Obgyn Flashcards
What kind of exercise is allowed in heathy pregos? What is not allowed?
Moderate exercise- swimming, walking, even cycling. Not allowed are scuba diving, skiing bc risk of fall, distance running
What is it called when a prego in 2nd to 3rd trimester dvlps urticarial papules, plaques surrounding UMBILICUS
Herpes gestationis which is NOT causes by herpes. It is AUTOIMMUNE
Vs PUPPP papules and plaques of preg affects the ABD straie and spares the umbilicus
How do you treat herpes gestationis?
Since it is autoimmune tx with steroids like triamcinolone. If topical not enough may need oral.
How to treat prego with bipolar- mainly depression?
ECT
Avoid SSRI monotherapy like fluoxetine in bipolar bc may induce mania
New palpable mass in 33 yo woman w fam bx of mother w br ca at 62 should receive what imaging?
Mammo and u/s in >30.
Palpable mass in woman in 30s
U/s. If atypical features then mammo too and core needle biopsy. It simple cyst can watch or aspirate
Elevated afp during preg in 16-20 wks due to? And what to do next?
Spina bifida, anenceph, improper fetal date or multiple gestations
Next thing to do is u/s
If u/s abn, amniocentesis and check achE levels
Low afp levels during preg hints at? What to do next?
Down syndrome
Need chromosome analysis next
R sided abd pain , tender adnexal mass, not sexually active
Ovarian torsion
Confirm w doppler pelvic u/s
Does tamoxifen incr risk of dvt
Yes
What level hcg should u see intrauterine preg?
1500 iu/L
If u dont then its an ectopic confirmed on TVUS. Even if the US shows only a cyst- that is the ectopic preg
If hcg less then 1500 then repeat hcg in 2-3 days to make sure rising appropriately >66% every 48 hrs
Subchorionic hematomas assoc with incr risk of
Spontaneous abortions
Hyperkeratotic flesh colored papules on vagina of a pregnant woman are?
Hpv warts. Continue with vaginal delivery since transmission only 1%
After how long is labor considered arrest of labor?
What to do next?
4 hrs with no cervical change but adequate contraction
6 hrs no cervical change with inadequate contractions
Place intrauterine monitor to count montevideo units. Adequate contractions at least 200 mvus.
Treatment of hpv warts on vagina?
Trichloroacetic acid
If multiple recurrences then excise or ablate
How does antiseizure med affect ocp?
Decr ocp effectiveness bc p450
Female atheletes with ammenorrhea bc
Decr lh and gnrh means decr estrogen.
Causing infertility, osteopenia
Gp b strep bacteriuria is checked in rectovag culture at 35-37 wks gestation and tx with intrapartum abx like amp, pcn, cefazolin at least 4 HOURs before delivery.
If term baby (>37 wks, no ROM), then what is management of baby?
Observe for two days.No labs
If not term or ROM, then observe and get blood cx, labs
Pt calls u with vulvovaginitjs symptoms not improvedwith antifungal cream? What could it be? Is it enough to tell her what to do over the phone?
No often physician and pt detail of problem not reliable. Need to get vaginal secretion and test for pseudohyphae in candidiasis, clue cells in bacterial vaginosis, trichimonads in trichimoniasis
Prego is worried bc her partner having active hsv infection. What is best test?
Hsv igG ab screen
Better than the genital hsv pcr!!
If positive offer acyclovir to take wt 36 wks u y delivery
What is ulipristal?
Antiprogestin. Emergency contraception within 5 days after unprotected sex. A negative prego test does not mean not prego bc serum/urine test to detect pregnancy 1-2weeks.
Note the copper iud is most effective contraceptive and not indicated in cervicitis.
What to give sexual assault to prevent hiv, hepb, chlam, gon, trichimonas
Hiv with 3 drug regimen like tenofovir-emtricitabine and raltegravir Hep b prophx if not vaccinated Chlam with AZITHRO Gon with ceft Trich with metronidazole
What is treatment combo for prego with active tb?
inH, rifampin, and ethambutol
Hold off on pyrazinamide
How often to test chlaymydia in pregos?
How to tx prego?
First screening at prenatal visit, then repeat in third trimester in women
When do you expect breech baby to turn cephalad by?
36 wks. If still not cephalic at 37 weeks, then need external cephalic version
Adnexal cyst >10 cm in nonprego expected to spontaneously resolve.
If prego, when do you remove the cyst?
At second trimester to decr risk of fetal complicatiobs
Which is CI to combined oral contraceptives?
Tobacco use
Age
Headaches
Migraines with aura!!!
Age 35 and more than 15 ciga a day!!!
Hx it stroke, vte, br ca
Its the estrogen that incr these risks!!
Cervical intraep neoplasia in girl 25, how to manage?
Conservatively w cytology and colposcopy q6m bc likely to regree 25 have many options like ablation, cryosurg, excision
How much folate should women take? Women on anticonvulsanta?
0.4 mg/day
4mg/d for more than 1 mo if on anticonvulsants or hx of baby w neural tube defecr
Lobular carcinoma in situ found on core needle. Next step?
Excisional biopsy!! No need for sentinal node biopsy.
They are not malignant but incr risk dcis and invasive cancer and should be followed up. Some lll have bl mastectomy prophylactically.
How do u expect tfts to change w prego?
Look like hyperthy picture. Incr in t4, t3 and appropriately low to mild low
When screening for thyroid dz need to check ONLY tsh !!!
Can hiv mama w low viral load and hig cd4 breast feed?
No!!!
Also cant if on chemo or rad or drug use
The accidental use of ocp when getting pregos is assoc w how much teratogenicity
Negligible
pid pt tx if severe pain
Should only be iv!!!
No im or oral
Cefoxitin+doxy or ceft and doxy
Prego woman had kid who is due for mmr, varicella polio vaccines. Should he get them?
Yes ok for kid to get!! Just not the prego
Lady who had lap r salpingectomy got ruptured ectopic preg 8 hrs ago now w no flatus or voiding and w incr abd pain and distension has
Urinary retention!! From anesthesia and all the volume repletion
Not intrabad hemmorrhage bc would have rigidity and guarding
Not cystotomy (hole in bladder) bc would have rigid and guard
45 yo lady high f, hr, rr, sweating, agitated/ams, muscle rigidity. Recently started on phenelzine. What does she have and what is tx?
Serotonin syndrome which has clonus and hyperreflex. Esp if combine mao and ssri
Nms is similar but doesnt have the clonus or hyperreflex. It has lead muscle pipe rigid and BRADYKINESIA
Tx supportive and benzo
Only test for prego in third trimester is?
Ua to check glc and protein
U check uti only during first trimester
Baby born w adducted and internally rotated arm with forearm pronated and flexed wrist- what is prognosis
Good 80% w full or near recovery in a yr. called erbs palsy
A serious complication is phrenic n involvement and diaphram paralysis
Horner syndrome is NOT assoc
Rh positive mom with second baby worried about hemolysis. Her hubby is rh neg…
No need to worry unless rh neg in mana and try to decr risk after first preg by giving rhogam within 3 days of delivery
Prego w hx of cin sp loop electrosurgical procedure w hx if preterm labor should have what mgnment?
At 2nd trimester (16-24 wks) serial us for cervical length. If short, place cervage
Tx of endometritis (f, tenderness, foul vagina disharge)
Main risk? Is it prolonged rupture of membranes or route of delivery?
Clinda and gentamycin. Fyi flagyl is CI in br feeding
Not amp and gent
Route of delivery- much higher in c section
When dichorionic/diamniotic twin birth vaginally and one baby delivered but other still waiting and second baby w reassuring heart tracing and contractiosn q3min then what to do? And both in vertex/vertex
Deliver normally
No need for oxytocin unless protracted labor
Vs monochorionic/monoamniotic twins deliver csection
Pt 36 yo on pap has HGSil high grade squamous intralesion. Next step
Colposcopy by 2% chance has invasive cervical cancer and 20% of getting if untreated. High likelihood of testing positive for hpv dna so dont need to check it
If a pt has ascus then check hpv
Unilateral brown nipple dc needs what next
Mammo!!!
Not cytology bc not sens or spec
ogt in prego- 50 g and wait one hr glc should be
Gestational dm w diet discussed should have what glc goals
Fasting glc
1 hr postprandial
Rhd neg mom giving birth and father unknown rh status- should she get anti d ig?
Yes!!
Possible cause of microcephaly in baby
Eating undercooked meet or contact w cat feces causing toxo
Vs smoking causes low birth weight
