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BOARD REVIEW > OBSTETRICS and GYNECOLOGY > Flashcards

OBSTETRICS and GYNECOLOGY Flashcards

1
Q

Premenopause

Dysmenorrhea
Dyschezia
Dyspareunia

Dx?

A

EnDometriosis

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2
Q

Metromeorrhagia
Colicky dysmenorrhea
Dyspareunia
Pelvic pain

Dx?

A

Adenomyosis

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3
Q

Tender, soften premenstrual uterus

A

Halban sign

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4
Q

Exophytic mass projecting into endometrial cavity

A

Endometrial polyps

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5
Q

Snowstorm pattern

A

H. Mole

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6
Q

Levator ani muscles (3)

A

PuboRectalis
PuboCoccygeous
IlioCoccygeous

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7
Q

Blood supply of posterior vaginal wall

A

Middle Rectal Artery

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8
Q

The labia minora is invested by which structure?

A

Sebaceous gland

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9
Q

Artery frequently encountered when Pfamnensteil skin incision is performed during cesarean delivery

A

Superficial Epigastric artery

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10
Q

Artery should be fpund and ligated prior to performace of Maylard incision

A

Inferior Epigastric artery

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11
Q

Chronic pain may develop in the area of Pfannentwil skin incision if this nerve is severed or entrapped

A

IlioHypogastric nerve

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12
Q

Structures that provide support for fecal continence

A

Internal and external anal sphincter

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13
Q

Landmark used when performing nerve block

A

Ischial spine

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14
Q

Blue tint of the cervix that is due to increased cervical vascularity in pregnancy

A

Chadwick sign

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15
Q

Relationship between ureter and uterine artery near the insertion to the uterus

A

Ureter is 2cm LATERAL to the cervix and crosses UNDER the uterine artery

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16
Q

Vascular supply of uterus from?

A

Uterine artery

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17
Q

Artery, that comes off the posterior division of the internal iliac artery

A

Superior Gluteal Artery

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18
Q

Mobility of this joint aids in the delivery of the obstructed shoulder in the case of shoulder dystocia

A

Sacroiliac

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19
Q

Plane of LEAST pelvic dimensions

A

The plane of midpelvis

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20
Q

Pelvic inlet boundaries

A

Posterior - Promontory
Lateral - Linea terminalis
Anterior - horizontal pubic rami

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21
Q

The LEAST clinically important diameter of pelvic inlet

CANNOT be directly measured

SHORTEST distance from sacral promontory and symphisis pubis

Measures 10.5cm

A

Obstetric conjugate

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22
Q

Contains the SMALLEST pelvic diameter

Serves as the point to measure station

Marked by interspinous diameter

A

Midpelvis

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23
Q

Most common Caldwell-Moloyanatomical pelvis

A

Gynecoid

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24
Q

Structure arises from the urogenital sinus

A

HUGE-V

Hymen
Urethra
Glands - Skene and bartholin
Epithelium of vagina
Distal Vagina/ lower 2/3

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25
Q

Uterine anomaly LEAST likely associated with renal abnormality

A

Arcuate uterus

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26
Q

Remnant of mesonephric tissue

A

Gartner duct cyst

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27
Q

Gestational age where differentiation between male and female external genitalia can be seen

A

12 weeks gestation

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28
Q

Fetal antimüllerian hormone produced

A

Sertoli cells

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29
Q

Imaging modality that has the highest accuracy for the diagnosis of uterine anomaly

A

MRI

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30
Q

Which anomaly would a surgical procedure be recommended prior to attempting pregnancy

A

Unicornuate uterus with communicating horn

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31
Q

Uterine anomaly arises from a complete lack of fusion of the mullerian ducts

A

Uterine didelphys

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32
Q

Septate uterus in 3D sonography

A

Intrafundal downward cleft measuring <1cm

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33
Q

Uterine anomaly associated with highest risk of obstetrical complication

A

Unicornuate non-communicating

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34
Q

Female metanephros will ultimately form..

A

Kidney

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35
Q

Most common uterine anomaly

A

Bicornuate uterus

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36
Q

Local production of this hormone is necessary for virilization of male genitalia in the fetus

A

Dihydrotestosterone

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37
Q

Hormone that prevents the formationof the uterus, fallopian tube, and upper vagina

A

Antimüllerian hormone

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38
Q

Non-rhythmic, usual intensity of 5-24mmHg and can be detected by bimanual examination

A

Braxton hicks contractions

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39
Q

A soluble receptor attenuates vascular endothelial and placental growth factor in vivo

A

sFlt-1

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40
Q

According to WHO, protein deposition is highest per day in what trimester?

A

3rd trimester

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41
Q

Fetus gains the most weight proportionately during this period of pregnancy

A

10-20 weeks gestation

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42
Q

When are maternal iron stores used in pregnancy?

A

Latter half of pregnancy

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43
Q

Unchanged coagulation factor level in pregnancy

A

Antithrombin III

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44
Q

Hepatic enzyme increased in normal pregnancy

A

Alkaline phosphatase

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45
Q

After ___ weeks’ gestation, the placenta is the main source of placental growth hormone

A

20 weeks

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46
Q

Hormones secreted by the posterior pituitary gland

A

Oxytocin
ADH

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47
Q

Pregnancy related memory decline is limited to which period in pregnancy?

A

3rd trimester

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48
Q

The average ovulatory menstrual cycle ranges from 25 to 32 days. Which phase of the cycle is most consistent in length?

A

Luteal

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49
Q

When does LH secretion peak in reference to ovulation

A

10-12 hours after

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50
Q

Hormone rescues the corpus luteum during early pregnancy

A

Human chorionuc gonadotropin

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51
Q

Following ovulation, when is the latest time fertilization can occur for a successful pregnancy to ensue?

A

24 hours

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52
Q

This gives rise to the chorionic structures that transport oxygen and nutrients between the fetur and mother

A

Villous trophoblast

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53
Q

Provides tensile strength of the fetal membranes

A

Amnion

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54
Q

The phenomenon that describes how fetal cells can become engrafted in the mother during pregnancy and then be identified decades later is called

A

Microchimerism

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55
Q

At term, what is the average amniotic fluid volume?

Normal volume?

A

Average - 1000mL

Normal vol. - 750-800mL

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56
Q

What gestational age are peak maternal B-hCG levels reached?

A

10 weeks

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57
Q

Half-life of human placental lactogen

A

10-30mins

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58
Q

What is the source of the precursor for progesterone production by syncytiotrophoblast

A

Maternal cholesterol

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59
Q

Maternal surface of placenta

A

Basal plate

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60
Q

Fetal surface of placenta

A

Chorionic plate

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61
Q

Placental measurements

A

Weight - 500g at term
2 to 4 cm thick
Normal placenta increases in thickness at a rate of approximately 1mm per week

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62
Q

In what situation is the submission of placenta for patho examination most informative and cost effective?

A

Oligohydramnios complicating the 3rd trimester

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63
Q

Percentage of placental villi can be lost without resulting in adverse impact to the fetus

A

30%

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64
Q

On pathology:
“Massive perivillous fibrin deposition”

A

Recommend antiphospholipid antibody lab panel

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65
Q

Retroplacental hematoma noted during a 28 week ultrasound performed for lagging fundal height

Indication for what?

A

Screen fetal-maternal bleed

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66
Q

Maternal malugnancy least likely to metastasize to the placenta

A

Cervical cancer

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67
Q

Average length of a full term umbilical cord

A

50-60cm

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68
Q

A single umbilical cord cyst is found during a first trimester utz performed for assessment of vaginal bleeding. Next step?

A

Schedule follow-up utz at 16-18weeks gestation

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69
Q

A true knot in the umbilical cord is associated with?

A

Stillbirth
Polyhydtamnios
Monoamniotic twin gestation

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70
Q

What is assumed when using the first day of the last menstrual period for dating?

A

Patient ovulated approximately 2 weeks later

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71
Q

Approximately how long is each trimester of pregnancy?

A

14 weeks

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72
Q

When is a conceptus termed an embryo?

A

Third week from the last menstrual period

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73
Q

Neural tube closes at?

A

6 weeks gestation

*start folic before 6weeks for it to be efficacious

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74
Q

How does oxygen content of the blood coming to the heart from the inferior vena cava compared to oxygen contents of blood leaving the placenta?

A

Lower

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75
Q

After birth, the intraabdominal remnants of the umbilical vein become?

A

Ligamentum teres

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76
Q

Anemia in the fetus

A

30%

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77
Q

Approximately what percentage of the total hemoglobin is hemoglobin F in a term fetus?

A

75%

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78
Q

This is the last stage of fetal lung development that starts late in the fetal period and continues into childhood

A

Alveolar stage

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79
Q

Biosynthesis of surfactant takes place in the?

A

Type II pneumocytes

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80
Q

Starting at what gestational age does the fetus engage in respiratory movements that are intense enough to move amniotic fluid in and out of the respiratory tract?

A

4 months

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81
Q

At what gestational age does swallowing begin?

A

10 - 12 weeks gestation

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82
Q

How much amniotic fluid do term fetuses swallow per day?

A

200 - 760 mL per day

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83
Q

This gives meconium its greenish black color

A

Biliverdin

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84
Q

Fetal kidney starts producing urine at?

A

12 weeks gestation

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85
Q

How much urine does a fetus make at term?

A

650mL per day

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86
Q

When does the fetal thyroid concentrate iodide more avidly than the maternal thyroid?

A

12 weeks gestation

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87
Q

Where is fetal immunoglobulin M (IgM) produced?

A

Fetus

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88
Q

Immunoglobulin in colostrum provides mucosal protection against enteric infections

A

IgA

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89
Q

What is uteroplacental blood flow at term?

A

700 - 900 mL/min

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90
Q

How does IgG cross the placenta?

A

Trophoblast receptor-mediated transfer

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91
Q

Average oxygen saturation of intervillous blood

A

65-75%

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92
Q

At term, what is the average PCO2 in the umbilical arteries?

A

50mmHg

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93
Q

Set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management

A

Preconceptional care

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94
Q

Preconceptional folic acid can reduce the recurrence risk of having a child with neural tube defect by what percentage?

A

72%

CNS development at embryonic period

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95
Q

Birth defects are responsible for what percentage of infant mortality?

A

20%

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96
Q

Recommended daily dose of folic acid for all women who may become pregnant

A

400mg

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97
Q

Fetal tissues most susceptible to damage by high blood phenylalanine levels

A

Cardiac and neural

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98
Q

Worldwide, what is the most common single-gene disorder?

A

Hemoglobinopathies

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99
Q

Best way to identify a genetic abnormality in a stillborn fetus

A

Chromosomal microarray analysis

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100
Q

When do B-hCG levels peak in pregnancy?

A

60-70 days after last menstrual period

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101
Q

Alcoholic mom

A

Baby with facial abnormality, fetal growth restriction, and CNS dysfunction

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102
Q

Most complete source of nutrients for pregnant woman

A

Dairy

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103
Q

Mineral least likely to be supplied in quantities sufficient for pregnancy when ingesting a normal diet

A

Iron

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104
Q

Which vitamin, when ingested in large quantities, causes a well-described constellation of birth defects

A

Vitamin A

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105
Q

Which type of fish contains a level of methylmercury LOW enough to be safe for consumption during pregnancy?

A

Salmon

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106
Q

At least how much elemental iron should be given as a supplement daily to a pregnant woman?

A

27mg

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107
Q

Maternal vit D deficiency associated with?

A

Congenital rickets

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108
Q

Air travel is not recommended after which gestational age?

A

36 weeks

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109
Q

Only vaccine with proven fetal harm

A

Smallpox

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110
Q

Recommended amount of caffeine consumption in pregnancy according to ACOG

A

<200mg per day

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111
Q

Standard error for ultrasound estimates of fetal weight after the first trimester

A

20%

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112
Q

Minimum mean sac diameter measurement necessary to diagnose an anembryonic pregnancy with certainty

A

25mm

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113
Q

Additional utz measurement should be taken in the same image that the cerebellum and cisterna magna are evaluated?

A

Nuchal fold

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114
Q

“Tear drop shape” lateral ventricle on prenatal sonography

A

Agenesis of corpus callosum

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115
Q

Caudal regression sequence is increased in what maternal medical complication?

A

Diabetes mellitus

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116
Q

Most common class of congenital anomalies

A

Cardiac

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117
Q

Primary source of amniotic fluid in late 2nd trimester

1st trimester?

A

2nd trimester - Fetal urine production
1st trimester - fetal skin, flow across amnion and flow across fetal vessel

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118
Q

Normal volume of blood flow to the gravid uterus at term

A

500ml/min

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119
Q

Tonicity:
Fetal urine is ___tonic in amniotic fluid
Fetal urine is ___tonic to maternal plasma

A

Isotonic ro amniotic fluid
Hypotonic to maternal plasma

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120
Q

Polyhydramnios in utz

A

Amniotic fluid index >25cm
Single deepest vertical pocket >8cm
Amniotic fluid index >97th percentile for gestational age

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121
Q

Fetal growth restriction with polyhydramnios is most classically associated with?

A

Trisomy 18

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122
Q

Anhydramnios or severe oligohydramnios prior to what gestational age is most likely to be associated with lethal pulmonary hypoplasia?

A

Before 20 weeks

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123
Q

Approximately how many medications do women take while pregnant?

A

2-3

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124
Q

An agent that acts during embronic or fetal development to produce a permanent alteration of form or function

A

Teratogen

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125
Q

Aminoglycoside side effect

A

Ototoxicity

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126
Q

Chloramphenicol side effect

A

Ashen-gray skin

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127
Q

Tetracycline side effect

A

Decidious teeth discoloration

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128
Q

antiviral agent associated with skull, palate, eye, skeleton, and gastrointestinal abnormalities

A

Ribavirin

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129
Q

Effects of diethylstibesterol exposure in utero

A

Hypospadias
Vaginal clear cell adenocarcinoma
Hypoplastic, T-shaped uterine cavity

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130
Q

Primary source of mercury

A

Consumption of large fish

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131
Q

First trimester warfarin exposure

A

Nasal hypoplasia

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132
Q

In what phase of cell division are oocytes arrested between birth and ovulation?

A

Prophase I

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133
Q

Fetus with multiple anomalies including hypertelorism, syndactyly, VSD and a cleft lip and palate
Placneta is small and with asymmetric growth restriction

A

Digynic triploidy

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134
Q

45,X/ 46,XX

A

Turner syndrome

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135
Q

Term that describes whether or not a dominant gene is phenotypically expressed

A

Penetrance

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136
Q

Cytogenetic karyotype is performed on chromosomes arrested in what phase of replication?

A

Metaphase

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137
Q

Elevated maternal serum alpha fetoprotein has been associated with?

A

Preeclampsia
Omphalocele
Maternal hepatoma

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138
Q

Low levels of maternal serum Estriol as part of quadruple screen —-> investigate for?

A

Smith Lemli Opitz syndrome

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139
Q

Femur ratio of <= 0.90
Suggest?

A

Increase risk for trisomy 21

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140
Q

Appropriate screening test for hemoglobinopathies in patients of African descent

A

Hemoglobin electrophoresis

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141
Q

Ashkenazi jews should be checked for?

A

Canavan disease
Familial dysautonomia
Tay sachs disease

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142
Q

Immunoglobulin subtype that may contribute to fetal hemolytic anemia

A

IgG

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143
Q

Amount of fetal erythrocytes required to sensitize a D-negative woman

A

0.1 mL

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144
Q

26yo pregnant
New onset severe headache
Generalized edema
Fetal hygroma and dx of trisomy 18
Fetal hydrops
Hypertension
4+ proteinuria
Elevated serum crea
Fetal demise - severe pokyhydramnion and placentomegaly

A

Mirror syndrome

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145
Q

Why does ABO incompatibility manifest in first-born neonates, despite the lack of prior maternal exposures?

A

Most group O women have previously been exposed to bacteria possessing A- or B-like antigens

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146
Q

Fetus with premature atrial contractions can later be found to have which arrhthmia?

A

Supraventricular tachycardia

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147
Q

Sustained fetal tachyarrythmias can lead to?

A

Hydrops

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148
Q

Agents commonly administered to women to treat fetal tachyarrythmias

A

Sotalol
Digoxin
Flecainide

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149
Q

Congenital adrenal hyperplasia is caused by what enzyme deficiency?

A

21-hydroxylase deficiency

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150
Q

Before what gestational age does maternal treatment with dexamethasone need to commence to prevent virilization of a female fetus with congenital adrenal hyperplasia?

A

9 weeks’ gestation

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151
Q

The neural damage in myelomeningocele is the result of?

A

Exposure to amniotic fluid

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152
Q

Main concern in an isolated congenital diaphragmatic hernia

A

Low lung volumes

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153
Q

Female fetus with lower urinary tract obstruction is associated with?

A

Increased likelihood for complex malformations

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154
Q

Contrainidications to vesicoamniotic shunt placement in fetus with bladder outlet obstruction

A

Female sex
Aneuploidy
Presence of renal cyst

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155
Q

Indication for in utero fetal cardiac intervention

A

Critical aortic stenosis

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156
Q

Goal of fetal aortic valvuloplasty

A

Preserve left ventricular function and prevent left hypoplastic heart syndrome

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157
Q

Goal of antepartum fetal surveillance

A

Avoid unnecessary intervention

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158
Q

Contraction stress test is for?

A

Identify uteroplacental insufficiency

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159
Q

Nonstress test is for?

A

Assess fetal condition rather than uteroplacental function
Similar ability to predict fetal well-being as contraction stress test
Time to perform a nonstress test is much shorter than a contraction stress test

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160
Q

This can assess fetal breathing

A

Cervical exam

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161
Q

% of spontaneous abortions occur within the first 12 weeks of gestation

A

80%

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162
Q

Most common chromosomal abnormality in the setting of first-trimester spontaneous abortion

A

Monosomy X (Turner syndrome)

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163
Q

Septic abortion
41c temp
78/42mmHg
Cervical motion tenderness
Generalized malaise

Tx?

A

Antibiotic against Group A streptococcus

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164
Q

Cervical insufficiency

A

Cerclage

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165
Q

Short cervix

A

Daily vaginal progesterone

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166
Q

Woman without hx of prior CS, removal of prophylactic transvaginal cerclage is recommended at

A

37 weeks gestation

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167
Q

Indication for transabdominal cerclage

A

Hx of transvaginal cerclage

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168
Q

Known risks of prophylactic cerclage

A

Bleeding
Infection
Membrane rupture

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169
Q

Medical abortion risk of failure

A

2 -17%

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170
Q

Suction curettage efficacy rate

A

96%-100%

171
Q

Least effective route of Misoprostol as a drug for cervical ripening

A

Oral

172
Q

Prophylaxis for postabortive infection

A

100mg doxycycline 1 hour prior and 200mg doxycycline after the procedure

173
Q

Risk of mifepristone exposure in pregnancy which include?

A

5% risk of fetal malformations

174
Q

Side effects of misoprostol

A

Fever and chills

175
Q

Risk of uterine rupture with medical termination of a 2nd trimester pregnancy in a setting of prior CS delivery

A

0.4%

176
Q

Among women who become pregnant while using contraception, relative number of ectopic pregnancies increased with

A

Progestin-releasing intrauterine device

177
Q

In ectopic pregnancy, the absence of which tubal tissue layer facilitates rapid invasion of proliferating trophoblasts into the muscularis

A

Submucosa

178
Q

Classic triad of clinical symptoms of an ectopic pregnancy

A

Delayed menstruation
Pain
Vaginal bleeding

179
Q

Neck and shoulder pain experienced in an ectopic pregnancy is due to

A

Diaphragmatic irritation due to hemoperitoneum

180
Q

Minimum rise of B-hCG expected in 48hr from an early progressing intrauterine pregnancy

A

53%

181
Q

What % of ectopic pregnancies demonstrate appropriately rising B-hCG levels

A

33%

182
Q

Progesterone value threshold most helpful to exclude ectopic pregnancy

A

> 25 ng/mL

183
Q

Expected findings on tv utz if the date is correct and the pregnancy is viable

A

Gestationa sac
Yolk sac
Fetal pole with cardiac motion

184
Q

Purpose of performing a dilatation and curettage prior to administering methotrexate

A

To confirm the absence of trophoblastic tissue

185
Q

MOA of methotrexate

A

Impedance of DNA and RNA synthesis

186
Q

Ectopic resolution rate following methotrexate administration

A

90%

187
Q

Single best predictor of successful treatment with single dose methotrexate

A

B-hCG

188
Q

41 yo G5P3 6-7 weeks AOG
Lower abdominal pain
Hx tubal ligation 2 years ago during her 3rd CS

Risk of this pregnancy continues

A

Placanta accreta

189
Q

Adjunctive treatment can be employed to decrease or manage complications associated with a cervical ectopic pregnancy

A

Uterine artery embolization

190
Q

This hormone is pivotal in diagnosis, management, and surveillance of gestational trophoblastic disease

A

Human Chorionic Gonadotropin

191
Q

H moles as a group are differentiated histologically from non-molar neoplasms by the presence of

A

Vili

192
Q

Pathogenesis of complete H mole

A

Androgenesis
Dispermic fertilization
Maternal chromosome inactivation

193
Q

Criteria for diagnosis of gestational trophoblastic neoplasia

A

Rise in B-hCG
Plateau of B-hCG levels
Persistence of B-hCG for 6 months or more

194
Q

Gestational trophoblastic neoplasia may develop after?

A

Evacuation of partial mole
Delivery of normal term pregnancy
Ectopic pregnancy in fallopian tube

195
Q

The most consistent finding with gestational trophoblastic neoplasia

A

Uterine bleeding

196
Q

Most characteristic feature of invasive mole

A

Penetrates deeply into myometrium

197
Q

Most characteristic of gestational choriocarcinoma

A

Commonly accompanied by ovarian theca-lutein cysts

198
Q

Most characteristic of placnetal site trophoblastic tumor

A

High proportion of free B-hCG is considered diagnostic
Best treated by hysterectomy due to chemotherapy resistance
Arise from intermediate trophoblasts at the placental site

199
Q

Clinical features of epithelioid trophoblastic tumor are most similar to?

A

Placental-site trophoblastic tumor

200
Q

Metastatic spread of choriocarcinoma thru?
Distant mets at?

A

Hematogenous
Lung

201
Q

Characteristic of amnion

A

Provides tensile strength to resist rupture of membranes

202
Q

Phase 2 of parturition

A

Uterine activation, cervical ripening

203
Q

Clinical stages of labor is which phase of parturition?

A

Phase 3

204
Q

Stage of labor where the fetus is delivered

A

Stage 2

205
Q

Cervical softening in phase 1 of parturition results in part from?

A

Increase stromal vascularity

206
Q

Primary source of corticotropin-releasing hormone in pregnancy

A

Placental

207
Q

Uterine contraction pain causes

A

Myometrial hypoxia
Uterine peritoneum stretch
Compression of nerve ganglia in yhe cervix

208
Q

After cervix is fully dilated, what is the most important force in fetal expulsion

A

Intraabdominal pressure

209
Q

Most important component of pelvic floor

A

Levator ani muscle

210
Q

What is the initial step that leads to placental separation following delivery of the infant?

A

Tension pulls it away from the implantation site

211
Q

Mechanism of placental delivery when the placenta leave the body BEFORE the retroplacental hematoma

A

Schultze mechanism

212
Q

NSAIDs (Indomethacin) targets which enzyme in prostaglandin priduction?

A

Cyclooxygenase 1

213
Q

Administering Terbutaline, a B2 adrenergic receptor agonist, causes uterine relaxation by?

A

Increased cyclic adenosine monophosphate levels

214
Q

Ovulation returns _ to _ weeks after birth

A

4 to 6 weeks

215
Q

Uterotonins in phase 3 parturition

A

Emdothelin 1
Angiotensin II
Prostaglandins

216
Q

Most common fetal lie

A

Longitudinal

217
Q

Fetus lies with the long axis transversely, what is the presenting part?

A

Shoulder

218
Q

Neck is only partly flexed with the anterior fontanel is presenting
What is the fetal attitude?

A

Sinciput

219
Q

What composes the cephalic pole?

A

Head

220
Q

Reason for high incidence of breech among hydrocephalic fetuses

A

Cephalic pole needs more room

221
Q

Incidence of breech at term

A

3%

222
Q

Leopold maneuver determines degree of fetal descent

A

4

223
Q

The term engagement refers to?

A

Biparietal diameter passing through the pelvic inlet

224
Q

Lateral deflection of the sagittal suture toward the sacral promontory

A

Anterior asynclitism

225
Q

Which portion of labor does the cervix dilate very little but the connective tissue component change considerably

A

Preparatory division

226
Q

Stage of labor where the patient reaches complete cervical dilatation through delivery of the fetus

A

Stage 2

227
Q

Prolonged 2nd stage of labor causes

A

Sedation
Macrosomia
Contracted maternal pelvis

228
Q

When the cervix becomes as thin as the adjacent lower uterine segment, what is the effacement?

A

100%

229
Q

Majority of labor dystocia is due to?

A

Asynclitism

230
Q

Lowest contraction pressure necessary to cause cervical dilatation

A

15 mmHg

231
Q

Protraction is defined as ___cm/hr cervical dilatation for a minimum of ___ hours

A

1 cm/hr
4hours

232
Q

Treshold for adequate uterine contractions

A

180 montevideo units

233
Q

Maternal risk associated with precipitous labor

A

Uterine atony

234
Q

The infant delivered with a precipitous labor is at risk of?

A

Brachial plexus palsy

235
Q

Contracted pelvic inlet

A

Transverse diameter <12cm

236
Q

Interischial tuberous diameter measurement serves as the threshold to define pelvic outlet contraction

A

8cm

237
Q

Most mentum posterior presentation will convert to mentum anterior
True or false?

A

True

238
Q

Cause of foot drop and pain after vaginal delivery

A

Prolonged 2nd stage of labor

239
Q

Most reliable portion of fetal electrocardiogram

A

R-wave peaks

240
Q

Current fetal monitors can detect

A

Separate heart rates from a twin gestation

241
Q

Fetal heart rates defines fetal bradycardia and fetal tachycardia

A

<110 and >160

242
Q

Most common cause of fetal tachycardia

A

Chorioamnionitis

243
Q

Single most reliable sign of fetal compromise

A

Reduced variability

244
Q

Frequency cycle of 2-5cycles/min

A

Sinusoidal fetal heart rate pattern

245
Q

Occuring with >=50% of conrractions in a 20min period

A

Recurrent fetal heart rate decelerations

246
Q

Deceleration that begins after the peak of contraction and returns to baseline after the contraction ends

A

Late

247
Q

Physiologic event results in compensatory rise in fetal heart rate during a variable deceleration

A

Occlusion of the umbilical vein

248
Q

Itching and incisional discomfort post CS
Give?

A

Nalbuphine

249
Q

Primary and most important reason for administering epidural test dose

A

Rule out intravenous catheter placement

250
Q

Local anesthetic associated with both neurotoxicity and cardiotoxicity at similar serum drug levels

A

Bupivacaine

251
Q

Level of blockade desired with spinal anesthesia for cesarean delivery

A

T4

252
Q

Vassopressor associated with fetal acidemia when used in OB anesthesia setting

A

Ephedrine

253
Q

Most common complication associated with epidural anesthesia

A

Hypotension

254
Q

Which pulmonary lobe most often onvolved in aspirationas a complication of general anesthesia

A

Right lower lobe

255
Q

Nerve primarily involved with pain associated with perineal stretching

A

Pudendal

256
Q

Direct cause of most maternal deaths involving regional anesthesia

A

High spinal blockade

257
Q

FDA approved peptic ulcer prevention

A

Misoprostol

258
Q

Half-life of oxytocin
Onset of action?

A

3 minutes
Onset is 1min

259
Q

Oxytocin’s similarity to arginine vasopressin accounts for which unwanted side effect?

A

Water intoxication

260
Q

Benefit of membrane stripping at term

A

Reduced incidence of postterm pregnancy

261
Q

Most common position for vaginal delivery is?

A

Knee-chest

262
Q

Benefits of delayed cord clamping in preterm infants

A

Decrese IVH
Decrease NEC
Decrease need for blood transfusion

263
Q

Risk of delayed cord clamping

A

Increased hyperbilirubinemia

264
Q

Occiput transverse position of the fetal head in the maternal pelvis

A

Easiest way to rotate is manually
Can be rotated with Kielland forceps
Seen with android pelvises

265
Q

Persistent occiput posterior

A

2-10% of cephalic fetuses deliver in the OP position
Increased blood loss compared to occiput anterior
More 3rd or 4th degree lacerations compared to occiput anterior position

266
Q

Most common maneuver used to reduce a shoulder dystocia

A

Suprapubic pressure

267
Q

Water birth

A

Lower rate of anesthesia block!

268
Q

Genital mutilation types

A

Type 1 - partial or total removal of clitoris and/or prepuce
Type 2 - partial or total removal of clitoris AND LABIA MINORA
Type 3 - partial or total removal of LABIA MINORA and/or MAJORA and INFIBULATION W/ or W/O clitoridectomy

269
Q

Indication for episiotomy

A

Breech
Shoulder dystocia
Persistent occiput posterior position

270
Q

Uterine atony
Tx?

A

Intramuscular methylergonovine

271
Q

Among singleton pregnancies, breech presentation persists in what percentage at term?

A

3-5%

272
Q

Risk factors for breech presentation

A

Prior breech fetus

273
Q

Best indicator of pelvic adequacy for vaginal breech delivery

A

Steady cervical dilatationand progressive descent of station with contractions

274
Q

The index and middle fibger of one hand are applied over the maxilla to flex the head while the fetal body rests on the palm of the same hand with legs straddling the forearm

A

Mariceau maneuver

275
Q

Process by which a frank breech fetus is manually converted to a footling breech presentation within the uterus during a cesarean or vaginal delivery

A

Decomposition

276
Q

Most adequate method of pain management for planned vaginal delivery of a breech fetus

A

Epidural anesthesia

277
Q

External cephalic version (breech to cephalic)

A

Recommended if possible
MOXIBUSTION is an alternative medicine technique that she could consider

278
Q

Absolute contrainidication of externa cephalic version

A

Twin gestation

279
Q

External cephalic version success is improved with

A

Acute tocolysis

280
Q

Internal podalic version

A

Manipulation within the uterus to yield a breech presentation, typically reserved for delivery of a second twin

281
Q

Risk factor for urinary retention

A

Episiotomy

282
Q

Interventions which may reduce maternal perineal wall laceration during a forceps assisted vaginal delivery

A

Early disartuculation
Mediolateral episiotomy
Cessation of pushing during disarticulation

283
Q

Subgaleal henorrhage is seen more frequently with what delivery route?

A

Vacuum extraction

284
Q

In the setting of an occiput posterior position, correctly placed blades are equidistant from what landmark?

A

Midline of face and brow

285
Q

How is asynclitism resolved after placement of forceps?

A

Pulling and/or pushing each branch along the long axis

286
Q

Forces produced by a forceps-assisted vaginal delivery

A

Friction
Traction
Compression

287
Q

Action necessary to rotate a fetus from an occiput posterior to an occiput anterior position

A

Flexion of fetal head

288
Q

Pelvic type generally associated with persistent occipuy posterior position

A

Anthropoid

289
Q

Best forceps used to attempt rotation from occiput anterior to occiput posterior

A

Piper

290
Q

Least common indication of primary cesarean delivery

A

Placenta previa

291
Q

Most inappropriate indication for primary cesarean delivery

A

Early-onset severe preeclampsia

292
Q

Vertical midline incision compared to transverse skin incision

A

Decreased risk of neuropathy
Greater ease with wound care
Decreased risk of subfascial hematoma

293
Q

Usual tolerated blood loss volume without hemodynamic compromise

A

2000 mL

294
Q

Emergent repeat cesarean delivery has these risks/ complications compared to planned procedure

A

Bladder injury
Ureteral injury
Blood transfusion

295
Q

Potential indication for a classical hysterotomy

A

Maternal morbid obesity
Densely adherent bladder
Back-down transverse fetal lie

296
Q

Benefit of using monofilament suture vs braided suture (vicryl)

A

Decreased risk of infection

297
Q

Potential advantage of closure of of parietal peritoneum prior to closure of fascia at the time of cesarean delivery

A

Avoidance of distended bowel at the time of fascial closure

298
Q

Intervention most likely to decrease adhesion formation at the time of cesarean delivery

A

Achieving hemostasis

299
Q

Disadvantage of uterine exteriorization for repair of hysterotomy

A

Increased nausea and vomiting

300
Q

Compared to manual extraction, spontaneous delivery of the placenta with fundal massage has shown to reduce the risk of?

A

Postpartum infection

301
Q

During CS, a hysterotomy is made in the lower uterine segment. What setting should the incision be made relatively higher on the uterus to avoid uterine vessel laceration or unintended entry into the vagina

A

A completely dilated cervix

302
Q

Use of scissors for sharp extension instead of blunt extension has been associated with

A

Blood loss
Operative time
Unintended extensions

303
Q

Failure to recognize dextrorotation of uterus prior to hysterotomy increases the risk of damage to?

A

Left uterine artery

304
Q

Benefits of low transverse uterine incision compared to classical incision

A

Ease of closure
Less likely to rupture in subsequent pregnancies
Lower risk of incisional adhesions to bowel or omentum

305
Q

The first fascial layer incised in Pfannensteil incision

A

External oblique

306
Q

Benefits of pfannenstiel incision vs vertical midline incision

A

Less operative pain
Improved cosmetic result
Less risk of incisional hernia

307
Q

When performing Pfannentiel skin incision, which vessel should be anticipated halfway between the skin and fascia, several cm from the midline?

A

Superficial epigastrics

308
Q

To reduce postop morbidity, ACOG recommends antibiotic prophylaxis to be given within how many mins prior to skin incicsion?

A

60mins

309
Q

Recommendation for antibiotic prophylaxis at cesarean delivery for women with significant penicillin allergu include a single dose of which agent?

A

Gentamycin + Clindamycin

310
Q

Although not recommended by ACOG, elective CS on maternal request should only be considered when?

A

The pregnancy has reached at least 39 completed weeks

311
Q

Ridk factor for urinary retention after cesarean delivery

A

Postoperative narcotic analgesia

312
Q

Suture most appropriate for repair of bladder mucosa and muscularis layer

A

3.0 vicryl

313
Q

Circumstances with increased risk of unintentional cystostomy

A

Hx of prior CS delivery
Need for emergent CS delivery
CS delivery in the 2nd stage of labor

314
Q

Most closely approximates the risk of ureteral injury at the time of cesarean delivery

A

1 in 3000

315
Q

Cesarean hysterectomy increases the risk of?

A

Urinary tract damage

316
Q

Benefits of Vertical midline incision compared to transverse skin incision

A

Decreased risk of neuropathy
Greater ease with wound care
Decreased risk of subfascial hematoma

317
Q

No prenatal visit
In active labor
Refuse all blood products due to religion
What will you do?

A

Proactive administration of uterotonics if atony occurs

318
Q

Maternal obstetrical complication increased in cesarean delivery compared to vaginal delivery

A

Infection
Hemorrhage
The
Thromboembolism

319
Q

Adverse neonatal outcome that may occur in CS delivery

A

Respiratory distress syndrome

320
Q

Pelvic shape predisposed to occiput transverse position

A

Platypelloid and Android

321
Q

Maneuver that involves replacement of the fetal head into the pelvis folled by cesarean delivery

A

Zavanelli maneuver

322
Q

Cutting the clavicle with scissors or other sharp instrument. Done for dead fetus

A

Cleidotomy

323
Q

Major function of human placental lactogen

A

To induce lipolysis and protein synthesis leading to a constant nutrient supply to the fetus

324
Q

Elevated maternal serum Alpha fetoprotein suggests?

A

Neural tube defects
Spina bifida
Meningomyelocele
Anencephaly
Gastroschisis or omphalocele
Previa or accreta

325
Q

Increased incidence of myelomeningocele is associated with which medication?

A

Valproic acid

326
Q

Risks of amniocentesis

A

Pregnancy loss
Chorioamnionitis
Fetal injury with needle
Maternal infection
Alloimmunization of an Rh-negative woman carrying an Rh-positive fetus
Premature rupture of membrane

327
Q

Classic findings of Down syndrome on obstetric ultrasound are?

A

AV canal and Pyloric stenosis

328
Q

Paternal nondysjunction sex chromosomal abnormalities are

A

Turner syndrome 45,XO
Klinefeltet syndrome 47,XXY

329
Q

Decreased level of maternal serum alpha fetoprotein may be seen in

A

Down syndrome

330
Q

Lithium in pregnancy

A

Ebstein anomaly - displacement of tricuspid valve

331
Q

Fluxetine ond several other SSRIs

A

Increase in fetal cardiac anomaly

332
Q

Low dose aspirin

A

Slightly reduce the risk of preeclampsia

333
Q

Most favorable fetal presentation and position to achieve a vaginal delivery

A

Vertex with occiput anterior

334
Q

2nd degree laceration

A

Extends ito the perineal body, but does not involve the anal sphincter

335
Q

First degree laceration

A

Mucosa or skin only

336
Q

4th degree laceration

A

Can be button-hole
Rectal mucosa is torn but sphincter is intact

337
Q

Used to ripen cervix if Bishop score is greater than 5

A

Oxytocin

338
Q

Used to ripen the cervix if the Bishop score is less than 5

A

Prostaglandin E2 gel or
PGE2 pessary (cervidil) or
PGE1M (misoprostol)

339
Q

Maternal contraindications for the use of prostaglandins

A

Asthma
Glaucoma

340
Q

Obstetric contraindications for the use of prostaglandins

A

Prior cesarean section
Non reassuring fetal testing

341
Q

A device to measure the pressure changes during contractions and can evaluate the adequacy of contractions

A

Intrauterine pressure catheter (IUPC)

342
Q

Device that can directly monitor fetal heart rate and variability

A

Fetal scalp electrode

343
Q

Absolute contraindication of TOLAC (trial of labor after cesarean)

A

Prior classical hysterotomy or other vertical uterine incision —–> uterine rupture

344
Q

MOA of Magnesium sulfate

A

Antagonizes calcium and stabilizes cell membranes

345
Q

MOA of terbutaline

A

Increase conversion of ATP to cAMP, which results i. Decrease levels of free calcium ions through sequestration in the sarcoplasmic reticulum

346
Q

MOA of Indomethacin

A

Blocks cyclooxigenase and decreases levels of prostaglandins

347
Q

Side effects of Magnesium sulfate

A

Flushing
Diplopia
Headache

348
Q

Most effective test to monitor patients for magnesium toxicity

A

Serial deep tendon reflex (DTR) exam

Mg <10mg/dL –lost DTR
Mg >10mg/dL – respiratory depression, hypoxia and cardiac arrest

349
Q

Maneuver that involves pressure on either fetal shoulder to diminish the biacromial diameter in effort to free the anterior shoulder and allow delivery of fetus

A

Rubin maneuver

350
Q

Least invasive maneuver where the maternal hips is flexed increasing the size of pelvic outlet

A

Mcrobert maneuver

351
Q

Placing a hand behind either the anterior or posterior fetal shoulder and rotating the fetus in 180deg to lead to descent and delivery of shoulders

A

Wood’s cork maneuver

352
Q

Involves replacement of the fetal head by reversing the cardinal movements of labor

A

Zavanelli maneuver

353
Q

Sequela to toxoplasmosis infection

A

IUGR
Microcephaly
Choriretinitis
Intracranial calcification
Hearing loss
Mental retardation
Hepatosplenomegaly
Ascites
Periventricular calcification
Ventriculomegaly
Seizures

354
Q

Sequela of rubella infection

A

Fetal growth retardation
Sensorineural hearing loss
Cardiac lesions
Eye defects
= seen in first 12 weeks of gestation

355
Q

Effects of CMV infection in fetus

A

Mental retardation
Microcephaly
Chorioretinits
Cerebral calcifications

MOST COMMON CONGENITAL INFECTION IN PREGNANCY

356
Q

Congenital herpes results to

A

Growth restrictions
Eye disease
Microcephaly
Hydraencephaly

357
Q

Tobacco abuse causes

A

IUGR

358
Q

Cleavage between 3 and 8 days and occurs after placental differentiation occured but prior to amnion formation

A

Monochorionic - diamniotic twinning

359
Q

Cleavage during the first 2 to 3 days and occurs before cells are differentiated to form throphoblast

A

Dichorionic-diamniotic twins

360
Q

Embryo cleavage between days 8 and 13 again occurs after differentiation of trophoblast but after formation of amnion

A

Monochorionic - monoamniotic gestation

361
Q

After day 15 of development

A

Singleton pregnancy

362
Q

Hypertension that is present before pregnancy, sustained hypertension before 20 weeks’ gestation, ot hypertension persisting fpr more than 6 weeks postpartum

A

Chronic hypertension

363
Q

Mayernal blood screening test that looks at levels of AFP, B-hCG, estradiol and Inhibin A to assess the probability of potential genetic abnormalities

Done in 2nd trim (bet 15 and 18 weeks)

A

Quad screen

364
Q

Severe criteria pre eclampsia blood pressure

A

SBP >160 mmHg or DBP > 110mmHg

365
Q

Asymptomatic bacteriuria may cause?

A

Pre-term birth
Low birth weight infant

366
Q

Side effect of CIPROFLOXACIN in pregnancy

A

Renal anomalies in fetus (1st trim exposure)

367
Q

Factors that may lead to oligohydramnios

A

Chromosomal abnormalities
Uteroplacental insufficiency
Hypertension
Postterm pregnancy
Twin-twin transfusion syndrome

368
Q

DOC for asymptomatic bacteriuria

A

Cephalosporin (cefazolin, cedotetan, or ceftri)
Or
Ampicillin and gentamicin

10 tp 14 days of combine IV and oral

369
Q

Criteria of Chorioamnionitis

A

Maternal fever >38deg C
And at least 2:
- elevated wbc
- maternal tachycardia
- uterine tenderness
- fetal tachycardia
- foul smelling amniotic fluid

370
Q

Gold standard of dx of chorioamnionitis

A

Culture of amniotic fluid (amniocentesis)

371
Q

Most common cause of chorioamnionitis

A

Polymicrobial infection of rectovaginal organism

372
Q

Most concerning complications of pyelonephritis

A

Acute respiratory distress syndrome (ARDS)

373
Q

Most common precursor of neonatal sepsis which has a high rate of fetal mortality

A

Chorioamnionitis

374
Q

1st trimester infection of parvovirus b19

A

Miscarriage

375
Q

Midtrimester infection of parvovirus B19

A

Fetal anemia and hydrops

376
Q

How do parvovirus cause fetal anemia?

A

Bone marrow suppression

377
Q

When to start antiretroviral (HAART) Therapy in pregnant women with HIV

A

2nd trimester

—– ideally, CS
—– no breastfeeding!

378
Q

Most common cause of bloody nipple discharge
(-) mass

A

Benign intraductal papilloma

379
Q

Solitary, mobile, non painful, rubbery breast mass
Dx?

A

Fibroadenoma

380
Q

Multiple, painful, bilateral, and fluctuate throughout the menstrual cycle

A

Fibrocystic breast change

381
Q

Firm, fixed breast mass

A

Invasive breast cancer

382
Q

Breast mass
Epithelial and stromal proliferation
Fibroadenoma
With scattered maligmamt cells

A

Cystosarcoma phyllodes

383
Q

2nd most common cause of bloody nipple discharge

A

Invasive papillary carcinoma

384
Q

ER+ PR+
Tx?

A

Aromatase inhibitor (LETROZOLE) with hormone receptor positive cancers

385
Q

First line hormone therapy for premenopausal women

A

Tamoxifen

386
Q

Monoclonal antibody for adjuvant treatment in tumors that are HER2/neu positive

A

Trastuzumab

387
Q

Most reliable predictor of all breast cancer survival is

A

Stage of breast cancer at the time of diagnosis

388
Q

+ PT
Vaginal bleeding
Closed cervix
B-hcg = 1,000,000 mIU/mL

Dx? Next step? Tx of choice?

A

Gestational trophoblastic disease
Complete pelvic utz
Suction curettage

389
Q

Intrauterine fetus
Marked thickening and cystic formation within the plancenta
Significant increased serum B-hcg

A

Incomplete (partial) molar pregnancy

390
Q

Profuse vaginal bleeding
Solid intrauterine mass
Serum B-hCG = 220mlU/mL
Dx?

A

Placantal site Trophoblastic tumor
Serum marker = human placental lactogen
Tx of choice = hysterectomy

391
Q

FIGO staging

A

Stage 1 - persistently elevated serum B-hcg with tumor confined to the uterus
Stage 2 - tunor outside uterus but limited to vaginal and or pelvis
Stage 3 - pulmo mets with or without uterine, vaginal or pelvic tumor mets
Stage 4 - all other mets (brain, liver, kidney and GI tract)

392
Q

Ascites
Hydrothorax
Ovarian fibromas and other pelvic tumor

A

Meigs syndrome

393
Q

Profuse watery discharge (hydrops tubar profluens)
Pelvic pain
Pelvic mass

A

Latzko’s triad

394
Q

Spontaneous or pressure induced release of watery or blood-tinged vaginal discharge resulting in shrinkage of pelvic mass
Fallopian tube tumors

A

Hydrops tubae profluens

395
Q

Hypertension
Obesity
Insulin resistance or NIDDM
Hypertriglyceridemia
Increased peripheral vascular disease
Elevated catecholamines

A

Syndrome X or metabolic syndrome

396
Q

Pathognemonic of granulosa cell tumors

A

Call-exner bodies (microcluster arrangement)

397
Q

Most common type of germ cell tumor

A

Dysgerminoma

398
Q

Most common chemotherapeutic regime following treatment for epithelial ovarian cancer

A

Carboplatin and Taxol

399
Q

Most common mullerian anomaly due to malfusion of paramesonephric (mullerian) ducts

A

Septate uterus

400
Q

Patients with septate uterus high risk of?

A

Recurrent first trimester pregnancy loss

401
Q

Typical pubertal sequence

A

Accelerated growth
Thelarche
Pubarche
Menarche

402
Q

Blood test that would confirm diagnosis of menopause

A

FSH

403
Q

Only indication for Hormone Replacement Therapy (HRT)

A

Cardiovascular disease prevention

404
Q

Hallmarks of adenomyosis

A

Menorrhagia and dysmenorrhea

405
Q

Risk factor of endometrial CA

A

Obesity
Nulliparity
Early menarche
Late menopause
Family hx
Lynch syndrome II
Exogenous estrogen or Tamoxifen use

Protective: hx of oral contraceptives and multiparity

406
Q

Risk factors of Ovarian CA

A

BRCA 1 mutation
Early menarche
Late menopause
Nulliparity
Family hx

Protective: OCP use (also protective in breast CA)

407
Q

Most common presenting symptom of patient w/ cervical cancer

A

Abnormal vaginal bleeding

408
Q

MC clinical condition associated with development of endometrial hyperplasia

A

Polycystic ovarian syndrome

409
Q

Hereditary predisposition to the development of colon, breast and endometrial cancer

A

Type II Lynch syndrome

410
Q

Benign inclusion cyst created in fallopian tube by invagination of tubal serosa

A

Walthard nest

411
Q

Tumor marker useful in follow up of tubal serous carcinomas

A

CA-125

412
Q

MC primary malignant neoplasm of fallopian tubes

A

Papillary serous adenocarcinoma

413
Q

Standartd tx for tubal carcinoma

A

TAH/BSO - aggressive cytoreductive surgery and chemotherapy

414
Q

Lymphatic drainage of fallopian tube

A

Para-aortic lymph nodes

415
Q

MC location on the vulva to find adenoid cystic carcinoma

A

Bartholin’s gland

416
Q

Single most important prognostic factor in woman with vulvar cancer

A

Lymph node metastasis

417
Q

Vaginal tumor presents as mass of grape-like nodules most commonly in first 2 years of life

A

Embryonal rhabdomyosarcoma (sarcoma botryoides)

418
Q

MC location of primary vaginal carcinoma (squamous cell) lesion

A

Upper 3rd and posterior wall of vagina

419
Q

Risk factor of PID

A

Age <20yo
Multiple sex partner
Nulliparity
Prev hx of PID

420
Q

Risk factor of PID

A

Age <20yo
Multiple sex partner
Nulliparity
Prev hx of PID

421
Q

Pt with uterus larger than expected from hx of gestation
Vaginal bleeding
Passes grape-like tissue from the vagina
Dx?

A

Hydatifldiform mole

422
Q

Chocolate cysts

A

Endometriomas (cystic form of endometriosis on the ovary)

423
Q

Risk factor of vulvar carcinoma

A

Older age
Smoking
Prev Squamous cell CA of cervix/vagina
Chronic vulvar dystrophy
Immunocompromised

424
Q

MC organism causes pelvic inflammatory disease

A

N. gonorrhea and chlamydia

BOARD REVIEW (19 decks)

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