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PROLOG > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What is the next best test for a cfDNA which screens positive for Turner, 45, X?

A

Diiagnostic test:
Chorionic villus sampling (10-12wks)
Amniocentesis (>15wks)

cfDNA has a low PPV in populations with low “a prior” risk

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2
Q

Most common pathogens in chorioamnionitis and TX

A

Mycoplasma, enterobacteriaceae, GBS, S. aureus, G. vaginalis, GC/CT

Ampicillin and Gentamycin (add Clindamycin if C/s) - one additional dose after delivery

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3
Q

which kidney and ureter naturally enlarge in pregnancy

A

the right- caused by compressive forces of the uterus displaced onto the right by the sigmoid colon and by hormonal effects of progesterone decreasing peristalsis

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4
Q

failure rate of Nexplanon

expulsion of IUD in SVD vs CD

A

0.05%; 5-10% vs 20%;

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5
Q

Threshold Hgb per trimester for dx anemia:

Test with most sn/sp for dx iron deficient anemia:

A 
11 (first and third), 10.5 (second) 
serum ferritin (low)
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6
Q

When do you deliver a prior cCD? Risk of uterine rupture?

A

36-37wks; 4-9%

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7
Q

Side effect of hydralazine

A

hypotension, tachycardia

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8
Q

Hyperthyroidism risks to pregnancy; Method for Tx in pregnancy

A

cardiac arrhythmia, CHF, osteoporosis, thyroid storm/ PTL, PreE, IUGR, IUFD;

PTU in first trimester (avoid hepatotoxicity to mom by switching to methimazole in second and third tri), methimazole in 2nd-3rd tri (avoid embryopathy- aplasia cutis and esophageal or choanal atresia)

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9
Q

Once common meds fail in a PPH, in a hemodynamically unstable patient, what is the next course of action?

A

balloon tamponade- can be left in place for 24hrs, 86-100% success rate. Can control bleeding to get to UAE if possible.

If bleeding persists- laparotomy to consider B-lynch vs hysterectomy

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10
Q

A gestational sac of __mm without an embryo demonstrates a non-viable pregnancy

A

25 mm

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11
Q

The only category 1 contraceptive method for a breastfeeding women in the immediate postpartum period is:

A

the copper IUD. All progesterone containing methods may effect breastfeeding (data remains inconclusive)

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12
Q

In a pregnant patient with a persistent HA in whom preE has been reasonably excluded- what else is on the ddx? What imaging?

A

caffeine withdrawal, intracranial mass, intracranial hemorrhage, vertebral artery dissection, dural venous sinus thrombosis …. MRI/MRA/MRV can dx most intracranial lesions

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13
Q

Risk factors for placental abruption:

A

maternal age, grand multiparity, smoking, cocaine use, HTN, Poly, PPROM, multifetal gestation, leiomyomas, previous abruption, trauma

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14
Q

EPPDS >10 but not acutely suicidal or manic- preferred management:

A

Psychotherapy vs CBT …..if this fails, trial of SSRI (sertraline, fluoxetine, citalopram, paroxetine)

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15
Q

Define macrosomia:

When to recommend CD for macrosomia:

A

Birth weight >4500g

EFW >5000g or 4500g with DM

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16
Q

DDx for pt with lab evidence of hemolysis, and/or elevated liver enzymes, and/or low plts

A

HELLP, Acute fatty liver of pregnancy, TTP, ITP, SLE, APS, cholecystitis, viral hepatitis, acute pancreatitis, disseminated herpes, hemorrhagic or septic shock

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17
Q

Types of twins and embryo division:

A

Dizygotic- always Di/di

Monozygotic- di/di (D13)

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18
Q

Monochorionic pregnancies: TTTS Dx, Staging and screening

A

US finding of poly/oli, growth discordance >20%, fetal hydrops, abnormal UA dopplers
Quintero:
I- bladder present of donor twin, UA doppler normal
II- bladder of donor is not visible, UA dopplers normal
III- donor bladder not visible, abnormal UA dopplers
IV- Fetal hydrops present
V- Demise of either twin

Starting at 16 weeks, screened every 2 weeks for fluid, bladder, UA dopplers. Growth q3-4weeks

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19
Q

What should you watch out for in monochorionic twins s/p laser ablation for TTTS?

A

Twin anemia/polycythemia syndrome- Dx by MCA doppler studies

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20
Q

When to not administer late preterm steroids:

A

Chorioamnionitis, a previous course has already been given, maternal diabetes, multifetal gestation, fetus with major nonlethal malformations (trial did not include DM, multifetal gestation, previous steroid exposure, nonlethal malformations)

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21
Q

How to dx and tx DIC:

Cause of DIC in setting of abruption:

A

Clinical suspicion based on context (abruption, pph, sepsis) Decreased plts, low fibrinogen, elevated PT/PTT. Tx underlying disease, replace factors with cryo

tissue factor is released by shearing of placenta into maternal circulation activating factors X and Xa leading to excess production of thrombin and fibrin clots

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22
Q

Features suspicious for malignancy in an adnexal mass in a pregnant patient? best imaging?

A

> 5cm with complex features (solid components, papillary excrescences), thick septations

Anechoic, simple masses can be monitored, most will resolve

MRI (gadolinium has been associated with high rheum, inflammatory, and skin conditions, as well as stillbirth)

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23
Q

In order to improve the chance of a successful ECV, what med is helpful?

When to perform ECV?

A

Terbutaline almost doubles the success rate

ECV should be performed at 37wks

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24
Q

How to manage suspected listeriosis exposure:

A

Sx but no fever- consider prophylactic abx
Sx +fever- Abx

IV ampicilin + gent or TMP/SMX (PCN allergic)

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25
Q

Severe headache relived by supine position:

A

Dural puncture HA- caused by unanticipated puncture of dura during epidural placement- tx with blood patch, second one if first fails (promising new regional nerve blocks)

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26
Q

Next test after oligohydramnios is found in a normally grown fetus….

A

NST, evaluation of fetal wellbeing

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27
Q

Management of uterine inversion:

A
  1. Leave placenta in place if still attached!
  2. Adminiter uterine relaxant (nitro, terb, mgso4)
  3. Replace with manual pressure
  4. If all fails, go for laparotomy
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28
Q

Tx of mastitis

Tx of breast abscess

A

NSAIDs, frequent emptying (nursing, pumping)

Abx: dicloxacillin, cephalexin, clindamycin (all safe) or TMP-SMX if concern for s. aureus, IV abx if sepsis

Abscess: drainage + abx until fever/sx resolve

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29
Q

Risk factors for cervical insufficiency

A

multiple second trimester losses, collagen disorders, cervical procedures

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30
Q

Indications for cerclage placement

A

Hx: 1+ second tri losses related to painless cervical dilation, in absence of labor or abruption OR hx of prior cerclage

PE: painless cervical dilation of exam in 2nd tri

US: current singleton pregnancy, prior PTB <34wks, cervical length <25mm and <24wks

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31
Q

US findings of accreta

A

lacunae with placenta, loss of retroplacental hypoechogenic zones (absence of normal decidua), hypervascularity in myometrium or placenta, myometrial thinning at placental bed, placenta bulging into bladder

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32
Q

Risk of placenta accreta with previa and prior c/s #

A

1 prior c/s- 3.3%, 2 prior 11%, 3 prior 40%, 4 prior 61%, 5 prior 67%

WIthout previa- 0.03->0.2->0.1->0.8–>4.7%

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33
Q

Incidence of brachial plexus injury with shoulder dystocia- how many resolve without permanent injury?

A

Incidence- 40%

Resolve without lasting injury- 90%

34
Q

What is the only maneuver to resolve shoulder dystocia not associated with neonatal injury (after all adjustments)

A

Delivery of posterior arm

35
Q

When to delivery placenta previa with accreta?

A

34 0/7-35 6/7 weeks

36
Q

Low PAPP-A is most specific in predicting ___.

A

IUGR > PreE

37
Q

Standard approach to painful crisis in sickle cell pt?

A

Tx of precipitating factors such as dehydration, hypoxia, and infection. Aggressive pain control with opioids. Potential transfusion for refractive pain crisis.

Hydroxyurea is CI in pregnancy pts - increased risk of malformations and stillbirth

38
Q

Prenatal care for sickle cell patients:

A

Monthly Hgb, CMP; iron is avoided unless documented low ferritin; folic acid supplementation (5mg/day), prevention of dehydration; ASA for prevention of preE; baseline and urine culture per trimester (tx or suppress bacteruria); fetal growth US 28, 32, 36 weeks

39
Q
  1. Postpartum evaluation of women with GDM:

2. Lifetime risk of T2DM after GDM:

A
  1. 2hr GTT @6-12 wks postpartum with repeat testing q3yrs

2. Sevenfold lifetime increased risk

40
Q

Prognosis of many autoimmune diseases in pregnancy:

A

Sx worsen in 40%, improve in 30%, and stay the same in 30%

41
Q

Which medications should you avoid in a patient with myesthenia gravis?

Why should you treat MG promptly in prengnancy?

A

Magnesium sulfate, calcium channel blockers, B-blockers, aminioglycosides, fluoroquinolones, macrolides

antibodies cross placenta, 10-20% of neonates can be affected by neonatal MG (tx with pyridostigmine, steroids)

42
Q

Extremely premature or low birth weight infants have a lower incidence of ____ if born at a Level III NICU vs lower?

A

severe intracranial hemorrhage and death

43
Q

Which vaccines are contraindicated in pregnancy?

What additional vaccines are recommended to HIV+ women in pregnancy?

What vaccines should be avoided in women with CD4<200?

A

live flu, MMR, varicella, zoster, HPV (not recommended)

hep B and pneumococcus

MMR, varicella, zoster

44
Q
  1. Least risky antiepilecptics in pregnancy:
  2. How to manage these meds in pregnancy
  3. teratogenicity associated with valproate
  4. recommend supplement for women with epilepsy
A
  1. lamotrigine (lamictal), levetiracetam (keppra), oxcarbazapine (trileptal)
  2. check levels periodically
  3. NTDs
  4. Folic acid 1-4mg daily (research has not proven whether this actually decreases NTDs when taking antiepileptics)
45
Q

Most common nutritional deficiencies in malabsorptive gastric bypass:

A

protein, iron, vitamin B12, vit D, folic acid, calcium

46
Q

How does work up change for rhesus alloimmunization in first pregnancy vs a h/o:

A

Repeat titers q month until 24wks, then q2wks VS no titers, go straight to fetal testing (if different father) then MCA scan q1-2 weeks at 18wks GA

47
Q

What bacteria does gentamicin cover?

What abx should be added to chorio regimen if pt needs CD?

A

gram negative aerobes

clindamycin or metronidazole

48
Q

Taking low dose ASA can reduce the risk of PreE by __% in pregnancies at increased risk.

A

24%

49
Q

Therapeutic hypothermia must begin within __hrs of birth for suspected neonatal encephalopathy.

A

6

50
Q

What medications should a an asthmatic be on if she experiences sx daily (multiple uses of SABA) and FEV1 is >70%?

A

Low-med dose ICS +LABA (or LTRA or theophylline)

51
Q

What are signs c/w an event which could cause neonatal encephalopathy?

A
  1. APGARs <5 @5 and 10 min
  2. UA pH <7 or base deficit >12
  3. MRI showing brain damage
  4. Multisystem organ failure
52
Q

What type of CP is most consistent with an intrapartum or acute peripartum event?

A

spastic quadriplegia or dyskinetic CP

53
Q

US findings of congenital syphilis

A

hydrops, placentomegaly, FGR.

54
Q

Tx of late latent syphilis vs early latent/primary/secondary syphilis

A

2.4 MU pcn G benzathine x3 weekly doses vs 1x dose of 2.4 MU

55
Q

What is echo evidence of peripartum cardiomyopathy?

A

EF <45%, impaired fractional shortening, and increased left ventricular end-diastolic dimension

56
Q

rate of birth defects in general population vs individuals with antiepileptic drug exposure:

Amount of folic acid to rx to pt taking antiseixure meds:

A

2-3% vs 4-7%

4mg

57
Q

What is granulomatous infantiseptica?

A

In utero infection of listeria- diffuse maculopapular rash and abscesses in multiple internal organs of a new born. The placenta will also show abscess formation.

58
Q

What percent of low-lying placentas resolve before delivery?

A

93-98% (low lying is within 2cm of the cervical os)

59
Q

What is the annual avg background radiation from the environment?
Radiation from a low-dose abdominal CT?

A
  1. 1-2.5mGy

2. 5mGy

60
Q

What is the fetal anomaly with the highest increased attributable risk from obesity?

A

Neural tube defect (> than cardiac defects, orofacial cleft, limb reduction, anorectal atresia)

61
Q

Which thalassemia can be diagnosed by hgb-electropohoresis?

A

Beta-thalassemia

62
Q

Phenylketonuria is autosomal recessive or dominant?
Fetal risks?
What dietary restriction is advised?

A

Autosomal recessive
Fetus born to diet unrestricted mother- 92% increased risk of dev delays, 73% risk of microcephaly, 12% risk of cardiac defects
Phe-free diet: avoid protein rich foods, aspartame, non-wheat flour, soy

63
Q

What are two laboratory tests which characterize acute fatty liver of pregnancy and distinguish it from other liver pathology in pregnancy?

A

Hypoglycemia and elevated ammonia

64
Q

What is the treatment and goal plts for ITP?

A

Prednisone (1-2mg/kg/d) for at least 3 weeks

50,000 plts (safe for delivery)

65
Q

What is the most common surgical emergency in pregnancy?

A

Acute appendicitis

66
Q

At what viral load should you consider treatment for Hep B in pregnancy?
With what antiretroviral?

A

6-8log10 copies/mL

Tenofovir

67
Q

what is the most common karyotype of a complete mole?

A

46, XX, all paternal

68
Q

What fetal complication is most associated with Anti-Ro, Anti-La antibodies ( Sjogren, SLE)

A

Congenital heart block

69
Q

Mortality risk for normal BPP?

A

<1 in 1000 within 1 week of normal BPP

70
Q

What two criteria does the diagnosis of TTTS require?

A
  1. mono-di twin pregnancy

2. presence of oligo/poly MVP

71
Q

At what BMI should you use 3g Ancef (cefazolin)?

A

120 kg

72
Q

Recommended daily dose of folic acid for normal risk vs increased risk? (h/o NTD but some suggest obesity, poorly controlled DM, anti epileptic use, FHx are also risk factors)

A

400mcg vs 4000 mcg daily

73
Q

When should hCG effects on TSH normalize in pregnancy if no overt thyroid disease is present?

A

14 weeks

74
Q

Diagnosis of active vs late TB

A

Sputum CX vs skin test or Quantiferon gold

75
Q

Which tocolytic agent is CI in women with hypotension or preload dependent cardiac disease?

A

Nifedipine (vasodilator)

76
Q

Which thrombophilia test is not reliable in pregnancy?

A

Protein S

77
Q

Which umbilical cord blood component is most predictive of neurological injury as a result of acute intrapartum event?

A

Base déficit (>12)

78
Q

Associated US findings:

  1. CMV
  2. Parvovirus 19
  3. Syphilis
  4. Toxoplasmosis
  5. Varicella
A
  1. Intraabdominal calcifications, symmetric fetal growth restrictions
  2. Placentomegaly
  3. Intracranial calcifications and microcephaly
  4. Ascites
  5. Limb hypoplasia
79
Q

US findings for the following karyotypes:

  1. 45, X
  2. 47, XXY
  3. 47, XX +21
  4. 47, XY +18
  5. 47, XX +13
A
  1. Turners:Cystic hygroma, hydrops, short femur, coarctation of aortic, hypoplastic left heart, renal anomalies
  2. Kleinfelter: No US findings
  3. Ventriculomegaly, echogenic bowel, cardiac echo foco
  4. Overlapping fingers, clenched hands, choroid plexus cyst, GR
  5. Holoprocencephaly, midline facial defects, cardiac anomalies
80
Q

Enzyme correlated with AFLP

A

Fetal long-chain 3-hydroxyacyl- coA dehydrogenase

PROLOG (5 decks)

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