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USMLE STEP 2 CK RETAKE > Obstetrics > Flashcards

Obstetrics Flashcards

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USMLE® Step 1 flashcards
1
Q

Types of Aneuploidy

A
  • Downs 21
  • Edwards 18
  • Patau 13
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2
Q

First Trimester Aneuploidy Screening

A
  • US-Nuchal Lucency
  • PAPP-A
  • hCG
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3
Q

Triple Screen/Quad Screen findings in Downs

A

hCG increased

AFP decreased

Estriol decreased

Inhibin A Increased

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4
Q

Triple Screen/Quad Screen Findings in Edwards

A

hCG decreased

AFP decreased

Estriol very decreased

Inhibin A decreased

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5
Q

Gestational Diabetes Screening

A

1 hr GTT- >140

3 hr GTT-

  • >95
  • >180
  • >155
  • >140
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6
Q

Risk Factors for Gestational DM

A
  • BMI >30
  • Hx GDM
  • Pre-Diabetic
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7
Q

Maternal anemia Dx Usually caused by

A

Iron deficiency anemia Hgb<10 or HCT <30

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8
Q

Asx Bacteriuria

Presentation

Dx, Tx

A

(+) UA, no symptoms

Tx:

  • Amoxicilin
  • nitrofurantoin
  • Repeat UA after treatment
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9
Q

Cystitis

Presentation

Dx, Tx

A

Pt: Urgency, frequency, dysuria

Tx:

  • Amoxicillin
  • Second line-nitrofurantoin
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10
Q

Pyelonephritis

Presentation

Dx, Tx

A

Pt:

  • urgency,
  • Frequency,
  • Dysuria
  • Fever and
  • CVA tenderness

Tx: Ceftriaxone

Reasses after a few days

  • No improvement=abscess 14 days Abx U/S for drainage
  • Improvement=Pyelo 10 days Abx
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11
Q

Positive UA findings

A
  • Nitrites
  • Leukocyte Esterase
  • Lots of WBCs
  • (+) Bacteriuria
  • No epithelial
  • Cells >100 cfu
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12
Q

Transcranial doppler

  1. used when,
  2. or what,
  3. risk,
  4. Extra facts
A
  1. >20 wks Assessment of fetal anemia,
  2. Alloimmunization
  3. No risk
  4. Highly sensitive
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13
Q

Chorionic villous sampling

  1. Used when,
  2. for what,
  3. risk,
  4. extra facts
A
  1. >10wks
  2. Assessment of genetic disorders
  3. slight risk
  4. for early detection and early termination
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14
Q

Hyperthyroidism in pregnancy

Presentation

dx, tx

A

“overactive patient” can lead to fetal demise

Dx:

  • TSH decreased,
  • T4 increased

Tx:

  • PTU
  • Methimazole
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15
Q

Hypothyroidism in pregnancy

Presentation

Dx, Tx

A

Everything “Slowed” down leads to cretinism

Dx:

  • TSH Increased,
  • T4 Decreased

Tx:

  • Levothyroxine,
  • f/u dosing every 4 weeks larger doses required during pregnancy
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16
Q

What Anti-Epileptic Drugs are safe in pregnancy

A

Levitiracetam=Lamotrigine

Phenobarbital for active seizing

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17
Q

Hypertension in pregnancy

Goal

medications safe in pregnancy

A
  • Goal is BP <140/<80
  • alpha-methyldopa
  • Labetalol
  • hydralazine
  • Screening should be tight for eclampsia
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18
Q

DM in pregnancy

Goals and testing

A
  • Change oral medications to insulin before pregnancy
  • use insulin during pregnancy,
  • higher insulin requirement during pregnancy
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19
Q

Stage 1 Latent phase of labor time

A
  • Nulliparous 20hr
  • Multiparous 14hr
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20
Q

Stage 1 Active phase of labor time (prolonged or arrested)

A
  • Nulliparous 4 hours or no change
  • Multiparous 5 hours no change
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21
Q

Stage 1 Active phase of labor dilation per time

A
  • Nulliparous 1.2cm/hr
  • Multiparous 1.3 cm/hr
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22
Q

Stage 2 phase of labor time

A
  • nulliparous 3 hours
  • multiparous 2 hours
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23
Q

What are the stages of labor

A

Stage 1:

  • 0cm to 6cm (Latent)
  • 6cm to 10cm (Active)

Stage 2:

  • 10cm to fetus delivery

Stage 3:

  • Fetus deliver to placental delivery
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24
Q

Stage 3 of labor time

A

<30 min

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25
Q

Arrest of active phase of labor treatment

A
  • prolonged-oxytocin
  • arrest-c-section
  • if at negative station c-section
  • positive station-forceps, vacuum
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26
Q

Preterm Gestational age

A

24- 37 weeks

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27
Q

Term Gestation Age

A

37-42 weeks

28
Q

Premature Rupture of Membranes

Presentation

Dx, Tx

A

Usually due to infection GBS

Pt: (+) ROM, (+) term, no contractions

Dx: Clx, find the GBS

Tx: Deliver

  • GBS positive or unknown=give ampicillin
  • GBS negative=wait and watch
29
Q

Preterm Premature Rupture of Membranes

Presentation

Dx, Tx

A

Infection GBS

Pt: (+) ROM, not at term, no contractions

Dx: Clx

Tx: >34 wks=deliver

<24 wks=abortion

24-34wks=steroids

30
Q

Prolonged Rupture of Membranes

Presentation

Dx, Tx

A

Ascending infection, GBS

Pt: (+)ROM, no delivery >18 hrs

Tx: Deliver

GBS (+), unknown=ampicillin

GBS negative=wait

F/u for endometritis (baby out),chorioamnionitis (baby in)=

Ampicillin + getamicin +/- clindamycin

31
Q

Risk Factors for preterm labor

A

Cigarette smoking

young maternal age

multiple gestations

anatomical abnormalities

32
Q

Preterm Labor

Presentation

Dx, Tx

A

Pt: (+) contractions, cervical changes, not at term

Tx >34 wks=deliver

<20 wks=abortion

20-34wks steroids and tocolytics

33
Q

Mild Pre-eclampsia

BP

Timing

U/A

Sxs

Tx

F/U

A

BP->140/>80

Timing-sustained, after 20wks

U/A->300mg/dl, proteinuria

Sxs-none

Tx->37wks deliver

<37wks wait

F/U weekly

34
Q

Pre-eclampsia with severe features

BP

Timing

U/A

Sxs

Tx

A

BP->160/>110

Timing-Sustained, after 20wks

U/A->5g/dl, proteinuria

Sxs- severe features

Tx-Mg and deliver (induction)

35
Q

What are the severe features of Eclampsia

A

decreased platelets

increased LFTs

RUQ abdominal pain

increased Cr (1.1, or 2x)

Pulmonary edema

Headaches, Vision Changes

BP->160/>110

36
Q

HELLP Syndrome

A

Hemolysis

Elevated LFTs

Low Platelets

37
Q

Antidote for magnesium toxicity

A

Calcium

decreased deep tendon reflexes leading to decreased respiratory rate

38
Q

Twinning with different genders

A

Di-zygotic, Di-chorionic, Di-Amniotic

Risks: Preterm labor, malpresentation, PPH

39
Q

2 placentas, same gender

A

Monozygotic, Di-chorionic, Di-amniotic

40
Q

same gender, (+) septum, 2 sacs

A

Monozygotic, Monochorionic, Di-amniotic

Twin Twin transfusion (skinny twin will do better)

41
Q

same gender, no septum, 1 sac

A

Monoygotic, monochorionic, monoamniotic

Conjoined twins, cord entanglement

42
Q

PPH definition

A

500cc vaginal delivery

1000cc c-section

43
Q

Uterine Atony

Presentation

Dx, Tx

A

Pt: Atonic uterus, PPH and boggy uterus

Tx: Massage

oxytocin

Surgery

44
Q

Uterine Inversion

Presentation

Dx, Tx

A

“Births itself”, can be caused by traction or oxytocin

Pt: PPH and absent uterus

Tx: Tocylytics-then put it back

45
Q

Placenta Accreta

A

burrows a little deeper

46
Q

Placenta Increta

A

invades the myometrium

47
Q

Placenta Percreta

A

Invades all the way though the endometrium

48
Q

Retained Placenta

Presentation

Dx, Tx

A

Pt: PPH and firm uterus

Tx: Dilation and curretage leading to TAG

49
Q

Normal Fetal Heart Rate

A

between 110-160

50
Q

High risk pregnancy or decreased fetal movement

antenatal testing

A

Non stress test

NST after vibroacoustic stimulation

biophysical profile between 3-8

gestational age <37 weeks =contraction stress test

51
Q

Describe early Decels, and what causes them

A

Heart rate deceleration in line with the peak of contraction

head compression

52
Q

Describe variable decelerations and what causes them

A

Heart rate deceleration without relation to contractions

cord compression

53
Q

Describe late decelerations and what causes them

A

Heart rate deceleration occuring after the peak of contraction

utero-placental insufficiency

54
Q

Placenta Previa

Presentation

Dx, Tx

A

placenta lies across the cervical os

presents with painless bleeding

Dx: U/S= Transverse lie

NST/CST=Fetal Distress

Tx: Urgent C-Section

55
Q

Vasa Previa

Presentation

Dx, Tx

A

Accessory lobe lies across the cervical os

Blood vessels tear when the cervix dilates

Presents with painless bleeding

Dx: NST/CST=fetal distress

Tx: Urgent C-Section

56
Q

Uterine Rupture

Presentation

Dx, Tx

A

Vaginal Birth after C-section

Presentation: Painful, “absent” uterus

Loss of fetal station

Tx: Crash Section

57
Q

Placental Abruption

Presentation

Dx, Tx

A

Usually due to HTN or cocaine use, MVA

Presentation: Painful Bleeding

Dx: U/S, Vitals, HgB, AMS, CST/NST

Tx: C-section

58
Q

Group B Strep Infection

Presentation

Dx, Tx

A

Screening should occur at week 10 and again at week 35

there will be a healthy delivery but toxic baby

Dx: Risk Factors-Any previous positive

prolong ROM, Intrapartum Fever

Tx: Ampicillin

Cefazolin

Clindamycin

Vancomycin

59
Q

HIV infection during pregnancy and delivery

Dx, Tx

A

ELISA confirm with western blot

if for baby Viral load

Tx: 2+1

2 NRTI (Tenofovir +Emtricitabine) or (Zidovudine+Lanivudine)

NNRTI (Nevirapine)

60
Q

Toxoplasmosis

Presentation

Dx, Tx

A

Presentation-Mom=Mono like illness

Baby=Brain calcifications, Ventriculomegaly, Seizure Disorder

Dx: Toxo Ab (+)=do nothing

Toxo Ab(-)=avoidance

61
Q

Syphilis

Presentation

Dx, Tx

A

Presentation

  1. Painless chancre
  2. targetoid lesions affecting the palms and soles
  3. Neuro Sxs

Dx

  1. Darkfield microscopy
  2. RPR—FTA-Abs
  3. CSF VDRL, RPR

Tx= Penicillin

62
Q

Rubella Congenital Infection

Presentation

Dx, Tx

A

Presentation: Baby-Blueberry muffin baby, Cataracts, Congenital heart defects, deafenss

Tx: Vaccinate three months prior to pregnancy, avoidance

63
Q

Herpes congenital Infection

Presentation

Dx, Tx

A

Painful burning prodrome, vesicels on an erythematous base

Dx: PCR

Tx: (val)acyclovir

follow uup for blindness, preterm, IUGR

64
Q

When do you use the Forceps or vaccum during delivery

A

Fetal distress or prolonged or arrested labor plus

Full effacment and 2+ station

65
Q

When do you use cervical cerclage

A

When there have been multiple second trimester losses

ROM around week 14

Be sure to remove the cerclage at week 36

USMLE STEP 2 CK RETAKE (15 decks)

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