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COMLEX Level 2 > OB/GYN COMAT > Flashcards

OB/GYN COMAT Flashcards

1
Q

If fluids are given to a mom w/ chorioamnionitis, she may develop __________

A

Pulmonary Edema

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2
Q

Maternal CO will increase up to ____ d/t HR and SV

A

33%

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3
Q

Maternal SVR is ______ than PVR

A

greater

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4
Q

95% of pregnant women will have _______

A

systolic murmur

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5
Q

Uncontrolled DM mothers have an increased chance of having a child w/ ______, ______ and _______ deformaties.

A

Midline, Cardiac, CNS

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6
Q

Most effective screen test for Trisomy 21:

A

Cell Free DNA

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7
Q

___ g of protein is recommended during pregnancy

A

70

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8
Q

6 defects associated w/ valproic acid

A

2 CHAPS

  1. Spina bifida
  2. Atrial septal defect
  3. Cleft palate
  4. Hypospadias
  5. Polydactyly
  6. Craniosynostosis
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9
Q

Woman presents for labor w/ no complication, next step?

A

PmHx, Targeted PE

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10
Q

Late fetal decelerations are d/t

A

Uteroplacental insufficiency

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11
Q

PPV is used on a neonate, place the head in the

A

Sniff position

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12
Q

Supress breast milk by

A

binding, ice, NSAIDs

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13
Q

1 RF for developing postpartum depression

A

Hx of Depression

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14
Q

Who needs to be treated in a case of BV

A

just mom

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15
Q

Cancer tx that is least likely to be recommended in a pregnant cancer pt.

A

Radiation

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16
Q

Mom BMI is elevated, most likely complication to develop is

A

HTN

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17
Q

Rq for pre-eclampsia

A

> 20 wksHTNProteinuriaEdema

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18
Q

Pre-eclampsia + Bleeding =

A

Placental abruption

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19
Q

RF for preeclampsia

A

PH FOAM

  1. Age
  2. Multiple Gestations
  3. History of chronic high blood pressure, diabetes, kidney disease or organ transplant.
  4. First pregnancy.
  5. Obesity, particularly with Body Mass Index (BMI) of 30 or greater.
  6. Previous history of preeclampsia.
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20
Q

Mom is Dx w/ hemolytic Dz, severity indicated by measuring _____ in the amniotic fluid

A

Bilirubin

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21
Q

MOA of Mg Sulfate as a tocolytic

A

Competes w/ Ca into cells

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22
Q

Amniocentesis shows low glucose, Cz?

A

Amnion Fluid infection

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23
Q

Pt w/ nl appearing anatomy and repeated pregnancy loss. First r/o …

A

Intra uterine abnormality (Septate Uterus)

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24
Q

____ myxomas may interfere w/ carrying a child to term

A

Submucosal

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25
Pt presents w/ high grade squamous intraepithelial cytology but negative colposcopy. Next step?
Bx by Loop electrosurgical excision procedure (LEEP)
26
Continuous Fetal Heart monitor decreases the chance of ....
Neonatal Seizures
27
Pt w/ high Hcg, heavy cycles, pelvic pressure, vomiting.Consider ...
Molar Pregnancy
28
45 yo pt has cycle day 3 FSH > 30. Why can't she conceive?
Late maternal age and low follicle availability.
29
Define the types of incontinence:OverflowStressUrgeMixedFunctional
Overflow -- can't fully empty (>200mL), weak detrusor muscle, obstruction Stress -- leak during valsalva maneuvers Urge -- Hyper/Overactive bladder Mixed -- Urge + StressFunctional -- can't get to the bathroom
30
Twin A Vertex + Twin B BreechBirth Plan?
Twin A VD | Twin B Reposition VD or CS
31
Twin A Breech + Twin B BreechBirth Plan?
C-section for both
32
Twin A Breech + Twin B VertexBirth Plan?
C-Section for both
33
Neonates born w/ IUGR are at risk for...
1. Cesarean delivery 2. Hypoxia 3. Meconium aspiration 4. Hypoglycemia 5. Polycythemia 6. Hyperviscosity 7. Motor and neurological disabilities
34
RF of Fibroids
AA HTN Early Menarche Nulliparity
35
Woman presents w/ pelvic pain, mass in the uterus, inability to get pregnant, and menorrhagia...Dx?
Fibroids
36
Pt found to have granulose tumor. It is excised. What other screen should be done?
Uterine sampling
37
Pt presents w/ uncontrolled, untreated PID. Peritoneal signs present. Pregnancy is R/O. Medical Tx initiated. Next step is ...
emergent laparotomy d/t probable ovarian abscess.
38
Pt presents w/ Dysmenorrhea, Dyspareunia, Dyschezia, and Depression...Dx?
Endometriosis
39
Pt w/ ovarian insufficiency refuses Tx. She is at risk for...
Osteoporosis and osteopenia
40
Klinefelter Syn Characteristics
XXY Gynecomastia Atrophied Testes Low Testosterone High FSH, LH, Estrogen
41
Pt in 3rd trimester presents w/ painless bleeding following intercourse...Dx?
Placenta Previa -- Placenta is covering the cervical os. | Dx w/ U/S
42
Risks for osteoporosis
ALL ACCESS ``` Age Low weight Lots of fractures Alcohol Calcium low Corticosteroids Estrogen low Smoking Sedentary ```
43
Tx to prevent osteoporosis
Vit D and Calcium
44
Pt <30 presents w/ a breast mass...Next Step?
U/S
45
Tx for chorioamnioitis
Gent + Amp (or Clind for PCN allergy)
46
Pt in 3rd trimester w/ RUQ Abd pain, HA and nausea, Neg for Protein in UA...Dx?
HELLP Syn
47
Pts 21-30 yo w/ no abnl paps. When to repeat pap?50-65 yo?
q 3yq 5y + HPV
48
Define dystocia
abnormalities in labor and delivery
49
Sexually active women < 24yo need an annual screen for ...
HIV, Gon, Chlam
50
Tx for mastitis...
PO Abx + continue breastfeeding.
51
Pt presents w/ abnl menses, obesity, acne, male hair growth...Dx?
PCOS
52
How much Folic Acid is recommend for women w/ prev birth afflicted w/ NTD
4000 micrograms/day
53
Pt has a Hx of HSV and is in labor. When do you do a C-section?
Hx of disease plus...Present lesions or Prodromal Sx
54
Pt can't get pregnant d/t PID. If a child is desired, recommend ...
in vitro fertillization
55
Breast screening starts at age ...
50
56
IUGR is suspected. Fetal percentile is <10%. To assess fetal well being perform a ...
Umbilical artery doppler
57
NST is negative. Next Step?
Biophysical Profile
58
Biophysical Profile determines ...
fetal hypoxia by Amniotic Fluid Level, movement, tone, breathing, NST in late 2nd/3rd trimester
59
Fetal anemia is suspected. R/o w/
MCA Doppler
60
Non-reactive NST =
2 accelerations in 20 min
61
Breast abnormality in pts greater that 30...next step?
Dx Mammogram
62
Androgen insensitivity presents as ...
46 XY Phenotypic Female w/ breasts and a blind vaginaNo uterus, ovaries, or pubic hair
63
Kallman presents as ...
Congenital hypogonad hypogonadism that can't smell, low sex hormones and absent GnRH
64
(MRKH Syn) Mullerian agenesis presents as ...
46 XX Female w/ blind vagina and no uterusOvaries are present!
65
Pt has uterine atony. Hx includes asthma and HTN. No response to Oxytocin. Next Step?
Misoprostol rectally
66
Carboprost (15 met PGF2) contradiction is
Asthma
67
Methylergonovine (Ergot) contradiction is ...
HTN of any kind
68
Congenital Varicella Syn presents as ...
IUGRCicatricial scarring rashLimb HypoplasiaChoriretinitis
69
Mono/Di/Mono twinning occurs b/t days....
4 and 8
70
Conjoined twins occur b/t days ...
13 +
71
Mono/Mono/Mono twins occur b/t days ...
8 and 12
72
Di/Di/Di Twins occur b/t days ...
0-1. Two eggs are needed
73
Di/Di/Mono Twins occur b/t days ...
0-3
74
Tx for precocious puberty
GnRH Agonist Leuprolide or Goserelin
75
Most common cause of SAB in first trimester
Chromosome abnl
76
Nl blood loss in a vag delivery ...C/S...
<500ml<1000ml
77
Bleeding in a menopause pt. Next Step?
Endometrial Bx
78
Age range for Pap smear
21-65 yo
79
Pt has an average risk of colon cancer, when do you screen?
50 yo q 10y
80
Pregancy can be seen via u/s if beta hcg is above ....
2000
81
_____ contraception reduces gyn Ca
COCP
82
What is the order of Sexual Development in girls?Boys?
Girl: Boob, Hair, Growth Spurt, PeriodBoys: Balls, Voice, Penis, Hair, Growth Spurt
83
Define False Labor
Contractions that do not cause cervical change
84
Define Chronic HTN
Repeated BP above 140/90 before 20 wks gestation and <300mg protein in a 24hr urine
85
Define Gestational HTN
Repeated BP above 140/90 after 20 wks gestation and <300mg protein in a 24hr urine
86
Pt presents w/ vague GI complaints. PE shows adnexal fullness and nodularity in the cup-de-sac. Positive abdominal ascites...Dx?
Ovarian Cancer
87
Define Primary Amenorrhea
No cycle by 16 yo
88
First test for primary amenorrhea?
Urine Hcg
89
Pt at 16 wk gestation presents w/ mild persistent asthma that is unresponsive to albuterol. Rx...
Budesonide, LDCS
90
What structures, if inflamed, can cz dyschezia?
Rectal Serosa (Endometriosis)Cardinal Ligament (Rectocele/Uterine Inversion)
91
Define Bisacromial Diameter
Widest distance b/t fetal shoulders
92
Define True Conjugate
Sacral promontory to superior pubic symphysis
93
Define Obstetric Conjugate
Entry into the pelvic inlet/true pelvis.Shortest AP distance in the pelvis. From sacral promontory to mid pubic symphysisDiagonal Conjugate - 1(or2)cm = Obstetric Conjugate
94
Define Diagonal Conjugate
ONLY CONJUGATE THAT CANBE MEASUREDSacral promontory to Inferior pubic symphysis
95
Define Interspinous Diameter
Distance b/t the ischial spines.Shortest transvers distanceUsed as demarcation for station zero
96
Pt has endometrial hyperplasia and a complex adnexal mass. Irregular vag bleeding. Dx?
Granulosa tumor secreting excessive estradiol.
97
Ovarian mass that has a calcified appearance on CT
Teratoma -- contain all 3 germ layers. Benign
98
Pt presents w/ Virilization. Testosterone is elevated, DHEA-S is nl. Ovarian mass present... Dx?
Sertoli-Leydig tumor that secretes androgens
99
Nest of transitional epithelium w/n fibrous stroma.Small and solid
Brenner Tumor
100
Dx modality for fibroids is ...
transvaginal ultrasound
101
Tx for ectopic pregnancy that has not ruptured.
MTX
102
What is levnorgestrel?
Plan b -- use 24 to 72 hr post coitus.No effect on current pregnancy
103
Whats misoprostol?
PGE1 Analog -- induce contractions. Often used in combination w/ MTX, but not on ectopic pregnancies
104
RF for PROM
InfectionSmokingSubstance abuse Uterine abnormalityAge <18 >40Low Social economical statusHx of PROM/abortion
105
Use for clobetasol propionate
Vulvar Lichen Sclerosus
106
Define Cervical cerclage
Purse string suture to help retain pregnancy.Removed at 36 wks
107
Indication for a cervical cerclage
Pt has multiple SAB prior to 20wks d/t painless cervical dialation
108
Pt has a history of spontaneous preterm birth. She curently pregnant, net step?
Progesterone b/t 16 and 36 wks
109
What population should not get estrogen containing contraception?
Pts >35 yo + smoker
110
Pt has had STI w/n the last 3 mo, what contraception is she ineligible for?
All IUD
111
What is a sonohystogram?
The uterus is filled w/ saline and ultrasound is used to detect uterine pathology
112
What is uterine synechiae?
Asherman syndrome, characterized by the formation of intrauterine adhesions, which are usually sequela from injury to the endometrium, and is often associated with infertility.
113
Pregnant mom has poorly controlled diabetes, what three things are happening to baby?
HyperinsulinemaHyperglycemicMacrosomia
114
Pt presents w/ LSIL, next step?
>25 yo = Colposcopy21-24 yo = Repeat pap in 12 months
115
Define Autonomy
Allowing pt to make decisions of care received
116
Define Non-malefience
Do no harm to the pt intentionally
117
Define Justice
All pts have equal access to treatment unless clinically indicated
118
Define Beneficence
Risk versus benefit.
119
Kleihaur-Betke Test is for...
Unexplained fetal demise to r/o fetomaternal hemorrhageTest for fetal blood in maternal blood
120
IUGR is strongly associated w/
CP
121
First line for depression in pregnancy2nd?3rd?
SSRI, Sertaline2nd -- Bupropion, Venlafaxine3rd -- Tricyclic
122
How often should a neonate eat?
8-12x/day
123
4wo should eat ... x/day
7-9
124
8w0 should eat ... x/day
5-7
125
Any deliver <34 wks should receive ...
Bethamethasone for fetal lung maturity
126
Define Missed SAB
<20 wksClosed CervixASx -- no bleeding"Don't 'feel' preggo anymore
127
Define Inevitable SAB
Open CervixBleedingNo POC delivered
128
Define Complete SAB
Closed CervixContracted UterusBleedingAll POC delivered
129
Define Incomplete SAB
Open CervixBleedingPartial POC delivered
130
Define Threatened SAB
Closed CervixBleeding Fetus still viable
131
Asthma in pregnancy increases the risk of ...
perinatal mortality and SAB
132
Pt at <37 wks is in labor. Bethamethasone is given, what lab is increased?
Glucose
133
Pt that had Cs 3 yo ago has pain at the lateral edge of the incision which is well healed. Pain is burning/sharp and reproducible in clinic. Dx?
Ilioinguinal/hypogastric nerve entrapment
134
Clomiphene and Metformin are used in OB to Tx...
infertility d/t PCOS
135
First line Dx for placenta previa
Tansvaginal ultrasound
136
COPC are given to tx endometriosis, as such .... will resolve
Dysmenorrhea
137
Pt is violent w/ partner, next step is to ...
refer to Mental Health
138
Most common cz of irregular bleeding in adolescence is ...
failed production by corpus luteum
139
Dx test for Rh Alloimmunization
Indirect coombs
140
Most common complication w/ forced delivery is ...
Perineal laceration
141
The combo screen is done at ... and includes ...
11-14 wkPAPP-A, HCG, Nuchal Translucency U/S
142
Quad screen includes ...
EstrodiolInhibin AAFPHcg
143
Late 3rd trimester woman presents w/ b/l yellow d/c from her nipples. This is d/t ...
distention of the lumens by accumulating secretary material
144
Septic AB is tx w/...
Fluid, Clinda, Dilate and evacuate
145
Preggo is exposed to varicella, tx w/ ...
Varicella IG
146
Prenatal test for CMV is done by...
CMV PCR via amniocentesis
147
First line tx for urinary incontinence and pelvic organ prolapse?
Kegal Exercises
148
Pt at 38 wks presents w/ PROM, first step is ...
give Gent and Amp
149
Postpartum hemorrhage + Uterus is Firm, Dx is ...
Retained placenta | Tx: D+C, Hysterectomy, Track Hcg
150
Postpartum hemorrhage + Uterus is Boggy, Dx is ...
Uterine Atony | Tx: Massage >> Oxy >> Surgery
151
Postpartum hemorrhage + Uterus is Absent, Dx is ...
Uterine inversion | Tx: Put it back >> Tocolytics >> Tococlonics
152
Postpartum hemorrhage + Uterus is Normal, Dx is ...
Laceration | Tx: Sutures
153
HBs-Ag +HBe-Ag +Anti- HBs -IgM Anti- HBc +IgG Anti- HBc -Dx?
Acute Hep B Infection | Sx: Anorexia, Nausea, Jaundice, RUQ Pain
154
HBs-Ag +HBe-Ag -Anti- HBs -IgM Anti- HBc -IgG Anti- HBc +Dx?
Chronic Hep B Infection
155
HBs-Ag -HBe-Ag -Anti- HBs +IgM Anti- HBc -IgG Anti- HBc -Dx?
Hep B Immunity from Vaccination
156
HBs-Ag -HBe-Ag -Anti- HBs +IgM Anti- HBc -IgG Anti- HBc +Dx?
Hep B Immunity from Infection
157
HBs-Ag + means ...
active infection
158
Anti HBs + means ...
Immunity
159
HBs-Ag+, Anti-HBc IgG + means ...
Chronic Infection
160
HBe-Ag is only present in the ... stage
acute
161
Surgical patient presents w/ tachycardia, dyspnea, wheezing, bronchospasm, flushing ...Dx?
Pt is having an allergic reaction, most often d/t latex and iodine.
162
Most likely complication of amniocentesis is ...
PROM
163
Preggo pt has condyloma acuminata, tx w/ ...
Trichloroacetic Acid
164
Preggo has HPV, Trichloroacetic Acid has failed, tx w/ ...
Cryoablation
165
Biggest risk in post-date delivery ...
Dystocia
166
Macrosomia is defined as a birth weight ...
> 4500g (9lb 15oz)
167
Evaluation of endometriosis includes ...
Clnc Sx >> Pelvic U/S >> Laparoscopy
168
DEXA. scan occurs at ...
65yo
169
g/day growth at 15 weeks
5
170
g/day growth at 20 weeks
10
171
g/day growth b/t 20-32 weeks
20
172
g/day growth after 32 weeks
30
173
RF for Primary Dysmenorrhea
SmokingNulliparityHeavy MensesDepression
174
Level of FSH, LH and Estrogen in a pt w/ hyperprolatinemis
All decreased
175
Define PMDD
PMS + Socioeconomic Dysfunction
176
Tx for urge incontinence
Anticholinergic/Muscarinic Antagonist -- darifenacin, tolteroldine, oxybutynin
177
Cz of Non-painful bleeding in the 3rd trimester
Placenta previaVasa Previa
178
When to give MTX for Ectopic Pregnancy
1. HCG <80002. No Heart Tones3. No Folate4. Fetus <3cm
179
Pt 33 wks pregnant is involved in a MVA and begins premature labor. What sx, if present, is contradictory to use of tocolytics?
Hemorrhage
180
Pt has a molar pregnancy, what screen do you want>
CXR
181
Pt is DM-1, how will baby be affected?
Small and hypoglycemic
182
This drug given during labor is associated w/ a decrease in intracranial hemorrhage
Bethamethasone
183
Pt displays mullein agenesis, be sure to also check
The kidneys for abnormalities
184
Simple breast cyst w/ pain, Tx?
FNA
185
When examining a assault case, ... is key`
photographic evidence
186
1st and 2nd choice in initial treatment of hypovolemic shock
1. Packed RBC2. Lact Ringers/NS
187
Mass in vagina, needs reduction in order to defecate.Posterior wall deficit
Rectocele
188
Anterior wall deficit, urinary retention, kinked ureter.
Cystocele
189
Vag apex bulge
Enterocele
190
APGAR =
Appearance (Color)Pulse (HR)Grimace (Relex)Activity (Muscle Tone)Respiration (Breathing)
191
When examining a assault case, ... is key?
photographic evidence
192
What med should be offered to a rape victim?
Abx for STIAnti-Viral for HIV
193
Amorphic calcifications wo localization of a discreet mass is found on mammogram. Dx?
Ductal Carcinoma In Situ
194
CO in multiple pregnancy is increased 20%, as such prevalence of ... is higher in these pts
anemia
195
FNA of Breast mass returns bloody fluid, next step?
Excisional Bx to r/o Ca
196
Immunizations for a preggo HIV pt
Hep AHep BTdapPneumococcalIM Flu
197
Effect of maternal HTN on fetus?
IUGR
198
Define post operative fever
Fever w/n 48 of surgery, most likely not infectious. Expectant Management recommended
199
Placental abruption may lead to ... if the pt is not treated.
DIC
200
What medication should be given to a Turner pt
Conj Estrogen
201
Preggo has uncomplicated UTI, Rx? | if complicated...
Nitro | Amp/Gent
202
What OB condition carry Hx as the largest RF?
EctopicPretermDystociaPre-eclampsia
203
HPV testing starts at ...
30 yo
204
Elective CS can occur after ...
39 wks
205
What is elevated in an asx post menopause woman
LDL
206
pt presents w/ post partum fever, hypotension, multi-organ involvement, purulent dc, rash, necrosis...Dx?
GAS Infection
207
PMDD/PMS Rx
Sertaline
208
Toxo infection while preggo, Rx?
Spiramycin
209
How much weight to gain if BMI>3025-2918.5-24<18.5
>30 -- 11-20 25-29 -- 15-25 18.5-24 -- 25-35 <18.5 -- 28-40
210
Pre-Eclampsia is cz by ... after ... wks
Placental hypoperfusion 18

COMLEX Level 2 (8 decks)

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