OBGYN Flashcards
1
Q
RF for Shoulder Dystocia
A
big baby, mom obesity, increase weight gain in prego, gestational diabetes, post term prego
2
Q
How do you dx Chorioamnionitis? when do you commonly see this?
A
CLINICALLY DX! = maternal fever, uterine tenderness in the presence of confirmed PROM in absence of UTI or URI.
3
Q
Primary ovarian insufficiency definition
A
Menopause(1yr w/o period) before age 40
4
Q
Criteria for active labor
A
Rapid cervical chains of greater than 1 cm/h beginning at 6 cm of dilation on average
5
Q
whats the target BP in prego women?
A
BP <140/80
6
Q
2 painfull 3rd trimester bleeding sc?
A
Placenta abruption & uterine rupture!
7
Q
estrogens effect on prolactin
A
estrogen helps ducts develop but also antagonizes positive effect of prolactin on milk production; once placenta is removed prolactin can go to work.
8
Q
Obesity risks to baby…
A
chronic HTN, Gestational diabetes, preeclampsia, fetal macrosomia, higher C-section rates, postpartum complications
9
Q
what bonds are broken when cervix dilates?
A
DISULFIDE BONDS
10
Q
Prego women w/HSIL(High grade squamous intraepithelial lesion) how do you F/U?
A
since shes pregnant you must do a colposcopy first & if invasive do cervical excision
11
Q
How many weeks is chorionic Villus sampling done at?
A
10 to 14 weeks. Associated with a 1 to 5% chance of fetal loss, as well as distal them defects. Preferred method in mothers with an increased risk of aneuploidy
12
Q
what should you always do when you find a prego women with HTN?
A
urinalysis for protein + if actual HTN and not transient = do U/S for IUGR
13
Q
Whats the major benifit with transdermal estrogen?
A
no increased risk of DVT!
14
Q
treatment for overflow incont.
A
Anti-Cholinergic(betha) > cath
15
Q
In a patient with hypothyroidism the dose of levothyroxine might need to be _____________due to the effects of combined oral contraceptives.
A
Increased
16
Q
What will you see with intra-amniotic Infection/Chorioamnionitis? tx?
A
PROM >18h, Uterine tenderness, maternal fever, fetal tach >160bpm maternal leukocytosistx: abx(ampicillin +gentamycin for vag +clindamycin if C) + delivery
17
Q
type of abortion: vaginal bleeding, cramping, cervical dilation but no POC passed yet..
A
inevitable abortoin = D&C if bleeding is heavy if not just wiat
18
Q
What is important to do for ppl with androgen insensitivity that you don’t do for mullerian agenesis?
A
Remove testes once developed to prevent cancer and then start hormone therapy.
19
Q
What are the 3 phases of the mentral cycle? Days?
A
- Menstrual phase (1-4) drop in E&P cause break down of functional layer2. Proliferate phase( 5-14): follicle grows producing increasing estrogen which promotes the growth of endometrium and inhibits LH(this theca and progest)3. Secretory phase(14-28) high estrogen causes + feedback on LH causing theca to increase progesterone = stabilizing endometrium.
20
Q
women cant get prego. she have regular menstral cycles and you have already worked up the dude and hes fine. what do you do next?
A
- Smush test for inhospitable Mucous2. check for ovulation(ovulation kit checking LH, Progesterone levels, BBT, Endometrial biopsy)
21
Q
what causes effacemnt of the cervix?
A
prostaglandins E2 *can use topically to ripen cervix*this is why indomethacin can be a tocolytic
22
Q
Placental abrution risks factors? what are you worried about when thsi happens?
A
RF: HTN, trauma, Cocaine + tobacco*DIC, hypovolemic shock, fetal hypoxia, preterm deliver
23
Q
highest incidence of cancer in women…
A
breast > lung > colon
24
Q
highest mortality of cancer in women…
A
lung > breast > colon
25
Cocaine use in prego
assoc w/placental abruption, preterm deliver, intraventricular hemorrhage, IUGR
26
pap smear screening
21q3
27
PTL 34-36 weeks management
bethamethasone, PCN of GBS unknown
28
28yo Prego. NV, RUQ Pain, BP 160/94, 98.9 F, Hg 8.5, Platelets 96K, +3 protein, AST/ALT elevated. dx? tx?
HELLP Syndrome = systemic inflammation + platelet consumption.tx: DELIVERY, MgSO4, Hydralazine
29
when do you admit a mom to the maternity unit?
when cervical dilation is at least 3 cm or PROM
30
Treatment of urinary tract infection in pregnancy? Treatment of pyelonephritis in pregnancy?
UTI: Macrobid, fosfomycin, Bactrim, Keflex - treat for 3 to 7 days Pyelo: Rocephin or cefepime, once fever free for 48h Only in treatment with PO anabiotic’s for 10 to 14 days
31
Motor/Hypertonic Incontinencehow do you dx? tx?
random detrusor muscle contractions that can occur at any time, randomly & @all volumes.\*day & night urination w/insuppressible urges.dx: cytometry = shows contractions at all volumes.tx: antispasmodics(solifenacin) or antimuscarinics(oxybutynin)
32
women is breastfeeding but experienceing great pain. her breasts are full and tender. what can you recommend to help?
frequent nuring, warm shower + hot compress, massaging breast + expressing milk to soften, good support bra, analgesic 20 min beofre breastfeeding.
33
What 4 things need to be ruled out immediately in early prego bleeding?
Lesions, RH -, Molar Pregnancy, Ectopic Prego
34
- 6 wk prego B-hCG initially 1500, 48hrs later its 3100. She has 3 days of spotting and uterine cramping. What would you see on U/S?
Viable IUP = spotting common in 1st trimester & since BhCG dbled its prob a viable prego
35
Amenorrhea
No peroids for 3+ consecutive months if regular, or 6+m if irregular
36
Marijuana use in prego
preterm delivery
37
During what time frame do you test pregnant women for gestational diabetes?
24 to 28 weeks
38
What does it mean if a babys lie is longitudinal?
baby and mom are in same vertical axis
39
RF for spontaneous abortion
DM, chronic RF, SLE, smoking, alcohol, radiation, infections, advaced age, advanced parity\*preeclampsia is not a RF! neither is previous abortion!
40
Vasa Previa
fetal vessels transcerse over Os.classic triad: rupture of membranes, painless vaginal bleeding, fetal bradycardia
41
describe the normal changes in thyroid function during pregnancy
decreased TSH, Increased total T4 and mild increase in free T4
42
Arrested labor in the acitve stage of labor.
no change in 4h w/good contracor no change in 6h w/o good contrac\*tx w/augmentation of labor
43
what does a positive Progesterone challenge test tell you?
diagnostic of anovulation! = need to give cyclic progesterone to prevent endometrial hyperplasia. give Clomiphene if pregnancy is desired.
44
bradycardia in FHR
\<110 bpm
45
During what time frame can amniocentesis be done?
15 to 20 weeks. Used to diagnose genetic abnormalities. Carries a risk of fear maternal hemorrhage of 1 to 2%. A 0.5% chance of fetal loss.
46
@ what week will you have fetal heart beat? what will b-hCG be?
week 6! b-hCG should be around 5-6000.
47
Estrone
dominant during menopause = from adipose tissue
48
when do you do Osteoporosis screening?
dexa @ 65 or 60 if smoker
49
Swyer Syndrome
46XY congenital lack of testes. Resulting in no MIS causing female appearance
50
HELLP or Eclampsia...which do you deliver?
both! tx is immediate delivery!
51
How do you explain post partum urinary retention? when shoudl you be able to pee?
regional anethesia can cause bladder atony. should be able to void 6h s/p deliver/cath removal
52
thalidomide in prego...what does this treat?
tx multiple myeloma. causes: phocomelia(malformed limbs), limb retardation, ear/nasal anomalies, cardiac defects, pyloric or duodenal stenosis
53
How do you test for gestational DM? when?
third trimester.-1h glucose: +\>140-3h glucose: + if fasting \>95, 1h\>180 2h\>155 3h\>140
54
sx of CMV in mom + baby
mom: looks like the flubaby: jaundice, petechial, LP, IUGR, hearing loss, hepatosplenomeagly\*prob be a distractor
55
IUP w/bleeding, + passage of clots, open OS, retained parts...
Incomplete abortion
56
Trastuzumab associated cardiotoxicity -tx, monitoring?
trastuzumab-associated cardiotoxicity is reversible; there is complete recovery of cardiac function after treatment discontinuation. Echo after 1 year of treatment & repeat q6months for 2 years minimum
57
puberty takes --- yrs to complete and is usually done by age ---.
3-4, 16 yoa
58
AD dz's
polydactyly, hunting chorea, achondroplasia, marfan, myotonic dystrophy, PCKD, NF, Osteogenesis imperfecta
59
PTL 32-33.6 weeks management
bethamethasone, tocolytics & PCN if GBS unknown
60
Vaccines safe in prego(6)
influenza(all), hep B(exposed), hep A(exposed), Penumococcus(high risk only), Meningococcus(outbreaks), Typhoid
61
@5 week b-hCG should be around....
1500-2000
62
How do you dx cystocele?
PE will show mass @ the roof of vagina; presents w/incontence
63
PALM COINE
Polyps, Adenomyosis, Leiomyomas, Malignancy, Coagulopathies, Ovarian Dysfunction, Endometrial probs, Iatrogenic = IUD, Not Yet Classified^causes of anatomic causes of uterine bleeding
64
During what time frame can amniocentesis be done?
15 to 20 weeks. Used to diagnose genetic abnormalities. Carries a risk of fear maternal hemorrhage of 1 to 2%. A 0.5% chance of fetal loss.
65
urge to void the bladder is at ----cc.
250
66
What do you do if you dnt know the Rh type of the baby? i.e. dad is unknown!
amniotic fluid PCR
67
what do you do to check for Mg tox?
check DTR! these will go before respiratory depression!
68
how many days after delivery for milk production to reach appreciable levels
1-3d
69
how long do postpartum blues lasts? when is it postpartum depression?
blues = less than 2wksdepression = with in 6months
70
Uterine Inversion presentation and tx
lower abdominal pain, round mass protruding through the cervix, fundus not palpable, hemorragic shock.tx: fluid replacement, push uterus back in then remove placenta and give uterotonic drugs(helps uterus contract and stops bleeding)
71
Prolactin production is triggered by...
TSH, D will block prolactin
72
what defines arrested active labor?
stage 1 active labor....\>4h w/good contractions\>6h w/o contractions
73
describe a baby in footling breech
baby in breech w/one leg extended out vagina and one knee pulled up against chest.
74
Tx of HELLP & Eclampsia?
delivery!
75
Failed 1hr blood glucose level in prego?
140+ after administration of 50g PO glucose challenge
76
Mother w/PROM that has uterine contractions present...how do you manage?
deliver baby + cervical culture to chck for chorioamnionitis = IV abx
77
how long should it take to progress through active stage 1 labor?
1.2 cm/h null1.5 cm/h multi\*if slower = protracted labor
78
how do you date a pregnancy?
40 weeks after last menstrual period
79
NSAID use in pregnancy can cause ——hydraminos.
Olgiohydraminos
80
girl on period presetns with fever (102), diffuse macular rash on palsm + soles, hypotension, NV, diarrhea + AMS...dx? tx?
Toxic Shock Syndrome = will see desquamation 1-3 wks latertx: remove foreign body, Clinda+VancUsually due to GAS or S.Aureus
81
Pt has Hydatidiform mole removed. What will you see in b-hCG? How do you follow up?
b-hCG will slowly fall and be gone in 6 months. During this time she MUST BE ON CONTRACEPTION FOR 6 MONTHS
82
baby born w/thin, loose skin + small, thin umbilical cord + wide anterior fontanel. cause?
FGR! = do placental hystopath
83
What are Fibroids?
Leiomyomas in the Uterus = benign. Asymmetric, hard nodules, painful, may have iron def due to bleeding, can cause problems wiht pregnancy or obstruction due to location(due to size). Will increase in size with estrogen. dx: U/S tx: w/OCP
84
do OCP cause weight gain?
nope
85
What are the TORCH Infections?
Toxo, Other(Syphilis), Rubella, Cytomegalo, Herpes(HSV)
86
polyhydramnios = --cm
25 cm fluid
87
Matemal IV —
MgSO4
88
Fetal Alcohol Syndrome
midfacial hypoplasia, microcephaly, mental retardation, IUGR, short palpebral fissures, long philtrum, cardiac defects
89
Preeclampsia with severe features
\>160/110 + Proteinuria + any 1 of: Cr\>1.1, Plt\<100, elevated liver enzymes, RUQ pain, Pulmonary edema, HA or visual disturbances\*basically its gonna look like help but its missing all aspects of help\*\*can sometimes induce for vag delivery with this but often do C-section
90
What is gestational thrombocytopenia? Can she still have epidural?
Gestational thrombocytopenia is a common cause of thrombocytopenia in pregnancy and is a benign, asymptomatic condition defined by a platelet count of 70,000-150,000/mm3. Gestational thrombocytopenia develops in the second or third trimester of pregnancy in patients with no prior history of thrombocytopenia or associated fetal thrombocytopenia and resolves after delivery. The etiology is not well understood but may be a combination of hemodilution and accelerated destruction of platelets. However, the risk of fetal and maternal hemorrhage is not increased. Management is conservative and includes serial complete blood counts, with frequency depending on severity. The patient should be evaluated postpartum to ensure resolution. \*can have epidural as long as platelets \>70k
91
MC trisomy @term
21
92
Define Primary Amenorrhea. Causes?
absence of menses by age 15 or absence of menses within 5 years of breast development
Kallman syndromeMullerian agen(46XX)Androgen insensitivity(46XY)Turners (45X)Swyer Syndrome(46XY)
93
How long after ovulation can an egg be fertilized?
12-24 h
94
Sx of a complete/incomplete mole?
elevated B-HCG, rapid increasing size compared to date, Hyperthyroidism(bhcg looks like TSH), Hyperemesis Gravidarum(severe, dehydrating morning sickness w/electrolyte abnormalities), snowstorm on pelvic U/S, grapelike masstx: D&C and give OCP to prevent pregnancy
95
sx of HSV in mom
PAINFUL BURING PRODROM then appearance of vesicles!
96
Osteoporosis tx
bisphosphonates
97
frank breech
legs up in air
98
what type of cancer is mammary pagents dz?
adenocarcinoma
99
Presentation of Placenta Previa VS Placenta Abruption
\*Previa = painless vaginal bleeding in 3rd trimester, blood from cervix\*Abruption = Painful uterus w/bleeding in thrid trimester!
100
3rd trimester screening tests
1. Diabetes2. CBC3. Atypical Antibody Testing
101
Common causes of variable decelerations
Umbilical cord compression
102
What is the typical presentation of PROM? what is the MCC?
sudden gush of copeous vaginal fluid that is usually clear. U/S would show Oligohydramnios. MCC is infection(Chorioamnionitis) but can be non infectious
103
Why do you get these skin changes in prego: Striae gravidarum, spider angiomas & palmer erythema, Chadwich Sign, Linea Nigra, Chloasma.
Striae gravidarum = stretch makrs, spider angiomas & palmer erythema = increased skin vascularity, Chadwich Sign = bluish or purple discoloration of the vagina and cervix as a result of increased vascularity, Linea Nigra = midline pigmentation, Chloasma = blotchy pigmentation fo the nose and face
104
tx of ruptured ectopic prego
SURGERY NOW!
105
Hirsutism
mild masculinization = fat and hairy
106
5 common causes of Hirsutism/virilization
1. PCOS2. Sertoli-Leydig Tumor3. Adrenal Tumor4. CAH5. Familial hirsutism
107
Mittelschmerz syn?
pain on 1 side of lower abdomen around d10-14 of menstral cycle lasting 1 d = ovulation!
108
when should you advise a couple who wants to get pregnant to have sex?
5 days prior to ovulation and throughout the day of ovulation
109
LH stimulates _____ cells to make \_\_\_\_\_.
leydig/theca, testosterone & progesterone
110
What labs do you need @ initial vists for prego?
1.RhD type + ab2.Hg/Hct, MCV(CBC)3.HIV, VDRL/RPR, HBsAg4.Rubella + varcella immunity5.pap test6. chlamydia PCR7. urine cult + protein
111
causes of vaginal bleeding in postmenopausal women. Whats the most common?
1. Atrophy(MC)2. Endometrial Carcinoma3. Hormone Repacment Therapy(HRT)
112
Protracted labor in the second stage of labor.
longer than 2h in nullipar (3w/epi)longer than 1h in multipar(2 w/epi)\*tx w/operative vag del or c-section
113
define Eclampsia. tx?
\>140/90, Proteinuria, SEIZURES. tx: protect mothers airway and tongue, MgSO4 5g to stop seizures w/maintence 2g/h, IV oxy for deliver, diastolic BP goal 100-90 w/IV hydralazine and/or Labetalol
114
Cytotec(Misoprostol)
o Given prior to PitocinGiven for women with unfavorable cervix/closed increases cervical ripening!
115
describe a baby in frank breech
baby in breech w/legs extended up to head
116
normal amniotic fluid = ---cm
9-25cm of fluid
117
define inadequate contractions?
\<3 in 10 min w/ab soft to palp
118
what is the best dx for chocolate cysts?
laproscopic visulization w/lazer ablation.
119
What does a negative estrogen-progest challenge test tell you?
diagnostic of outflow obstruction or endometrial scarring(Asherman Syndrome) = do hysterosalpingogram(HSG) to ID
120
How much weight should you gain during prego if you are overweight?
15-25lbs
121
Valproic acid(depakote) in prego
NTD(spina bifida), cleft lip, renal defects
122
managment of ROM & PROM?
delivery! they are at term so induce PROM and deliver be sure ot test PROM for GBS and give Ampicillin if needed
123
Fetoscopy. When is this done? WHy?
done after 20 wks, bascially fetal surgery or skin biopsy. prego loss risk 2-5%
124
whats Chorionic Villus Sampling(CVS)? when is this done? why?
U/S giuded samping of chorinonic villi = done between 10-12 wks = done for karyotyping
125
1st trimester to induce abortion
misoprostol
126
work up and tx of prolacintoma
suspect if galactorrhea or amenorhea. get prolactin level then MRI.tx: Pramixpaxole \< cabergoline
127
what do you give for seizure in a prego women with epilepsy?
phenobarbitol
128
type of abortion: vaginal bleeding and cramping w/no POC on sonogram
complete abortion; if previous IUP had been confirmed just tx sx. if not then monitor bHCG to r/o ectopic prego
129
T/F raloxifene has no risk of DVTs
FALSE! Raloxifene still has risks of DVTs + hot flashes+bone & -breasts
130
Down Syndrome
trisomy 21: mental retardation short stature, muscular hypotonia, brachycephaly, short neck, oblique orbital fissure, flat nasal bridge, small ears, nystagmus, protruding tongue, congential heart disease, duodenal atresia
131
Signs babies is getting enough breastmilk
-3-4 stools in 24hrs-6 wet diapers in 24hrs-Weight gain-Sounds of swallowing
132
Transverse vs longitudinal cephalic v breech
Transverse = perpendicular to momlongitudinal = parallel with moncephalic = head @ cervixbreech = ass @ cervix
133
When do u treat osteopenia?
1. When they bc osteoportic 2. When they have a fragility fracture 3. When the FRAX score tells u to
134
Hyperemesis Gravidarm dx vs regular NV in 1st trimester
presence of ketones in urine = hyperemesis!
135
what happens to TV, FEV1, FRC in prego?
tidal volume increases, FEV1 doesnt change, Functional residual capacity decreases
136
PTL \<32 weeks management
betamethasone, Mg, tocolytics & PCN if GBS unknown
137
Treatment of genital warts?
The three major treatment modalities employed in patients with condylomata acuminata are chemical or physical destruction, immunotherapy, and surgical excision. Chemical destruction is preferred as the initial approach by many physicians. Trichloroacetic acid application destroys the lesion by protein coagulation. The clearance rate is not very high; therefore, repeated applications are usually necessary. \*will turn white with application of acetic acid
138
causes of vaginal bleeding in reproductive age women. Whats the most common?
1. Pregnancy(MC)2. Anatomy(PALM COEIN)3. Dysfunctional/abnormal Uterine Bleeding
139
What is a Biophysical Profile?
BPP: NST, Fetal chest expansions, fetal movement, fetal muscle tone, amniotic fluid index.Scored 0-10, each cat worth 2 pts, normal 8-10
140
prego women w/hyperemesis gravidarum; confusion, fallen 2x while standing, nystagmus. dx?
wernicke encephalopathy(encephalopathy, oculomotor dysfunction/nystagmus, ataxia)
141
Tx of HA in prego
Amitriptyline
142
SSRI that is not sage in prego...
paroxetine! other SSRIs are safe
143
PTL 34-36 weeks management
bethamethasone, PCN of GBS unknown
144
46XY w/primary amenorrhea
Androgen insensitivity=no androgen receptor! Balls present and making testosterone but due to lack of receptor wolf degrades, MIF degrades mullerian.+testes +breast -pubes -uterus =primary amenorrhea
145
C/I to breastfeeding
Galactosemia, Untreated TB, HIV infection, Herpetic breast lesions, Active Varicella Infection, Chemo or Radiation, Active Substance Abuse
146
how long should stage 2 of labor last?
3h null2h muli\*anything -1 is protracted(2h null, 1h multi)
147
Dilantin in pregnancy
aka phenytoin. can cause: fetal hydantoin syndrome(IUGR, craniofacial dysmorphism(epicanthal folds, depressed nasal bridge, oral clefts), mental retardation, microcephaly, nail hypoplasia, heart defects)
148
Borderline oligohydramnios = ---cm
5-8cm fluid
149
IUP w/bleeding, + passage of contents, closed OS, U/S shows nothing...
complete abortion
150
baby born w/warm, moist skin, tachy, poor feeding, irritabliity, poor weight gain...dx?
neonatal thyrotoxicosis! mom prob has anti-TSHr ab! which cross the placenta causeing release of excessive TH in baby.tx: methimazol + BB = will resolve in 3 months
151
medical abortion drugs....when can you use these?
Mifepristone = progesterone antagonist + Misoprostol = PGE1\*used within first 63days, works w/in 3 days
152
elevated AFP indicates...
abdominal wall defect\*low is trisomy 18 or 21
153
how many kcals per day do you need to add for prego? what baout for breastfeeding?
300 kcal per day for prego & 500 kcal per day if breastfeeding.
154
Rh - mothers need to be given....
Rogam! = mom doesnt Rh factor and will have Ab to this factor -- baby will have this factor = give rogam toprevent abortion
155
If you have arrest of labor in stage 2 and you ahve already given oxytocin what do you do?
operation vaginal delivery \> c-section\*vacuum assited or forcepts
156
what is the most common fetal lie& presentation in utero?
longitudinal = mom and baby on same vertical axis & cephalic = head comes out first
157
can you give OCPs to reduce the size of ovarian cysts?
nope! they dont work dont do this
158
in addition to paps what must you do for owmen \<25
pap + gon/chal test
159
How much weight should you gain during prego if you are obese?
11-20lbs
160
Stages of Loss:
o Denialo Angero Bargainingo Depressiono Acceptance
161
tx of endometriosis
NSAIDS + OCP then for real fix = surgical ablation/resection
162
Pt exposed to herpes zoster while Prego she had vzv as a child. tx?
If she has a hx of vzv then she is considered immune or if she received 2 dose varicella vaccine. No tx required.
163
HTN meds safe in prego
methyldopa, labetalol, hydralazine, nifedipine2nd line: clonidine, Thz
164
Description of Candidiasis of the nipple. tx?
sore nipple, painful nipple, peeling at periphery.tx: mom w/topical clotrimazole or miconazole; baby w/oral nystatin
165
after 9 wks teratogens will mostly effect..
organ hypertrophy and hyperplasia
166
what ligament is weak in...rectocele, cystocele & uterine prolapse?
weak cardinal ligament + pelvic floor relaxation\*increased risk with large multiple births
167
Itrauterine Fetal Demise(IUFD)How do you dx this?
fetal death at \>20 weeks\*\*can only dx w/lack of fetal cardiac activity(no heart movement) on transabdominal U/S\*absent fetal movement or absence of fetal heart sounds on doppler could be bc baby is sleeping or not in the right position this is why you must visualize absence of heart movement w/U/S
168
What does it mean if a babys lie is transverse?
baby is at a right angle to the mother
169
tetracyclin in prego
blocks 30s ribosome. teeth discoloration/anomalies after the 4th month
170
Inpatient tx for PID
1. Cefoxitin + doxy2. Clinda + Genta
171
Virilization
hirsutism +! = fat, hairy, enlarged clitoris, deep voice, amenorrhea + increase in muscle mass
172
sx of postpartum thyroiditis
non tender, goiter – form of mild autoimmune thyroiditis --- up to 1 year after pregnancy
173
Define Menopause
1yr w/o period
174
inpatient PID tx
IV cefoxitin or cefotetan + doxycyclin If PCN allergy: clindamycin + gentamycin
175
MCC of Vulvar cancer? MC type?
SCC caused by HPV
176
Amenorrhea and can’t smell
Kallman syndrome = no GnRH = no LH & FSH = no E&P-boobs +uterus
177
osteoporosis prophylaxis @ 50
Vit D3 + Ca
178
Sx of Mg tox? tx?
NV, flushing, HA, hyporeflexia, hypocal, respiratory paralysis, cardiac arresttx: stop Mg, IV Ca-gluconate bolus\*sx will be worse with RENAL INSUFF!
179
Risk factors for cervical cancer
tobacco use, low SES, Immunosup, oral contraceptive use, high risk sex partners, STI, HPV
180
MC trisomy causing 1st trimester lost
trisomy 16
181
complete breech
baby cris-cross apple sauce folded in a ball!
182
What happens wk 4-8 postconception?
\*\*Major organs formed\*\* most important time
183
Management of Prolapsed Umbilical Cord?
place pt in knee-chest position, elevate presenting pts, avoid palpating the cord, give C-Section.
184
Whats Cell-Free DNA screen? when can this be done?
ID genetic shit from babys cells that are in moms blood as early as 10 wks!
185
Sx of Toxo in mom?
mono-like illness in prego = baby will have brain calcifications, ventriculomegaly & seizures
186
41w gestation. NST w/FHR 140. FHR decreased to 120 after contraction peak. BBP score of 4. no accelerations for \>40 min dispite vibroacostic stimulation. dx?
Uteroplacental insufficiency
187
PTL \<32 weeks management
betamethasone, Mg, tocolytics & PCN if GBS unknown
188
CVS. when do you do this? why?
10-13 wks(1st trimester), checks for genetic abnormalites! = good bc can be done early = make decision earlier. 0.22% loss
189
define Post Term Pregnancy. MCC?
pregnancy that is 40 weeks or over. MCC is idiopathic!
190
Normal baseline fetal heart rate
110 to 160
191
What is secondary arrest of labor? how do you tx it?
cessation of labor that was initially doing fine for 2h...tx w/membrane rupture manually or just watch
192
what do you test for in the 3rd trimester?
as you begin 3rd u check for 3 big things!1. Gestational Diabetes2. Alloimmunizatoin3. Anemia
193
how does hypothyroid cause secondary amenorrhea? how do you treat?
hypothyroid = increased TSH = increases prolactin production = inhibits GnRH causing amenorrhea.\*will also see dec FSH & LH(duh) just like wiht a prolactinoma.tx: levothyroxine
194
Criteria for a reactive non-stress test? What is considered an acceleration?
Acceleration is an increase in heart rate 15 beats above baseline lasting for greater than 15 seconds after 32 weeks. A reactive stress test includes 2 accelerations in a 20 minute period.
195
Estradiol
dominant during reproductive years = from granulosa cells
196
define late pregnancy bleeding...
vaginal bleeding after 20 wks
197
During pregnancy when do Rh negative mothers need RhoGAM?
Once at 28 weeks and again after delivery
198
How long after ejaculation can sperm survive in the vagina?
24-48h
199
ICSI vs IVD vs IUI
\*Intracytoplasmic Sperm Injection(ICSI) = manual sperm + egg + implant\*In Vitro Fert(IVD) = Egg + sperm in dish, let fertilize nat + implant\*Intrauterine Injection(IUI) = sperm injected into uterus
200
Why do you do a Biophysical Profile on a baby?
to asses fetal oxygenation through ultrasound observation and the nonstress test.
201
Hydralazin vs labetalol for HTN prego
cant give labetalol w/bradycardia
202
what vessels are in the suspensitory ligmanets?
ovarian A & V
203
define Macrosomia. Complications for mom & baby?
EFW \>90-95th for gestational age.Mom: perineal lacerations, PPH, Emergency C-section, pelvic floor injury.Fetus: shoulder dystocia, birth injury, asphyxia
204
outpatient PID tx
IM ceftriazone + oral doxy
205
tx of diabetes in prego?
insulin \> metformin \> glyburide
206
whats the thinking behind a NST?
baby moves = increase in baby hr! --\> you want to see accelerations & variability
207
hormone levels in menopause...
elevated FSH and LH
208
neural tube should close by ---- postconception.
22-28 d
209
@d28 what happens if prego?
bhCG produced by implanted egg supports CL allowing it to continue to produce progesterone until wk 10 when placenta takes over allowing CL to degrade, bhcg levels to fall but E&P levels maintained
210
IUP w/bleeding, closed OS, U/S shows live baby....
threatened abortion, get bed rest and see if its okay.
211
women in 3rd trimester comes in complaining of bleeding, PE shows bright red blood from cervix. dx?
placenta previa\*shoudl always do U/S before PE
212
mother is + for syphilis. what do you do?
treat her w/ penicillin
213
define Gestational Hypertension. how do you tx? when do you deliver?
sustained BP elevation of 140/90 or greater after 20 weeks WITHOUT PROTEINURIA. tx conservatively(rest, water, less salt) if really high can use labetalol or hydralazine
\*deliver at 37 weeks!
214
Changes in Prego w/GI
decreased GI motility & gastric motility due to increased progesterone
215
dx of ectopic prego can be made with....
\>1500 bhCG w/o IUP on vaginal sonogram
216
what drugs will cause secondary amenorrhea?
DA antagoinist like atypical antipsychotics.
217
T1 DM risks to baby...
spontaneous abortion, congenital malformations, IUFGR, Fetal Macrosomia, polyhydramnios, preterm birth, HTN Complication
218
women at risk for NTD should consume ---mg of folic acid. Those who are not shoudl take ---mg.
risk = 4mg; no risk = 0.4 mg
219
Side effects of SSRIs in newborns? Which SSRIs safe for use in pregnancy?
Exercise can cause persistent pulmonary hypertension of the newborn, poor feeding and or jitteriness. SSRI that are safe sertraline \> citalopram \> fluoxetine avoid paroxetine!! Mothers room and peroxy teen will need an echo the baby after birth to rule out any ASD.
220
tx of GBS?
ampicillin or Clindamycin if pcn allergy
221
What is a smush test? what is this used for?
tests infertility due to hostile cervical mucus = \<6 cm on smush test = too thick =( idealy want \>6cm this is good. tx Estrogen to thin mucus if too thick
222
Mother w/PROM that has uterine contractions present...how do you manage?
deliver baby + cervical culture to chck for chorioamnionitis = IV abx
223
PID sx + MCCwhen do you admit?
MCC: Gon, Cla + vaginal florasx: pelvic pain, sick patient!, cervical discharge, cervical motion tenderness, uterine tenderness, adnexal tenderness (like cervicitis + other sx)\*\*if NV, Fever = admit
224
Criteria for preterm labor
1. 20-37 week2. 3 contractions in 30 min3. Cervical dilation of at least 2 cm or effacement
225
Who needs treatment for exposure to shingles? What’s postexposure prophylaxis?
Exposure prophylaxis is the varicella vaccine within five days of exposure. For those who are not immune and also immuno compromised they will receive varicella zoster immuno globin or antiviral therapy.
226
tx of hot flashes
SSRI = venlafaxine
227
when do you do MCA doppler? what does this telll u about the baby?
\>20 wks. "water flows faster than ketchup"\*high diastolic = anemia
228
Klinefelter Syndrome
47XXY; dx usually made during puberty = tall, testicular atrophy, azopermia, gynecomastia, truncal obesity, learning disorder, AI dz, low IQ
229
Placenta previa vs Placeta abrution on presentation?
Previa = PAINLESSAbrution = PAINFUL
230
What happens wk 3 postconception?
trilaminar germ disk with ectoderm, mesoderm & endoderm is formed
231
Stress IncontinenceCause? tx?
weakened pelvic floor can cause bladder to fall into the vagina = cystocele. any increase in intraabdominal pressure can cause leakage of urine. dx via PE. Tx = pessaries to strengthen floor. if that doesnt work do surgery
232
What is the earliest test they can be done determine fetal gender? When can this be done?
Cell free DNA can be done at 10+ weeks, can evaluate for aneuploidy and determine gender in addition to assess Rh status in baby
233
tx teratoma? type of pt u see this in? what are they at risk for? why?
\<20 yoa, weight gain or abdominal growth, large cysts, tx w/cystectomy to spare ovary.\*at risk for ovarian torsion due to extra weight from teratoma!
234
Common causes of late deceleration
Fetal hypoxia and or uteroplacental insufficiency
235
How does lactation prevent pregnancy?
Elevated prolactin blocks GnRH but only works for about 6months
236
management of late bleeding in pregnancy..
CBC, DIC workup, type + cross + match, Sonogram! (NEVER PERFORM A DIGITAL OR SPECULUM EXAM UNTILL U/S RULES OUT PLACENTA PREVIA), large bore IV w/NS, Urinary Catheter
237
Diethylstilbestrol(DES) in pregnancy..
"estrogen" that caused T-shaped uterus, vaginal adenosis w/risk of clear cell carcinoma, cervical hood, incomplete cervix, preterm delivery
238
sx of postpartum thyroiditis
non tender, goiter – form of mild autoimmune thyroiditis --- up to 1 year after pregnancy
239
how do you treat MVP in prego?
BB
240
before --- wks you can give corticosteroids
37 wks
241
sx of prego in 2nd trimester. normal weight gain?
feeling better!(morning sickness i gone), Round Ligament pain w/movment due to stretching. Normal weight gain is 1 lb per week after 20 wks
242
APGAR score...explain..
Activity, Pulse, Grimance(irritability), Appearance, Respiration(cry?)0-2 normal is 7-10
243
MC breech presentations
- Incomplete Breech = 3-4% \*one leg down- Complete Breech = 5-12% \*baby curled into ball with legs crossed- Frank Breech = 48-73% \*babys legs straight up into the air
244
CST late decelerations
utero-placental insufficiency
245
What is the typical presentation of PROM? what is the MCC?
sudden gush of copeous vaginal fluid that is usually clear. U/S would show Oligohydramnios. MCC is infection(Chorioamnionitis) but can be non infectious
246
23 yo F w/FNV, LQ tenderness, RUQ pain w/inspiration, intermenstral spotting, pain that is worse w/menses. dx?
PID! \*intermenstral spotting was prob cervicitis
247
Ionizing Radiation in pregnancy
no single diagnostic procedure results in radiation exposure to a degree that woudl threaten the developing baby.
248
how do you manage asthma inprego?
Inhaled BB, then inhaled corticosteroids or cromolyn sodium then subQ terbutaline+steroids for acute cases
249
complications of D&C
endometritis and retained products of conception(POC)
250
When is Rh screening done?
28 weeks
251
type of abortion: viable prego w/vaginal bleeding but no cervical dilation
threatened abortion! = observation
252
when do you check for anemia during pregnancy? what is normal? how do you F/U & tx?
1st and 3rd!28-30 wks = nadir of Hg/Hct: 10/30\*if less than this do iron studies and tx w/iron supplimentation!
253
which mole has 69 chromosomes? pathogenesis?
incomplete mole, x2 sperm + 1 egg
254
all girls should develop menarche by ---- and begin to develop secondary sex char by ----.
15, 13
255
best indicator of severity of Rh hemolytic dz
bilirubin from amniotic fluid
256
Misoprostole vs Mifepristone?
\*Misoprostole(PGE1) = causes uterus to contract ad expel products\*Mifepristone(--|PG) = causes trophoblast to be removed from the decidua = terminates prego
257
define premature rupture of membranes
ROM w/o contraction between 37-42 wks
258
Mom is Hep B +. How do you tx baby?
C-section to reduce risk of transmission +IVIg Hep B + HBV on day of delivery
259
moms bleeding, baby shows tachy w/decreased variability and sinusoidal pattern...
placenta abruptio! =sinusoidal pattern shows placental insufficiency
260
what do you give a young girl wiht irregular, heavy bleeding? why?
NSAIDs, young women who just started menarche will often have abnormal cycles likely do to anovulation and NSAIDs are kinda like pushing the reset button on it to regulate the cycle.
261
Overflow or Hypotonic Incontinencehow do you dx? tx?
lesions of the pine or nerves of any kinda(trauma, diabetic neuropathy, multiple sclerosis) = loss of sensory feedback indicating fullness. involuntary loss of urine day and night WITHOUT THE URGE OR ABILITY TO VOID. Bladder never empties.dx: cystometry shows absence contractionstx: timed voids w/bithanechol or cathiterization
262
testosterone in mullerian agen vs androgen insens?
normal in mullerian but elevated in androgen insen.
263
Women with skin colored papules on labias. dx?
Condylomata acuminata = HPV 6 & 11!\*smooth, flat, papules, or califlower like
264
Placenta Percreta
Placenta Percreta = villi invade all teh way to the uterine serosa or the bladder
265
tx for complex cysts?
laparoscopy to remove just the cysts.
266
Patau Syndrome
trisomy 13: frofound mental retardation, IUGR, Cyclopia, Proboscis, holoprosencephaly, severe cleft lip w/palate. meav survual = 2days
267
Where does the uterus get its blood supply from?
Internal iliac A. gives off uterine A.
268
nonmodifiable breast cancer risk factors
BRCA +, 1st degree relative, white, increase in age, early menarch/late meno
269
Tx of UTI in prego
alwasy treat!!! even if asymtomatic!1st = amoxicillin or`nitrofurantoin2nd = IV ceftriaxone
270
What is the Uterosacral Ligament?
connects uterus to the sacrum. need to be removed with TAH. Be careful bc they might look like Ureters
271
What labs do you need from prego @35-37 wks?
GBS Culture!
272
How much weight should you gain during prego if you are of normal weight?
25-35lbs
273
Changes in Prego w/Heme
increase in RBC MASS; will see dillutional anemia, increased WBC count(max 16,000 @3rd trimester), normal platlets, increased coag factors from liver
274
tx of hyperthyroid in prego? what will you see for TSH & T4:?
dec TSH, inc T4tx: CANNOT DO RADIO I! tx w/PTU and if needed can do surgery in 2nd trimester
275
Changes in Prego w/Endocrine
increase in pituitary size and vasculitty, increase cortisol, increase in TBG due to estrogen = elevated T3/T4 total but normal free T3/T4
276
how do you usually dx endometriosis?
give OCP trial and if they get better = endometriosis; give NSAIDs for pain.
277
Risks for baby/mom associated w/tobacco/smoking
o Placental abruptiono Placental previao IUGRo Preeclampsiao Infection
278
sx of prego in 1st trimester. normal weight gain?
NV, fatigue, breast tenderness, frequent urination, SPOTTING AND BLEEDING(20%), weight gain 5-8 lbs
279
when do you give RhoGam in Rh- mom?
@28 wks and 72 hrs before fetal maternal mixing(birth)
280
Normal baseline fetal heart rate
110 to 160
281
when can you do amniocentesis? why?
\>16 wks to look for genetic defects. low risk to baby but not really done anymore bc if defects you basically only get 2-3 weeks to decided if u wanna keep it or not =/ been replaced with CVS and quad
282
Preeclampsia
\>140/90 + protinuria = \>37 deliver if \<37 rest!\*eclampsia, severe preeclampsia, HELLP deliver all these!
283
describe the histology seen on bx of fat necrosis of the breast?
foamy macrophages w/fat.\*may see in women how had previous breast surgery
284
How many additional kcal per dayI need it during pregnancy? How many during breast-feeding?
300 kcal/day during pregnancy and 500 kcal/day when breast-feeding
285
Adenomyosis. tx?
endometrium grows into the myometrium. symmetrically enlarged, soft, tender uterus, menorrhagia and dysmenorrhea
286
can you breastfeed w/hep C?
yup!
287
what do you do when you find a cysts between 3-10cm?
reimage within 12 weeks(U/S) to show any growth. if not just ignore it. if less than 3cm dont need to reimage.
288
define rupture of membranes
ROM + contraction between 37-42 weeks
289
Whats a Percutaneous Umbilical Blood Sample? Whats this used for? when can it be done?
transabdominal procedure done under U/S guidanace to sample fetal blood from umbilical vein after 20 wks. Done for karyotyping, looking at IgG, can be used to give transfusions. prego loss risk 1-2%
290
Tx of most GYN cancers w/mets?
Carboplatin & Paclitaxel
291
RF for breech presentation
o Prematurityo Multiple gestationo Genetic disorderso Polyhydramnioso Hydrocephalyo Anencephalyo Placenta previao Uterine anomalieso Uterine fibroids
292
46XX w/primary amenorrhea
Mullerian agenesis= no Müllerian ducts = no uterus or upper vag+ boobs, pubes, ovaries but -uterus = primary amenorrhea
293
FHR monitoring: Nadir + contraction mirroring each otherWhat could this mean?
normal or fetal head compression
294
normal FHR
110-160bpm
295
24 F prego, LMP 9w ago, recently stopped OCP and now has heavier periods, feels "incomplete bladder emptying" which she has had for awhile. PE shows 15w uterus w/irregular contores. dx?
leiomyomata uteri = bitch got fibroids she aight
296
Gestational diabetes goals. Tx hierarchy?
Fasting \<95, 1hr pp \<140, 2h pp \<120tx: diet \> insulin \> metformin \> glyburide
297
How do you dx Chorioamnionitis? when do you commonly see this?
CLINICALLY DX! = maternal fever, uterine tenderness in the presence of confirmed PROM in absence of UTI or URI.
298
sx of congential syphilis
1 trimester = dead baby2-3 trimester:saddle nose, saber skins, hutchinsons teeth(teeth w/pacman bites out of them), nasal discharge, generalized lymphadenopathy, hepatosplenomegaly.
299
Placenta Accreta
Placenta Accreta = villi invader the deeper layers of the endometrial deciduus basalis but do not penitrate myometrium.
300
What can you do to stop post partum hemorrage?
1. Uterine Massage2. Meds(OXYTOSIN)3. Balloon Tamponade4. Surgery = ligate Uterine A then Internal Iliac and if that doesnt work do TAH.
301
Protracted labor in the active stage of labor.
\<1.2cm/h for nullipar\<1.5cm/h for multipar\*tx w/augmentation of labor
302
tachycardia in FHR
\>160 bpm
303
DES is associated wiht....
Adenocarcinoma of the vagina
304
FHR monitoring: Nadir is sharp and not related to contractionsWhat could this mean?
cord compression, oligohydraminose, cord prolapse
305
Weird shit tahts normally w/in first few hrs of delivery
Shivers, temp \<100.4 is considered normal, bloody discharge up to 3 weeks afterward(will get lighter and ligher in color)
306
what is required for an adequate CST?
3 contractions every 10 min
307
tx of postpartum endometritis
clindamycin + genta
308
what causes hypercoagulability in prego?
increase clotting factors, decrease PC/S and INCREASED FIBRINOGEN\*if you ever see normal fibrinogen in prego especially close to term think DIC.
309
pathophys of preeclampsia
diffuse vasospasm caused by loss of prego refractivness to vasoactive substances such as angiotension & changes decreases in prostacyclin(vasodil), increases in Thromboxane(vasoconstrictor)
310
2 painless 3rd trimester bleeding sc?
Placenta previa & Vasa Previa
311
when measuring fetal station what is 0?
ischial spine
312
During pregnancy when do Rh negative mothers need RhoGAM?
Once at 28 weeks and again after delivery
313
Which Ig crosses the placenta?
IgG
314
Failed 1hr blood glucose level in prego?
140+ after administration of 50g PO glucose challenge
315
what is a chocolate cysts? sx?
endometriosis! causing dysmenorrhea, dyspareunia and infertility.
316
define Preeclampsia. tx? When do you deliver?
Sustained bp of 140/90 or greater WITH Proteinuria(\>300 mg or Pro/Cr \>0.3) tx: \<37 wks = rest, hydralazine, benzo in hospital. if \>37 wks = IV oxytocin to induce labor, IV MgSO4 to prevent seizures
317
Women w/painful ulcers on vaginal who also has feeling of not being able to empty her bladder completely. comes in to ER complaining of Fever + HA + dysuria.how do you dx?
THIS IS HSV! dx w/ viral PCR\*lumbosacral neuropathy of HSV can cause urinary retention
318
Define Intrauterine Growth Restriction(IUGR)
Fetus with an estimated fetal weight(EFW) \<5th-10th percentile for gestational age.can be: Symmetric IUGR or Asymmetric IUGR(usually normal head but tiny body)
319
sx of HSV in baby?
IUGR, preterm birth, Blindness
320
pt w/endometriosis are at greatest risk for....
infertility
321
sx of prego in the 3rd trimester. normal weight gain?
decreased libido, back/leg pain, urinary freq, braxton-hicks contractions, LIGHTENING(fetal head moves into pelvis resulting in cervical dilation and less pressure on diaphragm), easier breathing, BLOODY SHOW(vaginal passageof bloody endocerical mucus indicating cerivcal dilation befor labor). 1lb per week after 20wks
322
prego women lacks rubella ab. what do you do?
advise to avoid travel to places w/rubella & vaccinate AFTER delivery as it is a live vaccine
323
causes of vaginal bleeding in premenstral girls. Whats the most common?
1. Foreign Body (MC)2. sexual abuse3. precocious puberty4. Sarcoma Botyroidesdx: speculum Exam!
324
type of abortion: vaginal bleeding, cramping, cervical dilation with some but not all POC passed
incomplete abortion! = emergency D&C if bleeding is heavy if not wait
325
What are the rules for a reactive NST?
\>32wks = 15x15; 2x20\*increase via 15 bpm for 15 sec w/2 of these occuring within 20 min\<32wks = 10x10; 2x20
326
Quad screening shows: decreased MS-AFP & Estriol but elevated hCG & Inhibin-A this corresponds w/....
Trisomy 21! DS!
327
CST variable decelerations
cord compression
328
where do the ovarian A & V come from on the left?
Aorta & Renal Vein\*just like in men
329
15 yo girl with heavy heavy menstral bleeding. How do you stop bleeding?
IV estrogen + anti emetic bc it’s gonna make her sick
330
what is Pseudocyesis?
woman who wants to be prego but cant basically believes shes prego = somatization stress!= somatization stress fx hypo-pit-ovar axis causing weight gain, amenorrhea and causes her to imagine a + prego test when its actually neg.dx: neg U/S, neg Prego tests + clinical
331
Warfarin(Coumadin) in prego
Chondrdysplasia(strippled dpiphysis), microcephaly, mental retardatoin, optic atrophy
332
28 yo women who has 2nd amenorrhea. FSH and LH are elevated. U/S shows many follicles. dx? tx?
Savage Syndrome/Resistant ovary Syndrome = basically early menopause =(\*no tx =(
333
what happens in prego with renal shit?
increase in GFR, decrease in Cr
334
Endometrial Bx Criteria
A. \>45: AUB or postmeno bleedingB. \<45: AUB w/unopposed estrogen(obesity, anov), failed men management, lynch syndrome.C. \>35: Atypical GLANDULAR cells on pap
335
Tx of chorioamnionitis?
1. Abx(amp + genta +/- clinda if c-section)2. delivery
336
sx of congential rubella\*when soudl mom get vac?
1 trimester = IUGR or Abortion3 trimester: "blue-berry muffin baby", petechia & purpura + 3Cs(Cataracts, Congenital Heart, Cdeafness)\*MMR vac 3 months prior to prego or after + avoid unvac babies
337
Uterine Rupturedx? tx?
vaginal bleeding, loss of electronic fetal HR, ab pain, loss of station of fetal head. dx: surgical exploration, tx w/ immediate delivery
338
Tx of epilepsy in prego?
all epilepsy drugs are teratogens!tx: L drugs are safest!\*Leviteracetan & Lemotriginednt forget to add FOLIC ACID
339
incomplete breech
aka footling = one leg curled up the other leg sticking out!
340
Failed 3hr blood glucose level in prego?
\> 180 after 1hr, \>155 after 2hr & \>140 after 3 hr challenge with 100g gluclose
341
2 MCC of cervicitis + sx
Cla + Gonsx: yellow-green discharge, cervical motion tenderness = do wet mount + KOH + PCR
342
Modifiable Breast cancer risk factors
HRT, Null parity, increase in age of 1st brith, alcohol
343
What happens wk 2 postconception?
bilaminar germ disk with epiblast and hypoblast layers; invasion of material sinusoids by syncytiotrophoblast = 1st time bhCG prego test can be positive
344
tx of vaginal atrophy
estrogen cream
345
Side effects of SSRIs in newborns? Which SSRIs safe for use in pregnancy?
Exercise can cause persistent pulmonary hypertension of the newborn, poor feeding and or jitteriness. SSRI that are safe sertraline \> citalopram \> fluoxetine avoid paroxetine!! Mothers room and peroxy teen will need an echo the baby after birth to rule out any ASD.
346
Shoulder DystociaManagement?
delivery of fetal shoulders is delayed after delivery of the head. Associated w/shoulders in teh AP plane.tx: suprapubic pressure, internal rotation of the fetal shoulders to the oblique plane
347
Pathogenesis of ovarian torsion
ovary mass causes twisting of ovary = ischemia & necrosis
348
Abruptio Placentadx? tx?
normally implanted placenta separates from the uterine wall before delivery of the fetus. dx w/U/S. tx: C-section, vaginal delivery \>36 wks, conservative if stable
349
cervical insufficiency =
\<2.5cmprogesterone
350
45X w/primary amenorrhea
Turners!No ovaries and no estrogen!Streak ovaries, short stature, webbed neck, infertility, amenorrhea, broad chest, urinary track abnormalities, bicuspid aortic, aortic core Tatian, dysgerminomas risk, normal intelligence- ovaries,breast,pubes but + uterus = primary amenorrhea
351
What happens if you dont treat primary genital herpes?
resolves on its own and will decrease in freq over time. Meds will speed resolution.
352
define HELLP syndrome. tx?
Hemolysis(H)Elevated Liver enzymes(EL)Low Platelets(LP)tx: prompt deliver w/corticosteroids to enhance post partium normalization of liver enzymes and platelet count.
353
Things that decrease & increase thyroid binding globulin
-Increase thyroid binding globulin: estrogens(pregnancy, oral contraceptives, hormone replacement therapy), Estrogen medications, tamoxifen, acute hepatitis -decrease thyroid binding globulin: androgenic hormones, high-dose glucocorticoids/Hypercortisolism, hypoproteinemia/nephrotic syndrome/starvation, chronic liver disease \*this is y you increase levo dose in Prego and with OCPs
354
Female causes of infertility workup
1. hostile mucous 6cm this is good. tx Estrogen2. Anovulation
355
Chemotherapy in prego..
greatest risk in first trimester; 2-3 is most resitant
356
dafuq are lewis antibodies?
- Lewis Antibodies are IgM and do not cross the placenta = not associated w/isosensitization or hemolytic disease of the fetus = no F/U needed.
357
Trastuzumab associated cardiotoxicity -tx, monitoring?
trastuzumab-associated cardiotoxicity is reversible; there is complete recovery of cardiac function after treatment discontinuation. Echo after 1 year of treatment & repeat q6months for 2 years minimum
358
when is abnormal uterine bleeding(AUB) normal?
near menarche or menopause
359
Criteria for VBAC?
\< 2 C-sections; Low Transverse incision on previous C-section
360
Common causes of variable decelerations
Umbilical cord compression
361
What is a Nonstress Test? What are nomal results? what do you want to see?
tests frequency of fetal movements using an external heart rate monitor.\*\<32 wks \>10 bpm lasting \>10s\*\>32 wks \>15 bmp lasting \>15syou want to see peaks on test
362
Managment of PPROM \<34 wks; PPROM \>34 wks
Preterm premature rupture of membbranes = \<37 wks.if PPROM \> 34 wks = deliery +abx + steroidsIf PPROM \< 34 wks = managed expectantly if not infection +abx +steroids\*if PPROM \< 34 wks w/infection = delivery +abx + sterids\*\*either way always give ABx + STEROIDS!
\<32 weeks give magnesium for neuroprotection
363
Tx of Hyperemesis Gravidarum
dietary modification \> Diphenhydramine(anti-his) \> Metoclopramide(D-antag) \> Ondansetron(5HT antag)
364
FHR monitoring: Nadir occurs slowly after contraction. as contraction subsides nadir is being reached.(late deceleration)What could this mean?
uteroplacental insufficiency
365
What is the Cardinal Ligament?
connects the uterus to the side wall + covers front and back of the uterus & connects the uterus to the bladder & rectum
366
Tx of chorioamnionitis and endomeritis
clindamycin +gentamicin + ampicillin
367
what organism causes mastitis? tx?
streptococcus!Penicillin or cephalosporin
368
Treatment of urinary tract infection in pregnancy? Treatment of pyelonephritis in pregnancy?
UTI: Macrobid, fosfomycin, Bactrim, Keflex - treat for 3 to 7 days Pyelo: Rocephin or cefepime, once fever free for 48h Only in treatment with PO anabiotic’s for 10 to 14 days
369
How long till active labor? nulli v multi?
20h in null; 14 multi\*active labor is 6cm
370
which mole has 46 chromosomes? pathogenesis?
complete mole, 1 sperm + empty egg that duplicates.
371
What do you do if mom is Rh- and baby is Rh+?
give Rogam @28wks and within 72 hr of birth
372
define preterm premature rupture of membranesManagement?
ROM w/o contractions between 24-36 wks\*\>34 wks deliver\*\<24 wks deliver/abort\*24-26wks = steroids + expected managment --\>risk for prolonged rupture of membranes
373
when the bladder reaches ---cc and above it becomes painful.
500
374
how do you dx rectocele?
PE will show mass at back of vagina; constipation relieved by inserting fingers into the vagina
375
type of abortion: sonogram w/nonviable prego but NO bleed, dilation or anything else
missed abortion tx w/D&C
376
NSAID use in pregnancy can cause ——hydraminos.
Olgiohydraminos
377
define secondary amenorrhea
women of reproductive age who has stopped having periods for \>6 months(if previously irregular) or who has missed the last 3 if previously regular. ^nobody waits that long to investigate though lol
378
Tobaccos fx on prego
causes intrauterine growth restriction(IUGR)
379
define: abortion
loss prior to 20 wks
380
Why is Rh incompatibility so much worse than ABO incompatibility?
Rh exposure takes time to develop so by end of 1st prego mom has recently started making IgG to baby = will make immediate attack on 2nd Rh + baby.\*ABO incompatibility causes an acute response and will lyse RBCs. type O moms have large Anti A&B IgG = big hemolysis vs Type A&B moms have small O IgG & mostly IgM which doesnt really cross the membrane.
381
PTL 32-33.6 weeks management
bethamethasone, tocolytics & PCN if GBS unknown
382
where does DHEA come from?
Adrenals in response to ACTH
383
Young women tx for some cancer w/chemo now presents with menopause sx...wtf happened?
1 ovarian insufficiency due to chemo attacking ovaries.
384
Amniocentesis. Whens this done? why?
U/S guided amio sampling, done after 15 wks, takes living fetal cells = fetal karyotpying, NTD screening,
385
Common causes of late deceleration
Fetal hypoxia and or uteroplacental insufficiency
386
Grading of Uterine Prolapse. how do you dx? tx?
1. lower2. almost to vaginal opening3. right at vaginal opening4. prolapsed out of vagina.dx w/PE. tx w/ hysterectomy or sling
387
Tocolgtic agents can be used to prolong pregnancy for no more than —
72 hrs ! Enough time to move mom to place with neonatal ICU and give IV bethamethasone
388
Tx of vulvar lichen sclerosis
Superpotent corticosteroid ointment
389
Precutaneous Umbilical Blood Sampling(PUBS)/Cordocentesis. why do you do this? when?
anytime between 20-32 wks to confirm fetal anemia & treat w/transfusion.\*if \>32 wks = deliver baby!
390
Placenta Accreta vs Placenta Increta vs Placenta Percreta
Placenta Accreta = villi invader the deeper layers of the endometrial deciduus basalis but do not penitrate myometrium.Placenta Increta = villi invade myometriumPlacenta Percreta = villi invade all teh way to the uterine serosa or the bladder
391
Sx in inflammatory breast carcinoma vs IDC or LBC
Inflammatory = Peau d'orange, edema + erythema\*erythema not seen in others.
392
What does it mean if a babys lie is oblique?
baby is at 45 degree angle to mother
393
HD estrogen will....
Stimulate LH(test+P)
394
When can you use methotrexate + leukovorin for ectopic pregnancy?
if bhcg \<5000 or 8000, \<3cm, no heart tones, moms not on folate
395
In a patient with hypothyroidism the dose of levothyroxine might need to be \_\_\_\_\_\_\_\_\_\_\_\_\_due to the effects of combined oral contraceptives.
Increased
396
Changes in Prego w/Pulmonary
tidal volume increases due to elevated diaphragm, residual volume decreases ==\> RESPIRATORY ALKALOSIS from dec Pco2 & inc pH
397
causes of secondary amenorrhea
1. Pregnancy2. Hypothyroidism3. Prolactinoma4. Meds5. Menopause6. Savage Syndrome/Resistant ovarian Syndrome7. Asherman's Syndrome8. Hypothalamus9. Primary Ovarian Insufficiency
398
tx for non-ruptured ectopic prego...
salpingostomy = reach in and remove
399
Presenation and tx of uterine rupture
sudden extreme abdominal pain, abnormal bump in abdoment, no contractions, regression of fetus as it is now floating in abdomen.tx: Laparotomy ASAP to get baby out then repair or hysterectomy
400
Arrested labor in the second stage of labor.
no pro after 3h in nulli par(4 w/epi)no pro after 2h in nulli par(3 w/epi)\*tx w/operative vag del or c-section
401
Dx of HSV? Tx in prego?
PCR, (Val)acyclovir from 36-delivery
402
What is a Contraction Stress Test(CST)? What do you want to see here?
tests ability of fetus to tolerate transitory decreases in intervillous blood flow that occur with uterine contractions. Expensive and 50% false +.Negative CST = no peaks on test = good sign!
403
Tx of vulvar lichen sclerosis
Superpotent corticosteroid ointment
404
Criteria for methotrexate use for ectopic prego
\<3.5cm, no fetal heart beat found, bhCG \<6000
405
Lithium in prego
ebsteins anomaly =atrialization of the right ventrical due to tricuspid valve being displaced down into the ventrical
406
how do u calculate prego due date?
LMP - 3 months + 7 days
407
Changes in Prego w/CV
decrease BP in 1st trimester, lowest at 24wks(should never see elevated arterial bp in prego). increase in plasma volume, decrease in SVR, increase in CO(loest in supine, highest in left later pos). left sternal systolic ejection murmer
408
mom gets epidural then hypotension why? tx?
epidural causes vasodilation + venous poolingtx: fluids, move onto Lside and give vasopressors
409
how do you measure cervical length?
trans vag U/S
410
UPT +, vaginal bleeding...next step?
do U/S to diff = baby, abortion, molar prego or ectopic pregnancy
411
Changes in Prego w/Renal
increase in volume = increase in kidney size, increase GFR, dec BUN, dec Cr, glucosuria
412
Common causes of early deceleration
Fetal head compression
413
Estriol
dominant during pregnancy = from placenta
414
tx of preeclampsia w/severe features
When do you deliver?
=sustained BP \>160/110, elevated Cr, Impaired LFT, thrombocytopenia, pulmonary edema, HA or vision changes
tx: DELIVER Now or at 34 weeks if u can = IV oxytocin, IV MgSO4 to prevent seizures, IV Hydralazine and/or Labetalol
415
what is prolonged rupture of membranes? managment?
\>18 hr ROM \*risk for GBS, Chorioamnitis(baby still in infect), endometritis(baby out inf)tx: Ampicillin + Erythromycin
416
Nuchal Translucency(NT) When is this done? whats normal?
1st trimester(10-13w) - should be \<3mm if more could indicate trisomy defect
417
Vaccines you cannot give in prego(6)
measles, mumps, polio, rubella, yellow fever, varicella
418
Mothers blood type is A-. why is this important?
she lacks the Rh surface antigen so she has antibodies to the surface antigen and will need rogam @ delivery + follow up testing
419
mother is + for PPD test. how do you work this up?
CXR! if + treat w/triple therapy(RIPE) if negative treat w/9 months of INH + B6
420
CST early decelerations
normal or head compression
421
highest mortality for GYN cancers...
Ovarian \> Endometrial \> cervical
422
Common causes of early deceleration
Fetal head compression
423
What labs do you need for prego @ 24-28 wks?
1.Hg/Hct, MCV(CBC)2.RhD type + ab3. 1hr Glucose tests
424
If you have labor arrest in stage 1 active and they tell u contractions are adequate....what do you do?
C-section! if not adequate give oxytocin!
425
tx of unruptured ectopic prego
1. Methotrexate(\<3.5cm, no fetal heart beat found, bhCG \<6000)2. Laproscopy w/Salpinostomy or Salpingectomy
426
Trimethadione in prego..
anticonvulsant. causes: facial dysmorphisms(short upturned nose, slanted eyebrows), cardiac defects, IUGF, mental retardation
427
Placenta Increta
Placenta Increta = villi invade myometrium
428
Criteria for active labor
Rapid cervical chains of greater than 1 cm/h beginning at 6 cm of dilation on average
429
Tx for Cla + Gon
Cla = doxy or azithGon = IM Ceftriaxone
430
do bx for endometrial sampling and you see hyperplasia tx? adenocarinoma tx?
hyperplasia = progesterone --| estrogen via blocking FSHAdenocarcinoma = TAH + BSO\*if there is mets tx w/Carboplatin & Paclitaxel
431
4 tocolytic agents and their major C/I
1. MgSO4 IV - renal insufficiency and myasthenia gravies2. Terbutaline - cardiac dz, DM, uncontrolled hyperthyroidism3. CCB (nifedipine)- hypotension4. Indomethacin(PG blocker) - \>32 weeks = will close PDA :(
432
FSH stimulates _____ cells to make \_\_\_\_\_.
sertoli/granulosa, estrogen
433
male workup for infertility includes...
1. ED - look @ nighttime tumescence test. If psyc = counciling; If not = Sildenafil2. Semen analysis = look @ number + Motility
434
risk factors for preeclampsia
previous hx, chronic HTN, multifetal prego, molar prego, diabetes, chronic renal dz, APLS, vascular dz, tripolidy, extremes of age
435
XLR Dz's
Hemophila A, Color blindness, complete androgen insensitivity, diabetes insipidus, hydrocephalus, G6PD deficiency, Duchenne muscular dystrophy
436
tx of HTN in prego?
alpha methyl dopa, labetalol, hydralazine,
437
How do you use B-quant in ectopic prego?
B-quant = bhcg.\*If \>/=1500 and in fallopian tube = ectopic.\*if \<1500 and in fallopian tube = wait! may still be traveling to uterus = wait 48hrs and try again.
438
IUP w/bleeding, open OS & U/S shows dead baby..
inevitable abortion
439
Treatment of genital warts?
The three major treatment modalities employed in patients with condylomata acuminata are chemical or physical destruction, immunotherapy, and surgical excision. Chemical destruction is preferred as the initial approach by many physicians. Trichloroacetic acid application destroys the lesion by protein coagulation. The clearance rate is not very high; therefore, repeated applications are usually necessary. \*will turn white with application of acetic acid
440
dafuq do the following do for lactation: Progest, Estro, Prolac, oxytocin
Progest: increase lobules, alveoliEstrogen: increase ductsProlac: milk productionOxy: milk let down
441
Which do you work up 1st in infertility M or F?
Male!
442
Human Placental Lactogen(hPL) is simular to ----- and causes----.
GH & Prolactin, antagonizes the cellular actions of insulin = pregnancy glucose intolerance
443
What must you do for a mom with hypothyroid in prego?
increase her dose of durgs bc TBG increases in prego and will further take up T4 resulting in low lvls if not.
444
how do you dx AUB? Tx?
exclusion! tx: OCP & NSAIDs to reduce bleeding
445
Sx of Oxytocin tox? tx?
3: Hyponatremia, Hypotension & TACHYSYSTOLEtx: 3% hypertonic saline\*Oxytocin is simular to ADH
446
Placenta Previadx? tx?
placenta is implanted in the lower uterine segment. dx w/U/S. tx: tx: C-section, vaginal delivery if less than 2cm covering os, conservative if stable then planned C-section
447
What is post partum hemorrhage?
vaginal delivery = 500 ccC-section = 1000 cc
448
Pt w/history of multiple Gc/Chla infections now presents with fever, leukocytosis and adenexal mass. workup ? tx?
U/S will show ABSCESS = needs to be drained and started on abx(cefoxitin, doxy, metro, clinda, genta)
449
Outpatient tx for PID
1. Ceftriaxone IM + Doxy + Metro2. Cefox + probenecid + doxy + metro\*proben = prevents drug from being pee'd out\*metro treats for anaerobes!
450
What happens wk 1 postconception?
implantation of the blastocysts on the endometrium
451
young girl w/pharyngitis, fever, lower ab pain. dx?
Gonococcal pharyngitis, test for w/NAAT
452
Edward Syndrome
trisomy 18: profound mental retardation, rocker bottom feet, clenched fist, F \> M; mean survival = 14days
453
How do you manage post term pregnancy?
1. check gestational age! make sure shes actually post term!2. assess for likelihood of sucessful induction of labor by assessing cervix + bishop score. If bishop 8 or above = induce labor.
454
What happens in Polycystic ovarian Syndrome?
ovary is replaced by thousands of follicles that produce large amounts of estrogen which then is converted to testosterone = fat, hairy, irregular menses, deep voice, trouble getting prego, DM, dyslipidemiadx: LH/FSH \>3 makes dx. elevated testosterone but normal DHEAStx: OCP + Metformin(reduces androgens), clomiphene to help with getting prego
455
how do you dx endometrial cancer?
this will be seen in post meno women wiht abnormal bleeding = do endometrial sampling and a D&C, can also do pelvic ultrasound to see if thickness is \<5mm.
456
how long shoudl stage 3 of labor last?
30 min. no matter how long the other stages were its always 30 min!
457
MCC of Vulvovaginitis + sx
Candida, Gardnerella(BV), TrichomonasSx: pruritis, odor, discharge
458
How many additional kcal per dayI need it during pregnancy? How many during breast-feeding?
300 kcal/day during pregnancy and 500 kcal/day when breast-feeding
459
what diabetic drug doesnt really cross the placental membrane?
Glyburide
460
workup for vulvovaginitis What would you see for each to dx?
normal saline slide & KOH prep slide1. Candida = Hyphae on KOH tx antifungal topical or fluconazole2. Gardnerella(BV) = clue cells on saline + fishy on KOH, tx metro3. Trichomonas = motile flagellated on saline, tx both partners w/metro
461
oligohydramnios = ---cm
\<5cm fluid
462
What does a positive estrogen-progest challenge test tell you?
bleeding = there just wasnt enough estrogen in the first place. look at FSH to ID etiology.\*elevated FSH = ovarian failure\*low FSH = need to r/o brain tumor.
463
What is gestational thrombocytopenia? Can she still have epidural?
Gestational thrombocytopenia is a common cause of thrombocytopenia in pregnancy and is a benign, asymptomatic condition defined by a platelet count of 70,000-150,000/mm3. Gestational thrombocytopenia develops in the second or third trimester of pregnancy in patients with no prior history of thrombocytopenia or associated fetal thrombocytopenia and resolves after delivery. The etiology is not well understood but may be a combination of hemodilution and accelerated destruction of platelets. However, the risk of fetal and maternal hemorrhage is not increased. Management is conservative and includes serial complete blood counts, with frequency depending on severity. The patient should be evaluated postpartum to ensure resolution. \*can have epidural as long as platelets \>70k
464
What are the escalating steps for heavy, life threatening bleeding.
\*always remember 2 large bore IVs + IVF1. IV estrogen to stop2. Balloon tamponade3. D&C4. Uterine A. Embolization5. Hysterectomy
465
what does a negative progesterone challenge test tell you?
absence of withdrawal bleeding is caused by either inadequat estrogen priming of the endometrium or outflow tract obstruction(imperforate hymen).
466
Define Preterm deliverymanagement?
20-34 wks\<20 = abort\>34 deliver20-34 depends! as long as no C/I = steroids + Tocolytics to help lungs mature! \*will only last a day or so
467
What is Pubic Symphysis Diastasis? cause? rf? tx?
progesterone & relaxin cause increased pelvic motility and widening, after tramatic delivery(fetal macrosomia, multiparity, precipitous labor, operative vag delivery) can present w/difficulty ambulating, RADIATING SUPRAPUBIC PAIN w/an intact neuro exam.tx: NSAIDs, PE, resolves 4-6 wks
468
What is an Umbilical Artery Doppler? Was are some nonreassuring findings that may indicate need for delivery?
measures ratio of systolic and diastolic blood flow in the umbilical artery = bottom of troft should be above baseline for normal.\*Nonreassuring findings = absent diastolic flow & reversed diastolic flow
469
tx of Bactauria in prego
Cephelaxin, amox-clau, nitrofurantoin, fosfomycin
470
Pt exposed to herpes zoster while Prego she had vzv as a child. tx?
If she has a hx of vzv then she is considered immune or if she received 2 dose varicella vaccine. No tx required.
471
target HTN in prego...
diastolic 90-100
472
what is asherman syndrome?
scarring of the uterus due to extensive uterine curettage and infection-producting adhesions.
473
define Infertility
inability to conceive after 1 year
474
women presents with severe and sudden onset of abdominal pain that was not provoked by anything. dx? workup? tx?
U/S will likely show a cysts = weight causes twisting around suspensory ligament.\*surgery to untwist and tack down ovary! if necrotic remove.
475
define Eclampsia. tx?
\>140/90, Proteinuria, SEIZURES. tx: protect mothers airway and tongue, MgSO4 5g to stop seizures w/maintence 2g/h, IV oxy for deliver, diastolic BP goal 100-90 w/IV hydralazine and/or Labetalol
476
Failed 3hr blood glucose level in prego?
\> 180 after 1hr, \>155 after 2hr & \>140 after 3 hr challenge with 100g gluclose
477
what is the most serious complication of fetal demise? when is this seen? what do you do if this is present?
DIC! seen w/fetal death \>2 wks ago = due to release of thromboplastic from decaying fetus. if present do emergent D&C(\<23wks) or induction w/prostoglandins(\>/= 23wks). if not DIC just wait for natural abortion/delivery
478
AR dz's
deafness, CF, thalassemia, albinism, SS anemia, Tay-Sachs dz, PKU, CAH, Wilson
479
tx of anemia in baby
\*determined via Precutaneous Ubilical Blood Sampling(PUBS) if...\>32 wks = deliver\<32 wks = transfuse!
480
Prego lady who is itchy. Says her sister had the same thing when she was Prego. No rash seen and dark urine. Dx? Tx?
Intrahepatic cholestasis of prego! Usually worse at night and on feet and hands too. Increased risk of preterm birth. Tx: ursodeoxycholic acid
481
Define Premature Rupture of Membranes
rupture of the fetal membranes before onset of labor
482
How do you manage cord compression? what would you see on FHR monitoring?
move mother onto left side to avoid compressing IVC, Amnioinfusion if ruptured membranes.On FHR monitoring would see sharp decelerations not related to contractions.
483
Lichen Plantus v Lichen Simplex Chronicus v Lichen Sclerosus
\*Lichen Sclerosus = thin, white, wrinkled skin over the labia majora/minora + atrophic changes.\*Lichen Simplex Chronicus = hyperplastic response to repetitive scratching and irritation = thick leathery textured skin.\*Lichen Planus = glassy bright red erosiuns and ulcerations of vulvovaginal area(purp papules assoc w/HEP C), wickham striae
484
What is an adequate contraction? how can you tell?
use IUPC --\> 200 mV in 10 min or 3 in 10 min that feel strong!
485
Kallmann syndrome tx
Replace hormones appropriate for sex
486
cause of symmetrical IUGR(\<10% for gestational age) in 1st trimester.
Chromosomal Abnormalities \> infection
487
Human Chorionic Gonadotropin(hCG) is made by ---- and peaks at ---.
placental syncytiotrophoblast, 10 weeks
488
women with recurrent canidida inf...what shoudl you check?
a1c
489
Criteria for a reactive non-stress test? What is considered an acceleration?
Acceleration is an increase in heart rate 15 beats above baseline lasting for greater than 15 seconds after 32 weeks. A reactive stress test includes 2 accelerations in a 20 minute period.
490
when does the transition from latent to active labor occur?
when cervix is 6 cm dilated
491
What is the earliest test they can be done determine fetal gender? When can this be done?
Cell free DNA can be done at 10+ weeks, can evaluate for aneuploidy and determine gender in addition to assess Rh status in baby
492
3 in utero shunts within fetus
1. Ductus Venosus: umbilical vein --\> IVC2. Foramen Ovale: RA --\> LA3. Ductus Arteriosus: Pulmonary A ---\> descending aorta
493
How many weeks is chorionic Villus sampling done at?
10 to 14 weeks. Associated with a 1 to 5% chance of fetal loss, as well as distal them defects. Preferred method in mothers with an increased risk of aneuploidy
494
Post date baby date?
\>42wks
495
Describe the 4 stages of labor
1: Latent = onset of regular uterine contractions; Active: acceleration of cervical dilation(6cm)2: Cervix 10 cm dilated and baby descends through the birth canal3: baby delivery begins & ends with placenta delivery4: 2hr period after the end of stage 3, to monitor mom`
496
D&E use? complications?
2nd trimester abortion procedure; comp: uterine performation, retained tissue, hemorrhage, infection, DIC
497
How do you manage post term pregnancy?
1. check gestational age! make sure shes actually post term!2. assess for likelihood of sucessful induction of labor by assessing cervix + bishop score. If bishop 8 or above = induce labor.
498
Abortion vs Intrauterine fetal demise
Abortion is death before 20 wksIUFD comes after 20 wks
499
Define Abortion, preterm birth and full term birth
Abortion = \<20 wksPTB = 20-36 wksFTB = \>36 wks
500
@ what weeks is tocolytics C/I?
34 wks or more
501
Colostrum
first secretion of mammary ducts after deliver, high in protein low in fat. contains IgA for passive immunity.
502
cause of asymmetrical IUGR(\<10% for gestational age) in 2/3st trimester.
HTN, smoking,maternal malnurition, utero-placental insufficiency
503
U/S finding of RH dz...
1. increase systol flow on MCA doppler.2. Fetal Hydrops(ascites, pericardial effusions + other effusions, scalp edema)
504
describe a baby in complete breech
baby in breech with knees pulled against tummy
505
tx of hypothyroid in prego? what labs will you see for tsh and t4?
dec T4 & inc TSHtx: frequent TSH assesment and give levothyroxine\*\*if already on levo you will need to increase the dose for prego
506
Quad screening shows: decreased MS-AFP, Estriol, hCG & Inhibin-A this corresponds w/....
Trisomy 18! Edwards Syndrome
507
streptomycin in prego
inhibits 30s ribosome. Causes CN8 dmg(hearing) = hearing loss
508
During what time frame do you test pregnant women for gestational diabetes?
24 to 28 weeks
509
Who needs treatment for exposure to shingles? What’s postexposure prophylaxis?
Exposure prophylaxis is the varicella vaccine within five days of exposure. For those who are not immune and also immuno compromised they will receive varicella zoster immuno globin or antiviral therapy.
510
pt w/constant and continuous leak of urine day or night...dx?
fistuladx: inject dye into bladder or rectum and insert tampon in vagina if leak then the dye will leak onto tampon
511
Things that decrease & increase thyroid binding globulin
-Increase thyroid binding globulin: estrogens(pregnancy, oral contraceptives, hormone replacement therapy), Estrogen medications, tamoxifen, acute hepatitis -decrease thyroid binding globulin: androgenic hormones, high-dose glucocorticoids/Hypercortisolism, hypoproteinemia/nephrotic syndrome/starvation, chronic liver disease \*this is y you increase levo dose in Prego and with OCPs
512
where do the ovarian A & V come from on the right?
IVC & Aorta
513
Genitourinary Syndrome of Menopausesx? pe?
sx: dryness, itching, dysparuria, urinary incon,recurrent UTI, Pelvic pressure, VAGINAL BLEEDINGpe: narrow introitus, pale mucosa, dec elasticity, dec rugae, PETECHIA, FISSURES, loss of labial volume
514
define an acceleration on a NST (assume \>35wks). whats a + NST?
acceleration: \>15 bpm for \>15s returning to normal w/in 2 min.+NST: \>2 accel in 20 min each above 15bpm and \>15s.
515
Isotretinoin(accutane) in pregnancy
congenital deafness, microtia, CNS defects, congential heart defects
516
women reports pain with penitration. dx? tx?
genito-pelvic disorder = due to trauma, abuse or lack of knowledge.tx: kegals + desensitization
517
target diastolic bp in HTN mother
90-100
518
Mother on antiseizure medication. When idealy should u start Folate supplementation? how much?
3 months prior to conception -- 4mg/d
519
How long do you continue Mg after delivery in mother w/preeclampsia? How do you tx Mg toxicity?
24h then stop -- treat tox with Ca gluconate
520
management for subchorionic hemorrhage?
monitored with US. increased risk of abortion - consider progesterone in case by case basis
521
Intrapartum monitoring of IUGR? When should you deliver?
IUGR if 2nd trimester fundal height\>2cm diff from GA & \>3cm in 3rd trimester. US assessing for growth q2-4 weeks. If abnormal on US plan for delivery at 38 weeks.
522
Fever & uterine fundal tenderness \>24hrs after CS
dx? tx?
postpartum endometritis, the most common cause of postpartum fever. Other presenting features of postpartum endometritis include purulent vaginal discharge, boggy uterus, and increased vaginal bleeding. Postpartum endometritis, a **polymicrobial infection** of the uterine decidua, is caused by the ascent of vaginal flora into the uterine cavity during labor, delivery, or the immediate postpartum period. Infection is common in both patients with prelabor rupture of membranes (PROM) (ie, membrane rupture before onset of contractions at \>37 weeks gestation) and those with preterm PROM (ie, \<37 weeks gestation).
a broad-spectrum intravenous antibiotic regimen that includes penicillin-resistant anaerobic coverage is required. The most appropriate therapy is clindamycin plus gentamicin. Clindamycin covers aerobic gram-positive cocci and penicillin-resistant anaerobes. Gentamicin covers gram-negative and some gram-positive bacteria (eg, Staphylococcus). Treatment is continued until the patient is afebrile for ≥24 hours. Ampicillin plus gentamicin is a broad-spectrum regimen commonly used for *chorioamnionitis*, an intrapartum uterine infection. However, this regimen does not cover penicillin-resistant anaerobes. Ampicillin-sulbactam would be an appropriate alternate to clindamycin.
