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Rizk Review > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Role of estrogen in combined OCPs?

A

FSH suppression

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2
Q

Effect of FSH suppression by combined OCPs?

A

Prevents maturation of follicle

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3
Q

Role of progesterone in combined OCPs?

A

LH suppression

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4
Q

Effect of FSH suppression by combined OCPs?

A

Prevents ovulation (LH surge), Promotes cervical mucosal thickening

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5
Q

Shared effect of estrogen and progesterone in combined OCPs?

A

Thinning of endometrial lining … inhibits implantation of fertilized ovum

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6
Q

Which form of birth control is indicated for females immediately after delivery?

A

Progesterone-only OCPs

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7
Q

Why are Progesterone-only OCPs indicated immediately after delivery?

A

Progesterone cannot pass into breast milk

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8
Q

Why might lactation be thought to serve as contraception?

A

Increased prolactin inhibits release of GnRH … No ovulation with low LH/FSH

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9
Q

Route of contraception administered by Norplant?

A

Releases small amount of progestin

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10
Q

AE of Norplant?

A

Break-through pregnancy (ectopic)

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11
Q

Definition of melasma?

A

Dark pigmentation of face

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12
Q

Risk factors for melasma?

A

OCP use, Pregnancy

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13
Q

Recommended dose of Ca2+ for pregnant females < 19 yo?

A

1300 mg

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14
Q

Recommended dose of Ca2+ for pregnant females > 19 yo?

A

1000 mg

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15
Q

Recommended dose of Fe for pregnant females?

A

30 mg

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16
Q

Recommended dose of Folate for pregnant females?

A

1 mg

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17
Q

Recommended dose of Folate for pregnant females with HX of pregnancy with NTD?

A

4 mg

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18
Q

Average weight gain during pregnancy?

A

20-40 lbs

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19
Q

Which screening should be performed during 1st trimester for African, Asian females?

A

Thalassemia

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20
Q

Which screening should be performed during 1st trimester for AA females?

A

Sickle Cell

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21
Q

3 effect of Sickle Cell disease during pregnancy?

A

Increased risk of crisis … CHF, Pulmonary infarction, Pre-eclampsia

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22
Q

Treatment of choice for pregnant female who is HIV (+)?

A

IV zidovudine during delivery; Oral zidovudine to baby

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23
Q

How long should Zidovudine be administered to baby born to HIV (+) mother?

A

6 weeks

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24
Q

Best route of delivery for HIV (+) female?

A

C-section

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25
Q

Normal risk of vertical transmission of HIV?

A

25%

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26
Q

Risk of vertical transmission of HIV after administration of zidovudine?

A

8%

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27
Q

Should female with HIV breastfeed?

A

No … HIV is absolute contraindication to breastfeeding

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28
Q

If pregnant female is not immune to Rubella, should you give the vaccine?

A

No … MMR vaccine is live-attenuated

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29
Q

On routine GYN exam, unilateral adnexal mass is palpated in young asymptomatic female – diagnosis?

A

Failure of dominant follicle to rupture

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30
Q

Treatment for Failure of dominant follicle to rupture?

A

None

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31
Q

US of pregnant female shows corpus luteum cysts – next step in workup?

A

Observe … cyst will begin to shrink at 10 weeks, disappear at 16 weeks

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32
Q

What accounts for increased nausea/vomiting in pregnancy?

A

Increased estrogen, progesterone, β-HCG

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33
Q

Definition of Chadwick’s sign?

A

Blue discoloration of cervix

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34
Q

Definition of Goodell’s sign?

A

Cervical softening

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35
Q

At what point in pregnancy does β-HCG have 100% sensitivity?

A

11 days after missed period

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36
Q

In which condition is β-HCG very low?

A

Ectopic pregnancy

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37
Q

In which condition is β-HCG very high?

A

Hydatidiform mole

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38
Q

What is doubling time of β-HCG during normal pregnancy?

A

2 days

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39
Q

At what point in pregnancy does β-HCG level peak in pregnancy?

A

8-10 weeks

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40
Q

Most reliable method of determining gestational age?

A

US

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41
Q

How do you determine gestational age with US?

A

Gestational sac diameter (in mm) + 30

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42
Q

2 aspects of clinical presentation for molar pregnancy?

A

Painless vaginal bleeding; Hyperemesis

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43
Q

Change to uterus size in setting of molar pregnancy?

A

Larger than expected

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44
Q

Prognosis for 80% of hydatidiform moles?

A

Benign

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45
Q

During pregnancy, cardiac output increases by …

A

40%

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46
Q

Which type of murmur is always pathologic when heard during pregnancy?

A

Diastolic

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47
Q

Hematologic change seen in pregnancy?

A

Increased coagulability

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48
Q

Which type of murmur is normal when heard in pregnancy?

A

Systolic

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49
Q

Change to BUN and creatinine in pregnancy?

A

Increase … due to fluid expansion

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50
Q

Which 2 pulmonary values increase during pregnancy?

A

Tidal volume, O2 consumption

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51
Q

Which 2 pulmonary values decrease during pregnancy?

A

Residual volume, FRC

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52
Q

Which molecule is responsible for insulin resistance in pregnancy?

A

HPL (Human Placental Lactogen)

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53
Q

What accounts for improvement in PUD during pregnancy?

A

Increased prostaglandin production

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54
Q

Which 2 neurologic conditions might improve during pregnancy?

A

MS, Migraines

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55
Q

Which endocrine condition might improve during pregnancy?

A

Graves disease

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56
Q

2 contraindications to use of IUD?

A

Vaginal/cervical infection; HX of infertility

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57
Q

What size of uterus is contraindicated in IUD use?

A

Depth of uterus <6 cm

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58
Q

Contraindication to use of Diaphragm as birth control?

A

Latex allergy of patient or partner

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59
Q

2 AEs of Diaphragm as birth control?

A

UTI, Toxic shock syndrome

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60
Q

Which pathogen is associated with IUD placement?

A

Actinomyces israelii

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61
Q

Role of estrogen in combined OCPs?

A

FSH suppression

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62
Q

Effect of FSH suppression by combined OCPs?

A

Prevents maturation of follicle

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63
Q

Role of progesterone in combined OCPs?

A

LH suppression

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64
Q

Effect of FSH suppression by combined OCPs?

A

Prevents ovulation (LH surge), Promotes cervical mucosal thickening

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65
Q

Shared effect of estrogen and progesterone in combined OCPs?

A

Thinning of endometrial lining … inhibits implantation of fertilized ovum

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66
Q

Which form of birth control is indicated for females immediately after delivery?

A

Progesterone-only OCPs

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67
Q

Why are Progesterone-only OCPs indicated immediately after delivery?

A

Progesterone cannot pass into breast milk

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68
Q

Why might lactation be thought to serve as contraception?

A

Increased prolactin inhibits release of GnRH … No ovulation with low LH/FSH

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69
Q

On 2nd trimester US, thickened nuchal translucency is associated with …

A

Down Syndrome

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70
Q

Which NTD screening should be provided to females < 35 yo?

A

AFP

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71
Q

Change to serum AFP in NTD?

A

High

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72
Q

3 other etiologies of high serum AFP?

A

Multiple gestation, Duodenal atresia, Gestational age error

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73
Q

Change to serum AFP in Down Syndrome?

A

Low

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74
Q

Which NTD screening should be provided to females > 35 yo?

A

Triple marker … AFP, Estriol, β-HCG

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75
Q

4 components of Quad Screen for NTD?

A

AFP, Estriol, β-HCG, Inhibin A

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76
Q

5 screenings that should be performed during 3rd trimester?

A

Gestational DM, GBS, Chlamydia/gonorrhea, RH blood type, HSV

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77
Q

At what stage in gestation should female be evaluated for gestational DM?

A

Between 24-28

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78
Q

Treatment for vaginal birth if 3rd trimester GBS screening is (+)?

A

Intrapartum IV penicillin

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79
Q

In addition to Down Syndrome, what is another complication of pregnancy > 35 yo?

A

Multiple fetal losses

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80
Q

Renal abnormality associated with Turner’s Syndrome?

A

Horseshoe kidney

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81
Q

35 yo female presents at 15 weeks; Triple marker screen shows increased AFP – what is next step in management?

A

Amniocentesis

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82
Q

Role of amniocentesis in female >35 yo with increased AFP?

A

Determine fetal karyotype

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83
Q

Best method of determining fetal RH isoimmunization and fetal CBC?

A

Percutaneous umbilical cord sample

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84
Q

Complication of amniocentesis?

A

Amniotic fluid embolus

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85
Q

Clinical presentation of Amniotic fluid embolus?

A

Pregnant female with hypotension, tachycardia, bronchospasm, cyanosis

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86
Q

Hematologic complication of Amniotic fluid embolus?

A

DIC

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87
Q

Treatment for Amniotic fluid embolus?

A

Intubation

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88
Q

Role of Chorionic villi sampling during pregnancy?

A

Best diagnostic way to detect fetal chromosomal abnormalities

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89
Q

Indication for testing fetal lung maturity?

A

If premature delivery is necessary

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90
Q

Normal L:S ratio in fetal lung maturity testing?

A

> 2:1

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91
Q

L:S ratio during fetal lung maturity testing stands for …

A

Lecithin : Sphingomyelinase

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92
Q

Which substance increases lecithin and surfactant during pregnancy?

A

Corticosteroids

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93
Q

2 complications of gestational DM?

A

Shoulder dystocia, Uterine atony

94
Q

In setting of shoulder dystocia, fetal anterior shoulder will impact …

A

Maternal symphysis

95
Q

DOC for diabetic nephropathy?

A

Labetolol … (ACEIs = teratogenic)

96
Q

What type of Ig does RH (-) mother produce against RH (+) fetus?

A

IgG

97
Q

What IgG titer in mother is significant?

A

1:16

98
Q

When should RhoGAM by administered?

A

28 weeks AND within 72 hours of delivery

99
Q

Alternate name for RhoGAM?

A

IgG anti-D

100
Q

What is does of RhoGAM that is administered both antepartum and postpartum?

A

1500 IU IV/IM

101
Q

During an acute HTN episode, what is the target BP for pregnant female?

A

Drop BP to mild-moderate level … (don’t normalized completely to <120/80)

102
Q

2 DOCs for HTN crisis in pregnant females?

A

Labetalol, Hydralazine

103
Q

1 DOC for mild-moderate HTN during pregnancy?

A

Methyldopa

104
Q

3 complications of tobacco use during pregnancy?

A

Placental abruption, Placenta previa, IUGR

105
Q

Fetal Hydantoin Syndrome is associated with increased risk of …

A

Neuroblastoma

106
Q

Change to eyes in setting of Fetal Hydantoin Syndrome?

A

Coloboma

107
Q

Best management of asymptomatic pregnant female who presents on initial visit, found to have bacteriuria?

A

Treat with ampicillin, cefalexin, nitrofurantoin

108
Q

34 yo female G3P2A0 presents with recurrent cystitis – what is best management?

A

Treat with nitrofurantoin for ENTIRE pregnancy

109
Q

Best management for pregnant female who presents with pyelonephritis?

A

Admission, IV ABX

110
Q

Best management for pregnant female who is concerned that she may have been exposed to chickenpox?

A

If mother is NOT immunized … Check varicella titer, give IgG within 72 hours

111
Q

Best management of fetus born to mother with possible chickenpox exposure?

A

Give infant IgG if mother was exposed within 3-5 days before/after delivery

112
Q

DOC for Toxoplasmosis during 1st trimester pregnancy?

A

Spiramycin

113
Q

DOC for Toxoplasmosis during 2nd/3rd trimester pregnancy?

A

Pyrimethamine, Sulfadiazine

114
Q

When during gestation is travelling outside of country considered to be safe?

A

18-32 weeks

115
Q

Are inhaled and systemic steroids safe to use during pregnancy in patients with asthma?

A

Yes

116
Q

28 yo female G2P1A0 presents with non-tender LLE swelling after sitting in car for 3 hours; What is best management?

A

Perform venous Doppler, Administer IV heparin

117
Q

What accounts for hypercoagulability during NML pregnancy?

A

Increased levels of coagulation factors – fibrinogen, VWF, Factor VIII

118
Q

How long should anti-coagulation meds be continued in pregnant female after delivery?

A

Until 6 weeks post-partum

119
Q

Change to spine during 3rd trimester pregnancy?

A

Increased lumbar lordosis

120
Q

What accounts for low back pain during 3rd trimester pregnancy?

A

Relaxion of pelvic girdle ligaments

121
Q

2 most common pathogens responsible for PID?

A

Chlamydia, Gonorrhea

122
Q

Best Outpatient treatment for PID?

A

Ampicillin + Sulbactam + Doxycycline

123
Q

Best Inpatient treatment for PID?

A

Cefotetan + Doxycycline

124
Q

3 circumstances in which patients should be admitted for PID?

A

PID during pregnancy; PID with underlying HIV; PID with ovarian abscess

125
Q

Change to β-HCG for gestational age in setting of ectopic pregnancy?

A

Low

126
Q

Which type of imaging is most sensitive for detection of ectopic pregnancy?

A

Transvaginal US

127
Q

Procedure used during treatment of ectopic pregnancy?

A

Exploratory laparotomy

128
Q

DOC for treatment of ectopic pregnancy?

A

Methotrexate

129
Q

Pattern of β-HCG trends in setting of ectopic pregnancy that is responsive to methotrexate treatment?

A

β-HCG = high on 4th day; β-HCG = drops by 15% on 7th day

130
Q

Alternate name for pseudocyesis?

A

Pseudo-pregnancy

131
Q

Best management of pseudocyesis?

A

Referral to psychiatry

132
Q

Exercise recommendation during pregnancy?

A

Exercise = beneficial; Should be continued throughout pregnancy

133
Q

State of cervix in setting of threatened abortion?

A

Closed

134
Q

2 steps of workup for threatened abortion?

A

Check β-HCG level; Check fetal cardiac activity

135
Q

State of cervix in setting of inevitable abortion?

A

Open

136
Q

First step of workup for inevitable abortion with protrusion of products of conception through cervix?

A

Send fetal tissue for chromosomal analysis

137
Q

Most common cause of abortion during 1st trimester?

A

Chromosomal abnormalities

138
Q

Important step of treatment for mothers after inevitable abortion?

A

Treat RH- mothers with RH Ig to suppress immune response (in preparation for subsequent pregnancies)

139
Q

During monitoring of β-HCG after complete abortion, levels do not return to zero – diagnosis?

A

Incomplete abortion

140
Q

State of cervix in missed abortion?

A

Closed

141
Q

State of cervix in complete abortion?

A

Closed

142
Q

Appearance of intrauterine cavity in setting of missed abortion?

A

Nonviable fetus

143
Q

Appearance of intrauterine cavity in setting of complete abortion?

A

Empty

144
Q

Complication of missed abortion?

A

DIC

145
Q

2 aspects of treatment for septic abortion?

A

D&C, ABX

146
Q

2 ABX of choice used during treatment of septic abortion?

A

Levofloxacin, Metronidazole

147
Q

Diagnostic test for Asherman Syndrome?

A

Hysteroscopy

148
Q

Change to LH in setting of Asherman Syndrome?

A

NML

149
Q

Change to FSH in setting of Asherman Syndrome?

A

NML

150
Q

What is next best step of workup for mother who has not felt fetal movement for 8+ hours?

A

Real-time US

151
Q

Most common cause of early recurrent abortion?

A

Chromosomal abnormality

152
Q

Most common cause of late recurrent abortion?

A

Incompetent cervix

153
Q

Treatment for incompetent cervix?

A

Cerclage

154
Q

Important step of treatment to perform for incompetent cervix, before placement of cerclage?

A

Culture cervix for gonorrhea/chlamydia/streptococcus

155
Q

Risk factor for placenta previa?

A

Prior c-section

156
Q

Clinical presentation of placenta previa?

A

Painless vaginal bleeding

157
Q

Ideal delivery of female with placenta previa?

A

C-section

158
Q

Clinical presentation of placenta abruption?

A

Painful vaginal bleeding

159
Q

3 risk factors for placenta abruption?

A

Cocaine use, Injury, Smoking

160
Q

4 DOC for treatment of thyroid storm during pregnancy?

A

β-blockers, PTU, Corticosteroids, Iodine

161
Q

β-blockers, PTU, Corticosteroids, Iodine Appearance of blood smear in setting of HELLP Syndrome?

A

Schistocytes

162
Q

What is most effective treatment for HELLP Syndrome?

A

Delivery of fetus

163
Q

Metabolic change associated with Acute Fatty Liver of Pregnancy?

A

Hypoglycemia

164
Q

Complication of Acute Fatty Liver of Pregnancy?

A

DIC

165
Q

Best recommendation about pregnancy for females with Acute Fatty Liver of Pregnancy?

A

Patient should be advised against pregnancy

166
Q

21 yo female presents at 35 weeks gestation for intense pruritis and dark urine – diagnosis?

A

Intrahepatic cholestasis of pregnancy

167
Q

Hallmark lab value seen in setting of intrahepatic cholestasis of pregnancy?

A

Increased bile acids

168
Q

Where is pruritis most intense during intrahepatic cholestasis of pregnancy?

A

Palms, Soles

169
Q

Classic triad of symptoms seen in Pre-eclampsia?

A

HTN, Proteinuria, Edema

170
Q

Ocular symptom seen in severe pre-eclampsia?

A

Retinal hemorrhage

171
Q

How long should IV MgSO4 be administered to patient with severe pre-eclampsia?

A

24 hours after delivery

172
Q

Definition of eclampsia?

A

Pre-eclampsia with seizure OR coma

173
Q

Treatment of eclampsia during pregnancy is contraindicated in patients with which condition?

A

Graves disease

174
Q

2 DOCs for eclampsia that is non-responsive to MgSO4?

A

Diazepam, Phenytoin

175
Q

Why is BP control important during treatment of eclampsia?

A

Hemorrhagic CVA is common cause of death in setting of eclampsia

176
Q

Definitive treatment of eclampsia?

A

Delivery of fetus

177
Q

Clinical presentation of patient with magnesium toxicity after being treated for eclampsia with MgSO4?

A

Hyporeflexia

178
Q

DOC for treatment of magnesium toxicity?

A

IV calcium gluconate

179
Q

Risk factor for development of chorioamnionitis?

A

Prolonged rupture of membranes

180
Q

Classic triad of maternal clinical symptoms associated with chorioamnionitis?

A

Maternal tachycardia, leukocytosis, uterine TTP

181
Q

Fetal clinical presentation of chorioamnionitis?

A

Tachycardia

182
Q

Treatment of chorioamnionitis?

A

ABX + Delivery

183
Q

Normal fetal HR?

A

110-160 BPM

184
Q

Take immediate action if fetal HR is less than …

A

90 BPM

185
Q

2 methods of prenatal assessment?

A

Non-stress test, Biophysical profile

186
Q

What is considered to be a Normal fetal NST?

A

2 accelerations of 15 BPM, lasting 15 seconds … within 20 minutes

187
Q

Next step of workup if fetal NST is non-reactive?

A

Perform BPP

188
Q

5 components of BPP?

A

NST, Amniotic fluid, Breathing, Movement, Tone

189
Q

Normal BPP score?

A

8-10

190
Q

BPP score that suggests immediate delivery?

A

0-2

191
Q

Purpose of Contraction Stress Test?

A

Determine effect of uterine contractions on fetal HR

192
Q

3 types of fetal HR decelerations?

A

Early, Late, Variable

193
Q

Description of early deceleration?

A

Nadir of deceleration occurs at same time at peak of contraction

194
Q

Description of late deceleration?

A

Deceleration begins at peak of contraction

195
Q

Description of variable deceleration?

A

Decelerations don’t always occur with contractions; Shoulders

196
Q

Etiology of early deceleration?

A

Head compression

197
Q

Prognosis for early deceleration?

A

NML

198
Q

Etiology of late deceleration?

A

Uteroplacental insufficiency

199
Q

Prognosis for late deceleration?

A

Serious … Immediate C-section

200
Q

Etiology of variable deceleration?

A

Cord compression

201
Q

Prognosis for variable deceleration?

A

Change position of mother

202
Q

Definition of normal labor?

A

Uterine contractions that induce dilation and effacement of cervix

203
Q

___ refers to progressive thinning/shortening of the cervix during labor

A

Effacement

204
Q

___ refers to failed progression of labor after cervix has dilated to 6 cm

A

Prolonged active phase labor

205
Q

Management of prolonged active phase labor in female with hypotonic uterine contractions?

A

IV oxytocin

206
Q

Management of prolonged active phase labor in female with hypertonic uterine contractions?

A

Morphine

207
Q

___ refers to failed progression of labor after full dilation of cervix to 10 cm

A

Prolonged 2nd stage labor

208
Q

At what point is delivery of placenta considered to be abnormal?

A

30+ minutes after fetus delivery

209
Q

First procedure that is used during delivery of baby with shoulder dystocia?

A

McRoberts maneuver

210
Q

Description of McRoberts maneuver?

A

Flex mother’s hip as far back as possible; Exert downward traction on fetus’ head

211
Q

Procedure that is used during delivery of baby with shoulder dystocia, if McRoberts maneuver is unsuccessful?

A

Zavanelli maneuver

212
Q

Description of Zavanelli maneuver?

A

Push baby’s head up through vagina; Deliver baby via C-Section

213
Q

Best management of prolapsed umbilical cord?

A

OB emergency; Immediate C-section delivery is indicated

214
Q

Best management of fetus who presents in Breech position <37 weeks gestation?

A

Observation

215
Q

___ refers to subcutaneous extraperiosteal fluid collection with ill-defined margins, caused by pressure of dilated cervix on presenting part of scalp

A

Caput Succedaneum

(Caput crosses; Subgalleal crosses)

216
Q

Characteristic of fluid collection seen in Caput Succedaneum?

A

Extends across suture lines

217
Q

Best management of Caput Succedaneum?

A

Observation … Fluid collection will resolve spontaneously

218
Q

___ refers to subperiosteal bleeding caused by prolonged 2nd stage labor

A

Cephalhematoma

(Cephalhematoma does not cross)

219
Q

Characteristic of fluid collection seen in Cephalhematoma?

A

Does NOT extend across suture lines

220
Q

Best initial management of premature labor?

A

Bed rest; Hydration

221
Q

2nd step of premature labor management?

A

Tocolytic drugs + Corticosteroids + ABX (GBS)

222
Q

3 examples of tocolytic drugs used during management of premature labor?

A

MgSO4, Terbutaline, Nifedipine

223
Q

Where is pain felt during Braxton Hicks contractions?

A

Only felt in front of abdomen

224
Q

Where is pain felt during true contractions?

A

Begin in lower back; Move to front of abdomen

225
Q

Most common cause of postpartum hemorrhage?

A

Uterine atony

226
Q

Initial treatment of uterine atony causing postpartum hemorrhage?

A

Uterine massage + Oxytocin

227
Q

2nd most common cause of postpartum hemorrhage?

A

Trauma to uterus/cervix/vagina … macrosomia, operative delivery

228
Q

Best management of postpartum psychosis?

A

Psychiatric evaluation

229
Q

Which medication is NOT recommended in setting of lactation suppression?

A

Bromocriptine

230
Q

Effect of breast implants on autoimmune disorders (RA, SLE)?

A

None

231
Q

Effect of breast implants on increased risk of CA?

A

None

232
Q

When should females with breast implants begin mammograms?

A

Continue mammogram plan as usual

Rizk Review (19 decks)

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