OB, UST Revalida Review Flashcards
1
Q
OB History
A
G P (TPAL)
2
Q
Rule for EDD
A
Naegele’s Rule +7 -3
3
Q
Fundic height measurement starts at
A
16-18 weeks AOG
4
Q
Leopold’s manoeuvre starts at
A
28-30 weeks
5
Q
LM 1
A
Fundal grip
6
Q
LM 2
A
Umbilical grip
7
Q
LM 3
A
Pawlik grip
8
Q
LM 4
A
Pelvic grip
9
Q
Leopold’s maneuvers
A
10
Q
Level of uterus-AOG: Symphysis pubis
A
12 weeks
11
Q
Level of uterus-AOG: Midway between symphysis pubis and umbilicus
A
16 weeks
12
Q
Level of uterus-AOG: Umbilicus
A
20 weeks
13
Q
Adnexa cannot be evaluated if the uterus is ___ months size
A
3 months
14
Q
Consistency of cervix if pregnant
A
Soft
15
Q
Probable signs of pregnancy
A
1) Abdominal enlargement 2) Ballotement (20th week) 3) Braxton-Hicks contractions (28th week) 4) Outlining of fetus 5) (+) pregnancy test 6) Hegar sign 7) Goodell sign 8) Softening of cervix 9) Beaded pattern of cervical mucus
16
Q
Softening of uterine isthmus
A
Hegar sign
17
Q
Cyanosis of cervix
A
Goodell sign
18
Q
When Goodell sign is appreciated
A
4 weeks
19
Q
When softening of cervix is appreciated
A
6-8 weeks
20
Q
Beaded cervical mucus is an effect of what hormone
A
Progesterone
21
Q
Onset of elevated β HCG in pregnancy
A
8-9 days after ovulation
22
Q
Peak of elevated β HCG in pregnancy
A
60-70 days
23
Q
Nadir of β HCG in pregnancy
A
14-16 weeks
24
Q
Positive signs of pregnancy
A
1) FHT 2) Perception of active fetal movement by the examiner 3) Recognition of embryo or fetus by ultrasound
25
FHT-weeks: TVS
6-8 weeks
26
FHT-weeks: Doppler
10-12 weeks
27
FHT-weeks: Stethoscope
18 weeks
28
When active fetal movement is perceived by examiner
20 weeks
29
UTZ-weeks: Gestational sac
4-5 weeks
30
UTZ-weeks: Fetal heart beat
6-8 weeks
31
CRL is predictive of gestational age up to ___ weeks
12
32
Most accurate determinant of gestational age
1st trimester ultrasound
33
LMP may be used in determining gestational age if difference from early ultrasound is
Less than 2 weeks
34
Danger signs of pregnancy
1) Persistent headache 2) Blurring of vision 3) Persistent nausea and vomiting 4) Fever and chills 5) Hypogastric pain 6) Decreased fetal movement 7) Dysuria 8) Bloody vaginal discharge 9) Watery vaginal discharge 10) Edema of hands and feet
35
When to request: TVS for fetal viability and aging
Less than 12 weeks
36
When to request: Fetal biometry
\> 13 weeks
37
When to request: BPS
28 weeks
38
Physiologic anemia, 1st, 2nd, and 3rd trimester respectively
Less than 11 g/dL; less than 10.5 g/dL; less than 11 g/dL
39
WBC level in pregnancy
Leukocytosis
40
When to request HBsAg
Near term
41
What tests to request on the first visit
1) UTZ 2) CBC 3) Blood typing 4) UA 5) HBsAg if near term 6) Pap smear 7) GDM screening
42
Caloric requirements in pregnancy
1st trim: 2000 kcal/day 2nd trim: 2300 kcal/day 3rd trim: 2300 kcal/day
43
Normal weight gain pregnancy
25-35 pounds or 1 pound per week; 2 pounds in 1st trimester, 11 lbs each in the 2nd and 3rd trimester
44
Iron requirement for the entire pregnancy
1g
45
Breakdown of 1g iron need for pregnancy
300 mg: fetus and placenta 500 mg: expanding maternal hgb mass 200 mg: excreted
46
Amount of daily elemental iron required in pregnancy
30 mg
47
Required daily calcium supplementation in pregnancy
400-900 mg
48
Daily zinc requirement in pregnancy
12 mg
49
Impairs phosphorus absorption
Antacid
50
Daily folate requirement in pregnancy
350 mcg/day
51
Frequency of prenatal check up
1) Monthly until 28 weeks 2) Every 2 weeks until 36 weeks 3) Weekly 37 weeks onwards
52
Criteria for preterm labor
1) After 20 weeks, before 37 weeks 2) Regular contractions (4 in 20 minutes) 3) At least 1 of the following: Progressive cervical changes, cervical dilatation of 2 cm or more, effacement of 80% or more
53
Preterm labor: Etiology
1) Infection 2) Low socio-economic and nutritional status 3) Maternal factors: Uterine anomalies 4) Fetal factors: Multiple pregnancies, PROM, congenital malformations
54
Preterm labor: Predictors
1) Biochemical: Fibronectin and estriol 2) Sonographic: Cervical funnelling (YVU on sonography) and cervical length
55
Cornerstone in management of preterm labor
Forestall preterm delivery
56
Management of preterm labor
1) Tocolysis 2) Bedrest 3) Treat underlying infection
57
Preterm delivery should be delayed for only how long
At least 48 hours to allow steroids to work
58
Tocolytics
1) Beta agonist (ritodrine, terbutaline, isoxuprine) 2) MgSO4 3) CCB (nifedipine, nicardipine) 4) PG inhibitors (indomethacin, naproxen)
59
MOA in tocolysis: Beta agonist
Reduction of intracellular Ca
60
MOA in tocolysis: MgSO4
Calcium antagonist
61
Steroid therapy is indicated at what AOG
24-34 weeks
62
Betamethasone dose
12 mg/IM Q24h x 2 doses
63
Dexamethasone dose
6 mg/IM Q12h x 4 doses
64
Steroid that can cause periventricular leukomalacia
Dexamethasone
65
When to screen for GDM: Average risk
24-28 weeks
66
GDM: Screening modality
Average risk - FBS, RBS, HbA1c; High risk - 75g OGTT
67
High risk for GDM
1) Strong family history of DM 2) Obese, BMI \>30, or excessive gestational weight gain 3) Previous history of GDM, htn, metabolic syndrome, PCOS, and macrosomic infant 4) Glucosuria 5) Age \>25 6) Poor OB history: Fetal demise, fetal malformation 7) Current use of steroids 8) Member of ethnic groups with high GDM prevalence (includes Filipinos)
68
Macrosomia, weight
\> 9 lbs
69
Protocol for evaluation of diabetes in pregnant Filipino women
70
Protocol for evaluation of diabetes in High Risk pregnant Filipino women
71
Diabetogenic hormones secreted by placenta
1) GH 2) CRH 3) Placental lactogen 4) Progesterone
72
Fetal complications of GDM
o Abortion o Congenital anomalies o IUGR o Macrosomia o Hydramnios o Birth injury o Preterm delivery o Unexplained fetal death
73
Maternal complications of GDM
o Preeclampsia o Infections o Dystocia o Higher incidence of operative delivery o Diabetic Nephropathy, Retinopathy, Diabetic Neuropathy o Ketoacidosis
74
GDM management
1) Diabetic diet 2) 7-point CBG monitoring 3) Refer to endo if uncontrolled 4) Fetal surveillance
75
Diabetic diet: kcal/kg/day for normal body weight
30-35
76
Diabetic diet: kcal/kg/day for obese
24
77
Diabetic diet: Caloric composition
Complex carbs 40-50% Proteins 20% Unsaturated fats 30-40% Given as 3 meals and 3 snacks daily
78
7-point CBG monitoring
Pre-meals (3), 1 hours post meals (3), and at bedtime
79
Normal pre-meal CBG
70-100 mg/dL
80
Normal 1hr pp CBG
Less than 140 mg/dL
81
Normal 2hr pp CBG
Less than 120 mg/dL
82
When to do congenital anomaly scan
18-20 weeks
83
Conditions in GDM wherein early delivery is indicated
1) Vasculopathy 2) Nephropathy 3) Prior stillbirth 4) Poor glucose control
84
Htn in pregnancy is defined with a BP of
140/90 or higher on more than 1 occasion
85
Systolic BP of 140 mmHg or higher or a diastolic BP of 90 or higher on more than 1 occasion, \> 20 weeks AOG, no proteinuria
Gestational Htn
86
Systolic BP of 140 mmHg or higher or a diastolic BP of 90 or higher on more than 1 occasion, before 20 weeks AOG and persists beyond 12 weeks postpartum; no proteinuria
Chronic Htn
87
Systolic BP of 140 mmHg or higher or a diastolic BP of 90 or higher on more than 1 occasion, after 20 weeks AOG; (+) proteinuria
Preeclampsia
88
Proteinuria level to diagnose preeclampsia
300 mg or more in a 24 hour urine specimen
89
Maternal risk factors for preeclampsia
1) First pregnancy 2) Age under 20 or over 35 3) High bp before pregnancy 4) Previously preeclamptic 5) Short inter pregnancy interval 6) Family history of preeclampsia 7) Obesity 8) DM 9) Kidney disease 10) RA 11) Poor protein or low calcium status
90
Paternal risk factors for preeclampsia
1) First time father 2) Previously fathered a preeclamptic pregnancy
91
Fetal risk factors for preeclampsia
1) Multifetal pregnancy 2) Hydrops/triploidy 3) Hydatidiform mole
92
BP in mild preeclamspia
More than 140/80
93
BP in severe preeclampsia
More than 160-110
94
Proteinuria in mild preeclampsia
\>300 mg/d or \> +1 dipstick
95
Proteinuria in severe preeclampsia
\>2g/d or \> +2 dipstick
96
Cardinal principles in the treatment of preeclampsia
1) Prevent convulsions 2) Control htn 3) Deliver at optimum time and mode
97
Anticonvulsant of choice in pregnancy
MgSO4
98
MOA of MgSO4 in preventing convulsion
Reduces cerebral vasoconstriction and ischemia
99
MgSO4: Loading dose
4g SIVP over 20 mins 5g deep IM on each buttocks
100
MgSO4: Maintenance dose
5g deep IM on each buttocks q6
101
MgSO4: Serum therapeutic level
4-7 mEq/L
102
MgSO4: Parameters to monitor
1) DTR ++ 2) RR more than 12/min 3) UO at least 25-30 cc/hour
103
MgSO4 toxic level: Loss of patellar reflex
10 mEq/L
104
MgSO4 toxic level: Respiratory depression
12 mEq/L
105
MgSO4 toxic level: Altered atrioventricular conduction and complete heart block
15 mEq/L
106
MgSO4 toxic level: Cardiac arrest
\>25 mEq/L
107
Management for MgSO4 toxicity
Calcium gluconate 1g IV
108
Antihypertensives of choice to control bp in preeclampsia
1) Nicardipine 10 mg in 90cc D5W to run at 10 ugtts/min, titrate at increments/decrements of 5 ugtts/min to maintain BP of MAP 20% 2) Hydralazine 5 mg IV bolus followed by 5 mg incremental increases half hourly if DBP does not improve up to a total of 20 mg
109
Normal pH of the vaginal environment
3.8-4.2
110
Characterized by depletion of the normal lactobacillus population and an overgrowth of vaginal anaerobes accompanied by loss of usual vaginal acidity
Bacterial vaginosis
111
Bacterial vaginosis: Microorganism associated
Gardnerella vaginalis
112
Criteria for bacterial vaginosis
Amsel criteria
113
Components of Amsel criteria
1) Thin green or gray-white homogenous discharge 2) Clue cells 3) pH \>4.5 4) Amine door with 10% KOH (Whiff test)
114
Amsel criteria: # of criteria to be satisfied for appropriate diagnosis
3 out of 4
115
Bacterial vaginosis: Treatment of choice
Metronidazole 500mg BID x 7 days
116
Bacterial vaginosis: Alternative regimens
1) Metronidazole 2g single dose 2) Clindamycin 300 mg BID x 7 days
117
Condition: Copious yellow-green frothy discharge with pruritus and dysuria
Trichomonas
118
Condition: (+) hyphae or spores
Candidiasis
119
Condition: Severe vulvar pruritus with curd-like, whitish discharge to vaginal walls
Candidiasis
120
Condition: Fishy odor
Bacterial vaginosis
121
Vaginal pH in candidiasis
Less than 4.5
122
Vaginal pH in trichomoniasis
\>4.5
123
Treatment of choice for trichomoniasis
Metronidazole 500 mg BID x 7 days
124
T/F In trichomoniasis infection, treat sexual partner
T
125
Treatment for Candidiasis
1) Fluconazole 150 mg OD 2) Miconazole 100 mg vaginal suppository x 7 days 3) Clotrimazole vaginal tablet
126
Treatment for mixed vaginal infection
1) Miconazole + Metronidazole (Neopenotran) vaginal suppository ODHS x 7 days 2) Nystatin + Metronidazole (Flagystatin) vaginal suppository ODHS x 7 days
127
HPV type: Benign warts
HPV 6 & 11
128
HPV type: Premalignant and malignant lesions
HPV 16 & 18
129
Conditions that predispose to HPV infection
1) Immunosuppression 2) DM 3) Pregnancy 4) Local trauma
130
Treatment for condyloma acuminata
1) Podofilox 0.5% solution or gel 2) Imiquimod 5% cream 3) Cryotherapy 4) TCA 5) Electrocautery 6) Surgical excision
131
Podofilox: MOA
Antimitotic
132
Podofilox: T/F May be given in pregnant women
F
133
Imiquimod: MOA
Immune enhancer
134
Imiquimod: May be given in pregnant women
F
135
Cryotherapy: MOA
Thermal-induced cytolysis
136
Cryotherapy: Dose
Once a week for 1-2 weeks
137
Condyloma acuminata treatment that may be given to women
Cryotherapy
138
TCA: MOA
Chemical coagulation of proteins
139
TCA: T/F May be given to pregnant women
F
140
HPV serotypes covered by Cervarix
HPV 16 & 18
141
HPV serotypes covered by Gardasil
HPV 6, 11, 16, and 18
142
Cervical CA vaccination: Age group
13-26 y/o
143
T/F Males can be given cervical Ca vaccination
T
144
Genital ulcers, syphilis: Incubation period
2-4 weeks
145
Genital ulcers, syphilis: Primary lesion
Papule
146
Genital ulcers, syphilis: # of lesions
Usually solitary
147
Genital ulcers, syphilis: Edges
Sharply demarcated, round or oval
148
Genital ulcers, syphilis: Depth
Superficial or deep
149
Genital ulcers, syphilis: Base
Smooth, non purulent
150
Genital ulcers, syphilis: Induration
Firm
151
Genital ulcers, syphilis: Pain
Unusual
152
Genital ulcers, syphilis: Lymphadenopathy
Firm, nontender, bilateral
153
Genital ulcers, syphilis: Causative organism
T. pallidum
154
Genital ulcers, syphilis: Screening
RPR, VDRL
155
Genital ulcers, syphilis: Confirmation
FTA-ABS, MHA-TP
156
Genital ulcers, syphilis: Lesion of primary syphilis
Chancre
157
Genital ulcers, syphilis: Treatment for primary lesion
PEN G 2.4M units/IM single dose
158
Genital ulcers, herpes: Incubation
2-7 days
159
Genital ulcers, herpes: Primary lesion
Vesicle
160
Genital ulcers, herpes: # of lesions
Multiple
161
Genital ulcers, herpes: Edges
Erythematous
162
Genital ulcers, herpes: Depth
Superficial
163
Genital ulcers, herpes: Base
Serous, erythematous
164
Genital ulcers, herpes: Induration
None
165
Genital ulcers, herpes: Pain
Common
166
Genital ulcers, herpes: Lymphadenopathy
Firm, tender, bilateral
167
Genital ulcers, herpes: Causative agent
HSV 1 and 2
168
Genital ulcers, herpes: Diagnosis
1) Tzanck smear 2) Viral culture 3) Serology
169
Genital ulcers, herpes: Treatment
Acyclovir 200 mg, 5x/day for 7-10 days
170
Genital ulcers, chancroid: Incubation
1-14 days
171
Genital ulcers, chancroid: Primary lesion
Papule or pustule
172
Genital ulcers, chancroid: # of lesions
Multiple
173
Genital ulcers, chancroid: Edges
Undermined, ragged, irregular
174
Genital ulcers, chancroid: Depth
Excavated
175
Genital ulcers, chancroid: Base
Purulent
176
Genital ulcers, chancroid: Induration
Soft
177
Genital ulcers, chancroid: Pain
Very tender
178
Genital ulcers, chancroid: Lymphadenopathy
Tender, may suppurate, unilateral
179
Genital ulcers, chancroid: Causative agent
Haemophilus ducreyi
180
Genital ulcers, chancroid: Diagnosis
GSCS
181
Genital ulcers, chancroid: Treatment
Azithromycin single dose
182
Genital ulcers, lymphogranuloma vereneum: Incubation
3 days-6 weeks
183
Genital ulcers, lymphogranuloma vereneum: Primary lesion
Papule, pustule, or vesicle
184
Genital ulcers, lymphogranuloma vereneum: Edges
Elevated, round, or oval, irregular
185
Genital ulcers, lymphogranuloma vereneum: Lymphadenopathy
Tender, may suppurate, unilateral
186
Genital ulcers, donovanosis: Incubation
1-4 weeks
187
Genital ulcers, donovanosis: Primary lesion
Papule
188
Genital ulcers, donovanosis: Depth
Elevated
189
Genital ulcers, donovanosis: Base
Red and rough "beefy"
190
Genital ulcers, donovanosis: Lymphadenopathy
Pseudoadenopathy
191
Bleeding occurs at intervals of \> 35 days and usually is caused by a prolonged follicular phase
Oligomenorrhea
192
Bleeding occurs at intervals of less than 21 days and may be caused by a luteal- phase defect.
Polymenorrhea
193
Bleeding occurs at normal intervals (21 to 35 days) but with heavy flow (\>=80 mL) or duration (\>=7 days)
Menorrhagia
194
Bleeding occurs at irregular, noncyclic intervals and with heavy flow (\>=80 mL) or duration (\>=7 days)
Menometrorrhagia
195
Bleeding is absent for 6 months or more in a nonmenopausal woman
Amenorrhea
196
Irregular bleeding occurs between ovulatory cycles
Metrorrhagia
197
Spotting occurs just before ovulation, usually because of a decline in the estrogen level
Midcycle spotting
198
Bleeding recurs in a menopausal woman at least 1 year after cessation of cycles
Postmenopausal bleeding
199
Bleeding is characterized by significant blood loss that results in hypovolemia (hypotension or tachycardia) or shock
Acute emergent AUB
200
ovulatory or anovulatory bleeding is diagnosed after the exclusion of pregnancy or pregnancy-related disorders, medications, iatrogenic causes, obvious genital tract pathology, and systemic conditions
DUB
201
First thing to consider in patients with AUB
Rule out pregnancy
202
Ovulatory vs anovulatory: Usually secondary to a systemic or organic pelvic pathology
Ovulatory
203
Causes of AUB in anovulatory cycles
1) DUB 2) Endocrine disorders
204
Causes of AUB in ovulatory cycles
1) Systemic 2) Reproductive tract
205
Most common reproductive tract cause of AUB
Accidents of pregnancy
206
Structural causes of AUB
PALM 1) Polyp 2) Adenomyosis 3) Leiomyoma 4) Malignancy and hyperplasia
207
Non-structural causes of AUB
COEIN 1) Coagulopathy 2) Ovulatory dysfunction 3) Endometrial 4) Iatrogenic 5) Not classified
208
Criteria for diagnosis of PCO
1) 12 or more follicles measuring less than 10mm in diameter located subcapsularly 2) Increased ovarian volume more than 10 cm3
209
T/F Both ovaries must fit definition for diagnosis of PCO
F, only one
210
PCO management
1) Lifestyle modification w/ a target weight loss of 5-10% of initial weight, and target BMI 20-25 2) Metformin 500 mg BID or TID 3) Progesterone challenge (thick endometrium) or OCP (thin endometrium)
211
Medroxyprogesterone challenge
o Medroxyprogesteroneacetate(MPA) 10mg/tab 1 tab OD x 5 days o Comebackon Day 1 or Day 2 of menses o MPA 10mg/tab 1tab OD on Days16-25 of menses x 6 cycles o Repeat TVS after treatment
212
PCOS treatment that improves menstrual regularity among women with PCOS, regardless of body mass index
OCP
213
First choice in the treatment of hirsutism in PCOS
OCP
214
Component of OCP that suppresses LH hence decreases ovarian androgen production
Estrogenic component
215
Pinkish to reddish smooth polypoid mass protruding out of the cervical os
Endometrial polyp
216
Reddish, meaty tissue protruding out of the cervical os; with minimal vaginal bleeding
Submucous myoma
217
Heavy menstrual bleeding, and progressive dysmenorrhea
Adenomyosis
218
Uterus symmetrically enlarged, doughy, tender
Adenomyosis
219
Treatment of heavy menstrual bleeding: Non-hormonal
1) NSAIDs 2) Tranexamic acid
220
Treatment of heavy menstrual bleeding: Hormonal
1) COCs 2) Estrogens 3) Oral progestins 4) Depot progestins 5) Danazol 6) GnRH agonists 7) LNG-IUS
221
Fixed retroverted uterus; nodularities in cul de sac
Endometriosis
222
PID, etiologic agent: Rapid onset, and the pelvic pain usually begins a few days after the onset of a menstrual period
N. gonorrhea
223
PID, etiologic agent: Indolent course with slow onset, less pain, and less fever
C. trachomatis
224
PID in IUD, timing
At the time of insertion and 3 weeks after placement
225
PID: Minimum criteria for initiating therapy
1) Cervical motion tenderness 2) Uterine tenderness 3) Adnexal tenderness
226
Criteria for hospitalisation of PID
1) Surgical emergency 2) Pregnancy 3) Non-response to oral therapy 4) Inability to tolerate outpatient regiman 5) Severe illness, nausea and vomiting, high fever, tubo-ovarian abscess 6) HIV infection with low CD4+ count
227
Presumptive symptoms of pregnancy
1) Skin pigmentation (chloasma, linea nigra, striae gravidarum) 2) Nausea and vomiting 3) Thermal signs 4) Fatigue 5) Breast symptoms 6) Anatomical breast changes 7) Perception of feral movement (quickening) 8) Disturbance in urination 9) Cessation of menstruation 10) Changes in vaginal mucosa (Chadwick sign)
228
Condition: Strawberry cervix
Trichomonas vaginalis
229
Most commonly used method to rate the readiness of the cervix for induction of labor.
Bishop score
230
Bishop score
231
Bluish discoloration of the vagina
Chadwick sign
232
What happens to the cardiovascular output of the mother in pregnancy?
It increases with peak at the 2nd trimester (40%)
233
Mechanism of HPL as a diabetogenic hormone
Anti-insulin
234
A in FPAL includes
1) Abortion (spontaneous or induced) 2) H. mole, 3) Ectopic pregnancy
235
"Term" is defined as
37-42 weeks
236
Preterm is defined as
237
Asynclitism in which the sagittal suture is closer to the sacrum
Anterior asynclitism
238
Abortion is defined as
239
Conceptus is defined as fetus if AOG is
Less than 8 weeks AOG
240
Conceptus is called embryo if AOG is
Less than 8 weeks
241
Relation of the long axis of fetus to that of the mother
242
Pole that refers to the fetal head
243
Pole that refers to the fetus' breech and flexed extremities
Podalic pole
244
Refers to the relationship of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the birth canal
Fetal position
245
Cardinal movements of labor
EDFIEEE: Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion
246
First requisite for birth of the newborn
Descent
247
Cardinal movement that is essential for the completion o the newborn except when the fetus is small
Internal rotation
248
Asynclitism in which the sagittal suture is closer to the symphysis pubis
249
