OBGYN 1 Flashcards
1
Q
What is the risk of spontaneous abortion for all pregnancies?
A
15%
2
Q
Chromosomal abnormalities are found in what percentage of spontaneous abortions?
A
50%
3
Q
Chromosomal abnormalities are found in what percentage of spontaneous still births?
A
5%
4
Q
Chromosomal abnormalities are found in what percentage of spontaneous live births?
A
0.5%
5
Q
In spontaneous abortions, what is the most common trisomy seen?
A
Trisomy 16
6
Q
In spontaneous abortions, what is the most common single abnormality found?
A
45,X
7
Q
What percentage of 45,X conceptuses are lost before birth?
A
99%
8
Q
What percentage of Trisomy 21 conceptuses are lost before birth?
A
75%
9
Q
What is the most common cause of a lost pregnancy in the first trimester?
A
Chromosomal abnormalities.
10
Q
What is the most common cause of a lost pregnancy in the second trimester?
A
Uterine or environmental/anatomical.
11
Q
What is the Rad threshold for increased fetal risk to radiation exposure?
A
10 rads.
12
Q
High doses of radiation in the first trimester primarily affect developing organ systems such as the heart and limbs; in later pregnancy, what system is more sensitive to radiation exposure?
A
CNS
13
Q
It has been shown in numerous studies that nuchal translucency measured between 10-13 weeks is a useful marker for increased risk of what class of fetal disorders?
A
Chromosomal abnormalities; the larger the nuchal translucency, the greater the risk of other adverse pregnancy outcomes, including fetal demise, cardiac abnormalities, and other genetic syndromes, even if the karyotype is normal. The nuchal translucency will almost always disappear by 15 weeks; this does not reduce the risk of there being an aneuploid condition.
14
Q
In the first trimester, what are the three most common genetic disorders that are likely to be present, if nuchal translucency is seen on ultrasound?
A
Down syndrome, followed by Trisomy 18, then Turner syndrome.
15
Q
What is the most common symptomatic medical complaint in adulthood for patients with Achondroplasia?
A
Spinal stenosis.
16
Q
At how many weeks gestation is the MSAFP performed to screen for neural tube defects?
A
Between 15-21 weeks.
17
Q
What multiple level is considered to be and elevated MOM on a first MSAFP?
A
2.5 MOM; if the patient does not have an extremely elevated value (i.e. the value is <19 week gestation) a second MSAFP is usually drawn.
18
Q
This ultrasound marker is now appreciated as a sensitive marker for Down syndrome and other aneuploidies between 10 and 13 weeks. Outside this range, this marker disappears. What is this marker?
A
Nuchal Translucency.
19
Q
This class of antibiotics should not be used during the Third Trimester because they can cause kernicterus.
A
Sulfa drugs.
20
Q
What drug has been associated with an increased risk of ADHD and behavioral and learning problems?
A
Tobacco.
21
Q
How long does the CD recommend that a woman wait to become pregnant after receiving a live attenuated vaccine?
A
3 months.
22
Q
When does the CDC recommend that women receive the Influenza vaccine during pregnancy?
A
After the first trimester.
23
Q
The multiple marker screen test, also referred to as the expanded AFP test or triple screen, consists of maternal serum measurements of what three markers?
A
Estriol, hCG, AFP; the multiple maker screening test is used to determine a pregnant patient’s risk of having a baby with aneuploidy and a neural tube defect.
24
Q
AFP serum marker screening has the greatest sensitivity when done at what gestational week range in pregnancy?
A
16-18 weeks.
25
An MSAFP that is greater than or equal to how many Multiples of the Mean (MOM), indicates an elevated risk for neural tube defects and indicates that further work up and evaluation is needed?
> 2.0-2.5 MOM
26
There has not been an association of amniocentesis in the second trimester with fetal limb reduction defects. What procedure, when performed at a gestational age of less than 9 weeks has been associated with fetal limb reduction defects?
Chorionic villus sampling.
27
What is the genetic inheritance pattern of G6PD?
X-linked recessive.
28
Use of these antibiotics is associated with kernicterus in the newborn. They compete with bilirubin for binding sites on albumin, thereby leaving more free bilirubin free for diffusion into tissues. These antibiotics should be withheld during the last 2-6 weeks of pregnancy. What abx are these?
Sulfonamides.
29
Nitrofurantoins can cause what hematological problem in the mother and fetus if this genetic disorder is present?
Hemolytic anemia, if G6PD is present.
30
This drug has been associated with fetal hearing loss with prolonged treatment of Tuberculosis during pregnancy. Which drug is this?
Streptomycin.
31
What is the recommendation for vaccination of pregnant with regard to Influenza immunization?
Administration of the influenza vaccine is recommended if the underlying disease is serious.
32
What is the recommendation for vaccination of pregnant with regard to Typhoid immunization?
Typhoid immunization is recommended on travel to an endemic region.
33
What is the recommendation for vaccination of pregnant with regard to Hepatitis A immunization?
Hepatitis A immunization is recommended after exposure or before travel to developing countries.
34
What is the recommendation for vaccination of pregnant with regard to Cholera immunization?
Cholera immunization should be given only to meet travel requirements.
35
What is the recommendation for vaccination of pregnant with regard to Tdap immunization?
Tetanus-diphtheria immunization should be given if a primary series has never been administered or if 10 years have elapsed without the patient receiving a booster.
36
What is the recommendation for vaccination of pregnant with regard to Poliomyelitis immunization?
Immunization for poliomyelitis is mandatory during an epidemic, but otherwise not recommended.
37
What is the recommendation for vaccination of pregnant with regard to Smallpox immunization?
Smallpox immunization is unnecessary since the disease has been eradicated.
38
What is the recommendation for vaccination of pregnant with regard to Yellow fever immunization?
Immunization for yellow fever is recommended before travel to a high risk area.
39
What is the recommendation for vaccination of pregnant with regard to Mumps and Rubella immunization?
Mumps and Rubella immunization are contraindicated.
40
What is the recommendation for vaccination of pregnant with regard to Rabies immunization?
Administration of rabies vaccination is unaffected by pregnancy.
41
The time of the division of a fertilized zygote to form monozygotic twins determines what aspect of the anatomy of the pregnancy?
The placental and membranous anatomy; late division, after formation of the embryonic disk, will result in conjoined twins.
42
How does sex of the fetuses affect the amnion and chorion when dizygotic twins are present?
Dizygotic twins always have a dichorionic and diamniotic placenta regardless of the sex of the fetuses. The placentas of dizygotic twins may be totally separated or intimately fused.
43
Monozygotic twins are always of teh same sex byt may be monochorionic or dichorionic depending upon what?
When the division of the twins occurred.
44
Of monozygotic twins, 20-30% have this type of placentation, which is the result of separation of the blastocyst in the first two days after fertilization. What type of placentation is it?
Dichorionic placentation.
45
The majority of twins have what type of amniotic and chorionic placenta?
Diamniotic and monochorionic placenta.
46
What is the least common type of amniotic and chorionic placentation seen with twins?
Monochorionic and monoamniotic; its incidence is only about 1%.
47
The amount of iron that can be mobilized from maternal stores and gleaned from the diet is insufficient to meet the demands of pregnancy. A pregnant women with a normal hematocrit at the beginning of pregnancy who is not given iron supplementation will suffer from iron deficiency during the latter part of gestations. If the mother is iron deficient will the fetus have impaired hemoglobin production???
NO!!!; it is important to remember that the fetus will not have impaired hemoglobin production, even in the presence of maternal anemia, because the placenta will transport the needed iron at the expense of maternal iron store depletion.
48
True or False: Bilateral hydronephrosis and hydroureter is a normal finding during pregnancy and does not require any additional workup or concern.
TRUE!!!; when the gravid uterus rises out of the pelvis, it presses on the ureters, causing ureteral dilatation and hydronephrosis. It has also been proposed that the hydroureter and hydronephrosis of pregnancy may be owing to the hormonal effect from progesterone. In the vast majority of pregnant women the ureteral dilatation tends to be greater on the right side as a result of the dextrototation of the uterus and/or cushioning of the left ureter provided by the sigmoid colon.
49
By tradition the female pelvis is classified as belonging to one of four major groups: Gynecoid, Android, Anthropoid, and Platypelloid. Which is the classic female pelvis with a posterior sagittal diameter on the inlet only slightly shorter than the anterior sagittal diameter?
Gynecoid.
50
By tradition the female pelvis is classified as belonging to one of four major groups: Gynecoid, Android, Anthropoid, and Platypelloid. Which is defined by the posterior sagittal diameter at the inlet being much shorter than the anterior sagittal diameter, limiting the use of the posterior space by the fetal head?
Android.
51
By tradition the female pelvis is classified as belonging to one of four major groups: Gynecoid, Android, Anthropoid, and Platypelloid. Which is defined by the AP diameter of the inlet being greater than the transverse diameter resulting in an oval, with large sacrosciatic notches and convergent side walls; the ischial spines are likely to be prominent?
Anthropoid.
52
By tradition the female pelvis is classified as belonging to one of four major groups: Gynecoid, Android, Anthropoid, and Platypelloid. Which is defined as flattened with a short AP and wide transverse diameter; wide sacrosciatic notches are common?
Platypelloid.
53
A risk of RDS of 40% exists with an L/S ratio of 1.5:1; when the L/S ratio is less than 1.5, the risk of RDS is 73%. When the L/S ratio is greater than 2, the risk of RDS is slight, however, when the fetus is likely to have a serious metabolic compromise at birth (e.g. diabetes or sepsis), RDS may develop even with a mature L/S ratio (>2.0). This may be explained by lack of what particular phospholipid that enhances surfactant properties? The identification of this phospholipid in amniotic fluid provides considerable reassurance (but not an absolute guarantee) that RDS will not develop. Moreover,, contamination of amniotic fluid by blood meconium, or vaginal secretions with not alter the measurements of this phospholipid. What is the phospholipid?
Phosphotidylglycerol.
54
True or False: Nulliparity is a risk factor for Pre-eclampsia.
True.
55
These two types of hypertension seen in prenancy should be controlled with antihypertensive medications. Which types are they?
Severe hypertension associated with preeclampsia, and chronic hypertension; severe, but not mild hypertension associated with preeclampsia, should be controlled with hypertensive medication. Antihypertensive agents are useful in chronic hypertension but not preeclampsia unless the BP is in te severe range (lowering these BPs can help avoid stroke).
56
The BPP is based on FHR monitoring (generally NST) in addition to four parameters observed on real-time ultrasonography: 1) amniotic fluid volume 2) fetal breathing 3) fetal body movements, and 4) fetal body tones. Each parameter gets a score of 0 to 2. What total score is considered normal?
8 to 10.
57
The BPP is based on FHR monitoring (generally NST) in addition to four parameters observed on real-time ultrasonography: 1) amniotic fluid volume 2) fetal breathing 3) fetal body movements, and 4) fetal body tones. Each parameter gets a score of 0 to 2. What total score is considered equivocal?
6
58
The BPP is based on FHR monitoring (generally NST) in addition to four parameters observed on real-time ultrasonography: 1) amniotic fluid volume 2) fetal breathing 3) fetal body movements, and 4) fetal body tones. Each parameter gets a score of 0 to 2. What total score is abnormal and requires prompt delivery?
4 or less than 4; the false negative rate of BPP is less than 0.1%, but the false positive results are relatively frequent with poor specificity. Testing more frequently than every 7 days is recommended in patients with post-term pregnancies, connective tissue disease, chronic hypertension, and suspected fetal growth retardation, as well as in patients with previous fetal death. In patients with scores of 8, but with spontaneous late decelerations, the rate of cesarian delivery indicated for fetal distress has been 25%.
59
In the first trimester ultrasound estimate of gestational age is accurate to within 3 to 5 days. Estimating the uterine size on physical examination in the first trimester can result in an error of 1 to 2 weeks. What is the most accurate way of estimating fetal gestational age?
Crown to rump length on ultrasound.
60
A single serum progesterone can be used to establish that an early pregnancy is developing normally. What is the value that indicates this is occurring?
Serum progesterone level >25 ng/ml usually indicates a normal intrauterine pregnancy; <5 ng/ml usually indicates a non-viable pregnancy; progesterone levels in conjunction with quantitative HCG levels are often used to determine the presence of an ectopic pregnancy.
61
At what gestational age should the 1 hour glucose tolerance test be performed in a pregnant women, in order to screen for gestational diabetes? Why?!
24 to 28 weeks; the insulin resistance seen in gestational diabetes is thought to be due to the effects of Human Placental Lactogen, which is produced in the highest quantities by the placenta in the 24th to 28th weeks.
62
How much weight is a woman allowed to gain during pregnancy if she has a BMI between 19 and 25?
25-35 lbs.
63
How much weight is a woman allowed to gain during pregnancy if she has a BMI less than 19.8?
Up to 40 lbs.
64
How much weight is a woman allowed to gain during pregnancy if she has a BMI greater than 25?
0-15 lbs.
65
The fundal height of the uterus in centimeters has been found to correlate with gestational age in weeks with an error of 3 cm during what gestational age range?
16 to 36 weeks.
66
In an uncontrolled diabetic, what is the most likely cause for excessive fundal height found to be out of proportion to gestational age on physical exam?
Polyhydramnios, which can be a sign of poor glucose control.
67
In a patient who is 38 weeks gestation, what might be an normal physiologic explanation for a sudden decrease in the fundal height found on physical exam between weekly visits?
The decrease in fundal height between visits can be explained by engagement of the fetal head, which is verified on vaginal examination with determination of the presenting part at 0 station. Engagement of the fetal head commonly occurs before labor in nulliparous patients. Therefore no panic is necessary and it is appropriate for the patient to return for another scheduled visit in a week.
68
This fetal heart monitoring technique can detect fetal heart action as early as 5 weeks of amenorrhea. What is this technique?
Vaginal ultrasound.
69
With appropriate Doppler equipment, fetal heart tones can be heard as early as what gestational age?
10 weeks gestational age.
70
It is in appropriate to deliver any patient early prior to this gestational age, without documentation of fetal lung maturity. What is the gestational age?
39 weeks; this is due to the possibility of development of neonatal respiratory distress syndrome.
71
Post-term or prolonged pregnancies are those pregnancies that have gone beyond what gestational age?
42 completed weeks.
72
The Bishop score is a way to determine the favorability of the cervix to induction. The elements of the Bishop score include effacement, dilation, station, consistency, and position of the cervix. Points are assigned for each element and then totaled to give the Bishop score. Induction to active labor is usually successful with what Bishop score?
9 or greater; with a lower score, expectant management is advised.
73
The BPP consists of 5 tests:
1) Nonstress test
2) Fetal breathing movements- one or more episodes of fetal breathing movements of 30 seconds or more within 30 min
3) Fetal movement- three or more discrete body or limb movements within 30 min
4) Fetal tone- one or more episodes of extension of a fetal extremity with return to flexion, or opening or closure of a hand
5) Determination of Amniotic Fluid Volume- a single vertical pocket of amniotic fluid exceeding 2 cm
What are the components of the modified BPP test?
In the modified BPP, only the NST and determination of amniotic fluid volume are assessed.
74
The components of the BPP are assigned a score of 2 (normal) or 0 (abnormal or absent). These components include:
1) NST
2) Fetal Breathing Movements
3) Fetal Movement
4) Fetal Tone
5) Determination of Amniotic Fluid Volume
What score indicates a normal BPP?
8 to 10.
75
The components of the BPP are assigned a score of 2 (normal) or 0 (abnormal or absent). These components include:
1) NST
2) Fetal Breathing Movements
3) Fetal Movement
4) Fetal Tone
5) Determination of Amniotic Fluid Volume
What score indicates imminent delivery because fetal asphyxia is probable?
0 to 2.
76
The components of the BPP are assigned a score of 2 (normal) or 0 (abnormal or absent). These components include:
1) NST
2) Fetal Breathing Movements
3) Fetal Movement
4) Fetal Tone
5) Determination of Amniotic Fluid Volume
What score indicates repeat testing and delivery if persistent?
4 to 6.
77
Almost all cases of this type of pregnancy follow early rupture or abortion of a tubal pregnancy. What type is this?
Abdominal pregnancy.
78
In modern clinical medicine, once the diagnosis of fetal demise has been made, the products of conception are removed. If, however, the gestational age is more than 14 weeks and the fetal death occurred 5 weeks ago, what complication may present?
Coagulation abnormalities.
79
Acute Polyhydramnios tends to occur early in pregnancy and, as a rule, leads to labor before what gestational age?
28th week.
80
What are the most frequent maternal complications of polyhydramnios?
Placental abruption, uterine dysfunction, and postpartum hemorrhage.
81
The incidence of associated malformations in polyhydramnios is ~20%. What are the most common organ system malformations associated?
CNS and GI malformations.
82
This diagnosis is made based on the presence of painless cervical dilation with a history of pregnancy loss in the second trimester or early-third-trimester preterm delivery. What is the diagnosis?
Cervical insufficiency or incompetence.
83
A patient with a history of three or more midtrimester pregnancy losses or early preterm deliveries and evidence of cervical incompetency is a candidate for what procedure?
Cerclage; cerclage is not indicated for the prevention of first trimester losses, and it has not been shown to improve preterm delivery rate or neonatal outcome in twin gestations.
84
What percentage of human pregnancies have bleeding that occurs before 20 weeks of gestation?
30-40%; of these half will end in spontaneous abortion.
85
This diagnosis is made when uterine bleeding occurs before 20 weeks without any cervical dilation or effacement. Diagnosis?
Threatened abortion.
86
In a patient bleeding during the first half of pregnancy, this diagnosis is strengthened if the bleeding is profuse and associated with uterine cramping pains. Diagnosis?
Inevitable abortion; if cervical dilation has occurred, with or without rupture of membranes , the abortion is inevitable.
87
If only a portion of the products of conception have been expelled and the cervix remains dilated, what diagnosis is made?
Incomplete abortion.
88
If all fetal and placental tissue has been expelled , the cervix is closed, bleeding from the canal is minimal or decreasing, and uterine cramps have ceased, what diagnosis is made?
Completed abortion.
89
This diagnosis is suspected when the uterus fails to continue to enlarge with or without uterine bleeding or spotting. In this diagnosis fetal death occurs before 20 weeks gestation without expulsion of any fetal or maternal tissue for at least 8 weeks thereafter. Diagnosis?
Missed abortion; when a fetus is retained in the uterus beyond 5 weeks after fetal death, consumptive coagulopathy with hypofibrinogenemia may occur. This is uncommon, however, in gestations less than 14 weeks in duration.`
90
Though often underutilized, this test is a rapid non-surgical method to confirm the presence of unclotted intraabdominal blood from a ruptured tubal pregnancy. What is this test?
Culdocentesis; a negative test does not rule out a tubal pregnancy, but a positive test makes the likelihood high.
91
This diagnosis can be made clinically by the presence of maternal fever, tachycardia, and uterine tenderness. Diagnosis?
Chorioamnionitis; when chorioamnionitis is diagnosed, fetal and maternal morbidity increases and delivery is indicated regardless of the fetal age. Antibiotics must be administered to avoid neonatal sepsis.
92
What tocolytic agent should not be used in the setting of oligohydramnios?
Indomethacin; this is a prostaglandin synthesis inhibitor that can decrease fetal urine production and, itself, can cause oligohydramnios, and thus would exacerbate the condition.
93
This tocolytic agent should never be used in a patient who is actively bleeding because it is associated with maternal tachycardia and vasodilation. What is the tocolytic agent?
Tertbutaline.
94
This diagnosis is made when the weight of the fetus falls below the tenth percentile for a given age. Diagnosis?
Intrauterine Growth Restriction; IUGR.
95
IUGR can be classified as either symmetric or asymmetric. In asymmetric IUGR, the abdominal circumference is low, but the biparietal diameter may be at or near normal. In cases of symmetric IUGR, all fetal structures (including both head and body size) are proportionately diminished in size. What are the main causes of symmetric IUGR?
Fetal infections, chromosome abnormalities, and congenital anomalies.
96
IUGR can be classified as either symmetric or asymmetric. In asymmetric IUGR, the abdominal circumference is low, but the biparietal diameter may be at or near normal. In cases of symmetric IUGR, all fetal structures (including both head and body size) are proportionately diminished in size. What are the main causes of asymmetric IUGR?
Asymmetric IUGR is seen in cases where fetal access to nutrients is compromised, such as with severe maternal nutritional deficiencies or hypertension.
97
This virus is one of the most teratogenic agents known. Risk of congenital infection with this virus in the fetus is 80% when the mother has the infection in the first trimester, while the risk is decreased to 25% by the end of the second trimester; thus this virus is mostly a 1st trimester risk!!! What is the virus?
Rubella.
98
What is the treatment of choice for pregnant women who have asymptomatic N.gonorrhoeae infections and who are allergic to penicillin?
Spectinomycin; erythromycin is another drug that is effective in treating asymptomatic gonorrhea.
99
Patients with a history of thromboembolic disease in pregnancy are at high risk of developing it in subsequent pregnancies. Impedance plethysmography and Doppler ultrasonography are useful techniques even in pregnancy and should be done as baseline studies. Patients should be prophylactically treated with what medication even through the postpartum period, as this is the time of highest risk disease?
Low-dose heparin therapy.
100
The most important laboratory finding in pregnant patients with this condition is an elevation of serum amylase levels, which appears 12 to 24 hours after the onset of clinical disease. A useful diagnostic tool in the pregnant patient with only modest elevation of amylase values is the amylase creatinine ratio. In patients with this condition, the ratio of amylase:creatinine clearance is always greater than 5% to 6%. Diagnosis?
Acute Pancreatitis.
