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Step 2 Rotation Cards > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Placenta previa

A

painless third trimester bleeding
implantation across cervical os
increased risk with multiple c-sections

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2
Q

Placentia abruptio

A

sudden onset PAINful 3rd trimester bleeding

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3
Q

uterine rupture

A

can feel fetal parts - painful with or without bleeding

contraction and sudden fetal distress followed by loss of contractions and loss of fetal station

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4
Q

vasa previa

A

painless 3rd trimester bleeding - fetal bradycardia after ROM

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5
Q

gestational Diabetes

A

24-28wks
1 hr glucose challenge
3 hr GTT (need 2+)

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6
Q

Normal latent phase

A

20hrs - nulliparity

14hrs - multiparity

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7
Q

how to augment labor

A 
oxytocin 
misoprostol 
dinoprostone
amniotomy 
balloon to stimulate engagement
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8
Q

prolonged and arrested active phase

A

no cervical change after 4hrs of adequate contractions or 6hrs of inadequate contractions

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9
Q

prolonged 2nd stage

A

2hrs pushing in multi

3hrs pushing in a nulli

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10
Q

test to monitor for fetal anemia

A

MCA Doppler showing increased flow

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11
Q

timeline of amniocentesis

A

15-20 wks

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12
Q

timeline of chorionic villous sampling

A

10-13wks

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13
Q

what test allows access for transfusion

A

Percutaneous Umbilical cord sampling only do if <32wks

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14
Q

rhogram timelines

A

28wks and 72hrs of fetal maternal mixing (including abortions)

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15
Q

accelerations on a NST

A

increased HR of 15 bpm that is sustained for 15 seconds that occurs twice in 20 min

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16
Q

VEAL

CHOP

A

variable decelerations- cord compression
Early decelerations - head compression
Late decelerations - placental insufficiency

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17
Q

NST categories

A

cat 1 - normal
cat 2 - variability but some minimal abnormal
cat 3 - absent variability get baby out

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18
Q

IUD types

A

levonorgestrel (initial spotting)

copper (best one - but can increase bleeding and cramping)

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19
Q

plan B pill

A

levonorgestrel within 72hrs of intercourse - delays ovulation until sperm are gone - will not harm existing pregnancy

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20
Q

depo shot

A

3 months

absence of periods or abnormal bleeding

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21
Q

chronic HTN in pregnant women

A

bp >140 / >90 before 20 wks

control with alpha methyldopa

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22
Q

gestational HTN

A

elevated BP after 20wks in the absence of proteinuria

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23
Q

pre eclampsia without severe features

A

BP >140/>90 after 20wks
proteinuria >300mg
deliver at 37wks

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24
Q

pre eclampsia with severe features

A 
BP >160/>110 
creatine >1.1 or 2x baseline 
platelets < 100 
increased AST or ALT 
RUQ or epigastric pain 
pulmonary edema
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25
Q

eclampsia =

A

pre eclampsia with seizures

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26
Q

treatment of eclampsia

A

HTN - labetolol, hydralazine
Sz- Magnesium and possibly benzos
ultimate tx = deliver baby

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27
Q

down syndrome - hcg and inhibin A

A

increased hcg

increased inhibin A

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28
Q

elevated AFP

A

neural tube defects

abdominal wall defects

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29
Q

cell free DNA

A

10wks noninvasive

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30
Q

ROM

A

speculum exam - pool of fluid in the posterior vagina
nitrazine test - turns blue
ferning pattern when dry

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31
Q

premature ROM

A

> 37wks prior to onset of labor in the absence of contractions
(make sure to know GBS status)

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32
Q

preterm ROM

A

<37wks

  • if >34 wks - deliver
  • if <34 wks - corticosteroids and delay as much as you can
  • if <24wks nonviable
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33
Q

chorioamnionitis and endometritis

A

same (1 with baby in and other baby out)

  • maternal fever
  • maternal and/or fetal tachy
  • uterine tenderness
  • purulent amniotic fluid
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34
Q

treatment of chorioamnionitis and/or endometritis

A

IV ampicillin, gentamicin, and clindamycin

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35
Q

tocolytics

A

Magnesium - <32 wks neuroprotection
Ca channel block - nifedipine
PGE-i - not in >32 weeks (closes ductus)
B-agonists - for tachysystole only

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36
Q

congenital hypothyroidism

A

low birth weight

neuropsychological impairment

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37
Q

hypothyroid patients

A

High TSH low T4
infertile secondary to annovulation
tx - levothyroxine

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38
Q

hyperthyroidism

A

low TSH high t4
prior to preg - surgical resection or radioactive ablation
during preg - PTU (blocks T4 –> t3) or methimazole

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39
Q

valproate (pregnancy class)

A

teratgenic

  • cardiac abnormalities
  • neural tube defects
  • craniofacial abnormalities
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40
Q

epilepsy drugs to avoid in pregnancy

A

valproate
phenytoin
carbamzepine

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41
Q

epilepsy drug thats OK for pregnancy

A

levetiracetam

42
Q

First line Tx of UTI and backup

A

amoxicillin and nitrofurantoin backup

1st line IV = ceftriaxone

43
Q

other teratogenic meds

A 
ACE-I
ARBS
lithium
retinoic acid 
MTX
44
Q

diagnosis of twins

A

Uterus is large for dates
AFP is high on quad screen
US = Dx

45
Q

twins are at increased risk for

A

C-section

prematurity

46
Q

dizygotic dichorionic diamnitotic

A

2 placentas
2 sacs
2 eggs = 2 genders

47
Q

monozygotic dichorionic diamniotic

A

2 placentas
2 sacs
1 egg = 1 gender

48
Q

monozygotic monochorionic diamnotic

increased risk for

A

1 placenta
2 sacs
1 egg = 1 gender
twin twin transfusion (bigger twin at risk - small twin does better)

49
Q

monozygotic monochorionic monoamniotic

increased risk for

A

1 placenta
1 sac
1 egg = 1 gender
conjoined twins, cord entanglement

50
Q

all multi gestations are at increased risk for

A

breech birth
pre term
placenta previa
PPH

51
Q

delivery decisions for
cephalic - cephalic
cephalic - breech
breech - breech

A

vaginal
clinical judgment
c section

52
Q

latent phase definition

A

cervix dilatioin up to 6cms

53
Q

active phase of labor

A

6-10cm cervical dilation

54
Q

cervical changes during labor

and mechanism

A

changes from thick (nose) and firm to thin a short structure (lip)

mechanism - breaking of disulfide bonds between collagen = collagen ripening

55
Q

effacement of cervix

A

shortening

56
Q

cervical changes can be stimulated by:

A

fetal head engagement and by the production of prostaglandin E2

57
Q

fetal station numbers

A

-5 (uterus)
0 (ischial spine)
+5 (out of vagina)

58
Q

frank breech

A

knees extended

hips flexed

59
Q

complete breech

A

knees flexed

hips flexed

60
Q

footling breech

A

knees in any position

hips extended

61
Q

external version

A

attempted 37wks

62
Q

GPA

TPAL

A

term
preterm
abortions
living

63
Q

1st trimester labs

A 
ABO type 
rh Ag 
hgb/hct
rubella titers 
varicella titers
HIV
RPR 
Hep B 
gonorrhea 
chlamydia
64
Q

C section incision name

A

pfannestiel incision
bikini cut
vertical (classic or emergent)
transverse (planned)

65
Q

risks of vacuum delivery

A

denuding vagina (inside out)
cephalohematoma
facial lacerations

66
Q

risks of forcep delivery

A

maternal lacerations or hemorrhage
facial nerve palsy
skull fx
intracranial hemorrhage

67
Q

cervical insufficiency

A

she may begin to dilate very early in pregnancy

68
Q

anesthesia
stage I pain -
stage II pain -

A

T10-T12 visceral pain

S2-S4 somatic pain

69
Q

pudendal nerve block

A

block the somatic pain stage II
performed by palpating the ischial tuberosity and injection is made towards the pudendal nerve near the sacrospinous ligament

70
Q

epidural (DOC)

A

should be no pop
no CSF return
pain of contractions removed but not the pressure

71
Q

excess epidural anesthesia risks

A

vasodilation and hypotension

paralysis of the diaphragm if its too high

72
Q

cardio physiology of pregnancy

A

plasma volume increases
RBC mass increases
dilutional anemia
increased CO

73
Q

coagulation state of pregnant women

A

hypercoagulability
clotting factor increase
increased fibrinogen
increased D-dimer

74
Q

pulmonary changes of pregnancy

A

increased minute ventilation
increased tidal volume
decreased FRC

75
Q

genitourinary changes

A

increased GFR

creatine will be lower

76
Q

definition of PPH

A

500cc vaginal delivery

1000cc c-section

77
Q

uterine atony

A

MCC of pph
tired uterus fails to contract - feels BOGGY
(saturated oxytocin receptors)

78
Q

tx of uterine atony

A

1) uterine massage
2) uterotonics (methlergonovine, oxytocin, carboprost)
3) mechanical tamponade with bakri baloon
4) sx

79
Q

carboprost (hemabate) moa

A

PGF2alpha - smooth muscle contractions????

C/I - in asthma

80
Q

uterine inversion

A
  • uterus cant be felt may come out of the vagina

- increased risk with oxytocin and umbilical cord traction

81
Q

placenta accreta, increta, percreta

A

acreta - endometrium
increta - myometrium
percreta - serosa

82
Q

hepatitis B exposed baby

A

Hep B vaccine

IV Ig hep B

83
Q

HIV tx for a baby

A

AZT (zidovudine)

84
Q

toxoplasmosis

A 
mono like syndrome 
cat feces - uncooked meat exposure 
brain calcifications 
ventriculomegaly 
seizures
85
Q

CMV

A
  • jaundice
  • petechial - low platelets
  • intrauterine growth restriction
  • hearing loss
  • hepatosplenomegaly
86
Q

herpes

A
  • painful burning prodrome
  • vesicles on an erythematous base
  • PCR
  • c-section to avoid exposure
  • prophylaxis with acyclovir
87
Q

diagnosis of rectovaginal fistula

A

dark red velvety (rectal mucosa) on the posterior vaginal wall

88
Q

granulosa cell tumors

A 
malignant stromal cord tumors 
large >10cm 
complex 
post menopausal bleeding 
juvenile - precocious puberty  
estrogen secreting
89
Q

cause of granulosa cell tumors

A

endometrial hyperplasia from chronic unopposed estrogen exposure

90
Q

candida on microscope

A

pseudohyphae

91
Q

treatment of candida

A

fluconazole

92
Q

HELLP syndrome

A

hemolytic anemia
elevated LFTs
low platelets

due to systemic inflammation and platelet consumption

93
Q

acute abdomen signs

A

guarding with decreased bowel sounds

94
Q

implantation site of a gestational sac

A

upper fundal region

abnormal = outer quadrants (corneal arcus)

95
Q

chadwick sign

A

blue discoloration of vagina and cervix (6-8wks)

96
Q

hcg timeline

A

the 1st (4wks) doubles every 4hrs

peaks at 10wks

drops in 2nd trimester

97
Q

BP lowest peak

A

23-28wks

98
Q

virchow triad

A

hypercoagulability (increased fibrinogen)
stasis (venous)
endothelial damage

99
Q

MCC of increased AFP

A

dating error

100
Q

braxton hicks contractions

A

3rd trimister
sporadic
no cervical dilation

101
Q

presentation of ectopic pregnancy

A

unilateral lower abdominal or pelvic pain
vaginal bleeding
if ruptured can be hypotensive with peritoneal irritation

102
Q

exclusion criteria for MTX for ectopic

A 
immunodeficiency 
non compliant 
liver disease (ADR - hepatotoxicity) 
greater >3.5cm 
fetal heart auscultated 
breast feeding 
coexisting viable pregnancy

Step 2 Rotation Cards (14 decks)

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