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MCCQE1 > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Does MAP decrease or increase in pregnancy?

A

Descrease

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2
Q

Does preload decrease or increase in pregnancy?

A

Increase

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3
Q

Does heart rate decrease or increase in pregnancy?

A

increase

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4
Q

Does systemic vascular resistance decrease or increase in pregnancy?

A

Decrease

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5
Q

Does hemoglobin decrease or increase in pregnancy?

A

Decrease (RBC increase but plasma increases more)

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6
Q

Does FEV1 decrease or increase in pregnancy?

A

Doesn’t change

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7
Q

Does PaO2 decrease or increase in pregnancy?

A

Doesn’t change

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8
Q

Does the functional residual capacity decrease or increase in pregnancy?

A

Decrease

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9
Q

Does the tidal volume decrease or increase in pregnancy?

A

Increases

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10
Q

Changes in coagulation during pregnancy

A

↑von Willebrand factor= more fibrinogen
↑factors 7, 8, 10
↑inhibitor to tPA
↓Protein C, S and antithrombin

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11
Q

Nephrologic changes during pregnancy

A

o ↑GFR
o ↑Creatinine (0.4–0.8)
o More risk of kidney stones (usually at the pelvic brim)

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12
Q

GI changes durign pregnancy

A

o Reflux: PPI
o Nausea: Ondansetron
o Constipation: stool softener and motility agents
o Iron deficiency: Iron with stool softener and motility agents
o Gallbladder disease

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13
Q

What to do during the preconception visit

A 
Safety:
- Genetics
- Age
- Screen for domestic violence and abuse
Vitamins: Folate 
Vaccines: 
- Flu IM
- Hep B 
- MMRV (live attenuated) 
Lifestyle:
- Smoking
- Alcohol 
- Drugs/medications 
- Getting enough sleep
- Manage stress
- Plan maternity leave
- Safe to have sex
Optimization of disease 
- DM
- HTN
- Hypothyroid
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14
Q

First-trimester visit assessment.

A

Person

  • Is the pregnancy desired? (abortion, adoption)
  • Barriers to care
  • Vitals
  • Weight
  • Screen for abuse and safety
  • Social, medical, surgical, family histories
  • Medications and allergies
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15
Q

First trimester visiti assessment tests/labs

A
  • UPT
  • Confirm with TV U/S (location of pregnancy, gestational age, multiple gestation)
  • Hgb/hct
  • ABO type
  • Rh status
  • HIV
  • Hep B
  • RPR
  • Titers for varicella and rubella
  • U/A + Urinary culture (infection and bBaseline of proteinuria)
  • Screen for gonorrhea and chlamydia
  • Cytology
  • Genetic screen (cystic fibrosis for caucasic and sickle cell disease for african Americans)
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16
Q

Existing nomenclature to establish obstetric history

A
  • GPAC (gravid, para, abortions, c-sections)

* (G)TPAL (gravid, term, pre-term, abortion, living)

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17
Q

Examples of aneuploidies

A

Trisomy
• Down’s: 21
• Edwards: 18
• Patau’s: 13

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18
Q

1st trimester screening for aneuploidy

A
  • Nuchal translucency in a U/S (normal < 3 mm)
  • PAPP-A
  • hCG
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19
Q

2nd trimester screening for aneuploidy results for Down’s

A

↑ hCG
↓ PAPP-A
↓ Estriol
↑ Inhibin A

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20
Q

2nd trimester screening for aneuploidy results for Edward’s

A

↓ hCG
↓ AFP
↓ Estriol
↓ Inhibin A

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21
Q

Combined vs sequential screening for aneuploidy

A

Combined screening

  • 1st trimester + 2nd trimester
  • ↑Sensitivity
  • It’s good when mom is negative, but if positive, she’ll have less options because you waited

Sequential screening

  • 1st trimester –> invasive test if positive
  • ↑Specific but more invasive
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22
Q

Risk factors of gestational diabetes

A

BMI > 30
Hx of gestational DM
Pre-diabetic

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23
Q

Dx of gestational diabetes

A

1-hr glucose tolerance test (50 gr)
• Positive if > 140
• If positive, do the 3-hr

3-hr glucose tolerance test (100 gr)
Dx is made with 2 or more of these positive
o	Fasting > 95
o	1 hr > 180
o	2hr > 155
o	3 hr > 140
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24
Q

Tx of gestational diabetes

A

Insulin

- Goal: postprandial < 180

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25
Q

Patient with hemoglobin < 10 at 28 weeks of gestation.

Next step, tx?

A

Iron studies

Tx: Iron

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26
Q

Accuracy of gestational age estimation in U/S

A
  • 1st trim: GA +/- 1 week
  • 2nd trim: GA +/- 2 week
  • 3rd trim: GA +/- 3 week
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27
Q

Transcraneal dopple. When to use it?

A

Highly sensitive. Used to rule out fetal anemia (alloimmunization at week 20)
Screening test; Not diagnostic

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28
Q

Amniocentesis. When to use it?

A 
Genetic disorders (down’s)
It’s less used because can only be used until week 16 (too close to 21 weeks for termination of pregnancy)
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29
Q

Chorionic villus sampling. When to use it?

A

Genetic disorders, karyotype at week 10.

Early identification allows for early termination in high-risk pregnancies

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30
Q

Percutaneous umbilicus blood sampling (PUBS). When to use it?

A

Fetal anemia

Confirm and treat fetal anemia (e.g., transfusion)

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31
Q

Asx pregnant patient with the following results on the uroanalysis:

  • Nitrites
  • Leuko esterase
  • Lots WBC
  • Bacteruria
  • No Epithelial cells

Dx, tx?

A

Bacteruria Asx

Treat with amocilin (nitrofurantoin if penicil allergic)

Rescreen with uroanalisis at the end of the tx

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32
Q

Pregnant patient with Urgency/frequency dysuria. No fever, no CVA tenderness. The following are the results on the uroanalysis:

  • Nitrites
  • Leuko esterase
  • Lots WBC
  • Bacteruria
  • No Epithelial cells

Dx, tx?

A

Cystitis

Treat with amocilin (nitrofurantoin if penicil allergic)

Rescreen with uroanalisis at the end of the tx

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33
Q

Pregnant patient with Urgency/frequency dysuria. Has fever and CVA tenderness. The following are the results on the uroanalysis:

  • Nitrites
  • Leuko esterase
  • Lots WBC
  • Bacteruria
  • No Epithelial cells

Dx, tx?

A

Pyelonephritis

Take cultures, admit and start ceftriaxone.

Reassess in 3 days.

  • If better continue abx for 10 days according to sensitivity of culture.
  • If she doesn’t improve, consider abscess and get a U/A. Abx for 14 days according to sensitivity of culture.
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34
Q

Tx of hyperthyroidism during pregnancy?

A

Propylthiouracil (PTU)

o F/u: TSH q4weeks

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35
Q

Tx of hypothyroidism during pregnancy?

How often to assess TSH?

A

Levothyroxine

o F/u: TSH q4weeks

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36
Q

Safe antiepileptics during pregnancy

A

Levetiracetam, lamotrigine, phenobarbital

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37
Q

Patient with HTN who wants to get prenant. She is on ACE. What are the safe drugs in pregnancy?

A

• Alfa methyl dopa
• Labetalol
• Hydralazine
(ACE, ARB, CCB, diruetics are theratogens)

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38
Q

Diabetic woman on metformin who is planing to get pregnant. What is the target of A1C and want change needs to be done?

A
  • Target A1C < 7%
  • Diet + exercise
  • Change orals to insulin
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39
Q

Tx of known diabetes (not gestational) during pregnancy?

A
  • Basal-bolus strategy (Long acting insulin PM + rapid insulin with each meal)
  • Target postprandial
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40
Q

Stages of normal labor

A 
Stage I (From 0 to 10 cm of dilation)
- Latent: 0–6 cm
-  Active: 6–10 cm
Stage II (From 10 cm to baby delivery)
Stage III (From baby delivery to placenta delivery)
"Stage IV" (Posdelivery)
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41
Q

How much time should it take for the placenta fo be delivered?

A

30 min after baby delivery regardless of G/O Hx

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42
Q

Pathophysiology of changes in cervix during normal labor

A

Fetal head engagement leads to breakage of disulfide bonds between collagen and diffusion of water

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43
Q

Sequence of changes in cervix during normal labor

A
  • Softening
  • Effacement
  • Dilation
  • Position
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44
Q

How is fetal station defined in normal labor?

A

Defined according to position of baby according to the ischial spine (goes from -5cm to +5 cm)

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45
Q

What are the types of fetal positions?

A

Longitudinal cephalic (normal)
Longitudinal breech
Longotudinal transverse

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46
Q

Types of breech Birth

A

Frank (hips flexed, knees extended)
Complete (hips flexed, knees flexed)
Footling (hips extended, knees in any position)

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47
Q

Nulli patient in labor. Dilatation < 6 cm, but she’s taking > 20 hrs to achieve 6 cm of dilatation (> 14 hrs in multi) .

Dx, tx?

A

Prolonged latent phase

Tx:

  • Balloon
  • Amniotomy
  • Misoprostol
  • Oxytocin
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48
Q

Nulli patient in labor. Dilatation 7 cm, but no significant change in dilatation after 4 hours (> 5 hrs in multi) .

Dx, tx?

A

Prolonged active phase

Tx: Evaluate the 3 P’s
- If problem with Passenger: C-section
- If problem with Pelvis: C-section
- If problem with Power: Oxytocin first, then C-section
• To determine power:
o At least 200 Montevideo Units in 10 mins Intrauterine pressure catheter (IUPC)
o Or 3 contractions in > 30 mins (normal 3 in 10 mins)

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49
Q

Nulli patient in labor. Dilatation 10 cm, but baby is not delivered after 3 hours (> 2 hrs in multi) .

Dx, tx?

A

Prolonged stage II

Tx:
Evaluate Passenger and Pelvis. If problem, C-section
If power:
• Oxytocin first
• If oxytocin fails + negative fetal station: C-section
• If oxytocin fails + positive fetal station: Forceps or vacuum

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50
Q

Patient who is in labor and just delivered baby. However, delivery of placenta is taking more than 30 mins.

Dx, tx?

A

Prolonged stage III

Tx:

  • First uterine massage
  • Then, Oxytocin
  • Then, manual extraction
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51
Q

Gestational age to consider a pregnancy as “abrotion”`?

A

< 20–24 (varies)

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52
Q

Gestational age to consider a pregnancy as “preterm”?

A

24–37

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53
Q

Gestational age to consider a pregnancy as “ term”

A

37–42

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54
Q

Gestational age to consider a pregnancy as “postdate”

A

> 42

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55
Q

Pregnant patient with rush of clear fluid. How to confirm that this fluid is in fact amnitic fluid?

A
  • Confirm with Nitralazine tests (paper or swab turns blue) or…
  • Confirm with a dry slide in which you see ferning
  • U/S: Oligohydramnios
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56
Q

Pregnant patient in 38 week, with rush of clear fluid, but has no contractions. You confirm that it’s amniptic fluid.

Dx, next step and tx?

A

Premature ROM

Next step: Check GBS status
Tx:
- Delivery
- If baby GBS (+) or unknown statu: give ampicillin

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57
Q

Pregnant patient in 35 week, with rush of clear fluid, but has no contractions. You confirm that it’s amniptic fluid.

Dx and tx?

A

Preterm premature ROM

Tx:
> 34: deliver

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58
Q

Pregnant patient in 29 week, with rush of clear fluid, but has no contractions. You confirm that it’s amniptic fluid.

Dx and tx?

A

Preterm premature ROM

Tx:
24–34: steroids for lungs

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59
Q

Pregnant patient in 19 week, with rush of clear fluid, but has no contractions. You confirm that it’s amniptic fluid.

Dx and tx?

A

Preterm premature ROM

Tx:
< 24: abortion

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60
Q

Patient who > 18 hrs after ROM has not delivered.

Dx, next step and tx?

A

Prolonged rupture of membranes

Next step: Check group B strep (GBS) status

Tx:

  • Delivery
  • If baby GBS (+) or unknown status –> give ampicillin
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61
Q

Patient with recent prolonged ROM who not has fever and is toxic.

Dx, next step and tx?

A

Chorioamnionitis (if baby is in) and endometritis (if baby was delivered)

Next step: Rule out other infections (e.g., uroanalysis, chest xR, blood cultures)

Tx: ampicillin + gentamicin + clindamycin

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62
Q

Risks factors for preterm labor

A
  • Cigarette smoking
  • Young maternal age
  • Multiple gestations
  • Preterm mom
  • Anatomical defects
63
Q

Patient with pregnancy of 36 weeks, she has contractions and cervical changes.

Dx and tx?

A

Preterm labor

> 34: deliver

64
Q

Patient with pregnancy of 30 weeks, she has contractions and cervical changes.

Dx and tx?

A

Preterm labor

20–34: steroids + tocolytics (nifedipine) and transfer patient to tertiary care

65
Q

Patient with pregnancy of 19 weeks, she has contractions and cervical changes.

Dx and tx

A

Preterm labor

< 20: abortion

66
Q

Definition and tx of postdate labor

A

> 40 by conception or > 42 by last menstrual period

Tx:

  • Sure of dates + favorable cervix: induction
  • Sure of dates + not favorable cervix: C-section
  • If not sure: biophysical profile (non-stress test and U/S)
67
Q

Pregnant woman with size-date discrepancy and ↑AFP.

U/S shows babies with different genders

Type of pregnancy and risks associated with it?

A

Di-zygotic, di-chorionic, di-amniotic

Risks:
Preterm pregnancy, malpresentation, c-section, post-partum hemorrhage

68
Q

Pregnant woman with size-date discrepancy and ↑AFP.

U/S shows babies with same gender and 2 placentas

Type of pregnancy and risks associated with it?

A

Mono-zygotic, di-chorionic, di-amniotic

Risks:
Preterm pregnancy, malpresentation, c-section, post-partum hemorrhage

69
Q

Pregnant woman with size-date discrepancy and ↑AFP.

U/S shows babies with same gender, 1 placenta and septum (2 sacs).

Type of pregnancy and risks associated with it?

A

Mono-zygotic, mono-chorionic, di-amniotic

Risks:
Preterm pregnancy, malpresentation, c-section, post-partum hemorrhage, twin-twin transfusion

70
Q

Pregnant woman with size-date discrepancy and ↑AFP.

U/S shows babies with same gender, 1 placenta, and 1 sac

Type of pregnancy and risks associated with it?

A

Mono-zygotic, mono-chorionic, mono-amniotic

Risks:
Preterm pregnancy, malpresentation, c-section, post-partum hemorrhage, twin-twin transfusion, conjoined twins, cord entanglement

71
Q

Pregnant patient with non-sustained elevation of BP > 140/80. No other symptoms..

Dx and Management?

A

Transient HTN

Ambulatory BP

72
Q

Pregnant patient < 20 weeks with sustained BP > 140/80 without other symptoms.

Dx and Tx?

A

Chronic HTN (cHTN)

Alfa-methyl-dopa or
Labetalol or
Hydralazine
(Other meds are teratogenic)

Frequent U/A and U/S (assess growth restriction)

73
Q

Pregnant patient > 20 weeks with sustained BP > 140/80 without other symptoms.

Dx and Tx?

A

Gestational HTN

Alfa-methyl-dopa or
Labetalol or
Hydralazine
(Other meds are teratogenic)

Frequent U/A and U/S (assess growth restriction)

74
Q

Pregnant patient 20-36 weeks with sustained BP > 140/80 without other symptoms. Proteinuria > 5 g/dL

Dx and Tx?

A

Preeclampsia without severe features

Tx: wait and Weekly f/u to assess Sxs

75
Q

Pregnant patient >37 weeks with sustained BP > 140/80 without other symptoms. Proteinuria > 5 g/dL

Dx and Tx?

A

Preeclampsia without severe features

Tx: induce delivery

76
Q

Pregnant patient with sustained BP > 140/80 with proteinuria > 5 g/dL and severe sx (e.g., RUQ, pulmonary edema, headaches, vision changes)

Dx and Tx?

A

Preeclampsia with severe features

Tx: Magnesium and deliver (you may need to balance risk and benefict depending on gestational age and severity of symtoms)

77
Q

Pregnant patient without history of epilepsy who sudenly has a sezure.

Dx and tx?

A

Eclampsia

Tx: Magnesium and deliver (usually C/S) regardless of gestational age

78
Q

What are the alarm symptoms in preeclampsia?

A 
↓Ptls
↓LFTS
RUQ abd pain
↑Cr
Pulmonary edema
Headaches
Vision changes
79
Q

Patient with preeclampsia with severe features who is on magnesium. You notice decreased deep tendon reflexes. What is the antidote of magnesium?

80
Q

Definition of postpartum hemorrhage

A

o > 500 cc of loss in a vaginal delivery

o > 1000 cc of loss in a C-section

81
Q

Patient with postpartum hemorrhage. On physicial exam you feel a Buggy uterus.

Dx and tx?

A

Uterine atony

Tx:

  • Uterine massage
  • Oxytocin
  • Methylergometrine
  • Bakri balloon
82
Q

Patient with postpartum hemorrhage. On physicial exam you don’t feel the uterous, on speculum exam you see the uterus in vaginal canal.

Dx and tx?

A

Uterine inversion

Tx:

  • Tocolytics
  • Manually put it back in place
  • Then Oxytocin to help with the manual maneuver
  • Surgery if manual maneuver is not successful
83
Q

Patient with postpartum hemorrhage. On physicial exam you feel a normal uterus.

Next step?

A

Perform visual exploration a look for a vaginal laceration. Apply preasure and suture if needed.

84
Q

Patient with postpartum hemorrhage. On physicial exam you feel a firm uterus.

Next step?

A

Inspect placenta, verify that vessels go to the edges as reained placenta is the most likely Dx.

85
Q

Patient with postpartum hemorrhage. On physicial exam you feel a firm uterus.

Some of the vessels of placenta don’t go to the edges.
Dx and tx?

A

Retained placenta

Tx:

  • D/C
  • Hysterectomy

F/U: B-HCG levels to go to 0

86
Q

Patient with postpartum hemorrhage in whom you have tried everything and she keeps bleeding.

Tx?

A
  • 2 large bore IV (> 18 G)
  • IVF
  • Transfuse as needed
  • Prepare for either ligation, embolization or hysterectomy
87
Q

What do you see in a non-stress test?

A 
Variability 
o	Too little variability (flat line) and too much variability are bad 
Accelerations: 15/15, 2 in 20 is normal
o	Change in HR ↑15 bpm during 15 seconds
o	2 raise in HR in 20 mins
88
Q

Pregnant patient who doesn’t feel baby moving. You perform a non-stress test and it presents good variabily and 2 normal accelerations in 20 mins.

Next step?

A

Reassuring result

No need to repeat it

89
Q

Pregnant patient with a high risk pregnancy. You perform a non-stress test and it presents good variabily and 2 normal accelerations in 20 mins.

Next step?

A

Reassuring result

Repeat q week beacuse of high risk of pregnancy

90
Q

Pregnant patient who doesn’t feel baby moving. You perform a non-stress test and it shows a flat line in baby’s HR.

Next step?

A

Non-reassuring result (poor variability)

Next step: vibroacoustic estimulation and perform a new non-stress test (same interpretation)

91
Q

Pregnant patient who doesn’t feel baby moving. You perform a non-stress test and it shows a flat line in baby’s HR. You then perform vibroacoustic estimulation and perform a new non-stress test obtaining the same result.

Next step?

A

Non-reassuring result (poor variability)

Next step: perform a biophysical profile

92
Q

What do you see in a bipphysical profile?

A

It’s like an “APGAR” but in-utero

Score 0–10:

  • NST (0–2 points)
  • Amniotic fluid index (0–2 points)
  • Breathing (0–2 points)
  • Movement (0–2 points)
  • Tone (0–2 points)
93
Q

Score 8–10 in a biphysical profile. Next step?

A

Reassurance

94
Q

Score 3–7 in a biphysical profile. Next step?

A

Use gestational age to decide next step (delivery vs wait)

95
Q

Score 0–2 in a biophysical profile. Next step?

A

Fetal demise–> emergency C-section

96
Q

Patient in labor who is having 3 contractions in 10 mins. The patient is being moniored (contraction stress test) and you see decelerations that mirror each contraction.

Next step?

A

Early decelerations (head compression)

No action needed, continue labor

97
Q

Patient in labor who is having 3 contractions in 10 mins. The patient is being moniored (contraction stress test) and you see decelerations that have nothing to do with the contractions.

Next step?

A

Variable decelerations (cord compression)

No action needed, continue labor

98
Q

Patient in labor who is having 3 contractions in 10 mins. The patient is being monitored (contraction stress test) and you see decelerations that start right after the contractions.

Next step?

A

Late decelerations (utero-placenta insufficiency)

Take baby out! Most likely by c-section

99
Q

Most common causes of 3rd trimester bleeding?

A
  • Cervical lesions
  • Secondary to cervical dilatation
  • ROM with a bit of blood

Howerver, always assess mom a baby to rule out severe diseases

  • Mom’s Vitals, physical, Hgb, Plt, coags
  • NST or CST
  • U/S look for fetal HR
100
Q

Multiparous pregnant in 3rd trimester patient who presents with painless bleeding.

  • U/S: transversal lie
  • NST/CST: fetal distress

Dx, next step?

A

Placenta Previa (Placenta grows across the os. When cervix dilates–> placenta tears)

`Tx: urgent c-section

101
Q

Pregnant patient in 3rd trimester who presents with painless bleeding.

  • U/S: nromal
  • NST/CST: fetal distress

Dx, next step?

A

Vasa Previa (Accessory lobe connected to main placenta, which are located across the os)

Tx: urgent c-section

102
Q

Pregnant patient with history of c-section who is attempting vaginal delivery. Suddently she presents painful bleeding, loss of fetal station and loss of contractions.

Dx and next step?

A

Uterine Rupture

Next step: “crash”-section! (don’t wait to do any test)

103
Q

Pregnant patient in 3rd trimester, with history of HTN and cocaine use, who presents with painful bleeding.

Dx, next step and tx?

A

Placenta Abruption (Placenta rips off and the endometrium is teared )

Next step:

  • U/S
  • NST/CST
  • Mom’s vitals, Hgb, Plt, mental status

Tx: Urgent c-section

104
Q

Pregnant patient in second pregnancy who is Rh Ag (-), husband is Rh Ag (+). Next step to assess for alloimmunization?

A

Get Rh Ab status and titers

105
Q

Pregnant patient in second pregnancy who is Rh Ag (-), husband is Rh Ag (+).

Rh Ab (-)

Next step?

A

Give RhD Immunoglobulin at 28 weeks within 72 hrs of maternal-fetal blood mixing

106
Q

Pregnant patient in second pregnancy who is Rh Ag (-), husband is Rh Ag (+).

Rh Ab (+) titers < 1:8

Next step?

A

Give RhD Immunoglobulin at 28 weeks within 72 hrs of maternal-fetal blood mixing

107
Q

Pregnant patient in second pregnancy who is Rh Ag (-), husband is Rh Ag (+).

Rh Ab (+) titers > 1:8

Next step?

A

Perform transcraneal doppler

108
Q

Pregnant patient in second pregnancy who is Rh Ag (-), husband is Rh Ag (+).

Rh Ab (+) titers > 1:8
Normal flow on transcraneal doppler

Next step?

A

Give RhD Immunoglobulin at 28 weeks within 72 hrs of maternal-fetal blood mixing

109
Q

Pregnant patient in second pregnancy who is Rh Ag (-), husband is Rh Ag (+).

Rh Ab (+) titers > 1:8
High flow on transcraneal doppler

Next step?

A

If gestational age < 32 –> Percutaneous umbilical sampling (PUBS) and transfuse

If gestational age > 32 –> Deliver

110
Q

When to give RhD Immunoglobulin >

A

Mother: Ag (-), Ab (-)
Father: Ag (+) or unknown

Give RhD Immunoglobulin at 28 weeks within 72 hrs of maternal-fetal blood mixing

  • Delivery
  • D/C
  • C-section
  • Post-partum hemorrhage
111
Q

Pregnant patient with group B positive screening (uroanalysis and urorinary culture).

Next step?

A

Ampicillin

- If allergic: cefazolin, clinda, vancomycin

112
Q

Patient with negative group B screening but with high risk factor (Previous strep B in former pregnancy, Prolonged ROM, Intrapartum fever)

Should you treat?

A

Yes (Despite de negative screening), give Ampicillin

- If allergic: cefazolin, clinda, vancomycin

113
Q

Pregnant patient with positive Hep B screening.

How to manage delivery?

A
  • C-section to avoid maternal-fetal mixing
  • Give baby Hep B IV immunoglobulin (even if C-section) and HepB vaccine
  • Ideally, vaccinate mom before pregnancy
114
Q

Treatment of HIV in pregnancy

A

HAART “2+1”: 2 nucleoside reverse transcriptase inhibitors (NRT-i) + 1 Non- nucleoside reverse transcriptase inhibitors (NNRT-i)/ Protease inhibitor (P-i)
o NRT-i: Tenofovir + Emtricitabine or zidovudine + lamibudine
o NNRT-i: Nevirapine
o P-i: Atazanavir

115
Q

When can a HIV+ pregnant woman have vaginal delivery?

A

If VL < 1000 + HAART: vaginal delivery

• If VL > 1000 or no HAART: C-section

116
Q

Immigrant patient from Africa in delivery, you don’t know her HIV status. She didn’t have any prenatal care. Next step?

117
Q

Pregnant patient with Toxo Ab(+).

Next step?

A

Reassurance. She has immune response against the infection.

118
Q

Pregnant patient with Toxo Ab(-).

Next step?

A

Avoidance of risk factors:

  • Cat feces
  • Undercook meat
  • Cyst in soil
119
Q

Pregnant patient with painless chancre.

Dx and tx?

A

Primary syphilis

Tx: Penicillin x 1 IM

120
Q

Pregnant patient with targetoid lesions in palms and soles.

Dx, next steps and tx?

A

Secondary syphilis

Next steps: RPR, if positive confirm with FTA-Abs

Tx: Penicillin x 1 IM

121
Q

Pregnant patient with tabes dorsalis.

Dx, next steps and tx?

A

Terticiary syphilis

Nexy step: Lumbar punction–> CSF-RPR, if positive confirm with CSF-FTA-Abs

Tx: Penicillin q4h IV x 10 days

122
Q

Congenital syphilis manisfestations?

A

Rhinorrhea, saber shins, saddle nose, hutchinson’s

123
Q

Congenital rubella manisfestations?

A

Baby with congenital rubella ‘blueberry muffin’
• Petechiae purpura
• Cataracts
• Congenital heart defects
• Deafness
• Intrauterine growth restriction
• Abortion if contracted in 1st trimester

124
Q

Pregnant patient who didn’t received vaccination against MMRV. Recomendation to avoid rubella?

A

Stay away from kids who haven’t completed MMRV series. Stay away from sick people.

125
Q

Pregnant patient with vesicles on erythematous base in vagina.
Dx and tx?

A

Herpes simplex

Tx:

  • Valacyclovir or acyclovir
  • C-section to avoid baby passing through an infectious vaginal canal
126
Q

Congenital herpes manisfestations?

A
  • Intrauterine growth restriction
  • Preterm
  • Blindness
127
Q

Duration of implanon?

128
Q

Duration of hormal IDU?

129
Q

Duration of copper IDU?

130
Q

Duration of depro-provera injection?

131
Q

Contraceptive patches. Duration?

132
Q

Contraception method with the highest risk of DVT/PE?

133
Q

Contraception and DVT/PE. What are the risk factors?

A
  • Estrogen-based methods
  • Smoking
  • Age > 35
134
Q

Indications for vacuum delivery or forceps?

A
  • Prolong or arrest of labor
  • Fetal distress
  • Full effacement of cervix and > 2+ station
135
Q

Indications for episiotomy?

A
  • Macrosomia
  • First-time mom
  • Prevent uncontrolled lacerations
  • Prevent shoulder dystocia
136
Q

Types of episiotomy

A
  • Median: less pain, heals better. More risk of laceration

- Medio-lateral: hurts more, heals poorer. Less risk of laceration.

137
Q

Patient with history of multiple 2nd trimester loses.

Dx and tx?

A

Incompetent cervix

Cerclage at week 14. Remove at week 36 to prevent risk of cervical laceration

138
Q

Risk of opiates in labor

A
  • Risk of prolonged latent phase

- Risk of respiratory depression in baby

139
Q

1° causes of third-trimester bleeding.

A

Placental abruption and placenta previa.

140
Q

Classic ultrasound and gross appearance of complete

hydatidiform mole.

A

Snowstorm on ultrasound. “Cluster-of-grapes” appearance on gross examination.

141
Q

Chromosomal pattern of a complete mole.

142
Q

Molar pregnancy containing fetal tissue.

A

Partial mole.

143
Q

Symptoms of placental abruption.

A

Continuous, painful vaginal bleeding.

144
Q

Symptoms of placenta previa.

A

Self-limited, painless vaginal bleeding.

145
Q

When should a vaginal exam be performed with suspected placenta previa?

146
Q

Antibiotics with teratogenic effects.

A

Tetracycline, fluoroquinolones, aminoglycosides, sulfonamides.

147
Q

Shortest AP diameter of the pelvis.

A

Obstetric conjugate: between the sacral promontory and the midpoint of the symphysis pubis.

148
Q

Medication given to accelerate fetal lung maturity.

A

Betamethasone or dexamethasone × 48 hours.

149
Q

The most common cause of postpartum hemorrhage.

A

Uterine atony.

150
Q

Treatment for postpartum hemorrhage.

A

Uterine massage; if that fails, give oxytocin.

151
Q

Typical antibiotics for group B streptococcus (GBS) prophylaxis.

A

IV penicillin or ampicillin.

152
Q

A patient fails to lactate after an emergency C-section with marked blood loss.

Dx?

A

Sheehan’s syndrome (postpartum pituitary necrosis).

153
Q

Uterine bleeding at 18 weeks’ gestation; no products expelled; membranes ruptured; cervical os open.

A

Inevitable abortion.

154
Q

Uterine bleeding at 18 weeks’ gestation; no products

expelled; cervical os closed.

A

Threatened abortion.

MCCQE1 (19 decks)

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