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Step 2/Level 2 > Obstetrics > Flashcards

Obstetrics Flashcards

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1
Q

What is Goodell sign?

A

Softening of the cervix in early pregnancy

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2
Q

What is Chadwick sign?

A

Dark bluish-red discoloration of the vaginal mucosa in the 1st trimester

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3
Q

What are Hegar and Ladin signs?

A

Softening of the uterus in 1st trimester

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4
Q

What is Chloasma?

A

Skin hyper pigmentation of the face, often in sun-exposed areas in the 2nd trimester

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5
Q

What is Linea nigra?

A

Skin hyperpidmentation along the midline of the anterior abdominal wall in the 2nd trimester

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6
Q

What is Naegele’s rule?

A
  • To determine expected date of delivery

- Take 1st day of LMP and add 7 days. Then subtract 3 months. then add 1 year

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7
Q

When can beta HCG be detected in the urine? In the serum?

A
  • Urine=2 weeks after fertilization

- serum=1 week after fertilization

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8
Q

Which teratogen is associated with Ebstein anomaly?

A

Lithium

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9
Q

Which teratogen is associated with yellow-brown discoloration of teeth?

A

Tetracyclines

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10
Q

Which teratogen is associated with phocomelia (shortened limbs)?

A

Thalidomide

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11
Q

Which teratogen is associated with nasal hypoplasia and epiphyseal stippling?

A

Warfarin

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12
Q

When should a preggo be screened for syphilis?

A

first visit

-3rd trimester too if high risk

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13
Q

When should a preggo get the quadruple screen?

A

15-20 weeks

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14
Q

When should a preggo be screened for gestational DM?

A

24-28 week s

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15
Q

when should a preggo get RhoGAM if Rh(D) negative?

A
  • 28 weeks
  • after delivery
  • anytime there is potential hemorrhage
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16
Q

When should a preggo be screened for group B streptococcus?

A

35-37 weeks

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17
Q

What is an elevated AFP associated with?

A
  • neural tube defects
  • abdominal wall defects
  • multiple gestations
  • incorrect dating
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18
Q

Dec AFP, inc beta hCG, dec estradiol, inc inhibin?

A

Trisomy 21

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19
Q

Decreased AFP, estriol and beta hCG?

A

Trisomy 18 (Edwards)

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20
Q

When can chorionic villus sampling be done?

A

10-13 weeks

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21
Q

When can amniocentesis be done?

A

15-20 weeks

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22
Q

1st line pharmacotherapy for n/v in pregnancy?

A

pyridoxine (vitamin B6) and doxylamine (antihistamine)

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23
Q

What is hyperemesis gravidarum?

A

weight loss >5% of pre-pregnancy weight due to n/v

  • dehydration, ketosis, and abnormal labs
  • get US to r/o gestational trophoblastic disease and multiple gestations
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24
Q

What is the difference between an A1 and an A2 gestational diabetic?

A

A1=good control of BG with diet and exercise

A2=requires insulin

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25
Q

What ABX are good for asymptomatic bacteruria in preggos?

A
  • nitrofurantoin
  • amoxicillin
  • caphalexin
  • bactrim
  • fosfomycin
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26
Q

What is the treatment for a preggo with pyelonephritis?

A

-IV ABX (amp +gent, ceftriaxone, meropenem, zosyn)

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27
Q

Who should be treated with antibiotics for the duration of the pregnancy?

A
  • women with asymptomatic bacteriuria who failed treatment 2 times
  • Women with pyelonephritis x 1.
  • Give Nitrofurantoin for the duration of the pregnancy
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28
Q

What conditions are associated with p-ANCA?

A
  • Pauci-immune glomerulonephritis
  • microscopic polyangitis
  • Churg-strauss
  • Ulcerative colitis
  • Primary sclerosing cholangitis
29
Q

Which antihypertensives are good for preggos?

A

“Hypertensive Mothers Love Nifedipine”

  • Hydralazine
  • Methyldopa
  • Labetalol
  • Nifedipine
30
Q

What is the diagnostic criteria for pre-eclampsia?

A

-elevated BP >140/90 after 20 weeks gestation
AND
-proteinuria >300mg/24 hours
OR
-end organ dysfunction (renal insufficiency, thrombocytopenia, inc LFTs, HA, vision changes)

31
Q

Woman in labor develops hypotension, respiratory failure, unresponsiveness and DIC?

A

amniotic fluid embolism

32
Q

Choriorentinitis, diffuse intracranial calcifications and hydrocephalus in an infant? Tx?

A
  • Toxoplasmosis
  • Tx: mom: spiramycin
  • fetus: pyrimethamine + sulfadiazine + folinic acid
33
Q

Infant with sensorineural hearing loss, periventricular intracranial calcifications and microcephaly?

A

CMV

34
Q

Scarring of the skin and limb hypoplasia?

A

HSV

35
Q

Infant with anemia and hydrops fetalis?

A

Parvovirus B19

36
Q

Infant with PDA, cataracts and deafness?

A

Congenital Rubella (may also have blueberry muffin rash)

37
Q

Saddle nose, snuffles Hutchinson teeth and saber shins?

A

Syphilis

38
Q

Treatment for syphilis in a pregnant patient with a penicillin allergy?

A

Desensitization and PCN G

39
Q

Management of a susceptible pregnant woman who is exposed to someone with chickenpox?

A

Varicella immune globulin

40
Q

Management of a pregnant woman with chickenpox rash early in pregnancy?

A

acyclovir

41
Q

Management of a pregnant woman with a chickenpox rash around delivery?

A

Mom: acyclovir
Infant: varicella immune globulin

42
Q

Pt with HSV lesions or prodromal symptoms?

A

C-section

43
Q

At what beta hCG should you be able to see an IUP?

A

> 1500

44
Q

What patients are eligible for medical management of an ectopic pregnancy?

A
  • stable pt with normal renal and liver fxn

- Beta-hCG

45
Q

What is macrosomia?

A

Estimated fetal weight >4500 g

46
Q

What are some risk factors associated with IUGR?

A
  • Smoking
  • cocaine use
  • Low uteroplacental blood flow (HTN, DM, SLE)
47
Q

When is c-section offered to moms? Why?

A
  • estimated fetal weight >5000g (or >4500g in Diabetic mom)

- to reduce shoulder dystocia

48
Q

What is a normal (reactive) non-stress test?

A

-2 accelerations (>15bpm above baseline lasting 15 seconds) in 20 minutes

49
Q

What are the components of a biophysical profile? What is a reassuring score?

A

-NST
-amniotic fluid volume
-fetal breathing
-fetal movement
-fetal tone
(10 points total, 8+=reassuring)

50
Q

Which fetal heart tracing can result from fetal head compression? What does this look like?

A

Early decelerations (mirrors contractions –> starts when contraction starts and peaks with contraction peak)

51
Q

Which fetal heart tracing is a result of umbilical cord compression? What does it look like?

A
  • Variable decelerations

- Abrupt decrease and increase, not always in relation to the contractions

52
Q

What fetal heart tracing is a result of uteroplacental insufficiency? What does this look like?

A
  • Late decels

- U-shaped with gradual decals and gradual return, beginning AFTER the contraction peaks

53
Q

What can a sinusoidal pattern on FHT indicate?

A

severe fetal anemia

54
Q

Which type of hydatidiform mole has a higher risk for choriocarcinoma?

A

Complete

55
Q

Where does choriocarcinoma most commonly spread to?

A

Lung (be suspicious in postpartum patient with pulmonary symptoms)

56
Q

What is the karyotype in a partial mole?

A

69xxx/xxy/xyy

57
Q

What is the karyotype in a complete mole?

A

46xx/xy

58
Q

If a pregnant woman is Rh negative with anti-D antibodies, what is the next step?

A

indirect coombs-> if +, test paternal blood

59
Q

What should be monitored in an Rh - mom with Rh antibodies and an Rh+ fetus?

A

Maternal titers
-if >1:16 or 1:32 then you should test for fetal anemia using a MCA doppler (increased flow with anemia)or fetal blood sampling

60
Q

Painless vaginal bleeding late in pregnancy?

A

placenta previa

61
Q

Bleeding following ROM with non-reassuring FHTs?

A

Vasa previa

62
Q

Sudden-onset painful vaginal bleeding late in pregnancy?

A

Placental abruption

63
Q

What medication can be given in the setting of premature labor to be neuroprotective (dec risk of cerebral palsy?

A

-Magnesium sulfate IV

64
Q

What agents are used for tocolysis?

A
  • magnesium sulfate
  • indomethacin
  • terbutaline
  • nifedipine
65
Q

What are the stages of labor?

A
  • Stage 1 latent: onset of labor –> 6cm dilated
  • Stage 1 active: 6 cm –> 10 cm
  • Stage 2: 10cm–> baby out
  • Stage 3: baby out –> placenta out
66
Q

Big, soft, boggy uterus after deliver? Tx?

A

Uterine atony
-Fundal or bimanual massage, examine uterus for placental fragments, uterotonic agent (oxytocin, methylergonovine, carboprost, misoprostol)

67
Q

Tx for postpartum endometritis?

A

-broad spectrum ABX (gent and Clinda)

68
Q

Tx of mastitis?

A
  • Dicloxacillin
  • if MRSA suspected: Vanco, linda or Bactrim
  • US to check for an abscess

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