OBGYN Flashcards
By week _____ , fetal heart can be seen beating, BHcG: 1500, Yolk sac visualized
5 weeks
_____ is given to baby for HIV + mother on heart following delivery
Zidovudine
_______ cause increases in AFP during early trimester villious/chorio/CF-DNA sampling
Neural tube defect, ventral wall defect
increased AFP, + acetylcholinesterase a sign of _____ during early trimester screening
neural tube defect
decreased AFP + estriol, increased inhibin and HcG sign of ____ during early trimester screening
Downs Syndrome
Decreased AFP, Estriol, Inhibin, HcG is a sign of _____ during early trimester screening
Edwards Syndrome (Trisomy 18) : small head, jaw, overlapping clenched fingers
Gestational Diabetes Screening (Not Just A1C) : Glucose Load Test
Screen: 50 gram load, abnormal if glucose >_____
Definitive: 100 gram load, time series of glucose measurements
Fasting: ____
1 Hour: 180
2hr: ____
3hr: 140
130
95
155
When to give an RH(-) mother Rhogam for a child that’s RH (+)
1) ________, regardless
2) Post Delivery (peri window = 72hrs)
3) Miscarriage/Abortion
4) Instrumentation: Amniocentesis , CVS
5) _________
28 weeks
heavy vaginal bleeding
When is trimester screening recommended, ______ age
35+
Minimum age for amniocentesis _____
15 weeks (3+ months)
Thirst Trimester Bleeding Actions
1) ______
2) Pelvic Exam
Abdominal/Pelvic US, if placental previa you don’t want to rupture the placenta unknowingly
_______ cause of 3rd trimester bleeding usually results in painless bleeding, risk includes advanced age, multiple gestations, smoking/cocaine
Placenta Previa
Delivery Bleeding
1) ______ caused by placenta cemented to uterus
2) ______ caused by vilamentous cord insertion, umbilical vessels migrating across cervix
1) Placenta Accreta
Accreta: On top of myometrium
Increta : Into myometrium
Percreta : Through serosa, even into the bladder
2) Vasa Previa : Emergency C section, since fetus is affected and will become bradycardic
If GBS (+), plan for C section, Abx needed for GBS: Y/N
N
Indications for GBS treatment
1) GBS (+) Screen
2) _______
3) Maternal Fever
4) Pre-term labor
Extended membrane rupture >18hrs
Maternal toxoplasmosis treated with ______
Bacterim
limb hypoplasia, microcephaly, cataract, chorioretinitis, skin lesions in newborn, caused by ________
Varicella
Treatment for Varicella (+) pregnant mother
1) Acyclovir
2) _____
3) Vaccine
IgG immunoglobin
Treatment for neonate, if varicella suspected from maternal screen
1) ____
2) Acyclovir
IgG Immunoglobin
deafness, PDA, cataract, retardation, hepato-splenomegaly, thrombocytopenia –> blueberry muffin rash in newborn ________
Rubella
Two TORCH notorious for neonatal deafness
1) Rubella
2) ____
CMV
microcephaly, jaundice, periventricular calcifications, chorioretinitis, hepatosplenomegaly in newborn_______
CMV
Mother testing (+) for CMV, treat with ______
IgG + Gancicyclovir
_____ is a safe ART for HIV in mother and neonates. Neonates treated for ______ weeks
Zidovudine
6
anemia, thrombocytopenia, hepatosplenomegaly, swollen placenta, hydrops fetalis –> hutchison teeth, mulberry molars, saddle nose, sabre shins, deafness (bone effects are late infection______ neonatal infection
Syphillis
HepB post exposure prophylaxis_____
Vaccine + IgG
IUGR (Growth<10th percentile on US)
Symmetric [Systemic : Infection, Body Structure]
Aneuploidy
TORCH
Structural : NTD, congenital heart, ventral wall defect
Dx: karyotype, infection screen
Asymmetric [Fetal Connection Structures, Maternal]
Fetus : placental abruption, twin-twin steal, vilamentous cord insertion, infarction of placenta
Maternal : HTN, malnutrition, vasculitis, drugs, fetal hypoxia
Dx; Serial sono-grams , nonstress test
_____ is an evolution of preeclampsia, all warning sign s present (end organ damage: transaminases, RUQ, thrombocytopenia, AKI, pulm edema, headache/vision changes)
HELLP
Tx: Deliver (past 34 weeks) immediately
Preclampsia with seizure____
Eclampsia
BP control for preclampsia
BP>160/110 , over control leads to lower perfusion to the fetus. Hydralazine/Labetolol
Suspected PE in pregnant female, ______ test
VQ scan, avoid CT due to radiation exposure
VSD that becomes R–> L shunt is called_____ syndrome
Eisenmenger syndrome
PE during pregnancy = ____ chance of underlying clotting disorder, therefore send anti-coag workup
50%
Common thrombophilia Antithrombin 3 Factor 5 Leiden Prothrombin Antiphospholipid Hyperhomocystein
PE during pregnancy = ____ chance of underlying clotting disorder, therefore send anti-coag workup
50%
Common thrombophilia Antithrombin 3 Factor 5 Leiden Prothrombin Antiphospholipid Hyperhomocystein
How much to dose adjust up for hypothyroid ______ in pregnant
25%
___ is indicated for preeclampsia prophylaxis among gestational diabetes patients
Aspirin
_____ is ok to use during pregnancy, but not breast feeding
Metformin, Glyburide
_____ is a fetal syndrome associated with diabetes, not macrosomia
Caudal regression syndrome
- Non development of sacrum, lower extremities
Target LS ratio for fetal lung maturity
2.5
nocturnal pruiritis on palms/soles, increase Tbili, dark urine among pregnant women is caused by ________
Intrahepatic Cholestasis of Pregnancy
Tx: Ursodeoxycholic acid
______ can occur in pregnant women, in which RUQ pain, ascites, jaundice, encephalopathy
Tx: _____
Fatty Liver of Pregnancy
Tx: Deliver as soon as possible, as appropriate
Tx for pyelonephritis in a pregnant woman_____
Ceftrioxone + Gentamycin , can’t use quinolone
halperidol, risperidone, SSRI, metoclopramide are groups of medications famous for causing _____ side effect
Galactorrhea
- Medication gallactorhea is typically bilateral, unilateral needs to be investigated
Treatment for fibrocystic breast changes_____
OCP
Women>35 with first degree relative history, may do prophylaxis with _____ for breast cancer
Anastrazole
DCIS Treatment
1) Lumpectomy
2) Adjuvant radiation
3) _______ for 5 years
Tamoxifen/Anastrazole
Indication for Masectomy instead of Lumpectomy
1) Size > _____
2) 2+ quadrants
3) + margins
5cm
Indication for Adjuvant Chemo for ductal breast carcinoma
1) Size>____
2) Lymph node (+)
1cm
Premenarchial Bleeding Lesions
1) _______
2) Pitutiary/Ovarian tumor producing estrogen
Dx: _____
Sarcoma Botyroides
Pelvic exam under anesthesia
_____ for uterine fibroid therapy increases risk of ____ during delivery
Myemectomy, uterine rupture
Both endometrial hypertrophy and atrophy can cause bleeding (T/F)
True
Screening pattern of downs
1) ___ AFP
2) _____ Estriol
3) ______ b HCG
4) ______ Inhibin A
Low, Low, high, high
Screening pattern of Downs
1) ___ AFP
2) _____ Estriol
3) ______ b HCG
4) ______ Inhibin A
Low, Low, high, high
Screening pattern of Edwards
1) ____AFP
2) ___ estriol
3) ___ BHcG
4) ____ Inhibin A
low, low, low, low
Pan-down
Causes of increased AFP
1) NTD Defect
2) Ventral Wall Defect
3) Renal disease/Teratoma
4) __________
Twin pregnancy
When is RhoGAM not needed in RH negative mother______
When anti-D antibodies are developed, and no villious sampling/amniotic, instrumentation before pregnancy
____ is the premature separation of placenta from uterus, results in painful vaginal bleeding
Placental abruption , obstretric emergency ; DIC is a common complication (check fibrinogen)
____ is a cause of painless, third trimester bleeding
Placenta Previa
Dx: Transabdominal US
Tx: Serial US, if 2cm away from cervical Os can do vaginal delivery
Placenta previa increases risk for placenta accreta
Vasa previa bleed ______
immediate C section
Penicillin to mother with prior child with GBS sepsis, even if GBS test negative (T/F)
True
When to antibiose for GBS
1) GBS +
2) Prior child with GBS sepsis
3) Any maternal fever
4) _____
rupture of membrane>18 hours
When to antibiose for GBS
1) GBS +
2) Prior child with GBS sepsis
3) Any maternal fever
4) _____
Rupture of membrane>18 hours
T/F: GBS+ mother with plan for C section does not need penicillin
True
TORCH infection with chorioretinitis, diffuse intracranial calcifications, hydrocephalus_____
Toxoplasma
TORCH infection with limb hyoplasia, microcephaly, chorioretinitis ______
Varicella
- Give Ig to child congenital OR maternal infection during pregnancy
- If congenital, IV acyclovir to child
Varicella is a live attenuated vaccine
Mother exposed to Rubella during pregnancy_____
NTD, immunize after delivery given MMR is live vaccine, also no immunoglobin available
TORCH infection with blueberry muffin rash, cataract, PDA, deafness, retardation, hepatosplenomegaly and therefore thrombocytopenia ______
Rubella
Most common cause of sensorineural deafness in children ______
CMV
TORCH infection with periventricular calcification hepatosplenomegaly, chorioretinitis, IUGR_____
CMV
Treat mother with gancicyclovir/foscarnet, CMV Ig reduces risk of congenital infection
Active HSV mother should be ____ for delivery
C section, neonatal HSV has a 50% mortality rate
You can vaginal deliver HIV mother with RNA>1000 with appropriate triple therapy HAART (T/F)
False, go to C section
Hepatitis B mother
1) Child to receive HepB Ig + Vaccien
2) May deliver vaginally T/F
True: As long as mother is on therapy
Hepatitis B mother
1) Child to receive HepB Ig + Vaccien
2) May deliver vaginally T/F
True: As long as mother is on therapy
When is elective C section recommended in macrosomia
Weight >4.5Kg in diabetic mother, >5kg in non-diabetic mother
DVT/PE during pregnancy
Dx________
Tx______
VQ Scan
Low molecular weight heparin
You may anti-coagulate empirically if
1) Low EF<30% HF
2) Eisenmenger syndrome
DM2 control in pregnant patients very strict, POC>120 requires insulin
1Hr screening clamp >_____ diagnostic
130 - 140
DM2 control in pregnant patients very strict, POC>120 requires insulin
1Hr screening clamp >_____ diagnostic
130 - 140
Ectopic pregnancy therapy____
MTX for abortion, negative U/S does not mean rule out
When in doubt, repeat BHcG/US look for doubling if normal pregnancy
Ectopic pregnancy therapy____
MTX for abortion, negative U/S does not mean rule out
When in doubt, repeat BHcG/US look for doubling if normal pregnancy
Before cerclage for cervical insufficiency 2 conditions have to be met
1) Rule out of chorioamnionitis
2) _______
No active labor (dilated cervix)
Most common cause of premature rupture of membrane______
Chorioamnionitis
PROM: Nitrazine test (+), speculum exam with clear fluid, ferning on microscopy
If chorioamnionitis = have to deliver
if PROM without chorioamnionitis
1) Pre-term (24 - 33) weeks: Hospitalize, betamethasone + empiric antibiotics (ampicillin + erythromycin)
2) Term: Deliver
Umbilical cord collapse : Usually due to cord compression from breech position, results in fetal bradycardia/variable decelerations
Tx:________
Knee chest position
Terbutaline (reduces amplitude of contraction)
C section delivery
Umbilical cord collapse : Usually due to cord compression from breech position, results in fetal bradycardia/variable decelerations
Tx:________
Knee chest position
Terbutaline (reduces amplitude of contraction)
- B agonist, weirdly relaxes myometrium
- May therefore cause fetal tachycardia
C section delivery
Tracings
1) Early decelerations = _____
2) Variable deceleration = _____
3) Late deceleration = _____
Head compression (perfectly synced)
Cord compression (asyncronous, narrow complex)
Late bradycardia, off sync, uteroplacental insufficiency
Have to wait____ weeks after pregnancy before combined estrogen/progestone birth control, you can use progestin only immediately. DVT risk
3
Have to wait____ weeks after pregnancy before combined estrogen/progestone birth control, you can use progestin only immediately. DVT risk
3
___ are common medications promoting galactorrhea
Anti dopamine (haldol, risperidone, metoclopramide), SSRI
Treatment for breast fibroadenoma____
N/A
Situation where core needle breast biopsy better than FNA_____
Older woman, microcalcifications
When to avoid tamoxifen_____
Active smoker, thromboembolism risk
For new LCIS______
Surveillance +/- tamoxifen
When is a simple cyst removed______
seize >10cm
When is complex cyst removed____
Basically always, never do fine needle aspiration (dissemination)
_____ is a ovarian tumor that secretes testosterone
Sertoli-Leydig
_____ is a type of gastric tumor metastasizing to the ovary
Krukenburg, also can be CEA positive
HPV+ (16,18) ASCUS requires\_\_\_\_ OR LSIL with HPV+\_\_\_\_\_\_ OR HSIL\_\_\_\_
Colposcopy with ECC
2 ASCUS + Pap smears_____
Colposcopy with ECC
HPV (-) can try 2 paps before colposcopy in 1 year
If colposcopy shows CIN II, III (High Grade), micro-invasion, indeterminate colposcopy______
Cone biopsy/LEEP
If CIN 1 , or CIN II,III after colposcopy, pap q _____
If repeat CIN 2, 3 or stage 1 cancer
6 months , may add an additional colposcopy
Hysterectomy
Cervical cancer therapy, when to give adjuvant therapy
1) Tumor>___
2) Positive margin, or poorly differentiated
3) lymph node involvement
4cm
If cervical cancer diagnosed after 24 weeks pregnancy____
C section delivery, then treat
if <24 weeks, should do hysterectomy and abort
____ can cause Ca-125 elevation, but is not cancer
Endometriosis
Tx: OCP +/- danazol
When to operate on prolactinoma, size>____
1cm
Progestin challenge (+) means____
bleeding, no ovulation
Estrogen–> progesterone challenge (+) means____
Inadequate estrogen to develop the lining, if (-) then look for structural causes such as ashermans, outflow tract obstructions
- hysterosalpingogram
Treatment of PMDD____
SSRI
gold standard for CAH diagnosis____
cosyntropin stimulation test
Another early marker for Downs syndrome ____
PAPP-A
Increase in ____, results in iron sequestration and iron deficiency anemia in pregnancy
Hepcidin
_____ grows on chocolate agar
Neisseria Gonorrhea
Conditions causing low AFP _____, ______
Downs, Edwards
Increased AFP and ____ indicate neural tube defect
acetylcholinesterase activity
Increased AFP and ____ indicate neural tube defect
acetylcholinesterase activity
In a normal RH(-) pregnancy, Rhogam given at ___weeks, and within 72 hours of delivery. Anti D antibodies means mother can inactivate Rh+ so its protected
28
This pregnancy complication highly associated with DIC______
Placental abruption (pain, bleeding)
First step in vasa previa______
Emergent C Section (fetal bradycardia)
Varicella Prophylaxis
Maternal = Acyclovir + Ig , vaccine is live attenuated Child = Acyclovir + Ig
CMV prophylaxis
IgG + gangicyclovir/foscarnet
If HIV viral load >_____, then you cannot do vaginal delivery
1000
HELLP syndrome characterized by : ____, thrombocytopenia, liver enzymes,
hemolysis
Transfuse if Plt<20,000, ideally to 50,000 for C section
Pulm HTn, eisenmenger, history of post partum cardimyopathy should be adviseD_____
not to become pregnant
HF EF<30%, eisenmenger, Afib due to underlying heart disease are criteria for _____
Anticoag during pregnancy
T/F: Diabetes also associated with neural tube defects___
True
Cholestasis of pregnancy treatment______
Ursodeoxycholic acid (reduces cholestrol absorption, gallstone dissolution)
