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GAS > OBSTETRICS AND GYNECOLOGY > Flashcards

OBSTETRICS AND GYNECOLOGY Flashcards

1
Q

Bayi 4C (cephalus (hidro), chorioretinitis, cerebral calcification, convulsi)

A

TOKSOPLASMOSIS KONGENITAL

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2
Q

Bayi katarak, tuli sensorineural, PDA

A

RUBELLA KONGENITAL

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3
Q

Bayi cephalus (mikro), Chorioretinitis, cerebral calcification

A

CMV KONGENITAL

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4
Q

Bayi infeksi multipel, SSP, multipel organ

A

HSV KONGENITAL

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5
Q

Hamil, ≥1: Mual muntah sangat hebat, BB turun, ketonuria/dehidrasi/ensefalopati

A

HIPEREMESIS GRAVIDARUM

Nutrisi + istirahat, doksilamin 1x 10mg + vit B6 4x 10mg; multivitamin + dimenhidrinat 4x 50-100mg / prometazin 3-4x 5-10mg

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6
Q

Klasifikasi Hiperemesis Gravidarum

A

I: penurunan kesadaran (-), keton (-), dehidrasi (+)
II: penurunan kesadaran (-), keton (+), dehidrasi (++)
III: penurunan kesadaran (+), keton (+), dehidrasi (+++)

I = dehidrasi, II = keton, III = penurunan kesadaran

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7
Q

Tatalaksana Hipertensi Pada Kehamilan

A

EKSPEKTATIF: rajal + observasi perburukan menjadi gambaran berat, lab @2wk, aspirin preventif 1x 75mg hingga partus (GAMBARAN RINGAN); RANAP, MgSO4 4g 40% dalam akuades 10cc IV bolus 15-20m lalu 6g 40% dalam RL 500cc IV maintenance 28tpm 6h + NIFEDIPIN PO 10mg @15-30m max 30mg / nikardipin IV 5mg/h uptitrasi 2.5mg/h @5m max 10mg/h lalu nilai distres maternal/fetal. Jika ada LANGSUNG TERMINASI, jika tidak ada lihat usia gestasi, <24wk aborsi, 24-<34wk pertahankan/deksametason 2x 6mg IM 2d, ≥34wk terminasi (GAMBARAN BERAT). Metildopa 2x 250mg PO (GS KHUSUS HT KRONIS). Definitif tetap TERMINASI. Target BP 160/110, syarat MgSO4: refleks patela (+), ada ca glukonas, RR>16, UO>0.5/cc/kg/h. Ca glukonas 10mL 10% IV bolus 10m (antidotum MgSO4)

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8
Q

> 20wk: HT I + proteinuria >300mg/1+/d

A

PREEKLAMPSIA RINGAN

Tatalaksana Hipertensi Pada Kehamilan

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9
Q

> 20wk: HT II + proteinuria >2g/>2+/d / organ damage (PLT<100, Sc>1.1, LFT>2x, edema paru, stroke/pandangan kabur, oligohidramnion/IUGR)

A

PREEKLAMPSIA BERAT

Tatalaksana Hipertensi Pada Kehamilan

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10
Q

> 20wk: HT, riwayat HT (-)

A

HIPERTENSI GESTASIONAL

Tatalaksana Hipertensi Pada Kehamilan

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11
Q

<20wk: HT + proteinuria >300mg/d

A

SUPERIMPOSED PREEKLAMPSIA

Tatalaksana Hipertensi Pada Kehamilan

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12
Q

<20wk / sebelum hamil / >12 mgg postpartum: HT

A

HIPERTENSI KRONIS

Tatalaksana Hipertensi Pada Kehamilan

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13
Q

Preeklampsia + kejang

A

EKLAMPSIA

Tatalaksana Hipertensi Pada Kehamilan

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14
Q

DM Onset baru, TFU>UK, GDP >92 / TTGO >180/1 jam / >153/2 jam

A

DM GESTASIONAL

Lifestyle; insulin 0.5-1.5IU/kg/d

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15
Q

Air pervaginam, impartu (-), Nitrazine test (+) lakmus biru, mikroskopis fern test (+), oligohidramnion (+)
1. UK 24-<34 wk
2. UK 34-<37 wk
3. UK ≥37 wk

A

KETUBAN PECAH DINI
1. KPD SANGAT PRETERM
2. PPROM
3. PROM

Ampisilin 4x 2g IV + eritromisin 4x 250mg IV, konseling/terminasi (<24wk), persalinan dengan oksitosin (24-<34wk), persalinan dengan oksitosin (≥34wk)

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16
Q

KPD, demam, leukositosis >15rb, HR ibu >100, DJJ >160, amnion berbau

A

KORIOAMNIONITIS

TERMINASI KEHAMILAN, ampisilin 4x 2g IV + gentamisin 5mg/kg IV

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17
Q

Subpubic angle <90, konjugata diagonal <12.5, jarak linea interspinosum <10, linea terminalis teraba

A

CEPHALOPELVIC DISPROPORTION (CPD)

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18
Q

Kala II panjang, turtle sign (+)

A

DISTOSIA BAHU

ALARMER: ask for help; lift legs/butt (McRoberts: hiperfleksi kaki); anterior disimpaction of shoulder (Massanti: tekan suprapubik, Rubin: rotasi bahu); rotation of posterior shoulder (Wood: rotasi corkscrew); Manual removal of posterior arm (Schwartz); episiotomy; roll over (Gaskin: ibu posisi merangkak)

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19
Q

Tali pusat dibawah terendah janin, selaput ketuban (+)

A

TALI PUSAT TERKEMUKA

Lahirkan (pulsasi pusat (-)), O2 4-6lpm + knee chest + tokolitik, rujuk (pulsasi pusat (+))

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20
Q

Tali pusat tembus hingga vagina, selaput ketuban (-)

A

TALI PUSAT MENUMBUNG

Lahirkan (pulsasi pusat (-)), O2 4-6lpm + knee chest + tokolitik, rujuk (pulsasi pusat (+))

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21
Q

Tali pusat disamping janin, VT tidak teraba

A

OCCULT PROLAPSE

Lahirkan (pulsasi pusat (-)), O2 4-6lpm + knee chest + tokolitik, rujuk (pulsasi pusat (+))

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22
Q

Pendarahan UK<20wk, Porsio tertutup, jaringan (-), DJJ (+), TFU = UK, nyeri/darah minim

A

ABORTUS IMINENS

OBSERVASI, USG setiap bulan

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23
Q

Pendarahan UK<20wk, Porsio terbuka, jaringan (-), DJJ (±), TFU = UK, nyeri/darah banyak

A

ABORTUS INSIPIENS

ASPIRASI VAKUM MANUAL; ergometrin 0.2mg/5m IM / misoprostol 400mcg PO (UK<16), oksitosin 40 IU NaCl 0.9% (UK>16)

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24
Q

Pendarahan UK<20wk, Porsio terbuka, jaringan (+), DJJ (-), TFU < UK, nyeri/darah banyak

A

ABORTUS INKOMPLIT

Jari/forsep manual (UK<16, ringan), ASPIRASI VAKUM MANUAL; kuretase, ergometrin 0.2mg/15m IM / misoprostol 400mcg PO (UK<16, berat), oksitosin 40 IU NaCl 0.9% (UK>16)

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25
Q

Pendarahan UK<20wk, Porsio tertutup, jaringan (-), DJJ (-), TFU < UK, nyeri/darah minim

A

ABORTUS KOMPLIT

OBSERVASI Hb/klinis, sulfas ferosus 1x 600mg/d (Hb>7), transfusi (Hb<7)

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26
Q

Pendarahan UK<20wk, Porsio tertutup, jaringan (-), DJJ (-), TFU < UK, nyeri/darah minim

A

MISSED ABORTION

ASPIRASI VAKUM MANUAL/kuretase (UK<12), pastikan serviks terbuka lalu kuretase (UK<16), pastikan serviks terbuka lalu oksitosin 40 IU NaCl 0.9% (UK<22)

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27
Q

Pendarahan UK < 20wk, frekuensi >3x

A

ABORTUS HABITUALIS

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28
Q

Pendarahan UK<20wk, Tanda sepsis (+)

A

ABORTUS SEPTIK

Stabilisasi, ampisilin 4x 2g IV, gentamisin 5mg/kg/d IV, metronidazole 3x 500mg IV, kuretase/aspirasi vakum manual

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29
Q

Pendarahan UK < 20wk, jaringan anggur, Janin (-), diffuse snowstorm appearance, hCG >100rb

A

MOLA HIDATIDOSA KOMPLIT

Aspirasi vakum manual

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30
Q

Pendarahan UK < 20wk, jaringan anggur, Janin (+), focal honeycomb appearance, hCG >100rb

A

MOLA HIDATIDOSA INKOMPLIT

Aspirasi vakum manual

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31
Q

Pendarahan UK<20wk, hCG (+), nyeri goyang portio (+) / chandelier sign (+), RT cavum douglas menonjol, hipovolemia

A

KET

Resusitasi cairan, laparotomi eksplorasi (salpingostomi/ektomi)

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32
Q

Pendarahan UK<20wk, gestational sac (-)

A

BLIGHTED OVUM

Observasi/simtomatis; kuretase

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33
Q

Pendarahan UK ≥20wk, darah merah terang, nyeri perut (-), fetal distress (-), plasenta menutup OUI

A

PLASENTA PREVIA

Observasi/ekspektan: deksametason, tokolitik jika kontraksi (<37wk stabil), terminasi SC elektif jika parsial/total / pervaginam jika letak rendah/marginal (≥37wk stabil), SC cito (distres maternal/fetal/pendarahan aktif)

34
Q

Klasifikasi Plasenta Previa

A
  1. LETAK RENDAH: belum menutup OUI
  2. MARGINAL: di tepi OUI
  3. PARSIAL: menutupi sebagian OUI
  4. TOTAL: menutupi penuh OUI
35
Q

Pendarahan UK ≥20wk, Nyeri perut (+), bandl ring (-), fetal distress (+), hematoma retroplasental, darah merah gelap

A

SOLUSIO PLASENTA

Ekspektan/konservatif (<34wk stabil), terminasi (fetal/maternal distres/≥34wk)

36
Q

Pendarahan UK ≥20wk,Nyeri perut (-), fetal distress (+), pembuluh janin di bag terbawah apt test/kleihauer test (+) pink, darah segar setelah ruptur ketuban

A

VASA PREVIA

1 Plasenta: VELAMENTOSA
2 Plasenta: BILOBUS/SUCCENTURIAT

SC cito

37
Q

Pendarahan UK ≥20wk, Nyeri perut (+), bandl ring (+), fetal distress (+), pendarahan intraperitoneal, rw trauma/LMR

A

RUPTUR UTERI

Stabilisasi, ampisilin 2g IV SD, LAPAROTOMI EKSPLORASI (HISTERORAFI/EKTOMI)

38
Q

Pendarahan postpartum, kontraksi uterus lemah, lembek (+)

A

ATONIA UTERI

Stabilisasi (trendelenburg, IV, O2), plasenta lahir lengkap, masase fundus, oksitosin 40IU dalam 1L kristaloid/ergometrin 0.2mg IM/as traneksamat 1g IV/karboprost/misoprostol, kompresi bimanual internal, kompresi bimanual eksterna, kompresi aorta abdominal, ligasi arteri/ransel-B lynch/histerektomi

39
Q

Pendarahan postpartum, plasenta tertahan >30m, USG swiss cheese (+)

A

RETENSIO PLASENTA

Oksitosin 20-40IU dalam 1L NaCl 0.9%/RL 60tpm + 10IU IM + penegangan pusat terkendali; manual plasenta + ampisilin 2g IV SD + metronidazole 500mg IV; kuretase

40
Q

Klasifikasi Retensio Plasenta

A
  1. AKRETA: menembus endometrium
  2. INKRETA: memembus miometrium
  3. PERKRETA: menembus perimetrium/serosa
41
Q

Pendarahan postpartum, plasenta tertinggal, subinvolusio uteri

A

SISA PLASENTA

Oksitosin 20-40IU dalam 1L NaCl 0.9%/RL 60tpm + 10IU IM (awal), eksplorasi digitalis

42
Q

Pendarahan postpartum, laserasi perineum

A

RUPTUR PERINEUM

43
Q

Klasifikasi Ruptur Perineum

A

I: kulit perineum
II: otot perineum
III: otot sfingter ani
- A: <50% externa
- B: >50% externa
- C: externa + interna
IV: gr III + epitel anus

Konservatif (I), jahit (II), rujuk (III dan IV)

44
Q

Pendarahan postpartum, Endometrium melorot melalui serviks, penarikan pusat terlalu kuat, fundus (-) teraba

A

INVERSIO UTERI

Stabilisasi, reposisi/reduksi manual

45
Q

Postpartum, Demam (+), nyeri perut bawah, lokia berbau/purulen (+), subinvolusio uteri

A

ENDOMETRITIS

Ampisilin 4x 2g + gentamisin 1x 5mg/kg + metronidazole 3x 500mg @IV

46
Q

Dismenor hebat, dispareunia, diskezia, disuria, infertilitas, USG ground glass (+) luar cavum uteri

A

ENDOMETRIOSIS

NSAID, pil KB

47
Q

≥20wk, spalding sign (+) tengkorak tumpang tindih, naujokes sign (+) punggung melengkung, ball sign (+) hiperfleksi vertebra, gerhard sign (+) hiperekstensi kepala, robert sign (+) udara jantung/BV, DJJ (-), gerakan janin (-)

A

KEMATIAN JANIN DALAM RAHIM (KJDR) / STILLBIRTH

Ekspektatif, kuretase (<15wk), oksitosin IV 1-2IU/m uptitrasi 1-2IU/m @30m

48
Q

TFU<UK (diff ≥3), Janin <10 persentil, DJJ (+), AFI<5
1. T1, genetika, kepala:abdomen normal
2. T2-3, HT/DM/malnutrisi, kepala:abdomen tinggi

A

IUGR
1. TIPE I
2. TIPE II

FU, suportif

49
Q

TFU<UK, janin teraba jelas, AFI<5, SDP<2, komp renal (agenesis, BOO)

A

OLIGOHIDRAMNION

Amnioinfusion

50
Q

TFU>UK, balotemen >1, DJJ >1, lambda sign (+), T sign (+)

A

GEMELI

Suportif, pervaginam (vertex/bokong), SC (lintang)

51
Q

TFU>UK, janin sulit diraba, AFI>24, SDP>8, komp neurologi (spina bifida, anensefali), GI (atresia saluran cerna)

A

POLIHIDRAMNION

Amniocentesis

52
Q

TIPE GEMELI

A

1 plasenta, 1 amnion, komp terlilit pusat: MONOKORIONIK MONOAMNIOTIK
1 plasenta, 2 amnion, T sign (+), komp twin-twin syndrome: MONOKORIONIK DIAMNIOTIK
2 plasenta, 2 amnion, twin peak sign/lambda sign (+): DIKORIONIK DIAMNIOTIK

53
Q

Nyeri (-), puting terbenam (+), massa (-)

A

INVERTED NIPPLE

Manual (I); spuit (II), pembedahan (III), tetap menyusui

54
Q

Nyeri (-), puting terbenam (-), massa (-), luka

A

CRACKED NIPPLE

Lembabkan areola dengan ASI/lanolin; nipple shield, tetap menyusui

55
Q

Nyeri (-), puting terbenam (-), massa (+), unilateral

A

GALAKTOKEL

Aspirasi

56
Q

Nyeri (-), puting terbenam (-), massa (+), bilateral

A

BENDUNGAN PAYUDARA/BREAST ENGORGEMENT

Kompres hangat, pengeluaran ASI; bromokriptin 2.5mg

57
Q

Nyeri (+), puting terbenam (-), infeksi (-)

58
Q

Nyeri (+), puting terbenam (-), infeksi (+), fluktuasi (-)

A

MASTITIS

Kloksasilin 4x 500mg / eritromisin 3x 250mg 14d, tetap menyusui

59
Q

Nyeri (+), puting terbenam (-), infeksi (+), fluktuasi (+)

A

ABSES MAMMAE

Kloksasilin 4x 500mg / eritromisin 3x 250mg 14d, insisi drainase, STOP MENYUSUI

60
Q

Kista labia mayora 1/3 posterior, jam 5 dan 7

A

KISTA BARTHOLIN

Observasi; marsupialisasi

61
Q

Massa labia mayora 1/3 posterior, jam 5 dan 7, Infeksi (+), nyeri (+), supurasi (+), fluktuasi (+)

A

ABSES BARTHOLIN

Insisi drainase, Ab

62
Q

Kista anterosuperolateral vagina, jam 11 atau 1, obstruksi duktus mesonefros

A

KISTA GARTNER

Observasi; eksisi

63
Q

Kista multipel serviks berisi mukus

A

KISTA NABOTHI

Observasi

64
Q

Massa bertangkai pada serviks, pendarahan pasca koitus

A

POLIP SERVIKS

Polipektomi/ekstirpasi

65
Q

Massa bertangkai keluar melalui serviks, massa abdomen (+)

A

MIOMA GEBURT

66
Q

Nyeri adneksa/pinggang (+), tes kehamilan/plano (-), nyeri goyang portio (+), gejala infeksi, rw multipartner / IUD

A

PELVIC INFLAMMATORY DISEASE (PID)

Klindamisin 3x 900mg IV + gentamisin 2mg/kg IV loading (1st line) / cefotetan 2x 2g IV + doksisiklin 2x 100mg PO/IV

67
Q

Nyeri adneksa/pinggang (+), tes kehamilan/plano (-), nyeri goyang portio (+), gejala infeksi, rw multipartner / IUD, Demam tinggi, fluktuasi (+)

A

TUBO-OVARIAN ABSCESS

TX PID + insisi drainase

68
Q

Nyeri adneksa/pinggang (+) sangat berat, tes kehamilan/plano (-), massa adneksa (+), mual muntah, USG whirlpool sign (+), avaskularisasi

A

TORSIO KISTA OVARIUM

Detorsi <36h; salphingo-ooforektomi

69
Q

Massa dinding vagina anterior, gejala UT (+)

70
Q

Massa dinding vagina posterior, gejala GI (+)

71
Q

≥2 Trias rotterdam (Hiperandrogenisme (+), oligo/amenorrea sekunder, ovarium polikistik >12 folikel), infertilitas FSH rendah LH tinggi, USG string of pearls (+)

A

PCOS

KONTRASEPSI ORAL KOMBINASI (estrogen + progestin), finasterid, letrozole/klomifen sitrat

72
Q

Definisi Infertilitas

A

GAGAL KONSEPSI >12MO (<35Y) / >6MO (>35Y)

73
Q

Batasan dan Klasifikasi Infertilitas Pria
1. Jumlah
2. Motilitas
3. Morfologi
4. Semen
5. Sperma

A
  1. JUMLAH <15MIL/ML: OLIGOZOOSPERMIA
  2. MOTILITAS <40%: ASTHENOZOOSPERMIA
  3. Morfologi <4%: TERATOZOOSPERMIA
  4. Sperma (-), semen (+): AZOOSPERMIA
  5. Sperma (-), semen (-): ASPERMIA
74
Q

Alur Pemeriksaan Infertilitas Wanita

A
  1. MENS NORMAL: PROGESTERON MIDLUTEAL; <10 –> FSH + LH + PROLAKTIN
  2. MENS TIDAK NORMAL: TES KEHAMILAN; TIDAK HAMIL –> FSH + LH + PROLAKTIN
75
Q

Infertilitas wanita, progesteron midluteal >30

A

STRUKTURAL

76
Q

Infertilitas wanita, progesteron midluteal <10, FSH rendah, LH rendah

A

PITUITARY/HIPOTALAMUS

77
Q

Infertilitas wanita, progesteron midluteal <10, FSH rendah, LH tinggi

78
Q

Infertilitas wanita, progesteron midluteal <10, FSH tinggi, LH tinggi

A

PRIMARY OVARIAN FAILURE

79
Q

Infertilitas wanita, progesteron midluteal <10, prolaktin tinggi

A

HIPERPROLAKTINEMIA

80
Q

KB untuk Menunda Kehamilan

A
  1. PIL
  2. AKDR
  3. KONDOM
81
Q

KB untuk Menjarangkan Kehamilan (anak ≤2)

A
  1. AKDR
  2. SUNTIK
  3. MINIPIL
82
Q

KB untuk Menghentikan Kehamilan (anak ≥3)

A
  1. STERIL
  2. AKDR
  3. IMPLAN

GAS (14 decks)

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