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OB/GYN > OB OME > Flashcards

OB OME Flashcards

1
Q

Define and treat chronic htn in pregnancy

A

^140/^90 before 20 wks gestation

Tx alphamethyldopa
Can consider hydralazine and labetalol

((Avoid typical thiazide diuretics, acei’s, arb’s, ccb’s - teratogenic))

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2
Q

Define and manage mild preeclampsia

A

^140/^90 after 20 wks gestation
^300mg/dL proteinuria

Mag and deliver if ^36 wks
Wait and allow dev/growth if v36 wks

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3
Q

Define and manage severe preeclampsia

A

^140/^90 after 20 wks gestation
^5Gg/dL proteinuria
With sx (abdominal pain, headache, visual changes, ankle edema)

Mag and deliver emergently

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4
Q

Treat eclampsia

A

Stabilize seizure with mag

Emergent delivery

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5
Q

Treat HELLP

A

Emergent delivery

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6
Q

Epigastric pain in pregnancy

Think

A

Gerd (common)

Eclampsia HELLP Preeclampsia (Life-threatening)

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7
Q

tf

14 wk preggy htn to 145/95 first time recognized in office, treat?

A

F
To dx and tx htn, need 2 separate readings from 2 separste locations at least 2 weeks apart

So f/u 2 weeks for remeasurement
Can consider alphamethyldopa then

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8
Q

Most common cause of bilateral ankle edema in pregnancy

A

Vena cava compression

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9
Q

Signs of magnesium toxicity (eg to look for in mag check in preeclamptic preggy)

Mag mechanism
Treat toxicity

A

Hyporreflexia first
Respiratory depression next
Death

Mag blocks nmda channels, countering calcium flux
So give calcium carbonate to reverse toxicity

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10
Q

Route of mag administration for eclampsia

A

IV

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11
Q

Severe features of preeclampsia

A 
BP ^160/110
Thrombocytopenia v100
AST and ALT elevated x2 uln
Cr ^1.1 renal insufficiency
Pulmonary edema
New onset cerebral or visual disturbances
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12
Q

tf

Eclampsia always requires c-section

A

F

Not always – can induce labor as long as mom amd baby are stable

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13
Q

Quad screen for downs

A

HCG and Inhibin A UP

msAFP and Estriol DOWN

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14
Q

Quad screen for edwards

A

HCG and Inhibin A DOWN
msAFP and Estriol DOWN

Edward is down for everything

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15
Q

Inhibin A in triple screen

A

Inhibin A

Up in downs
Down in edwards
Variable in patau

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16
Q

Most common cause of elevated maternal serum AFP

Other causes

A

Mis-estimated gestational age

Neural tube defects
Abdominal wall defects
Multiple gestation

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17
Q

Elevated msAFP on prenatal screen

Next steps

A

Ultrasound to rule out mis-estimated geststional age

Chorionic villus sampling
Or Amniocentesis
To assess for chromosomal abnorm or ntd

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18
Q

Amniocentesis vs chorionic villus sampling

A

Both can be done after triple/quadruple screen and nuchal translucency ultrasound suggest a trisomy

Chorionic villus sampling can be done after 12wks to inform a 1st trimester abortion, higher risk to fetus

Amniocentesis can be done after 16wks to inform an early 2nd trimester abortion, lower risk than chorionic villus sampling

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19
Q

Percutaneus umbilical blood sampling

A

Done after fetal transcranial ultrasound to assess anemia and transfuse baby

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20
Q

Follow up a decreased nuchal translucency ultrasound

A

Chorionic villus sampling if ^12wks

Amniocentesis if ^16 wks

If clinical use eg elective termination or risk planning

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21
Q

cfDNA screens for

A

Downs
Rh mismatch
Sex determination maybe

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22
Q

Sheehan’s syndrome
Pres
Pathophys
Etiology

A

Vague symptoms of lethargy, weight gain, fatigue
Orthostasis, thinning hair, delayed dtr’s… weeks-months after giving birth

Panhypopituitarism
no ACTH driving Cortisol
no TSH driving T4
Lack of LH FSH and GH not as symptomatic with contributions to fatigue and amenorrhea

Ischemic necrosis of pituitary with INTRAPARTUM BLEED or POST-PARTUM HEMORRHAGE

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23
Q

Symptoms of panhypopituitarism

A

Vague symptoms of lethargy, weight gain, fatigue
Orthostasis, thinning hair, delayed dtr’s, amenorrhea

no ACTH driving Cortisol
no TSH driving T4
Lack of LH FSH and GH not as symptomatic with contributions to fatigue and amenorrhea

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24
Q 
No-Drugs teratogenic list in pregnancy
CV drugs
Psyche drugs
Abx
Neuro drugs
Acne drugs
Antineoplastic/immunosuppressives
A 
CV - ACEI's and ARBs
Psyche - Lithium
Abx - Tetracyclines eg Doxy
Neuro - antiepilepticS espec phenytoin
Acne drugs - Isoretinoin Vit A
Antineo/immunosup - Thalidomide, MTX
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25
Q

Why do levothyroxine levels need to be increased for hypothyroid pt who gets pregnant?

A

Prenancy increases thyroglobin… which binds T4 keeping it reserved but inactive

And probably need increases… that is why the increase in thyroglobin? Helps the euthyroid mama keep up with demand?

26
Q

Major side effect of
Valproate
Lithium
Escitalopram

A

Valproate - liver tox and blood disorders
Lithium - renal tox
Escitalopram - serotonin syndrome (ssri)

27
Q

How does Quetiapine cause amenorrhea and galactorrhea

A

Atypical antipsychotic
Can cause promactinemia
Has antidopaminergic action
Block dopamine, release prolactin

28
Q

TF

Gentamycin amd ciprofloxacin are contraindicated in pregnancy

A

T

29
Q

What happens to TSH Total T4 and free T4 in a normalpregnancy

A

TSH and free T4 normal

High Total T4 because estrogen induced increased thyroglobulin

30
Q

Treat UTI in preggy with ___ not ___

A

Nitrofurantoin (Macrobid)

Not TMP-SMX (Bactrim) – contraindicated in pregnancy

31
Q

TF
RPR and VDRL are specific for treponemes

How to follow up a positive

A

F
Can be positive with inflammation of other sorts eg lupus

So if screen positive with one of these, usually follow-up with a treponeme specific test like fta-abs, microhemagglutination, enzyme immunoassay, chemiluminescence assay, darkfield microscopu

32
Q

How to act on fetal bradycardia after paracervical block with lidocaine

A

Watch and wait – brady will be temporary…

33
Q

When to do c-section vs vacuum/forceps for arrest of active labor with adequate contractions

A

C-section if stuck at 0 station

Vac/forceps if stuck at +1 or +2

34
Q

How does accidental subdural anesthetic present

A

Like shock – subdural can travel up and down spine, causing sympathetic block and diaphragmatic block – hypotension, compensatory tachycardia, tachypnea but shallow with accessory muscles from diaphragmatic block, sob, tingling in distal extremities

35
Q

IUD vs BTL for contraception?

A

Prefer IUD… non-invasive, 5 year protection but reversible of desired, less risk of regret, surgical scarring, ectopic

36
Q

OCPs increase risk of

Decrease risk of

A

Increase vasculopathy
-DVT most significantly, also HTN, DM, hypertriglyceridemia

Decrease
Ovarian cancer (less cyst eruption)
Endometrial cancer (less inflammation)
Benign breast disease

37
Q

Emergency contraception can be used within how long of unprotected sex

A

120hrs 5 days

38
Q

Plan B generic
Mechanism
Not effective if

A

Levonorgestrel (progestin)
Prevent ovulation and implantation (negative feedback on LH FSH, thickens cervical mucus, alters endometrium)

Not effective if implantation had already occured

39
Q

Breast feeding mom who is married wants temporary contraception

A 
Mini pill (progestin)
Breast feeding - does not impact milk production
Married - does not need sti protection
Wants more kids - temporary

IUD (progestin) could also be a reasonable amswer for 5 years contraception, can be placed before discharge or at first post-partum visit

40
Q

Which female hormone negatively impacts breast milk production

A

Estrogen

41
Q

p only vs ep pill timing strictness

A

p only needs strict on the hour daily timing

ep is more forgiving/lax

42
Q

TF

Femal condom/diaphragm protects against STI’s

A

T

Barrier and Sperimicidal agent coating

43
Q

Tests to work up secondary amenorrhea, in order

A

UPT TSH PRL FSH

44
Q

How does prolactin cause amenorrhea

A

Inhibits GnRH release

45
Q

Savage syndrome
aka
pathophys
presentation

A

aka resistant ovary syndrome

ovaries good to go with follicles intact but do not respond to FSH and LH which are elevated for this reason

Woman too young for menopausal symptoms abated with estrogen/OCP

46
Q

resistant ovary syndrome
aka
pathophys
presentation

A

Savage syndrome

ovaries good to go with follicles intact but do not respond to FSH and LH which are elevated for this reason

Woman too young for menopausal symptoms abated with estrogen/OCP

47
Q

why does PCOS bleed with progestin challenge

A

because anovulation and constant estrogen leave endometrium constantly growing… finally sloughed with exogenous progestin

48
Q

TF

can see ovarian follicles on US in premature ovarian failure

A

F

no follicles

49
Q

how does premature ovarian failure present differently from savage/resistant ovary syndrome

A

same early menopausal symptoms but follicles not present on ultrasound in premature ovarian failure

50
Q

TF

side effects of oral contraception include premature ovarian failure

A

F

think more DVT or weight gain

51
Q

LH:FSH level in PCOS
LH:FSH level in menopause

A

PCOS 3:1

menopause 1:3

52
Q

what does clomiphene do

A

induces ovulation eg in PCOS

53
Q

scant vaginal fluid that is acidic and easily fractrures, classic for what phase of menstruation

A

early follicular

54
Q

vaginal fluid descriptions

early follicular
ovulatory
mid luteal
late luteal

A

early follicular - scant, acidic, easily fractrures

ovulatory - thin, stretches to 6cm, ferns, higher pH

mid luteal - thickened with less stretch

late luteal - thickened with less stretch

(built to keep foreign bodies out unless ovulating

55
Q

TF

in vitro fertilization or artificial insemination can be used when “uterus is inhospitible to sperm+

A

T
just need to bypass inhospitable cervical secretions

in vitro or artificial insem can work as long as axis is working…

56
Q

Suspect PCOS, next test to dx

A

LH:FSH ratio ^3:1

Hint ultrasound is not a necessary or sufficient part of the diagnosis

57
Q

PCOS at risk for what cancer

A

Endometrial

(No ovulation, no luteal/progesterone phase, unregulated estrogen (turned to testosterone peripherally) and unregulated endometrial growth

58
Q

When to get dexa for menopause

A

Age 65

Or earlier if risk factors for osteoporosid

59
Q 
Role of venlafaxine in menopause
Drug class
Mechanism in menopause
A

Treat hot flashes

snri

No one knows mechanism for this use

60
Q

What is AMH anti-mullerian hormone a sign of

A

Marker for primordial ovarian follicles / ovarian reserve

OB/GYN (5 decks)

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