Brainscape's Knowledge GenomeTM

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


See full index

OBGYN Step 2 > OB MTB > Flashcards

OB MTB Flashcards

1
Q

embryo is considered fetus at how many weeks gestation?

how long infant for?

A

8 weeks

infant for 1 year after birthNagele rule

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

Nagele rule

A

EDD : LMP - 3 months + 7 days

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

gestational age?

trimester breakdown

A

number of days since LMP

1st: 0-12 weeks (14 gestational age)
2nd: 12-24 weeks
3rd: 24-delivery

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

screening based on trimesters

A

1st: FHTs with Doppler
2nd: triple/quad screen, movement at 16-20 wks, u/s at 18-20 wks GA
3rd: frequent visits, monitor labs

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

Gs and Ps of female who presents with her 6th pregnancy, has had 2 abortions, 2 children born at term, and set of twins born preterm

A

G6P2124
G TPAL
(twins born preterm count as 1 pregnancy)

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

one of first signs of pregnancy on PE

A

Goodell sign: softening of cervix, may be felt at 4 weeks

in contrast, quickening is first time mother feels fetal movement

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

other signs of pregnancy
Ladin:
Chadwick:
chloasma:

A

Ladin: softening of midline uterus (6 wks)
Chadwick: blue discoloration of vagin and cervix (6-8 wks)
chloasma: “mask of pregnancy” (16 wks)

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

how rapidly is B-hCG produced in 1st trimester?

when does it peak?

A

doubles every 48 hrs in 1st 4 wks
peaks at 10 wks
drop in 2nd trimester, and rise slowly again in 3rd trimester to levels of 20-30,000 IU/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when/what B-hCG level should a gestational sac be seen on ultrasound?

A

at 5 wks or B-hCG of 1000-1500 IU/mL

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

changes in CO, HR, BP

A

^CO, ^HR, decreased BP (lowest 24-28 wks)

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

changes in coagulation

A

hypercoagulable, ^fibrinogen

but no increase in PT, PTT, INR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

1st trimester tests

A

see every 4-6 wks
11-14 wks: u/s for GA and nuchal translucency
blood tests, pap smear, Gc/Clamydia
1st trimester screening for chrom. abn.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

most accurate test to establish gestational age in 1st trimester

A

U/S, esp. 11-14 wks

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

2nd trimester screening

A

triple/quad screen 15-20 wks

ultrasound 18-20 wks for fetal malformations

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

3rd trimester visits

A

q2-3 wks until wk 36 then qwk
27: CBC (iron if hgb less than 11)
24-28: glucose load (140+ 3 hr gtt)
36: cerv. cx for Gc/Chl, recvag cx for GBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when to get CVS

amniocentesis

A

CVS: 10-13 wks in AMA or known genetic disease
amniocentesis: 11-14 wks

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

most common site of ectopic

risk factors?

A

ampulla of fallopian tube

PID, IUD, previous ectopic

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

ectopic pregnancy:

presentation and tests

A

u/l low abdominal or pelvic pain, vaginal bleeding, hypotensive with peritoneal signs if ruptured
tests: B-hCG, U/S, laparoscopy (tx)

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

unstable ruptured ectopic pts

A

need IV fluids, +/- blood products, +/- dopamine to stabilize BEFORE surgery
stable ruptured can go straight to sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

medical tx of non-ruptured ectopic

A 
MTX
labs: B-hCG, CBC, t/s, LFTs
look for 15% drop in hCG in 4-7 days
if not, 2nd dose MTX
if still not decreasing, resort to surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

exclusion criteria for MTX

A

immunodeficiency, noncompliant, hepatotoxicity, 3.5cm+, FH beat auscultated (^risk failure)

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

ectopic surgical tx

A

salpingostomy (cutting hole in tube, preserves)
salpingectomy (remove whole tube)
give RhoGAM if Rh negative

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

etiologies of abortion

A

*chromosomal abnormalities
anatomic abnormalities, infection (STDs), immune (aPL syndrome), endocrine (HTN, DM), malnutrition, trauma, Rh isoimmunization

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

tests to do in abortion

A

CBC, type/screen, U/S

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

if no products of conception found on u/s ?
if some POCs found ?
if intact POCs but bleeding and cervix dilated?
if intact POCs, no cervical dilation but bleeding?
if intact POCs but fetal death?
infection of uterus/surrounding areas?

A

complete abortion (f/u)
some: incomplete (D&C/medical)
bleeding/dilated: inevitable (D&C/medical)
bleeding/no dilation: threatened (bed/pelvic rest)
fetal death: missed (D&C/medical)
infection: septic abortion (D&C and IV abx (levaquin, metronidazole)

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

medical treatment of abortions (incomplete, inevitable, missed)

A

misoprostol (PGE1 analog): help open cervix and expulse fetus
if Rh- give RhoGAM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

complications of multiple gestations

A

spontaneous abortion of 1 fetus, premature L+D, placenta previa, anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

preterm contractions with cervical dilations called ?

A

preterm labor
if “gush of fluids” consider PROM
if just preterm contractions will not lead to cervical change

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

risk factors for preterm labor

A

PROM, multiple gestations, previous hx of preterm labor, placental abruption, maternal factors (anatomy, infection, pre-E, intra-abd. sx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

when NOT to stop preterm labor

A

pre-E/eclampsia, cardiac disease, cervical dilation of +4cm, maternal hemorrhage (placental abruption, DIC), fetal death, chorioamnionitis, between 34-37 wks, greater than 2500g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

most commonly used tocolytic

SEs?

A

Mg+: decreases uterine tone and contractions
SEs: flushing, HA, diplopia, fatigue
also, check DTRs and look out for respiratory depression and cardiac arrest
others: CCBs, terbutaline (B-agonist)
Do NOT use indomethacin

32
Q

PROM may lead to ?

A

preterm labor, cord prolapse, placental abruption, chorioamnionitis (do fewer pelvic exams to reduce risk of chorio)

33
Q

treatment of PROM

A

if chorioamnionitis: deliver NOW

if term and no chorio: wait 6-12 hrs for spontaneous delivery, than induce

34
Q

P-PROM treatment (preterm premature ROM) if no chorioamnionitis

A

betamethasone, tocolytics, ampicillin, 1 dose azithromycin (decrease risk of dev. chorio)
if PCN allergic: cefazolin and azithromycin
if high risk anaphylaxis: clindamycin and azithromycin

35
Q

PAINLESS vaginal bleeding

A

placenta previa
abnormal implantation over internal os
cause of 20% of hemorrhages
^risk with previous C-section, uterine sx, gestations, placenta previas in past

36
Q

types of placenta previa

A

complete, partial, marginal (adjacent, touching edge), vasa previa (fetal vessels over os), low-lying placenta (between 0-2 cm away)

37
Q

treatment of placenta previa

A

strict pelvic rest
immediate C-section if: cervix dilated +4cm (unstoppable labor), severe hemorrhage, fetal distress
get type/screen, CBC, PTT

38
Q

PAINFUL vaginal bleeding

A

placental abruption
may occur before, during, after labor (most commonly in 3rd trimester)
may present with contractions and possible fetal distress

39
Q

risk factors for placental abruption

A

HTN, prior abruption, cocaine use, external trauma, smoking during pregnancy

40
Q

types of placenta previa

A

concealed (blood in uterine cavity) and external

41
Q

risks with placenta abruption (most likely concealed type)

A

premature delivery, uterine tetany, DIC, hypovolemic shock, fetal hypoxia/death, Sheehan syndrome (postpartum hypopituitarism

42
Q

sudden onset EXTREME abdominal pain

A

uterine rupture
typically occurs during labor
+/- abnormal bump in abdomen, no contractions, regression of fetus
tx: immediate laparotomy and delivery

43
Q

what ^risk of uterine rupture

A

previous C-section with classic (longitudinal) incision OR low transverse (current)
trauma (MVAs), myomectomy, overdistension (polyhydramnios, twins), percreta

44
Q

hemolytic disease of newborn

A

fetal anemia and extramedullary production of RBCs
^heme and bilirubin in plasma (bili may be toxic)
can lead to erythroblastosis fetalis (^fetal cardiac output (CHF))

45
Q

Rh screening done when?

A

initial prenatal visit, if Rh- get Ab titers
no Abs: unsensitized
done again at 28 and 35 wks, if still unsensitized, give RhoGAM at 28 wks and at delivery

46
Q

Rh- mother is considered sensitized if Ab titers are more than ?

A

1:4
if the titer is less than 1:16 no further treatment
if more than 1:16: amniocentesis at 16-20 wks to evaluate fetal Rh status
if Rh+ then serial amniocentesis (evaluation of fetal bilirubin level)

47
Q

eclampsia treatment

A

(pre-E + tonic-clonic seizure)
stabilize mom then deliver
Mg+ sulfate and hydralazine

48
Q

complications of pregestational DM

A

^risk: pre-E, spontaneous abortion, rate of infection, PPH, congenital anomalies, macrosomia

49
Q

fetal testing in pregestational DM

A

32-36 wks: weekly NST (FWB) and U/S (fetal size)
36+ wks: 2x weekly (1 NST and 1 BPP (for amniotic fluid amount, FWB)
37 wks: L/S ratio, if mature, deliver
38-39 wks: deliver

50
Q

GDM complications

A

preterm birth, macrosomia (dystocia), neonatal hypoglycemia (increased glucose in utero raises insulin levels), DM persisting after delivery

51
Q

testing for GDM

A

glucose load test at 24-28 wks: 50g glucose, measure 1 hr later
+ if +140 mg/dL, then do glucose tolerance test: 100g glucose, measure fasting, 1,2,3 hrs
if 2/4+ : GDM

52
Q

when to do more than diet and exercise for GDM

A

if uncontrolled: fasting +95 mg/dL and 1 hr postprandial greater than 140 mg/dL
tx: insulin: NPH before bed and aspart before meals

53
Q

if GDM pts don’t want insulin

A

metformin and glyburide

54
Q

types if IUGR (bottom 10%)

A

symmetric: before 20 wks
asymmetric: brain weight NOT decreased, abdomen smaller than head, occurs after 20 wks

55
Q

etiologies of IUGR

A

chromosomal abn, NTDs, infection, multiple gestations, maternal HTN, renal disease, malnutrition, substance abuse (*smoking)

56
Q

complications of IUGR

A

premature labor, stillbirth, hypoxia, lower IQ, seizures, mental retardation

57
Q

macrosomic if how big, what to do next?

risk factors?

A

over 4500g, fundal height at lease 3 cm more than age, get an U/S to estimate weight by femur length, abd. circumference, head diameter
DM or obesity, AMA, postterm

58
Q

reactive NST defined by

A

detection of 2 fetal movements

2 accelerations of FHR greater than 15 bpm lasting 15-20 seconds over 20-min period

59
Q

BPP consists of

A

NST
fetal chest expansion (1+ in 30 min)
fetal muscle tone
amniotic fluid index (AFI) based on sonogram
each worth 2 pts, 8-10 is normal, 4-8 inconclusive, below 4 is abnormal

60
Q

normal FHR

A

110-160 bpm

61
Q

early decelerations

A

decrease in HR occurs with contractions due to head compression

62
Q

variable decelerations

A

decrease in HR and return to baseline with NO RELATIONSHIP to contractions
implies umbilical cord compression

63
Q

mnemonic for accels/decels

A 
VEAL CHOP
Variable - Cord compression
Early - Head compression
Accel - OK
Late - Placental insufficiency
64
Q

late decelerations

A

decrease in HR AFTER contraction started, no return to baseline until contraction ends
implies fetal hypoxia/placental insufficiency

65
Q

stage 2 steps

A
  1. engagement 2. descent 3. flexion
  2. internal rotation 5. extension 6. external rotation
  3. delivery of anterior shoulder
  4. delivery of posterior shoulder
66
Q

How to induce labor

A

Prostaglandin E2: cervical ripening (do not give to asthmatics)
Oxytocin: exaggerates uterine contractions
Amniotomy: puncture sac with hook, but inspect for a prolapsed cord first!

67
Q

prolonged latent stage
caused by ?
how to treat ?

A

longer than 20 hours for primi and 14 hrs for multi

causes: sedation, unfavorable cervix, uterine dysfunction with irregular/wk contractions
tx: rest and hydration, most convert to spontaneous delivery in 6-12 hrs

68
Q

protracted cervical dilation
cause?
treatment?

A

less than 1.2 cm/hr in primi, less than 1.5 in multi

causes: power, passenger, pelvis
tx: oxytocin or C-section

69
Q

arrest disorders

A

no cervical dilation for 2 hrs or no fetal descent for 1 hr

causes: cephalopelvic disproportion (tx: C-section), malpresentation, excessive sedation/analgesia

70
Q

breech positions:
frank
complete
footling

A

frank- hips flex knees extended (“frank hot dogs”)
complete -both hips and knees flexed
footling - feet first, single or double

71
Q

what to do if shoulder dystocia

A
  1. McRobert’s maneuver: mom flexes knees into abdomen with suprapubic pressure (Mc = Mom)
  2. Rubin maneuver: rotation of fetal shoulders by pushing posterior shoulder toward fetal back (Rubin = rotate)
  3. Woods: same as Rubin but towards fetal head
  4. deliver posterior arm 5. deliberate fx of fetal clavicle!
  5. Zavanelli maneuver: push head back and C-section, last resort!
72
Q

80% of postpartum hemorrhage due to ?

other causes

A 
uterine atony (inadequate compression of uterine blood vessels)
others: laceration, retained parts, coagulopathy
73
Q

risk factors for atony

A

anesthesia, uterine overdistension (twins, polyhydr.), prolonged labor, laceration, retained placenta (accreta), coagulopathy

74
Q

what to do if PPH

A

assure no uterine rupture or retained placental with bimanual exam, then bimanual compression and massage (controls most cases)
administer oxytocin if does not work (will constrict BVs)

75
Q

if inability to breastfeed after PPH, think ?

A

Sheehan syndrome

OBGYN Step 2 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions