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Step 2CK > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What’s the gestational age?

A

Number of days/weeks since last menstrual period

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2
Q

What’s the estimated day of delivery?

A

LMP- 3 months+7 days = estimated day of delivery

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3
Q

What defines the first trimester?

A

Up to 14 weeks

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4
Q

What defines the second trimester?

A

14-28 weeks

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5
Q

What defines the third trimester?

A

28 weeks-delivery

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6
Q

What if the fetus is born before 22 weeks?

A

No resuscitation

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7
Q

What if the fetus is born between 23-25 weeks?

A

Case by case

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8
Q

What if the fetus is born after 25 weeks?

A

Resuscitation always

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9
Q

What’s considered a preterm fetus?

A

25-37 weeks

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10
Q

What does TPAL stand for in parity?

A

Term births
Preterm births
Abortions
Living children

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11
Q

What cardiac parameter decreases in pregnancy (all others increase)?

A

Afterload

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12
Q

Is the FEV1/FVC changed in pregnancy?

A

No

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13
Q

Is the TV changed in pregnancy?

A

Yes, it’s increased

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14
Q

Is the RR changed in pregnancy?

A

No

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15
Q

Why does the LES have decreased tone in pregnancy?

A

Progesterone

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16
Q

How does GFR change in pregnancy?

A

It increases

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17
Q

What comprises the triple screen?

A
  1. AFP
  2. B-hCG
  3. Estriol
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18
Q

What comprises the quad screen?

A
  1. AFP
  2. B-hCG
  3. Estriol
  4. Inhibin A
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19
Q

When is the triple or quad screen done?

A

15-18 weeks

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20
Q

Why is the quad screen more sensitive than the triple screen?

A

Inhibin A

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21
Q

What does cell-free DNA testing test for in the first trimester at 7 weeks?

A

fetal sex, Rh factor, aneuploidy, genetic studies

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22
Q

Is cell-free DNA testing non-invasive?

A

Yep

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23
Q

What does the PAPP-A test involve in the first trimester?

A

B-hCG
PAPP-A
Nuchal translucency

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24
Q

After __ weeks, there is a visit every week?

A

36

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25
Q

At how many weeks is the CBC?

A

27

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26
Q

At how many weeks is the 1-hour glucose challenge test?

A

24-28

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27
Q

If glucose >___ at one hour, perform oral glucose tolerance test?

A

130

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28
Q

When do you swab for GBS?

A

Week 36

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29
Q

If Braxton-Hicks contractions become regular, what should be done?

A

Check cervix to rule out preterm labor

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30
Q

Which can be done earlier: chorionic villi sampling or amniocentesis?

A

Chorionic villi (10-13 weeks vs 15-17 weeks)

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31
Q

What’s the indication for chorionic villi sampling and amniocentesis?

A

If genetic aneuploidy screening test is positive

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32
Q

Do both chorionic villi and amniocentesis measure fetal karyotype?

A

Yes

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33
Q

Which is more dangerous: chorionic villi or amniocentesis?

A

Chorionic villi

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34
Q

What defines a reactive NST test?

A

2+ accelerations within 30 min

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35
Q

What do you do if the NST is nonreactive?

A

Vibroacoustic stimulation to wake the baby up

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36
Q

What does a BPP test?

A

Breathing, HR, movement, etc.

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37
Q

What does a BPP <4 indicate?

A

Fetal compromise

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38
Q

What’s the normal fetal HR?

A

110-160

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39
Q

What defines a fetal HR acceleration?

A

Increase in HR of 15 or more for longer than 15 sec

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40
Q

What are early decels?

A

Decrease in HR that occurs with contractions

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41
Q

What’s the cause of early decels?

A

Head compression

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42
Q

What’s the cause of variable decels?

A

Umbilical cord compression

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43
Q

What’s the cause of late decels?

A

Fetal hypoxia due to decreased placental perfusion

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44
Q

Which type of decel is most serious?

A

Late

“Don’t be late– its serious”

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45
Q

What’s stage 1 of labor?

A

Onset of labor to full dilation of cervix (2-18 hours)

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46
Q

What’s the latent phase of labor?

A

Onset of labor to 6cm dilation (4-7 hours)

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47
Q

What’s the active phase of labor?

A

6cm- to full dilation (1-1.5cm/hour)

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48
Q

What’s stage 2 of labor?

A

Full dilation of cervix to delivery (30 min to 3 hours)

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49
Q

What’s stage 3 of labor?

A

Delivery of neonate to delivery of placenta

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50
Q

What’s used for cervical ripening?

A

PG E2

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51
Q

What’s used for exaggerating uterine contractions?

A

Oxytocin

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52
Q

Can ectopic pregnancy cause vaginal bleeding?

A

Yes

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53
Q

What dx presents with hypotension, vaginal bleeding, and h/o PID?

A

Ectopic pregnancy

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54
Q

What’s the tx of an ectopic pregnancy?

A

Fluids and surgery if unstable, MTX if stable

55
Q

What are the exclusion criteria for MTX?

A
  1. Immunodeficiency
  2. Noncompliancy (need to follow-up)
  3. Liver disease
  4. Ectopic 3.5cm+
  5. Fetal heartbeat
56
Q

What kind of operation is performed to remove an ectopic pregnancy?

A

Salpingosotomy

57
Q

What defines an inevitable abortion?

A

Vaginal bleeding with a dilated cervix

58
Q

What is a missed abortion?

A

Death of fetus but all products of conception present in uterus and cervical os is closed

59
Q

What is a septic abortion?

A

Infex of uterus

60
Q

What abx do you treat a septic abortion with?

A

Cefoxitin + doxycycline

61
Q

What should Rh- mothers receive after an abortion?

A

Anti-D Rh immunoglobulin

62
Q

How is preterm labor defined?

A

Contractions with cervical dilation

63
Q

What are 2 examples of tocolytics?

A
  1. Terbutaline

2. CCB’s (preferred)

64
Q

What does it mean if the amniotic fluid has the following characteristics:?
Present in posterior fornix
Turns nitrazine paper blue
Ferning pattern

A

Prelabor rupture of membranes

65
Q

How long should you wait before inducing labor for PROM?

A

6-12 hours

66
Q

What’s the next step if there’s chorioamnionitis?

A

Delivery now

67
Q

What types of organisms usually cause chorioamnionitis?

A

Vaginal flora such as gardnarella, GBS, ureaplasma, or mycoplasma

68
Q

What dx presents with maternal fever, high WBC’s, maternal and fetal tachycardia, and uterine tenderness?

A

Chorioamnionitis

69
Q

What is placenta previa?

A

Placenta over internal cervical os, causes painless vaginal bleeding, requiring strict pelvic rest or urgent c-section

70
Q

What is vasa previa?

A

Fetal umbilical cord is present over the cervical os, causes heavy vaginal bleeding and needs emergent c-section

71
Q

What dx presents with sudden fetal bradycardia and palpable umbilical cord on vaginal exam?

A

Cord prolapse

72
Q

What are the 3 types of placental invasion and what’s the quick way of remembering them?

A
  1. Accreta: attaches
  2. Increta: invades
  3. Percreta: penetrates
73
Q

What dx presents with third trimester vaginal bleeding, contractions, severe abdominal pain, and possible fetal distress?

A

Placental abruption

74
Q

What is placental abruption

A

Premature separation of the placenta from the uterus

75
Q

How do you differentiate between placental abruption and placenta previa?

A

US

76
Q

What dx presents with sudden onset of extreme abdominal pain, abnormal bump in abdomen, no uterine contractions, and loss of fetal station?

A

Uterine rupture

77
Q

What’s the tx for uterine rupture?

A

Immediate laparotomy

78
Q

Rh incompatibility occurs when the mother is Rh __ and the fetus is Rh __?

A

Mother is Rh-

Fetus is Rh+

79
Q

What are the two categories of IUGR?

A
  1. Symmetric (brain in proportion)

2. Asymmetric (brain normal weight)

80
Q

What causes symmetric IUGR?

A

Genetic issues or fetal infex

81
Q

What causes asymmetric IUGR?

A

Uteroplacental insufficiency

82
Q

What’s considered a macrosomic baby (in grams)?

A

4500+ grams

83
Q

What dx presents with severe nausea and vomiting in pregnancy with a weight loss of >5% or >6lb?

A

Hyperemesis gravidarum

84
Q

What’s the best initial therapy for hyperemesis gravidarum?

A

Dietary modification

85
Q

In women with severe hyperemesis gravidarum what tx is beneficial?

A

Doxylamine or diphenhydramine

86
Q

How do you differentiate hyperemesis gravidarum from normal pregnancy nausea?

A

Urine ketones

87
Q

When do you screen for asymptomatic bacteriuria?

A

12-16 weeks

88
Q

Is colposcopy safe in pregnancy?

A

Yes

89
Q

Is endocervical curettage safe in pregnancy?

A

No

90
Q

What’s the tx of PUPPP (the rash from the insta account)?

A

Topical corticosteroids

91
Q

What dx during pregnancy presents with priuritis and elevated serum bile acid concentration?

A

Intrahepatic cholestasis of pregnancy

92
Q

What does intrahepatic cholestasis of pregnancy increase the risk of?

A

Intrauterine fetal death

93
Q

What’s the treatment for intrahepatic cholestasis of pregnancy?

A

Ursodeoxycholic acid and induction of labor at term

94
Q

What dx presents with nausea, vomiting, jaundice, and elevation in AST, ALT, and bili, and prolonged PT and during pregnancy?

A

Acute fatty liver of pregnancy

95
Q

How do you differentiate between acute fatty liver of pregnancy vs HELLP syndrome?

A

Acute fatty liver of pregnancy presents with hepatic insufficiency and abnormalities in coagulation profile

96
Q

What’s the tx for AFLP?

A

Stabilization and delivery

97
Q

What dx presents with hemolysis, elevated liver enzymes, low platelet count and is a complication of preeclampsia?

A

HELLP syndrome

98
Q

What dx presents with HTN, edema, and proteinuria during preg?

A

Preeclampsia

99
Q

What are the “severe features” in pre-eclampsia with severe features?

A

Mental status and vision changes, and RUQ pain

100
Q

What dx presents as a tonic-clonic seizure occurring in a patient with h/o pre-eclampsia?

A

Eclampsia

101
Q

What meds are used in eclampsia (2)?

A
  1. MgSO4

2. Hydralazine

102
Q

In Trisomy 18, which quad screen levels are decreased?

A

All of them

103
Q

Which trisomy presents with elevated inhibin A and B-hCG?

A

Trisomy 21

104
Q

What is normal variability in fetal HR?

A

6-25 bpm

105
Q

Do TRH and TSH receptor antibodies cross the placenta?

A

Yes

106
Q

Do TSH and T4 cross the placenta?

A

No

107
Q

How is hypothyroidism treated in pregnancy?

A

Levothyroxine

108
Q

How is hyperthyroidism treated in the first trimester of pregnancy?

A

Propylthiouracil

109
Q

How is hyperthyroidism treated in the second and third trimesters of pregnancy?

A

Methimazole

110
Q

What birth defect is associated with methimazole?

A

Aplasia cutis

111
Q

What defines prolonged latent stage?

A

When the latent stage lasts longer than 20 hours for the primipara and longer than 14 hours for the multipara

112
Q

What defines protracted cervical dilation?

A

When the primipara’s cervix does not dilate more than 1.2cm per hour or less than 1.5cm per hour in a multipara

113
Q

What defines arrest of descent?

A

When the fetal head doesn’t move down into the canal

114
Q

What defines arrest of cervical dilation?

A

When there is no dilation of the cervix for more than 2 hours

115
Q

Always remember to define each word piece by piece if you don’t immediately know an answer

A

Ok!

116
Q

You should not perform external cephalic version until after week ___?

A

37

117
Q

What dx presents when the fetus’s head has been delivered but the anterior shoulder is stuck behind the pubic symphysis?

A

Shoulder dystocia

118
Q

What’s the tx for mastitis?

A

Dicloxacillin

119
Q

What’s the tx for uterine inversion?

A
  1. Stop all uterotonic drugs

2. Manually reposition the uterus

120
Q

What’s the difference between postpartum blues vs postpartum depression?

A

Postpartum blues is transient and starts 2-3 days after delivery and resolves on its own in 2 weeks

121
Q

Is active TB a contraindication to breastfeeding?

A

Yes

122
Q

What’s the next step for a complicated breast cyst?

A

Biopsy and repeat imaging in 6 mos

123
Q

Primary amenorrhea is defined as the absence of menstruation by age __?

A

15

124
Q

Secondary amehorrhea is the absence of menses for more than __ mos in a female who menstruates regularly, and more than __ in a female with irregular menstrual cycles?

A

3, 6

125
Q

What’s the initial test for amenorrhea?

A

B-hCG

126
Q

What’s the first line tx for emergency contraception?

A

Copper IUD

127
Q

Levonorgestrel can be used up to __ days for emergency contraception?

A

3

128
Q

Paget disease vs. lichen sclerosis?

A

Paget is priuritic with a red lesion with a superficial white coating

129
Q

What’s the next step for Paget disease?

A

Biopsy

130
Q

What dx presents with a large, globular, boggy uterus?

A

Adenomyosis

131
Q

What is adenomyosis?

A

Invasion of the endometrial glands into the myometrium

132
Q

What’s the best initial step for postmenopausal (or even > age 45) bleeding?

A

Biopsy

133
Q

What type of HPV produces condyloma acuminata (genital warts)?

A

6 and 11

134
Q

If a patient with ovarian cancer has family history of ovarian cancer, what test is indicated?

A

BRCA

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