OBSTETRICS

Question 1

At what hCG level can you do a transvag US?

Answer 1

18,000

Question 2

At what hCG level can you do a transabdominal US

Answer 2

35,000

Question 3

Naegele’s rule for gestational age

Answer 3

+7day to LMP

- 3 months

Question 4

When is the quad screen done? What does it assess?

Answer 4

15-20 weeks
MSAFP, Estriol, hCG, Inhibin A
Eval for neural tube defects, spina bifida, ancephaly, and Ter of Fallot, trisomy 21, and other chromosomal

Question 5

What is “quickening”?

When does it start?

Answer 5

maternal awareness of fetal movement

16-20weeks

Question 6

dystocia

Answer 6

failure to progress
3Ps: power (uterine contractions)
passenger (baby too big/ wrong angle)
passage (canal too small)

Question 7

What changes are NOT normal during pregnancy

Answer 7

diastolic murmur
increased BP (after 20wks)
proteinuria

Question 8

fetal viability=

Answer 8

20 weeks/ 500gms

Question 9

term gestation

Answer 9

38-42 weeks

Question 10

Preterm =

Answer 10

<37 weeks

Question 11

early decelerations due to

Answer 11

head compression

Question 12

variable decelerations due to

Answer 12

cord compression

Question 13

late decelerations due to

Answer 13

uterine placental insufficiency

Question 14

Rhogam in rh negative prego w/o sensitivity given at

Answer 14

28 weeks

Question 15

Quad screen with decreased MSAFP & estriol

+ increased hCG and inhibin A

Answer 15

Trisomy 21 or 28 (or other chromosomal abnl)

Question 16

Increased MSAFP (maternal serum alpha fetal protein) seen in

Answer 16

neural tube defects: spina bifida, ancephaly, etc

Question 17

How much folic acid should prenatal provide

Answer 17

0.4 mg folic acid

Question 18

Nausea tx

Answer 18

1st gen antihistamine first choice

Esp in 1st trimester

Question 19

what happens during the 2nd stage of labor

Answer 19

“pushing stage”

from full cervical dilation to delivery of baby

Question 20

what happened during 3rd stage of labor

Answer 20

delivery of placenta

Question 21

Mean time of 1st stage of labor

Answer 21

nulliparous: 12 hr with 8hr of latent
multiparous: 6.5 hr with 5 hr of latent

Question 22

Movements of labor

Answer 22

Engagement- 0 station
Flexion
Descent
Internal rotation
Extension (of fetal head)
External rotation/restitution
Expulsion

Question 23

14 weeks gestation presents with vaginal bleeding and abdominal pain
next step

Answer 23

US to confirm IUP

must r/o ectopic

Question 24

16 weeks gestation
hyperemesis
US can not demonstrate fetal structure or HR
hCG is very elevated

Answer 24

Trophoblastic Disease

Hydatidoform Mole

Question 25

US shows focal cystic changes in the placenta and a "snow storm"

Answer 25

Hydatidoform Mole

Question 26

late vaginal bleeding in postpartum period with enlarged uterus and enlarged ovaries

Answer 26

r/o choriocarcinoma

Question 27

bleeding through a closed cervcical os

Answer 27

threatened abortion

Question 28

when do prego women get glucose screening

Answer 28

24-28 weeks

Question 29

SOC for gestational diabetes

Answer 29

insulin more frequent office visits q2-3 weeks meal planning

Question 30

HTN only during pregnancy and immed post partum

Answer 30

gestational HTN

Question 31

TOC HTN in pregnancy

Answer 31

Methyldopa or labetalol

Question 32

What HTN drugs contraindicated in prego

Answer 32

ACEI/ARB

Question 33

Post partum hemorrhage causes

Answer 33

``` 4 'T's: Tissue (retained placenta) Tone (uterine atony) Trauma (traumatic delivery, episiotomy) Thrombin (coagulation disorders, DIC) ```

Question 34

Dx for preeclampsia

Answer 34

BP >140/90 | +proteinuria (>0.3g in 24hrs)

Question 35

Definitive tx for preeclampsia/eclampsia

Answer 35

Delivery

Question 36

Severe preeclampsia tx

Answer 36

magnesium sulfate hospitalized modified bedrest <34weeks- corticosteroids plan delivery

Question 37

epigastric or RUQ pain and >20wks gestation | ~HTN

Answer 37

r/o HELLP hemolysis elevated liver enzymes low platelets

Question 38

Tx HELLP syndrome

Answer 38

magnesium sulfate BP control Stabilize mother Definitive- delivery of fetus

Question 39

placenta previa vs abruption placentae

Answer 39

previa is PAINLESS

Question 40

sudden gush of fluid >20 weeks | next step

Answer 40

sterile speculum exam to r/o PROM

Question 41

how to dx PROM

Answer 41

``` sterile speculum exam: pooling of fluid in posterior fornix nitrazine paper test pH 7.0-7.25 ferning leak with valsalva ```

Question 42

PROM with chorioamniotis

Answer 42

delivery regardless of age

Question 43

PROM at 34 weeks gestation

Answer 43

Induce labor

Question 44

PROM 24-34 weeks gestation

Answer 44

abx corticosteroids for lungs magnesium sulfate for fetal neural protection deliver once lungs mature

Question 45

PROM at 22-24 weeks gestation

Answer 45

terminate pregnancy vs abx and educate on risk

Question 46

Prego women hx premature labor and PROM

Answer 46

IM or intravag progesterone from week 16-36

Question 47

MCC postpartum hemorrhage

Answer 47

uterine atony

Question 48

post-partum fever soft-tender uterus leukocytosis

Answer 48

postpartum endometritis | abx- cefoxitin