Ob/Gyn APGO Flashcards
abnormal pap test results… whats the best next step in management?
colposcopy
- also do reflex HPV testing for high-risk HPV types
- if negative then do repeat testing in one year
whens the earliest indication to give a pt a pap smear?
21 years old regardless of coitarche
cervical cancer screening for women ages 30-65
-whats special about pts ages 21-24
cytology and HPV cotesting every 5 years (preferred)
or
cytology alone every 3 years (acceptable)
-no need to HPV test alone
- pts 21-24 –> considered a special population are ususally positive for HPV and end up clearing it anyways so its not worth it to test them for HPV
- do expectant management and repeat cytology alone in 12 months if a pt does test positive for HPV
pt with lower abdominal pain, adenexal pain/tenderness, fever, cervical motion tenderness, and vaginal discharge
pelvic inflammatory disease (usually caused by chlamydia and gonorrhea)
gold standard to diagnose herpes
culture: highly specific not super sensitive (false negative 10-20% of the time)
best to culture very early in course
how often do you screen for colon cancer in a pt with average risk
start screening at age 45-50
- yearly hemoccult testing
- flexible sigmoidoscopy every 5 years
- colonoscopy every 10 years
if pt has a first degree relative with colon cancer before age 60 then screen at age 40 or 10 years before dx of their relative and repeat every 5 years
DEXA test
used to test for bone mineral density… specifically in women who show signs of osteoporosis prior to age 65
what age should annual mammograms start for women?
40
how much folate should you give a woman of reproductive age
daily 400 microgram supplement
note: non-high risk pts get at least 0.4mg/day
high risk pts (pts with neural tube defect in previous pregnancy) get 4mg/day
what are the normal physiologic changes to lung capacities during pregnancy
increases: inspiratory capacity (due to increases in tidal volume and inspiratory reserve volume)… minute ventilation also increases –> responsible for respiratory alkalosis in pregnancy
respiratory rate does not change
decreases: functional residual capacity
why are pregnant pts more likely to get pulmonary edema
decreased plasma osmolality
sickle cell anemia prevalence in black pts and how to test for it in a pregnant pt
1/500 (autosomal recessive)
carrier state is found in 1/10 blacks
*test for this and all other hemoglobinopathies via electrophoresis
mediterranean populations are most at risk for what
beta-thalassemia
ashkenazi jews are at risk for what
fanconi anemia, tay-sachs, neimen pick, cystic fibrosis (all are autosomal recessive)
what is the best test for trisomy 21 and 18
cell free DNA screening with a detection rate of over 99% at 0.2% false-positive rate
most common form of inherited mental retardation
fragile x
most reliable method for confirming gestational age
dating ultrasound (specifically during the first trimester)
what do you expect to see in a pt with pre-existing diabetes vs gestational diabetes
pre-existing –> intrauterine growth restriction
gestational diabetes –> shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios, and fetal macrosomia
short in duration and less intense contractions associated with pain in the lower abdomen/groin
braxton-hicks contractions
how will a pregnant pt with dehydration present
maternal tachycardia and ketonuria
why would you do a nitrazine test
confirm rupture of membranes of if a pt is unsure about leakage of fluid
what do you do if the pt has an umbilical cord prolapse?
immediate c-section (even if the mom and baby both seem totally fine)
what is the single greatest risk factor for 3rd and 4th degree lacerations
median episiotomy
insufficient power of contractions
< 240 Montevideo units
give ptosin if this occurs