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obstetric - gynecol STEP 2 > other in pregnancy > Flashcards

other in pregnancy Flashcards

1
Q

Sheehan syndrome - clinical features

A
  1. Lactation failure
  2. amenorrhea, hor flashes, vaginal atrophy (low FSH, LH)
    Fatique, bradycardia (Low TSH)
    Anorexia, weight loss, hypotension (low ACTH)
    decreased lean body mass (Low GH)
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2
Q

uterus examination if pospartum hemorrhage and retained placental tissue

A

enlarged and atonic uterus

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3
Q

postpartum period - normal findings

A
  1. transient rigors/chills
  2. peripheral edema
  3. lochia rubra
  4. uterine contraction + involution
  5. breast engorgement
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4
Q

postpartum period - routine care

A
  1. rooming in/lactation support
  2. serial examination for uterine atony/bleeding
  3. perianal care
  4. voiding trial
  5. pain management
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5
Q

Cerclage is a procedure involving a suture or synthetic tape to reinforce the cervix in

A

patietns with history of 2nd trimester deliveries or short (less than 2.5 cm) cervical length

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6
Q

renal colicky in pregnant - next step

A

U/S

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7
Q

pregnancy and exercise - contraindications

A
  1. amniotic fluid leak
  2. cervical incompetence
  3. multiple gesation
  4. placenta abruption or previa
  5. premature labor
  6. preeclampsia/gestational hypertension
  7. severe heart or lung disease
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8
Q

pregnancy and exercise - unsafe activies

A
  1. contact sports
  2. high fall risk
  3. scuba diving
  4. hot yoga
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9
Q

amniotic fluid embolism - RF

A
  1. preeclampsia
  2. placenta previa or abruption
  3. 5 or more pregnancies
  4. cesarean or instrumental
  5. advanced maternal age
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10
Q

amniotic fluid embolism - complications

A
  1. cardiogenic shock
  2. hypoxemic resp failure
  3. DIC
  4. coma or seizures
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11
Q

amniotic fluid embolism - treatment

A

resp + hemodynamic support

+/- transfusion

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12
Q

3rd trimester - acute appnedcitisis - what is unique

A

pain is RUQ due to enlare uterus

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13
Q

Postpartum urinary retention - RF

A
  1. regional anesthesia
  2. operative vaginal delivary
  3. primiparity
  4. perineal injury
  5. cesarea
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14
Q

Postpartum urinary retention - clinical featrues

A

inability to void
incomplete emptuing
dribbling

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15
Q

postpartum urinary retention - management

A

self limited

intermitent urethral catheterization

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16
Q

the most appropriate 1st step in suspected appendicitis during pregnancy

A

U/S –> noncompression + dilation are diagnostic –> if not diagnostic –> MRI

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17
Q

peripartum cardiomyopathy - onset

A

after 36 wks

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18
Q

intrahepatic cholestasis of pregnancy

A
  • intense prurtus
  • elevated bile acids
  • elevated levels of liver aminotransferases
  • diagnosis of exclusion
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19
Q

acute fatty liver of pregnancy

A

malaise, RUQ pain, nausea, vomiting, sequelae of liver failure

  • hypoglycemia
  • mildly elevated liver enzymes
  • elevated bilirubin
  • possible DIC
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20
Q

Low back pain during pregnancy - etiology

A

enlarged uterus - exaggerated lordosis
joint ligament laxity due to high progesterone and relaxin
weak abdominal muscles –> decreased lumbar support

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21
Q

Low back pain during pregnancy - RF

A
  • excessive weight gain
  • chronic back pain
  • back pain in prior pregnancy
  • multiparty
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22
Q

Low back pain during pregnancy - imaging

A

not indicated

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23
Q

Low back pain during pregnancy - management

A
  • behavioural modification
  • heating pads
  • analgesics
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24
Q

multiple gestation - presentation

A
  1. exponential growth of uterus
  2. rapid weight gain by mother
  3. elevated β-HCG and MSAFP (levels higher than expected for estimated gestational age is the first clue to multiple gestation
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25
Q

…… increase the possibility for multiple gestation

A

fertility drugs

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26
Q

diagnostic tests for multiple gestation

A

US is done to visualize fetuses

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27
Q

multiple gestation - complications

A
  1. spontaneous abortion of one fetus
  2. premature labor + delivery
  3. placenta previa
  4. anemia
28
Q

nonclassic congenital adrenal hyperplasia - pathophys

A

AR, low 21-hydroxylase activity, Normal gluco-mineralocoticoids, high androgens

29
Q

nonclassic congenital adrenal hyperplasia - clinical features

A
  • early pubic/axilary hair growth
  • severe acne
  • hirsutism, oligomenorrhea in girls
  • high growth velocity + bone age
  • elevated 17 hydrxyprogesterone
30
Q

nonclassic congenital adrenal hyperplasia - treatment

A

hydrocortisone

31
Q

anterior vs posterior dislocation (appearance)

A

anterior: abducted and externally rotated
posterior: adducted and internally rotated

32
Q

osteoporosis nonmodifiable RFs

A
  1. age
  2. postmenopausal
  3. low body weight
  4. white or asian
  5. malabsorption
  6. hypercortisolism, hyperthyroidism, hyperparathyroidism
  7. inflam disorders
  8. chronic liver or renal disease
    + PRIOR HISTORY OF FRAGILITY FRACTURE (STRONGEST)
33
Q

osteoporosis modifiable RF

A
  1. smoking
  2. excessive alcohol intake
  3. sedentary lifestyle 4. medications
  4. low vit D or Ca2+
  5. estrogen def
34
Q

nitropruside during pregnancy

A

never

35
Q

TSH in pregnancy

A

decreased

36
Q

short cervix menas

A

less than 2 cm without history of preterm labor)

- less than 2,5 cm wih history of preterm labor)

37
Q

shoulder dystocia - RF

A
  1. fetal macrosomia
  2. maternal obesity
  3. excessive pregancy wight gain
  4. Gestational DM
  5. post-term pregnancy
38
Q

treatment of asymptomatic endometriosis

A

no treatment, just observation

39
Q

an abnormal biophysic profile is consistent with

A

fetal hypoxia

40
Q

amphetamines in pregnancy are associated with

A
  1. preterm delivery
  2. preeclampsia
  3. abruptio placentae
  4. fetal growth restriction
  5. intrauterine fetal demise
41
Q

gastroschisis - RF

A

1st trimester NSAID use

42
Q

labetolol - route of administration

A

IV

43
Q

plugged duct

A

FOCAL (vs engorgement) tenderness + firmness or erythema, no fever (vs mastitis)

44
Q

the most likely cause of the lack of accelerations in fetus

A

fetal sleep (last for 40 mins)

45
Q

hypoxic brain injury - causes

A

acute uteroplacental insufficiency: labor stress or abruptuio placentae

46
Q

postpartum bleeding after operative vaginal delivery - management

A

inspect genital tract injury

47
Q

magnesium toxicity - treatment

A
  • stop Mg

- start IV calcium gluconate bolus

48
Q

diagnosis of chronic or preexisting HTN

A

more than 140 / 90 before 20 wks during 2 seperate measurements taken at least 4 hours apart

49
Q

pregnant with not appropriate weight gain - Risks for

A
  1. preterm

2. fetal growth restriction

50
Q

shoulder dystocia - complications

A
  1. fractured clavicle
  2. fractured humerus
  3. Erb-Duchenne palsy
  4. Klumpke palsy
  5. perinatal asphyxia
51
Q

perinatal asphyxia - manifestations

A

variable presentation dependingon duration of hypoxia

2. altered mental status (eg. irritability, lethargy) resp or feeding difficulties, poor tone, seizure

52
Q

leakage of the spinal fluid may occur if the dura is inadvertently punctured during epidural placement - this results in

A

leakage of spinal fluid (aka wet tap) –> postural headaches that are worse with sitting and improved with lying down after delivery

53
Q

history of classic C-section or myomectomy with uterus entry - how to deliver

A

laparotomy + delivery

54
Q

Mg - therapeutic levels

A

5-8

toxic if more than 8.5

55
Q

Mg toxicity - seizures?

A

NO

56
Q

trichomonas vaginalis - screening in pregnancy

A

only in HIV (+)

57
Q

intrahepatic cholestasis of pregnancy - jundice

A

uncommon

further evaluation

58
Q

intrahepatic cholestasis of pregnancy - management

A
  • symptom relief, pruritus resolves in wkees after delivery. - Ursodeoxycholic acid is commonly used
  • early delivery is recommended to avoid fetal complications
59
Q

abruptio placenta - uterine size

A

increased

60
Q

history of classic C-section or myomectomy with entrance - how to delivery

A

C-section, but if present in labor –> urgent laparotomy and delivery –> if the labor is ruptured, delivery through the rupture site, if it is not –> make c-section

61
Q

intrahepatic cholestasis of pregnancy - obstetric risks

A
  1. fetal demise
  2. preterm delivery
  3. meconium stain amniotic fluid
  4. RDS
62
Q

how to differentiate PCOS from CAH

A

elevated 17 hydroxyprogesterone in CAH

63
Q

cervical mucous plug

A

barrier to ascending infections during pregnancy

- brown red or yellow thick

64
Q

obesity mediated anovulation

A

normal LH + FSH (no production of progesterone)

65
Q

malposition vs malpresentation

A

malpresentation is for ex breech

malposition is nonocciput anterior

obstetric - gynecol STEP 2 (22 decks)

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