  • 2nd and 3rd trimester bleeding
  • external cephalic version

**not indicated if dad is Rh-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

GBS rectovaginal screening should be performed at __ weeks

A

35-37 weeks

results valid for about 5 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

definition of short interpregnancy interval

A

<18 months from delivery to next pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

complications of short interpregnancy interval

A
  • maternal anemia
  • PPROM
  • preterm delivery
  • LBW
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what causes painful genital ulcers

A

HSV, h ducreyi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what causes painLESS genital ulcers?

A

treponema pallidum

chlamydia trachomatis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

common side effect of tamoxifen

A

hot flashes

theorized due to antiestrogenic activity in CNS which causes thermoregulatory dysfunction in the anterior hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

how to estrogen agonists increase risk of venous thromboemoblism

A

they increase protein C resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

why are pregnant women at higher risk of pyelonephritis

A

progesterone-related smooth muscle relaxation causes ureteral dilation

–> allows bacteria to ascend readily to upper urinary tract

*one third of pts with asx bacteriuria do no completely eradicate the bacteria so repeat ucx required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

next step for 21yo woman who has atypical squamous cells of undetermined significant, reflex HPV positive for high risk HPV

A

-repeat cytology in 12 months

21-24 is special age grp bc HPV so prevalent

if ASC-US persists for 2 years in age 21-24, would then do colposcopy

(if ASC-US in age >24 would do colposcopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

guidelines cervical ca screening women age 30-64

A
  • cotesting with cytology and HPV every 5 years

- 0r cytology alone every 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

which patients with ASC-US should get reflex HPV testing

A

recommended in patients >30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

when should elective C-section be scheduled

A

at least 39 weeks (dt risk prematurity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

ACOG mammogram guidelines

A

offer screening mammo to women 40 and up annually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

explain causes of R hydronephrosis in pregnancy

A
  • compression by uterus which is rotated right

- right ovarian vein lies over right ureter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

next step if pt has gestational trophoblastic disease

A

CXR

mets most commonly to lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

pregnancy weight gain guidelines

A
  • underweight- gain 28-40
  • normal- gain 25-35
  • overweight- 15-25
  • obese - 11-20
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

do you expect IUGR in pre-existing DM or gestational DM?

A

pre-existing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

mcc elevated maternal serum AFP

other causes

A

most common: underestimation of gestational age

  • twin gestation
  • NTD
  • abdominal wall defects
  • pilonidal cysts
  • cystic hydroma
  • sacrococcygeal teratoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

ibuprofen is safe to take until ___. why?

A

32 weeks

premature closure of ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what blood thinner is contraindicated in pregnancy

A

warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Quad screen

  • components
  • when done
  • who offered to
A

normal risk women in 2nd trimester (16-20 weeks)

AFP
hCG
unconjug estriol
inhibin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Cell free DNA (or NIPT screening) offered to who

when can it be done

A

women at increased risk for fetal aneuploidy

as early as 9 weeks and onward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

risks of gestational DM

A

macrosomia, shoulder dystocia
metabolic disturbances
preeclampsia
polyhydramnios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

most likely cause of variable decels

A

cord compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what is a cause of early decels

A

head compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

features of twin twin transfusion syndrome

A

recipient baby

  • plethoric
  • polycythemic
  • may get HF and hydrops from volume overload and poly

donor baby

  • small
  • anemic
  • IUGR and oligo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

protocol for baby born to HIV+ mom who has been treated

A

start AZT (zidovudine) immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

APGAR components

A 
HR
RR
Reflex
Activity 
Color
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

safest method to suppress lactation

A

-breast binding, ice packs, analgesia. avoid breast stim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

breastfeeding is a/w decreased risk of __

A

ovarian cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what hormonal changes occur right after delivery to allow milk prod?

A

rapid huge decrease in estrogen and progesterone -> progesterone no longer inhibiting alpha-lactalbumin by RER

progesterone withdrawal allows PRL to act unopposed in stimulating alpha-lactalbumin production

incr alpha-lactalbumin stimulates lactose synthase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

signs that baby is getting enough milk

A

3-4 stools in 24h
6 wet diapers in 24h
weight gain
sounds of swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

strategy to increase milk supply and how it works

A

increase suckling - increases supply of oxytocin, which is responsible for milk ejection

(prolactin increases production)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

treatment of nipple candidiasis

A
  • topical clotrimazole or miconazole
  • topical abx for often concurrent nipple fissures- triple antibiotic or mupirocin
  • can rx topical steroid to facilitate healing or cases where nipples are very red and inflamed

-treat baby with oral nystatin, followed by oral flucon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

what can 10-day medroxyprogesterone test tell you

A

can confirm low estrogen levels

presence of estrogen causes endometrial proliferation, which should shed when progesterone is withdrawn

pts without adequate estrogen will have min to no bleeding bc no lining to shed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

what type of contraception is contraindicated in pt with migraine with aura

A

estrogen containing

incr risk stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

untreated asx bacteriuria in pregnancy increases risk of

A

acute pyelo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

cause of chancroid and what does it look like

A

H ducreyi
multiple deep painful ulcers
base may have gray to yellow exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

risk factors for uterine inversion

A

things that overdistend the uterus

  • macrosomia
  • grand multiparity
  • mult gestation
  • polyhydramnios
  • fast delivery
  • placenta accreta

-iatrogenic- too much traction on umbilical cord when delivering placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

management of uterine inversion

A
  • immediate manual replacement (delay-uterus can swell and cervix can contract around it)
  • uterine relaxants (eg nitroglycerine, terbutaline) to assist replacement if unsuccessful. prefer not to use bc can worsen uterine atony after replacement
  • uterotonics only after uterus replaced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

expected fetal tracings in placenta previa vs vasa previa

A
  • normal fetal tracings in placenta previa early on as it’s mostly maternal blood loss
  • rapid deterioration of fetal tracing in vasa previa as bleeding is mostly fetal origin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

presentation of placenta previa

A

-painless vaginal bleeding after 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

dx and management of placenta previa

A
  • dx: transabdominal, then transvaginal u/s

- management: no intercourse, no digital cervical exam; admission for bleeding episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

how to evaluate risk for preterm labor

A

transvaginal u/s of cervical length

short cervix is strong predictor of ptl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

definition short cervix

A

2cm or less without history of ptl

2.5cm or less with history of ptl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

prevention of preterm birth, no h/o preterm labor

A

get TVUS cervical length, if short, give vaginal progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

prevention of preterm birth, yes h/o preterm labor

A

give IM progesterone
get TVUS cervical length, if normal get serial CL until 24
if short, do cerclage and serial CL until 24w

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

how does progesterone help prevent preterm labor

A

it maintains uterine quiescence and protects amniotic membranes against premature rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

hematometra- what is it and cause

A

collection or retention of blood in uterus

caused by imperforate hymen or vaginal septum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

fragile X genetics

A

GCC trinucleotide repeat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

purpose of fetal fibronectin

what is it?

A

negative predictor of preterm delivery

fibronectin is an extracellular matrix protein that acts as adhesive of fetal membranes to decidua; presence in cervical mucous indicates disruption or injury to mat-fetal interface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

testing indicated for recurrent first trimester losses

A
  • lupus anticoagulant
  • anticardiolipin antibodies
  • DM
  • thyroid disease
  • uterine imaging to exclude septum or anomaly (hysterscopy or hysterography)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

options to decrease risk perinatal transmission HIV

A
  • IV zidovudine at time of delivery
  • zidovudine to neonate

C-section before labor for viral load >1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

treatment for symptomatic MVP

A

beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

risk factors for preeclampsia

A
  • advanced maternal age
  • nulliparity
  • multip gestation
  • obesity
  • preexisiting med conditions (lupus, chronic HTN, DM)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

complications in obesity and pregnancy

A
  • chronic htn
  • gestational dm
  • preeclampsia
  • macrosomia
  • higher rates c-section and postpartum complic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

what antidepressant should NOT be used in pregnancy

A

parocetine- class D, fetal cardiac malf and persistent pulm htn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

therapeutic magnesium level for preeclampsia

A

4-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

loss of DTRs occurs at Mg __

A

7-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

respiratory depression occurs at Mg __

A

12-15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

cardiac arrest occurs at Mg __

A

15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

contraindications to expectant management of severe preeclampsia remote from term

A
  • thrombocytopenia
  • can’t control BP with max doses of 2 antihypertensives
  • nonreassuring fetal tracings
  • LFTs elev more than 2x normal
  • eclampsia
  • persistent CNS sxs
  • oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

how much fetal blood is neutralized by 300mcg of rhogam?

A

30cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

signs of fetal hydrops

A

develops in presence of decr hepatic protein production

defined as collection of fluid in body cavities

  • pericardial or pleural effusion
  • placentomegaly (edema)
  • polyhydramnios
  • hepatosplenomegaly if extramedullary hematopoeisis is extensive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

definition prolonged latent phase of labor

how to treat

A

> 20h for nulliparas
14h for multiparas

rest or augment labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

when should PID be treated in patient

A

severe, n/v, or pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

inpatient regimen for PID

A

IV cefoxitin and doxy

alternative: clindamycin and gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

outpatient regimen for PID and what do these meds cover

A

ceftriaxone (gonorrhea and some gm neg)

doxycycline (chlamydia)

metronidazole (anaerobes, mycoplasma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

retraction of fetal head is classic presentation of __

A

shoulder dystocia

do mcrobert’s maneuver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

management of IUGR

A

twice weekly non-stress test

AFI at least once a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

fetal growth restriction baby will be at risk for

A
  • chronic diseases such as cardiovascular disease, htn, stroke, copd, t2dm, obesity
  • cognitive delay in childhood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

non stress test is based on what principle

A

that when fetus moves heart acelerates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

fetal growth restriction is fetal weight less than __ percentile

A

10th

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

causes of prolonged periods fetal tachycardia

A
  • maternal fever

- chorioamnionitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

when might amnioinfusion be used

A

repeated variable decels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

how does head compression cause early decels

A

vagal nerve stim -> hr slows

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

uterine hyperstimulation can cause what fetal change

A

prolonged bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

initial measures to evaluate and treat fetal hypoperfusion/occasional late decels

A
  • left lateral position (increases perfusion to uterus)
  • maternal O2
  • stop oxytocin
  • intrauterine resuscitation with tocolytics and IVF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

most important source of lubrication in arousal phase

A

vaginal transudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

treatment for vaginismus

A

therapy with vaginal dilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

cause of intrahepatic cholestasis of pregnancy? treatment?

A

retain bile salt, which is deposited in dermis causing itching

initially- emollients and antihistamines

ursodeoxycholic acid- relieves itching and lowers serum enzyme levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

risk congenital varicella lowest in __ trimester

A

1st

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

what contraceptive decreases risk ovarian cancer

A

oral contraceptives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

what contraceptive decr risk endometrial cancer

A

progesterone IUDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

oral levornogestrol (plan B) should be taken within __ (time) of intercourse

how does it work

A

72h

progesterone incr delays LH surge (thus delays ovulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

copper IUD can be placed up to __ (time) after sex for emergency contraception

A

5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

most freq cause of preterm labor

A

idiopathic

dehydration, uterine distortion (eg from fibroids) can be associated with ptl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

benefits of betamethasone treatment in premature

A
  • incr pulm maturity, decr risk of severe resp distress syndrome
  • decr risk intracerebral hemorrhage and necrotizing enterocolitis in newborn
132
Q

magnesium sulfate MOA preterm labor

A

competes w/ calcium for entry into cells

133
Q

indomethacin MOA preterm labor

A

nonspecific COX inhibitor which blocks prostaglandin production

134
Q

ritodrine use and MOA

A

management of preterm labor

impairs intracellular cAMP concentration, facilitating myometrial relaxation

*contraindicated in DM

135
Q

nifedipine MOA preterm labor

A

CCB, interferes with calcium ion transfer thru myometrial cell membrane -> decr intracell calcium -> myometrial relaxation

136
Q

atosiban use and MOA

A

used in preterm labor

  • oxytocin receptor antagonist
  • blocks intracytoplasmic calcium release
  • downregulates prostaglandin synthesis
137
Q

tx stable uncomplicated pyelo

A

FQ like cipro

alternative sulfa/tmp

138
Q

tx rly sick pyelo

A

inpt IV aminoglycoside

plus ampicillin, piperacillin, or first gen cephalosporins, aztreonam, thhird gen cephalosporin, pip-tazo or FQ

when fevers and systemic sxs resolve, dc with 14 day course

139
Q

what is blood show

A

bleeding that may occur as cervix dilates

can be seen in normal labor

140
Q

septic pelvic thrombophlebitis

A
  • relapsing remitting fevers
  • thrombosis of pelvis venous system
  • diagnosis of exclusion. CT scan will show thrombosed veins
  • tx: short term anti coagulation
141
Q

5 causes of post-op fever

A 
Wind (atelectasis, PNA) pod 1-3
Water (UTI) pod 3-5
Walking (DVT, PE) pod 4-8
Wound (SSI) pod 5-7
Wonder drugs (anytime, drug fever)
142
Q

what abx are not appropriate for nursing mothers

A

doxycycline

ciprofloxacin

143
Q

tx endometritis

A

clindamycin, gentamicin

144
Q

complications of epidural

A
  • spinal headache
  • localized back pain
  • meningitis! (get LP!)
145
Q

how to stimulate mensturation in pt with hypothalamic amenorrhea (such as athletes, nutri deficiency)

A

combined OCP

they are hyperestrogenic dt prolonged suppression of ovarian function

need estrogen to cause enough proliferation of endometrial tissue

(progestins alone would maintain endometrial atrophy)

146
Q

elevated DHEAS and male features- most likely diagnosis

A

adrenal tumor

147
Q

to test ferning, where should sample come from

A

vagina

*cervix can have false positives!

148
Q

to do nitrazine and testing for ferning, where should sample come from

A

vagina

*cervix can have false positives!

149
Q

latency abx for preterm prelabor rupture of membranes

A

ampicillin + erythromycin

clindamycin+gentamicin if chorionamnionitis suspected

150
Q

what intervention can reduce the risk of preterm prelabor ROM?

A

weekly administration of 17a-hydroxyprogesterone starting between 16-20 weeks until 36 weeks

151
Q

delivery is recommended at __ weeks for women with PPROM

A

34

expectant management eg tocolytics is contraindicated at 36w due to risk of chorionamniotis

152
Q

what can cause false positive nitrazine test

A

semen

blood

153
Q

normal vag pH

normal amniotic fluid pH?

A

normal vag 4.5-6

amniotic fluid 7.1-7.3

154
Q

normal AFI

A

8-18

155
Q

AFI of __ considered oligohydramnios

A

<5

156
Q

when is c-section indicated for abruptio placentae

A

only if there are maternal or fetal indications

157
Q

lichen planus

A

6 P’s

  • purple
  • pruritic
  • polygonal
  • planar
  • papules
  • plaques

may have oral lesions, alopecia, and extragenital rash

158
Q

ultrasound findings c/w uteroplacental insufficiency

A
  • growth restriction
  • oligohydramnios
  • placental calcifications
  • fetal demise
159
Q

definition macrosomia

A

> 4000g

160
Q

what uterotonic contraindicated in hypertension

A

methergine

161
Q

what uterotonic contraindicated in hypotension

A

Dinoprost (E2)

162
Q

what uterotonic contraindicated in asthmatic pts

A

Hemabate (F2)

163
Q

mechanism of factor V leiden

A

mutant factor V

protein C normally binds and inhibits factor V. but now it can’t –> hypercoagulable state

164
Q

how do mifepristone and misoprostol working in terminating pregnancy

A

mifepristone- progesterone blocker

misoprostol- causes uterine contractions to expel contents

165
Q

Rotterdam criteria for PCOS

A
  1. oligomenorrhea/anovulation
  2. lab or clinical evidence hyperandrogenism
  3. polycystic ovaries on ultrasound
166
Q

can’t conceive bc of high prolactin, what may be the issue?

A

meds! antidopaminergic

eg quetiapine

167
Q

hormones in exercise induced hypothalamic amenorrhea

A

normal FSH

low estrogen

168
Q

how can you determine ovarian reserve

A

anti-Mullerian hormone

169
Q

lichen sclerosis appearance

A

smooth white plaques

porcelain or parchment like

170
Q

lichen planus

A

6 P’s

  • purple
  • pruritic
  • polygonal
  • planar
  • papules
  • plaques
171
Q

lichen simplex chronicus

A

caused by itch scratch itch cycle

damages skin –> thick labia

172
Q

treatment uncomplicated cervicitis

A

Empiric: Azithro + Ceftriaxone

confirmed chlamydia-azithro
(confirmed gonorrhea-azithro+ceftriaxone)

173
Q

what condition is tolteridine contraindicated

A

narrow angle glaucoma

174
Q

mirebegron

A

beta-3 antagonist

causes relaxation of detrusor muscle

avoid in htn, esrd, or liver disease

175
Q

cause urge incontinence

A

overactive detrusor

176
Q

cause stress incontinence

A

increase in intra-abdominal pressure

177
Q

colpocleisis

A

vagina surgically obliterated

178
Q

HRT effect on lipid

A

incr HDL

lower LDL

179
Q

location of leiomyomas most likely to cause infertility

A

submucosal

intracavitary

180
Q

purpose of using GnRH analogs before surgery

A

inhibit estrogen

reduce myoma size
decreased blood loss

181
Q

therapy if pt has failed NSAIDs and OCPs for leiomyoma

A

GnRH agonist

temporary only to bridge to surgery

182
Q

sequence of sexual maturation

A
  • thelarche (breast budding)
  • adrenarche (hair growth)
  • growth spurt
  • menarche
183
Q

risk of isoimmunization during pregnancy

A

2% antepartum
7% after full term delivery
7% with subsequent pregnancy

incidence and size of transplacental hemorrhage incr as pregnancy advances

184
Q

McCune Albright syndrome

A

premature menses, before breast and pubic hair development ____

185
Q

what measure in amniotic fluid is best indicator of Rh hemolytic disease

A

bilirubin

186
Q

nerves at risk in low transverse incision

A
  • iliohypogastric (sensory groin and pubis

- ilioinguinal (sensory groin, symphysis, labium, upper inner thigh)

187
Q

obturator nerve damage sx

A

can’t adduct thigh

can occur during LN dissection

188
Q

best predictor that hysterectomy will improve chronic pelvic pain

A

tenderness confined to the uterus

hysterectomy done for chronic pelvic pain only has 50 percent chance of improving sxs even in carefully selected pts

189
Q

positive Carnet’s sign

A

tenderness on lfexion of abdominal muscles

190
Q

tx of pain that is constant, refractory to hormones and reproducible with palpation of somatic structures

A

suggestive of neuromuscular pain or fibromyalgia

  • physical therapy
  • exercise
  • GABAergic meds like gabapentin/pregabalin may be helpful adjuncts
191
Q

PMS vs PMDD

A

PMS mostly somatic sx

PMDD mostly psych sxs that seriously impair usual functioning and personal relationships

192
Q

PMDD confined to __ phase of menstrual cycle

A

luteal

193
Q

how to predict whether BL oophorectomy (ie surgical menopause) will help severe PMDD

A

improvement with course of GnRH agonist

*risks of causing early menopause = CVD, early bone loss, hot flashes

194
Q

what supplement can improve PMS

A

at least 1200 mg calcium

195
Q

sequence of sexual maturation

A
  • thelarche (breast budding)
  • adrenarche (hair growth)
  • growth spurt
  • menarch
196
Q

cause of Kallmann syndrome

A

arcuate nucleus does not secrete GnRH

*also olfactory tract hypoplasia

197
Q

Chadwick’s sign

A

blueish cervix due to increased blood flow

indication of pregnancy

198
Q

ASCUS with negative HPV management

A

resume pap screening q3 years

199
Q

adnexal mass and endometrial hyperplasia = what cancer

A

granulosa cell tumor

^ secretes high levels of estrogen which stim endometrial hyperplasia

200
Q

ovarian mass ____ size increases suspicion for cancer

A

> 10cm

201
Q

most common type of ovarian neoplasm in women <30 years

A

germ cell tumor

202
Q

most common type of ovarian neoplasm in women >30 years

A

epithelial cell tumor

203
Q

how does really high beta hcg affect other hormone

A

beta hcg alpha subunit identical to that in LH and RSH

so ovaries stimulated -> make lutein cysts

thyroid gland -> stim to make thyroid hormone -> TSH suppressed

204
Q

what is nonreactive fetal stress test

A

no accels

205
Q

mcc nonreactive fetal stress testt

A

fetal sleep cycle (can last as long as 40 min)

206
Q

antiphospholipid syndrome

A

body makes Ab that makes blood more likely to clot

207
Q

absolute CI to hormonal contraception

A
  • active breast cancer
  • migraines w/ aura
  • uncontrolled htn
  • active hepatitis, severe cirrhosis, liver cancer
  • age 35 and up and 15 more more cigarettes/day
  • ischemic heart dz, stroke
  • less than 3 weeks postpartium
  • prolonged immobilization
  • thrombophilia (eg factor V Leiden, antiphospholipid antibody syndrome)
  • venous thromboemoblism
208
Q

GBS ppx for patients who have penicillin allergy but low risk for anaphylaxis

A

cefazolin

209
Q

best conditions to get accurate prolactin levels

A
  • fasting

- no breast stimulation for 24h

210
Q

bloody fluid aspirated from breast mass - next step?

A

excisional biopsy to check for breast cancer

*note if it was CLEAR fluid and mass resolves, can just reexamine in 2 months

211
Q

high risk groups that should get breast mri in addition to mammo for screening

A
  • BRCA carriers, first degree rel of BRCA carriers
  • mutations like Li-Fraumeni
  • h/o chest radiation between age 10-30
212
Q

breast mass, normall mammo. next step?

A

any solid breast mass on exam should be evaluated with cytology (FNA) or histology (excisional biopsy)

normal mammo does not rule out presence of cancer

213
Q

risk of chorioamnionitis outweight benefits of continuing tocolytics beyond __ (time)

A

48h

214
Q

frequent cause of cord compression

A

decreased amniotic fluid

215
Q

abruptio placentae with reassuring maternal and fetal status - management?

A

expectant

c/s only if maternal or fetal indications

216
Q

twins w single placenta has higher risk of _

A

twin twin transfusion syndrome

217
Q

twins w single amniotic sac have higher risk of _

A

cord entanglement and IUFD

218
Q

prophylactic latency abx indicated for __ weeks

A

<34

219
Q

risk factors vaginal cancer

A
  • age>60
  • HPV
  • smoking
  • in utero DES (clear cell only!)
220
Q

clinical feat vaginal cancer

A
  • vag bleeding
  • malodorous vag dc
  • irregular vaginal lesion
221
Q

most likely cause intermenstrual bleeding in 30-40yo, normal exam

A

endometrial polyp

uterus small nontender bc endmetr polyps are typically intracavitary

222
Q

Depot medroxyprogesterone is given how often

A

every 3 months

223
Q

Depot medroxyprogesterone is given how often

A

every 3 months

224
Q

first line antihypertensives during pregnancy

A

beta blockers
CCB
hydralazine
methlydopa

225
Q

definition of active phase labor protraction

A

cervix change <1cm every 2 hours

226
Q

neuraxial anesthesia can lengthen which phase of labor

A

second stage (max dilation to fetal delivery)

227
Q

definition preeclampsia

A

new onset htn (>=140 or >=90) at >=20 weeks

PLUS

proteinuria and/or end organ damage

228
Q

definition of preeclampsia severe features

A
  • BP >=160 or >=110 (two times at least 4 hours apart)
  • thrombocytopenia
  • elev Cr
  • elev transaminases
  • pulm edema
  • visual or cerebral sxs
229
Q

first degree lac

A

vaginal mucosa and perineal skin

230
Q

second degree

A

vaginal mucosa, perineal skin + perineal body

231
Q

third degree lac

A

anal sphincter muscles

232
Q

fourth degree

A

rectal mucosa

233
Q

dilation and evacuation for IUFD of what gest age

A

<24w

234
Q

induction for vaginal delivery for IUFD of what gest age

A

> = 24 weeks

235
Q

risk factors for postpartum uterine atony

A
  • uterine fatigue (prolonged or precipitous labor)
  • chorioanmnionitis
  • uterine over distension (multigest, maacrosomia, polyhydramnnios)
  • operative vag delivery
  • retained placenta
  • grand multip (>=5 deliiveries previously)
236
Q

interventions for pp uterine atony

A
  • bimanual uterine massage
  • correct bladder distension
  • hi dose oxytocin, misoprostol
  • tranexamic acid
  • carboprost, methylergonovine
  • balloon tamponade
  • poss surgery if unresolved
237
Q

moa tranexamic acid

A

antifibrinolytic agent - prevents break down of blood clots to provide hemostasis

238
Q

what HIV viral load may deliver vaginally

A

<=1000 copies, otherwise c/s

239
Q

mechanism androgen insens syndrome

A

46,XY pt has nonfunctioning androgen receptors

has functioning testes that make Anti-Mullerian hormone –> no internal female genitalia

meanwhile testost no effect = no male external genitalia; default female external

testost aromatized to estrogen = breasts, tall

240
Q

mechanism androgen insens syndrome

A

46,XY pt has nonfunctioning androgen receptors

has functioning testes that make Anti-Mullerian hormone –> no internal female genitalia

meanwhile testost no effect = no male external genitalia; default female external

241
Q

why are pregnant women at incr risk for cholesterol gallstone formation?

A

elev Estrogen and Progesterone promote gallbladder stasis and cholesterol supersaturation

242
Q

clinical features of Asherman syndrome

A

(intrauterine adhesions)

  • AUB
  • no menses
  • infert, recurr pregnancy loss
  • cyclic pelvic pain
243
Q

inadvertent spinal block - mechanism, presentation

A

epidural cath accidentally punctures dura

hypotension, respiratory depression due to diaphragmatic paralysis

244
Q

local anesthetic toxicity- mechanism, presentation

A

epidural catheter inadvert inserted into epidural vasculature

CNS anesthetic systemic toxicity, first blocks inhibitory pathways –> CNS overactivity (perioral numbness, metallic taste, tinnitus; may cause gen tonic clonic sz)

cardiovasc symp activation (tachy, hypertension) -> risk fulminant cardiovascular collapse

245
Q

management local anesthetic systemic tox

A
  • STOP drug
  • benzos for seizure control
  • supportive care
246
Q

30w pregnant with R upper and R flank pain, n/v

A

acute appendicitis

appendix gets displaced cephalad = atypical presentation in preg, thus often late diagnosed

247
Q

labs indicating proteinuria

A

> =300mg/24h
UPC>=0.3
or dipstick>=1+

248
Q

labial adhesions/fused labia minor cause and tx

A

mostly in prepubertal girls due to low estrogen

inflammation (eg from poor hygiene, infection, diaper rash, trauma) can also contribute to dev of adhesions

topical estrogen only if lesions are symptomatic

249
Q

when would you give intrapartum penicillin ppx to someone with unknown GBS statsus

A
  • ROM for >=18 hours (incr bacteria so incr risk transmission)
  • intrapartum fever
  • delivery at <37 w (immature immune sys more susceptible to infection)

alsoo anyone with

  • prior infant with early onset neonatal GBS infection
  • GBS bacteriuria or GBS UTI in current preg regardless of treatment
250
Q

causes of fetal hydrops

A

immune - Rh(D) alloimmunization

nonimmune

  • parvo B19
  • thalassemia (eg Hgb barts)
  • fetal aneuploidy
  • cardiovasc abnormalities
251
Q

what are intrauterine synechiae

A 
intrauterine adhesions
(eg after infection, intrauterine surgery ashermans)
252
Q

marker for epithelial ovarian cancer

A

CA-125

useful mostly in suspicious u/s postmenopausal women, as levels premenopausal can have false elevations

253
Q

marker for epithelial ovarian cancer

A

CA-125

254
Q

what non cancer things can cause elevated CA-125

A
  • fibroids

- endometriosis

255
Q

what is septic pelvic thrombophlebitis

A

a thrombosis of the deep pelvic or ovarian veins that becomes infected

a/w pelvic surgery or postpartum period

256
Q

how is septic pelvic thrombophlebitis diagnosed

A

diagnosis of exclusion

persistent fever unresponsive to broad spectrum abx, neg infectious workup

257
Q

treatment of septic pelvic thrombophlebitis

A
  • anticoagulation

- broad spectrum abx

258
Q

what is placenta accreta

A

uterine villi attach directly to myometrium instead of decidua

259
Q

risk factors placenta accreta

A
  • prior c/s
  • hist D and C
  • age >35
260
Q

antenatal diagnosis of placenta accreta

A

u/s irregularity or absence of placental-myometrial interface

intraplacental villous lakes

261
Q

management of antenatally diagnosed placenta accreta

A

planned cesearean hysterectomy

262
Q

outpt PID tx

A

ceftriaxone + doxy

263
Q

inpt PID tx

A

cefoxitin + doxy

264
Q

labetalol

  • what receptors it acts on
  • mechanism
  • time of onset
A

selective alpha-1
nonselective beta blocker

peripheral smooth muscle
metabolized in liver

IV- 10min
oral- 2h

265
Q

nifedipine

A

CCB inhibits calcium influx into vascular smooth muscle

met by liver

oral-10-15 minutes

266
Q

hydralazine

  • MOA
  • time of onset
A

directly dilates peripheral vessels

alters intracellular calcium release
inhibits smooth muscle calcium influx -> inhibt phosphorylation of myosin protein -> incr HR, SV, CO

met in liver

IV onset- 10-20 minutes

267
Q

methyldopa MOA

A

chronic HTN in pregnancy

alpha2 agonist

268
Q

what type of contraception should be avoided postpartum and why

A

avoid estrogen containing contraceptives <1month pp as it increases risk of thromboembolism

269
Q

how does breastfeeding cause hypoestrogenism

A

inc prolactin inhibits GnRH release

patients may thus experience dyspareunia -> tx = nonhormonal lubricants, moisturizers

270
Q

when should benign appearing endometrial cells on pap be worked up with endometrial sampling?

A

premenopausal w/ AUB or risk for endometrial hyperplasia
(otherwise not reported under age <=45 bc so common esp in first 10 days of period)

postmenopausal

271
Q

how can PCOS cause infertility?

A

high androgens -> lots of peripheral andorgen conversion to estrones

high estrone -> high freq, short interval GnRH pulses

such GnRH pulses favor LH secretion from ant pit = LH/FSH imbalance = lack of LH surge = follicle fails to mature and release oocyte

= anovulation

272
Q

definition postpartum urinary retention

A

can’t void >=6h after vaginal delivery or >=6 after foley removal after c/s

273
Q

cause of postpartum urinary retention (2)

A
  1. Perineal trauma (prolonged second stage labor and/or perineal lac) –> perineal nerve injury

damaged pudendal nerve > decr voiding sensation and cause external urethral sphincter dysfunction

  1. Bladder Atony. Epidural anesthesia = reduced sensory and motor spinal cord impulses –> suppress micturition reflex and decr detrusor tone
274
Q

management postpartum urinary retention

A

intermittent urethral catheterization + reassurance (usu self limited and resolves <1 wk)

275
Q

gestational DM target

  • fasting
  • 1 hour postprand
  • 2 hours postprand
A
  • fasting <=95
  • 1h pp <=140
  • 2h pp <=120
276
Q

treatment gestation DM

A

firstline: dietary mod

2nd line: insulin, metformin

277
Q

management of hypothyroidism in pregnancy

A

in normal pregnancy, estrogen increases thyroid binding globulin = need more thyroid hormone to saturate the binding sites

also get an increase in thyroxine production as hCG stim TSH receptors (have sim alpha subunit)

==> incr total T4 but same free T4

BUT in pts with pre-existing hypothyroidism, they can’t increase thyroxine prod appropriately, so must increase thyroxine dosage and adjust q4 weeks based on labs

278
Q

how can oxytocin cause hyponatremia

A

oxytocin has similar structure as ADH

elevated oxytocin can stim renal collecting ducts to increase free water absorption

279
Q

thyroid labs in normal first trimester pregnancy

A 
incr total T4
incr or unchanged total T3
decr TSH (suppressed by bhCG and increased T4)
280
Q

symptoms maternal toxo infection

A

can be asx

if sx:

  • fever
  • diffuse nonpruritic maculopapular rash that resolves spontaneously
281
Q

fetal findings toxo

A

T gondii preferentially destroys fetal neural tissue

  • -> BL ventriculomegaly, intracranial calcification
  • ascities, hepatosplenomegaly, fetal growth restriction
282
Q

causes symmetric vs asymmetric fetal growth restriction

A

Symmetric- chromosomal abnormality, congenital infection

asymmetric- tihngs that cause placental insuff; maternal malnutrition

283
Q

causes symmetric vs asymmetric fetal growth restriction

A

Symmetric- chromosomal abnormality, infection

asymmetric- tihngs that cause placental insuff

284
Q

how preeclampsia can cause pulm edema

A

general vasospasm (htn) = incr afterload

also, decr albumin, decr renal function, and incr vascular permeability

285
Q

normal renal lab changes in pregnancy and why

A

decr serum Cr

Renal blood flow (perfusion) and GFR increase in pregnancy. same prod of BUN and Cr but serum levels are decreased due to increased GFR

286
Q

why increased urinary protein excretion in pregnancy

A

greater renal basement membrane permeability

up to 300mg/day
so UA with trace protein is normal in pregnancy

287
Q

pt with elevated BP on OCPs, what should you do

A

stop the OCPs; can cause elevated BP and sometimes overt HTN

?mechanism, possibly estrogen increases hepatic angiotensinogen synth and other effects on renin-angiotensin system

risk of htn increases with duration of OCP use

288
Q

pt with elevated BP on OCPs, what should you do

A

stop the OCPs; can cause elevated BP and sometimes overt HTN

?mechanism, possibly estrogen increases hepatic angiotensinogen synth and other effects on renin-angiotensin system

289
Q

risks of intrahepatic cholestasis of pregnancy

A

bile acids can cross placenta and cause fetal complifcations

IUFD!
preterm delivery
neonatal resp distress syndrome

290
Q

management of intrahepatic cholestasis of pregnancy

A
  • deliver at 37wks
  • frequent antepartum nonstress tests
  • uresodeoxycholic acid (decr bile acid levels)
  • antihistamines
291
Q

why does intrahepatic cholestasis usu occur in 3rd trimester

A

incr Estrogen and Progesterone –> hepatobiliary tract stasis and decreased bile excretion

292
Q

characteristics of postpartum psychosis

A
  • depressed and/or manic mood
  • severe insomnia
  • agitation
  • disorganized behavior
  • **delusions and/or hallucinations

med emergency as mother may harm child under influence of delusions + at high risk for suicide

293
Q

betamethason can be given __ weeks to prevent neonatal resp distress syndrome

A

<37 weeks gestation

294
Q

bethanechol

A

stimulates M receptors, increasing bladder contractility

treats urinary retention (can tx overflow incont due to urinary retention)

295
Q

biophysical profile

  • purpose
  • components
  • meaning if abnormal
A

assess fetal oxygenation thru ultrasound observation and the nonstress test

components: (max 10pts)
- nonstress test
- AF volume
- fetal movements
- fetal tone
- fetal breathing movements

abnormal score (0-4) = fetal hypoxia due to placental insufficiency

296
Q

Magnesium is excreted by _

A

kidneys

297
Q

how does pregnancy increase risk kidney stones

A

progesterone induces urinary stasis and incr urinary calcium excretion

298
Q

risk factor yeast infection

A
  • increased estrogen (OCPs, pregnancy)
  • DM
  • immunosuppresion
  • abx use
299
Q

Amsel criteria

what is it, what is it for

A

BV

  1. pH>4.5
  2. whiff test
  3. clue cells
300
Q

treatment BV

A

metronidazole or clindamycin

301
Q

how do uretheral diverticula likely arise?

A

recurrent periurethral gland infections –> abscess that breaches urethral mucosa

causes tender ant vaginal wall mass. the diverticulum may collect urine and debris, resulting in purulent discharge, dysuria, or postvoid dribbling

302
Q

pH of vaginitis bugs

A

BV and Trich >4.5

yeast is normal pH <4.5 (specifically 3.8-4.5)

303
Q

complications after cervical conization

A
  • cervical stenosis
  • preterm birth
  • PPROM
  • 2nd trimester pregnancy loss
304
Q

management of pregnant woman with h/o HSV

A

antiviral suppression starting at 36 weeks

if have lesions/prodromal symptoms during labor –> c-section

305
Q

Erb-Duchenne palsy

  • presentation
  • nerve problem
A

waiter’s tip
C5 and C6

decreased or absent moro
Grasp reflex intact

306
Q

Klumpke Palsy

  • presentation
  • nerve problem
A

claw hand
C8 and T1 excessive traction

ipsilateral miosis and ptosis

307
Q

clinical features vaginal hematoma

A
  • vaginal mass
  • rectal or vaginal pressure
  • +/- hypovolemic shock
308
Q

treatment endometritis

A

gent/clinda

309
Q

manual vacuum aspiration can be done for abortion at what age

A

up to 8 weeks

310
Q

second stage arrest of labor

A

no descent after 4 or more horus of pushing in a primip with epidural (3 without)

or 3 or more horus in a multigravida with epidural (2 wituhout)

311
Q

cause and symptoms of ovarian hyperstimulation syndrome

A

bhCG (used to stim mult ovarian follicles) causes exaggerated ovarian response and overexpression of VEGF -> incr vasc permeability and capillary leakage -> third spacing and VEGF leakage into intraperitoneal cavity -> ascites and abdominal distension

1-2 wks after ovulatio induction

  • n/v/abd pain
  • pleural effusions
  • intravasc vol depletion (tachy, hemoconc, leukocytosis) due to third spacing, cab -> thromboemoblism, renal failure
312
Q

inevitable vs incomplete abortion

A

inevitable- dilated cervix, VB without expulsion.
can see or feel products of conception at or above cervical os

incomplete- some prod of conception expelled, some remain

313
Q

complex multiloculated adnexal mass with thick walls and internal debris

A

TOA

also will have fever, abd pain

314
Q

congenital adrenal hyperplasia characterized by elevated ___

A

17-hydroxyprogesterone

315
Q

management of Mullerian agenesis

A

get renal ultrasound! urogenital dev is from a common source so often have renal abnormalities

otherwise can also get surgery to elevate vagina

316
Q

what abx can you use to treat UTI in pregnancy?

A

Amoxicillin! or nitrofurantoin, or cephelexin

317
Q

what abx can NOT be used in pregnancy?

A 
do NOT use 
x bactrim (folate metabolism, kernicterus)
x cipro (bone deformities, arthropathy)
x doxycycline (bone, tooth dev)
318
Q

definition arrest second stage of labor

A

no fetal descent after pushing 3h (N) or 2h (M)

319
Q

how does abruption increase risk of DIC

A

tissue factor released by decidual bleeding

320
Q

postmenopausal woman with endometrial cells on pap testing - next step

A

further evaluate with endometrial bx

321
Q

cause HELLP syndrome

A

abnormal placentation triggers systemic inflamm and activation of coagulation sys and complement cascade

–> platelets consumed
microangiopathic hemolytic anemia, esp detrimental to liver. MAHA also causes incr bilirubin production and RBC fragments on smear

–> hepatocellular necrosis and thrombi in portal system –> elevated liver enzymes, liver swelling, distension of hepatic capsule

322
Q

duodenal atresia a/w

A

Down syndrome

VACTERL (vertebral, anal atresia, cardiac, tracheoesoph fist, esophag atresia, renal, limb)

323
Q

u/s findings a/w down syndrome

A
  • duodenal atresia
  • esophageal atresia
  • VSD
  • AV septal defect
  • thickened nuchal fold
324
Q

mnemonic for bugs that can be treated with metronidazole

A

GET GAP on the Metro

Giardia
Entameoba
Trich
Gardnerella (BV)
Anaerobes
Protozoa
325
Q

mnemonic for HTN drugs safe in pregnancy

A

Hypertensive Moms Love Nifedipine

hydralazine
methyldopa
labetalol
nifedipine

Uworld/shelf (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions