Obstetrics

Question 1

Fundal height formula

Answer 1

umbilicus-20wks+2-3cm/week

Question 2

Fetal heart via doppler, quickening

Answer 2

Fetal heart: 10-12wk

Quickening: 17-18wks

Question 3

Quad screen for Trisomy 18, 21 (MSAFP, Estriol, Inhibin A, BHCG)

Answer 3

Trisomy 18: all low

Trisomy 21: MSAFP/Estriol low; inhibin A, Bhcg high

Question 4

Causes fetal renal tubular dysplasia, neonatal renal failure, oligohydramnios, IUGR, lack cranial ossification in fetus

Answer 4

ACEi

Question 5

Causes neural tube defects, fingernail hypoplasia, microcephaly, developmental delay, IUGR in fetus

Answer 5

Carbamazepine

Question 6

Causes bowel atresia, malformation heart, limbs, face, GU; microcephaly, IUGR, cerebral infarct in fetus

Answer 6

cocaine

Question 7

Causes ebstein anomaly in fetus

Answer 7

Li

Question 8

Causes cerebral atrophy, microcephaly, mental retardation, spasticity, seizures, blindness in fetus

Answer 8

Mercury

Question 9

Causes IUGR, mental retardation, microcephaly, dysmorphic craniofacial, cardiac defects, fingernail hypoplasia in fetus

Answer 9

Phenytoin

Question 10

Causes hearing loss, CNVIII damage in fetus

Answer 10

streptomycin, kanamycin

Question 11

Causes cleft lip or palate, cardiac defects, microcephaly, mental retardation in fetus

Answer 11

Trimethadione

Question 12

Causes neural tube defects, minor craniofacial defects in fetus

Answer 12

valproic acid

Question 13

Causes nasal hypoplasia, stippled bone epiphyses, delayed delay, IUGR

Answer 13

warfarin

Question 14

causes inc SAB, microtia, thymic agenesis, CV defects, craniofacial dysmorphism, cleft lip, cleft palate, mental retardation in fetus

Answer 14

Vit A

Question 15

Causes hydrocephalus, intracranial calcifications, chorioretinitis, ring-enhanced lesion on MRI in fetus: dx and tx

Answer 15

Toxo
Tx with pyramethamine and sulfadiazine
spiramycin ppx in 3rd trimester

Question 16

Causes cataracts, purpuric rash, mental retardation, hearing longs, PDA: dx and prevention

Answer 16

Rubella

immunize before pregnancy

Question 17

Causes petechial rash, periventricular calcification in fetus: dx and tx

Answer 17

CMV

postpartum ganciclovir

Question 18

Causes maculopapular rash, LAD, hepatomegaly, rhinits in fetus: dx and tx

Answer 18

syphilis

penicillin

Question 19

Early decelerations

Answer 19

Head compressions by uterine conctraction (normal)

Question 20

Late decelerations

Answer 20

Uteroplacental insufficiency and fetal hypoxemia

Question 21

Variable decelerations

Answer 21

umbilical cord compression

Question 22

Definition of reactive NST

Answer 22

two accelerations >15bpm for 15sec (if >32wks) in 20 min period

Question 23

hyperemesis gravidarum: workup and tx

Answer 23

workup: bhcg, US to r/o molar
UA and electrolytes, LFT, bili, amylase/lipase
Tx: B6, doxylamine (antihist), promethazine or dimenhydrinate

Question 24

Defn gestational vs pregestational HTN and tx

Answer 24

Gestational HTN >20wks
Tx: methyldopa, labetalol, nifedipine
Dont give: ACEIs or diuretic

Question 25

Signs Mg toxicity and tx

Answer 25

Signs: loss DTRs, resp paralysis, coma
Tx: Ca gluconate

Question 26

painful dark vaginal bleeding vs painless bright red bleeding: dx and tx

Answer 26

painful dark: placental abruption; if severe immediate delivery
painless red: placenta previa; do not perform vaginal exam; c-section if >36wks, in labor, fetal distress, lung maturity

Question 27

complete vs incomplete molar pregnancy: karyotype, presence fetal tissue

Answer 27

complete: 46XX, no fetal tissue, high risk choriocarcinoma
Incomplte: 69XXY, contains fetal tissue

Question 28

Tx PPROM

Answer 28

> 34wks: consider labor induction
Abx
Antenatal steroids x48h if

Question 29

abd pain and picket fence fever postpartum: dx and tx

Answer 29

septic pelvic thrombophlebitis

broad-spectrum abx and anticoag with heparin 7-10d

Question 30

Abx for endometritis

Answer 30

clindamycin and gentamicin until afberile for 48h

add ampicillin for complicated cases