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COMLEX Level 2 > OB/GYN COMAT > Flashcards

OB/GYN COMAT Flashcards

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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
Q

Pt presents w/ high grade squamous intraepithelial cytology but negative colposcopy. Next step?

A

Bx by Loop electrosurgical excision procedure (LEEP)

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26
Q

Continuous Fetal Heart monitor decreases the chance of ….

A

Neonatal Seizures

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27
Q

Pt w/ high Hcg, heavy cycles, pelvic pressure, vomiting.Consider …

A

Molar Pregnancy

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28
Q

45 yo pt has cycle day 3 FSH > 30. Why can’t she conceive?

A

Late maternal age and low follicle availability.

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29
Q

Define the types of incontinence:OverflowStressUrgeMixedFunctional

A

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

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30
Q

Twin A Vertex + Twin B BreechBirth Plan?

A

Twin A VD

Twin B Reposition VD or CS

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31
Q

Twin A Breech + Twin B BreechBirth Plan?

A

C-section for both

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32
Q

Twin A Breech + Twin B VertexBirth Plan?

A

C-Section for both

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33
Q

Neonates born w/ IUGR are at risk for…

A
  1. Cesarean delivery
  2. Hypoxia
  3. Meconium aspiration
  4. Hypoglycemia
  5. Polycythemia
  6. Hyperviscosity
  7. Motor and neurological disabilities
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34
Q

RF of Fibroids

A

AA
HTN
Early Menarche
Nulliparity

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35
Q

Woman presents w/ pelvic pain, mass in the uterus, inability to get pregnant, and menorrhagia…Dx?

A

Fibroids

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36
Q

Pt found to have granulose tumor. It is excised. What other screen should be done?

A

Uterine sampling

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37
Q

Pt presents w/ uncontrolled, untreated PID. Peritoneal signs present. Pregnancy is R/O. Medical Tx initiated. Next step is …

A

emergent laparotomy d/t probable ovarian abscess.

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38
Q

Pt presents w/ Dysmenorrhea, Dyspareunia, Dyschezia, and Depression…Dx?

A

Endometriosis

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39
Q

Pt w/ ovarian insufficiency refuses Tx. She is at risk for…

A

Osteoporosis and osteopenia

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40
Q

Klinefelter Syn Characteristics

A

XXY
Gynecomastia Atrophied Testes
Low Testosterone
High FSH, LH, Estrogen

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41
Q

Pt in 3rd trimester presents w/ painless bleeding following intercourse…Dx?

A

Placenta Previa – Placenta is covering the cervical os.

Dx w/ U/S

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42
Q

Risks for osteoporosis

A

ALL ACCESS

Age
Low weight
Lots of fractures
Alcohol
Calcium low
Corticosteroids 
Estrogen low
Smoking
Sedentary
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43
Q

Tx to prevent osteoporosis

A

Vit D and Calcium

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44
Q

Pt <30 presents w/ a breast mass…Next Step?

A

U/S

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45
Q

Tx for chorioamnioitis

A

Gent + Amp (or Clind for PCN allergy)

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46
Q

Pt in 3rd trimester w/ RUQ Abd pain, HA and nausea, Neg for Protein in UA…Dx?

A

HELLP Syn

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47
Q

Pts 21-30 yo w/ no abnl paps. When to repeat pap?50-65 yo?

A

q 3yq 5y + HPV

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48
Q

Define dystocia

A

abnormalities in labor and delivery

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49
Q

Sexually active women < 24yo need an annual screen for …

A

HIV, Gon, Chlam

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50
Q

Tx for mastitis…

A

PO Abx + continue breastfeeding.

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51
Q

Pt presents w/ abnl menses, obesity, acne, male hair growth…Dx?

A

PCOS

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52
Q

How much Folic Acid is recommend for women w/ prev birth afflicted w/ NTD

A

4000 micrograms/day

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53
Q

Pt has a Hx of HSV and is in labor. When do you do a C-section?

A

Hx of disease plus…Present lesions or Prodromal Sx

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54
Q

Pt can’t get pregnant d/t PID. If a child is desired, recommend …

A

in vitro fertillization

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55
Q

Breast screening starts at age …

A

50

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56
Q

IUGR is suspected. Fetal percentile is <10%. To assess fetal well being perform a …

A

Umbilical artery doppler

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57
Q

NST is negative. Next Step?

A

Biophysical Profile

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58
Q

Biophysical Profile determines …

A

fetal hypoxia by Amniotic Fluid Level, movement, tone, breathing, NST in late 2nd/3rd trimester

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59
Q

Fetal anemia is suspected. R/o w/

A

MCA Doppler

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60
Q

Non-reactive NST =

A

2 accelerations in 20 min

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61
Q

Breast abnormality in pts greater that 30…next step?

A

Dx Mammogram

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62
Q

Androgen insensitivity presents as …

A

46 XY Phenotypic Female w/ breasts and a blind vaginaNo uterus, ovaries, or pubic hair

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63
Q

Kallman presents as …

A

Congenital hypogonad hypogonadism that can’t smell, low sex hormones and absent GnRH

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64
Q

(MRKH Syn) Mullerian agenesis presents as …

A

46 XX Female w/ blind vagina and no uterusOvaries are present!

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65
Q

Pt has uterine atony. Hx includes asthma and HTN. No response to Oxytocin. Next Step?

A

Misoprostol rectally

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66
Q

Carboprost (15 met PGF2) contradiction is

A

Asthma

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67
Q

Methylergonovine (Ergot) contradiction is …

A

HTN of any kind

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68
Q

Congenital Varicella Syn presents as …

A

IUGRCicatricial scarring rashLimb HypoplasiaChoriretinitis

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69
Q

Mono/Di/Mono twinning occurs b/t days….

A

4 and 8

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70
Q

Conjoined twins occur b/t days …

A

13 +

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71
Q

Mono/Mono/Mono twins occur b/t days …

A

8 and 12

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72
Q

Di/Di/Di Twins occur b/t days …

A

0-1. Two eggs are needed

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73
Q

Di/Di/Mono Twins occur b/t days …

A

0-3

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74
Q

Tx for precocious puberty

A

GnRH Agonist Leuprolide or Goserelin

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75
Q

Most common cause of SAB in first trimester

A

Chromosome abnl

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76
Q

Nl blood loss in a vag delivery …C/S…

A

<500ml<1000ml

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77
Q

Bleeding in a menopause pt. Next Step?

A

Endometrial Bx

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78
Q

Age range for Pap smear

A

21-65 yo

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79
Q

Pt has an average risk of colon cancer, when do you screen?

A

50 yo q 10y

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80
Q

Pregancy can be seen via u/s if beta hcg is above ….

A

2000

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81
Q

_____ contraception reduces gyn Ca

A

COCP

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82
Q

What is the order of Sexual Development in girls?Boys?

A

Girl: Boob, Hair, Growth Spurt, PeriodBoys: Balls, Voice, Penis, Hair, Growth Spurt

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83
Q

Define False Labor

A

Contractions that do not cause cervical change

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84
Q

Define Chronic HTN

A

Repeated BP above 140/90 before 20 wks gestation and <300mg protein in a 24hr urine

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85
Q

Define Gestational HTN

A

Repeated BP above 140/90 after 20 wks gestation and <300mg protein in a 24hr urine

86
Q

Pt presents w/ vague GI complaints. PE shows adnexal fullness and nodularity in the cup-de-sac. Positive abdominal ascites…Dx?

A

Ovarian Cancer

87
Q

Define Primary Amenorrhea

A

No cycle by 16 yo

88
Q

First test for primary amenorrhea?

A

Urine Hcg

89
Q

Pt at 16 wk gestation presents w/ mild persistent asthma that is unresponsive to albuterol. Rx…

A

Budesonide, LDCS

90
Q

What structures, if inflamed, can cz dyschezia?

A

Rectal Serosa (Endometriosis)Cardinal Ligament (Rectocele/Uterine Inversion)

91
Q

Define Bisacromial Diameter

A

Widest distance b/t fetal shoulders

92
Q

Define True Conjugate

A

Sacral promontory to superior pubic symphysis

93
Q

Define Obstetric Conjugate

A

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
Q

Define Diagonal Conjugate

A

ONLY CONJUGATE THAT CANBE MEASUREDSacral promontory to Inferior pubic symphysis

95
Q

Define Interspinous Diameter

A

Distance b/t the ischial spines.Shortest transvers distanceUsed as demarcation for station zero

96
Q

Pt has endometrial hyperplasia and a complex adnexal mass. Irregular vag bleeding. Dx?

A

Granulosa tumor secreting excessive estradiol.

97
Q

Ovarian mass that has a calcified appearance on CT

A

Teratoma – contain all 3 germ layers. Benign

98
Q

Pt presents w/ Virilization. Testosterone is elevated, DHEA-S is nl. Ovarian mass present… Dx?

A

Sertoli-Leydig tumor that secretes androgens

99
Q

Nest of transitional epithelium w/n fibrous stroma.Small and solid

A

Brenner Tumor

100
Q

Dx modality for fibroids is …

A

transvaginal ultrasound

101
Q

Tx for ectopic pregnancy that has not ruptured.

A

MTX

102
Q

What is levnorgestrel?

A

Plan b – use 24 to 72 hr post coitus.No effect on current pregnancy

103
Q

Whats misoprostol?

A

PGE1 Analog – induce contractions. Often used in combination w/ MTX, but not on ectopic pregnancies

104
Q

RF for PROM

A

InfectionSmokingSubstance abuse Uterine abnormalityAge <18 >40Low Social economical statusHx of PROM/abortion

105
Q

Use for clobetasol propionate

A

Vulvar Lichen Sclerosus

106
Q

Define Cervical cerclage

A

Purse string suture to help retain pregnancy.Removed at 36 wks

107
Q

Indication for a cervical cerclage

A

Pt has multiple SAB prior to 20wks d/t painless cervical dialation

108
Q

Pt has a history of spontaneous preterm birth. She curently pregnant, net step?

A

Progesterone b/t 16 and 36 wks

109
Q

What population should not get estrogen containing contraception?

A

Pts >35 yo + smoker

110
Q

Pt has had STI w/n the last 3 mo, what contraception is she ineligible for?

A

All IUD

111
Q

What is a sonohystogram?

A

The uterus is filled w/ saline and ultrasound is used to detect uterine pathology

112
Q

What is uterine synechiae?

A

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
Q

Pregnant mom has poorly controlled diabetes, what three things are happening to baby?

A

HyperinsulinemaHyperglycemicMacrosomia

114
Q

Pt presents w/ LSIL, next step?

A

> 25 yo = Colposcopy21-24 yo = Repeat pap in 12 months

115
Q

Define Autonomy

A

Allowing pt to make decisions of care received

116
Q

Define Non-malefience

A

Do no harm to the pt intentionally

117
Q

Define Justice

A

All pts have equal access to treatment unless clinically indicated

118
Q

Define Beneficence

A

Risk versus benefit.

119
Q

Kleihaur-Betke Test is for…

A

Unexplained fetal demise to r/o fetomaternal hemorrhageTest for fetal blood in maternal blood

120
Q

IUGR is strongly associated w/

A

CP

121
Q

First line for depression in pregnancy2nd?3rd?

A

SSRI, Sertaline2nd – Bupropion, Venlafaxine3rd – Tricyclic

122
Q

How often should a neonate eat?

A

8-12x/day

123
Q

4wo should eat … x/day

A

7-9

124
Q

8w0 should eat … x/day

A

5-7

125
Q

Any deliver <34 wks should receive …

A

Bethamethasone for fetal lung maturity

126
Q

Define Missed SAB

A

<20 wksClosed CervixASx – no bleeding”Don’t ‘feel’ preggo anymore

127
Q

Define Inevitable SAB

A

Open CervixBleedingNo POC delivered

128
Q

Define Complete SAB

A

Closed CervixContracted UterusBleedingAll POC delivered

129
Q

Define Incomplete SAB

A

Open CervixBleedingPartial POC delivered

130
Q

Define Threatened SAB

A

Closed CervixBleeding Fetus still viable

131
Q

Asthma in pregnancy increases the risk of …

A

perinatal mortality and SAB

132
Q

Pt at <37 wks is in labor. Bethamethasone is given, what lab is increased?

A

Glucose

133
Q

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?

A

Ilioinguinal/hypogastric nerve entrapment

134
Q

Clomiphene and Metformin are used in OB to Tx…

A

infertility d/t PCOS

135
Q

First line Dx for placenta previa

A

Tansvaginal ultrasound

136
Q

COPC are given to tx endometriosis, as such …. will resolve

A

Dysmenorrhea

137
Q

Pt is violent w/ partner, next step is to …

A

refer to Mental Health

138
Q

Most common cz of irregular bleeding in adolescence is …

A

failed production by corpus luteum

139
Q

Dx test for Rh Alloimmunization

A

Indirect coombs

140
Q

Most common complication w/ forced delivery is …

A

Perineal laceration

141
Q

The combo screen is done at … and includes …

A

11-14 wkPAPP-A, HCG, Nuchal Translucency U/S

142
Q

Quad screen includes …

A

EstrodiolInhibin AAFPHcg

143
Q

Late 3rd trimester woman presents w/ b/l yellow d/c from her nipples. This is d/t …

A

distention of the lumens by accumulating secretary material

144
Q

Septic AB is tx w/…

A

Fluid, Clinda, Dilate and evacuate

145
Q

Preggo is exposed to varicella, tx w/ …

A

Varicella IG

146
Q

Prenatal test for CMV is done by…

A

CMV PCR via amniocentesis

147
Q

First line tx for urinary incontinence and pelvic organ prolapse?

A

Kegal Exercises

148
Q

Pt at 38 wks presents w/ PROM, first step is …

A

give Gent and Amp

149
Q

Postpartum hemorrhage + Uterus is Firm, Dx is …

A

Retained placenta

Tx: D+C, Hysterectomy, Track Hcg

150
Q

Postpartum hemorrhage + Uterus is Boggy, Dx is …

A

Uterine Atony

Tx: Massage&raquo_space; Oxy&raquo_space; Surgery

151
Q

Postpartum hemorrhage + Uterus is Absent, Dx is …

A

Uterine inversion

Tx: Put it back&raquo_space; Tocolytics&raquo_space; Tococlonics

152
Q

Postpartum hemorrhage + Uterus is Normal, Dx is …

A

Laceration

Tx: Sutures

153
Q

HBs-Ag +HBe-Ag +Anti- HBs -IgM Anti- HBc +IgG Anti- HBc -Dx?

A

Acute Hep B Infection

Sx: Anorexia, Nausea, Jaundice, RUQ Pain

154
Q

HBs-Ag +HBe-Ag -Anti- HBs -IgM Anti- HBc -IgG Anti- HBc +Dx?

A

Chronic Hep B Infection

155
Q

HBs-Ag -HBe-Ag -Anti- HBs +IgM Anti- HBc -IgG Anti- HBc -Dx?

A

Hep B Immunity from Vaccination

156
Q

HBs-Ag -HBe-Ag -Anti- HBs +IgM Anti- HBc -IgG Anti- HBc +Dx?

A

Hep B Immunity from Infection

157
Q

HBs-Ag + means …

A

active infection

158
Q

Anti HBs + means …

A

Immunity

159
Q

HBs-Ag+, Anti-HBc IgG + means …

A

Chronic Infection

160
Q

HBe-Ag is only present in the … stage

A

acute

161
Q

Surgical patient presents w/ tachycardia, dyspnea, wheezing, bronchospasm, flushing …Dx?

A

Pt is having an allergic reaction, most often d/t latex and iodine.

162
Q

Most likely complication of amniocentesis is …

A

PROM

163
Q

Preggo pt has condyloma acuminata, tx w/ …

A

Trichloroacetic Acid

164
Q

Preggo has HPV, Trichloroacetic Acid has failed, tx w/ …

A

Cryoablation

165
Q

Biggest risk in post-date delivery …

A

Dystocia

166
Q

Macrosomia is defined as a birth weight …

A

> 4500g (9lb 15oz)

167
Q

Evaluation of endometriosis includes …

A

Clnc Sx&raquo_space; Pelvic U/S&raquo_space; Laparoscopy

168
Q

DEXA. scan occurs at …

A

65yo

169
Q

g/day growth at 15 weeks

A

5

170
Q

g/day growth at 20 weeks

A

10

171
Q

g/day growth b/t 20-32 weeks

A

20

172
Q

g/day growth after 32 weeks

A

30

173
Q

RF for Primary Dysmenorrhea

A

SmokingNulliparityHeavy MensesDepression

174
Q

Level of FSH, LH and Estrogen in a pt w/ hyperprolatinemis

A

All decreased

175
Q

Define PMDD

A

PMS + Socioeconomic Dysfunction

176
Q

Tx for urge incontinence

A

Anticholinergic/Muscarinic Antagonist – darifenacin, tolteroldine, oxybutynin

177
Q

Cz of Non-painful bleeding in the 3rd trimester

A

Placenta previaVasa Previa

178
Q

When to give MTX for Ectopic Pregnancy

A
  1. HCG <80002. No Heart Tones3. No Folate4. Fetus <3cm
179
Q

Pt 33 wks pregnant is involved in a MVA and begins premature labor. What sx, if present, is contradictory to use of tocolytics?

A

Hemorrhage

180
Q

Pt has a molar pregnancy, what screen do you want>

A

CXR

181
Q

Pt is DM-1, how will baby be affected?

A

Small and hypoglycemic

182
Q

This drug given during labor is associated w/ a decrease in intracranial hemorrhage

A

Bethamethasone

183
Q

Pt displays mullein agenesis, be sure to also check

A

The kidneys for abnormalities

184
Q

Simple breast cyst w/ pain, Tx?

A

FNA

185
Q

When examining a assault case, … is key`

A

photographic evidence

186
Q

1st and 2nd choice in initial treatment of hypovolemic shock

A
  1. Packed RBC2. Lact Ringers/NS
187
Q

Mass in vagina, needs reduction in order to defecate.Posterior wall deficit

A

Rectocele

188
Q

Anterior wall deficit, urinary retention, kinked ureter.

A

Cystocele

189
Q

Vag apex bulge

A

Enterocele

190
Q

APGAR =

A

Appearance (Color)Pulse (HR)Grimace (Relex)Activity (Muscle Tone)Respiration (Breathing)

191
Q

When examining a assault case, … is key?

A

photographic evidence

192
Q

What med should be offered to a rape victim?

A

Abx for STIAnti-Viral for HIV

193
Q

Amorphic calcifications wo localization of a discreet mass is found on mammogram. Dx?

A

Ductal Carcinoma In Situ

194
Q

CO in multiple pregnancy is increased 20%, as such prevalence of … is higher in these pts

A

anemia

195
Q

FNA of Breast mass returns bloody fluid, next step?

A

Excisional Bx to r/o Ca

196
Q

Immunizations for a preggo HIV pt

A

Hep AHep BTdapPneumococcalIM Flu

197
Q

Effect of maternal HTN on fetus?

A

IUGR

198
Q

Define post operative fever

A

Fever w/n 48 of surgery, most likely not infectious. Expectant Management recommended

199
Q

Placental abruption may lead to … if the pt is not treated.

A

DIC

200
Q

What medication should be given to a Turner pt

A

Conj Estrogen

201
Q

Preggo has uncomplicated UTI, Rx?

if complicated…

A

Nitro

Amp/Gent

202
Q

What OB condition carry Hx as the largest RF?

A

EctopicPretermDystociaPre-eclampsia

203
Q

HPV testing starts at …

A

30 yo

204
Q

Elective CS can occur after …

A

39 wks

205
Q

What is elevated in an asx post menopause woman

A

LDL

206
Q

pt presents w/ post partum fever, hypotension, multi-organ involvement, purulent dc, rash, necrosis…Dx?

A

GAS Infection

207
Q

PMDD/PMS Rx

A

Sertaline

208
Q

Toxo infection while preggo, Rx?

A

Spiramycin

209
Q

How much weight to gain if BMI>3025-2918.5-24<18.5

A

> 30 – 11-20
25-29 – 15-25
18.5-24 – 25-35
<18.5 – 28-40

210
Q

Pre-Eclampsia is cz by … after … wks

A

Placental hypoperfusion 18

COMLEX Level 2 (8 decks)

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