Ob/Gyn Blueprints & ACOG Flashcards by Jonathan Paul Ladera

What should all patients with bleeding during pregnancy receive?

Blood test for Rh status

If negative give RhoGAM to prevent isoimmunization

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What is terbutaline used for?

Beta 2 agonist

Used to relax the uterus in cases of uterine hypertonus or tachysystole (>5 contractions/10min)

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What are non-reassuring fetal signs, and how should patient be managed?

Repetitive late decelerations, bradycardias, and loss of variability

Face mask O2, place on left side to relieve IVC

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What are the three signs placental separation?

Cord lengthening, gush of blood, fundal rebound

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What does posterior succenturiate lobe? put patients at risk for?

Vasa previa

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What does sinusoidal pattern on continuous FHR monitoring suggest? What should be done?

Fetal anemia usually from vasa previa rupture

Emergent delivery

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What are classic findings of uterine rupture?

Severe abdominal pains with loss of station of fetal head in actively laboring patient with history of C-section

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What is the MoA of Mg in decreasing contractions? What are possible side effects?

Antagonizes calcium and stabilizes cell membranes

Flushing, diplopia, headache

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What are associated with increased risk for breech presentation?

Fetal anomalies like anencephaly and hydrocephaly

Uterine anomalies like oligo and polyhydramnios

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What are the initial steps in treating a patient presenting with eclampsia (seizing and HTN)?

ABCs
IV Mg
IV labetalol or hydralazine

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HTN early in 2nd trimester?

Hydatidiform mole and previous chronic hypertension

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What testing should be done in women over 30-65 with negative pap and HPV?

Next pap HPV in 5 years

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What testing should be done in women over 30-65 with negative pap and HPV?

Next pap HPV in 5 years

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How do you diagnose gestational hypertension?

elevated BPs (> 140/90 mm Hg) after 20 weeks’
gestation

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What is the next most important step in management of a patient with HELLP?

This is a subtype of severe preeclampsia, must induce labor if at 32-34 weeks.

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What is true gestational diabetes and how does it arise>?

impairment of carbohydrate metabolism that manifests during pregnancy

human placental lactogen act as anti-insulin agents leading to increased insulin resistance

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What are signs and sx of intra amniotic infection, and what needs to be done? I

Fever, tender fundus, elevated WBC

Induction of labor if normal FHT

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Contraindications to using Mg sulfate?

Myasthenia gravis

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Side effects of terbutaline?

Tachycardia hypotension anxiety and chest pain

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What are the karyotypes for a partial mole? Ultrasound finding?

Triploid 69 xxx(y)

Marked villi swelling

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Which moles put patients at increased risk of GTD?

Complete moles

What are the signs of metastatic gestational trophoblastic disease and what should be done?

Elevated beta HCg, no evidence of IUP,

CT c/a/p

What is the appropriate of management of cord prolapse in a laboring patient?

Lift fetal head and perform emergent c section

What is the treatment for VIN 3?

Wide local excision

What should be done if patient has ASCUS but is negative for high risk HPV?

Resume normal screening, Pap again in 3 years

What is most concerning finding on colposcopy?

Disorderly blood vessels

What should be done for HSIL if nothing found on ECC?

Cervical conization

What should be done for patients presenting with positive ECC?

Cervical conization

What is Meigs syndrome?

Triad of ovarian tumor,ascites, and Right hydrothorax

What is the usual ratio of FSH/LH in primary ovarian failure and why?

>1 because both elevated but FSH cleared slower

What is the best management for patient at 42 weeks with favorable cervix and no contractions?

admit for induction

What is polyhydramnios with rapid decompression of intrauterine cavity put the patient at risk for?

placental abruption

What is the most likely cause of vaginal bleeding and friable cervix on exam in a pregnant woman?

Cervicitis

What utero-tonic agent is contraindicated in mother's with asthma?

Prostaglandin F2-alpha - potent smooth muscle constrictor with effects on bronchi

What can prostaglandin F2 alpha be used for? Prostaglandin E1?

F2 alpha = uterotonic agent | E1 = cervical ripening

What are main associations with intrauterine fetal growth restriction (3rd TM)?

Fetal demise, perinatal demise, meconium aspiration, polycythemia, oligohydramnios

What is the appropriate management of intrauterine growth restriction?

Antenatal testing of fetal well being--> NST twice weekly, weekly AFI, weekly BPP

What are associated findings of Mitral valve prolapse, and how should it be treated in pregnancy?

Chest pain, palpitations, systolic ejection murmur with a click, treat with beta-blockers

What are the risks to the fetus in twin-twin transfusion syndrome?

high morbidity and mortality in both, neurological sequelae in surviving twin

A decrease in which hormones after delivery stimulate milk production?

Progesterone and estrogen (relieves inhibitory influence on production of alpha-lactalbumin by the rough endoplasmic reticulum)

What is the main abnormality caused by valproate in pregnancy?

Neural Tube defects

What is the utility of the fetal fibronectin test in women with pre-term contractions?

99% NPV if patient is symptomatic --> thus 99% with negative result will not deliver in next 14 days

What is the most important lab test to check with any pregnant woman with vaginal bleeding?

Type and screen -> to identify if RhoGAM needs to be administered

What is the most important treatment for pregnant women in 3rd TM with newly diagnosed HIV, to prevent newborn transmission?

IV zidovudine at the time of delivery, along with starting HAART

What is the goal of diastolic blood pressure reduction in a preeclamptic patient with bp 200+/100+?

reduce to 90-95 diastolic range, harm reduction

What is the treatment for fetal hydrops from Rh disease in the case of severe hemolytic disease?

attempt intrauterine intravascular fetal transfusion

What are associated non gyn findings in patients with lichen planus?

oral lesions, alopecia and extragenital rashes

When can manual vacuum aspiration be done in pregnancy?

before 8 weeks to terminate

What are the risk factors for developing pelvic organ prolapse?

increasing parity, increasing age, obesity, some connective tissue disorders (Ehlers-Danlos syndrome), and chronic constipation, vaginal > c section

What should be done for HSIL, with positive acetowhite staining on colpo, but negative ECC?

Cold knife conization, to see specimen from within os and assess for lesions

What should be done for a woman who presents in early first TM with heavy vaginal bleeding and severe anemia?

immediate D&C to remove products of conception and evaluate bleed