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Med School Year 2 Flash Cards > Repro 2 mixup > Flashcards

Repro 2 mixup Flashcards

1
Q

What labs do you order when a pt presents with new pregnancy?

A

Hbg/hct, UA, Glu, Lipids, Rh, Ab screen, PPD, A1C, HIV, Hep B/C, Rubella

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2
Q

How often do you perform risk assessments?

A

Up to 30 wks - every 4 weeks
30-36 weeks: every 2 weeks
36 to delivery is every week

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3
Q

What is chadwick’s sign?

A

bluish tint to vagina due to increased estrogen.

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4
Q

Sx of Pregnancy?

A

amenorrhea, urinary frequency, breast engorgement, nausea, fatigue.

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5
Q

hCG should be over what levels to confirm pregnancy?

A

typicall is above 25

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6
Q

What do you fear when you dx a missed abortion? how do you dx a missed abortion?

A

you worry about DIC. typically the fetus is dead for 6 weeks. You want to monitor fibrinogen levels. Fetus is retained, dead. Cervical os is closed. Tx with D&C.

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7
Q

What are the top 3 conditions associated with spontaneous abortion?

A

1: DM
2: Hypothyroidism
3: SLE

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8
Q

MC acquired abnormality of the uterus that can affect fecundity

A

Uterine submucous fibroids

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9
Q

tx of:

1: Threatened abortion
2: Incomplete/Inevitable abortion
3: Missed
4: recurrent

A

1: ultrasound, then reassure
2: stabilize, products evacuated
3: evacuate products surgically or D&C
4: R/o systemic dz. Genetic testing. R/O infxn.

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10
Q

Down’s syndrome is 95% due to?

A

meiotic nondisjunction

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11
Q

What does the MSTMS measure? When do you do it?

A

Measures AFP, hCG, and UE3. Do it at 16-18 weeks gestation

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12
Q

What marker can detect 80-85% of open neural tube defects? What protein is increased?

A

AFP. Acetylcholinesterase is increased

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13
Q

low AFP, Estriol, and hCG

A

Edwards syndrome.

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14
Q

low AFP, estriol. High hCG

A

Down’s syndrome

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15
Q

ACE Is cause what in fetus?

A

fetal nephropathy

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16
Q

Which anticoagulant would you want to use in a prego pt?

A

heparin because of the placental barrier.

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17
Q

When do you do the anatomical survey sono? What about the 50 gm glu?

A

18-20 wks, 24-28 wks

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18
Q

When do you perform the group B strep test?

A

34-37 wks

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19
Q

What is the plane of least diameter?

A

arrest of descent occurs most frequently here. Lower edge of pubis anteriorly, ischial spines and sacrospinous ligaments laterally, lower sacrum posteriorly

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20
Q

2 phases in the first stage of labor. What are they?

A

latent phase: cervical effacement and early dilatation occur. up to 4ish cm
Active phase: more rapid cervical dilatation. 4ish to complete.

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21
Q

How often should the fetal HR be evaluated in no risk factor situations?

A

Every 30 min in active phase of first stage, and every 15 min in second stage. W/risk factors: 15/5

22
Q

What are the 6 movements performed in the second stage?

A

Descent, Flexion, Internal rotation, extension, external rotation, expulsion

23
Q

What is the third stage consist of?

A

placental delivery by 30 min or manual removal if > 30 min.

24
Q

What are the 4 degree lacerations?

A

First: vaginal mucosa
Second: 1 + subcutaneous tissues
Third: 1+2+ anal sphincter
Fourth: Rectal mucosa

25
Q

What is the only drug approved for induction and augmentation of labor? What is the MC contraindication?

A

oxytocin. prior uterine surgery

26
Q

What are the post partum changes that occur?

A

Involution of the uterus (breast feeding speeds this process).
Lochia: post partum vaginal discharge
Vagina regains tone (Kegal helpful)
CV: initial increase in peripheral resistance. 2 wks to normalize

27
Q

What is the MC bacteria found in mastitis?

A

s. aureus. Tx with dicloxacillin and keep pumping.

28
Q

What type of fetal decelerations are there?

A

late: bad. Uteroplacental insufficiency.
early: ok. head compression
variable: usually ok. Cord compression. Abrupt slope.

29
Q

What constitutes as fetal distress? How do you perform intrauterine resuscitation?

A

Prolonged deceleration. Position on the left, check cervix for dilatation.

30
Q

What are the three MC causes of maternal death?

A

1: hemorrhage
2: infxn
3: HTN dz

31
Q

What is considered pre-term labor? What are some risk factors? How do you use the fetal fibronectin test to determine likelyhood of delivery?

A

< 37 weeks is preterm. some risk factors are cervitis, BV, Hx, multiples. If the fFN is neg - 98% chance no labor in next 2 wks. If positive, 50/50 shot.

32
Q

Prior to 34 weeks preterm labor what do you give?

A

steriods to promote lung maturity (dexamethasone). You also want to tocolyze (MgSO4) to allow for steriods to work.

33
Q

What are some alternatives to MgSO4?

A

CCB (nifedipine), Indomethacin (PG inhibitor)

34
Q

How do you dx premature rupture of membranes? (PROM)

A

pooling - fluid in vault
ferning
nitrazine paper
Amnisure - detects placental alpha microglobulin 1

35
Q

What is the mechanism of action of MgSO4?

A

Competes with Ca. mom may feel like she has the flu. Neuroprotection for remote from term fetuses.

36
Q

what is a possible side effect of indomethacin/toradol at high doses?

A

can cause PDA in fetus

37
Q

What is chorioamnionitis?

A

inflammation of the fetal membranes d/t a bacterial infection.

38
Q

How would you diagnose placenta previa? What are the different types of placenta previa?

A

Complete: totally covering the os. partial: partially covering. Marginal: edge extends to the internal cervical os.

Dx: painless bleeding. do transabdominal ultrasonography. You want to obtain fetal maturation w/o compromising mom

39
Q

What are the types of placenta accreta, and what do patients typically have a hx of?

A

Accreta: superficial.
Increta: invades part of myometrium
Percreta: extends to serosa.

Hx of prior uterine surgery.

40
Q

What is the predisposing factor for placental abruption? How would you make this dx? how is separation initiated?

A

maternal htn predisposing factor. Dx based on painful bleeding + uterine tenderness. separation initiated by hemorrhage into the deciduas basalis.

MCC of DIC in pregnancy.

41
Q

How do you make the diagnosis of uterine rupture?

A

sudden onset of intense ab pain and some vaginal bleeding.
abnormal fetal HR.

Tx: take it all out!!!

42
Q

What is vasa previa?

A

unprotected vessels pass over the cervical os. Not surrounded by Wharton’s jelly.

must do immediate abdominal delivery

43
Q

what is the MCC of postpartum hemorrhage?

A

Uterine atony

44
Q

5 minutes after delivery the placenta is delivered. there is a purple mass at the introitus and the fundus is not palpable. What happened?

A

uterine inversion. improper management.

45
Q

What is the 50 gram oral GCT?

A

screening only. Greater than 140 -> 3 hr GTT

Greater than 200 tx as diabetic

46
Q

What about the 100 gram 3 hr GTT?

A 
fasting > 105 --> tx as diabetic.
1 hr > 180
2 hr >155
3 hr >140
Screen everyone at 24-28 wks
47
Q

what are 2 main complications of gestational diabetes?

A

shoulder dystocia, macrosomia.

48
Q

What is preeclampsia? Eclampsia?

A

new onset HTN + proteinuria = preeclampsia.

eclampsia = seizures!

49
Q

What meds to use in HTN of pregnancy?

A

a-methyldopa
Nifedipine
Labetalol.

50
Q

What is the pathophys of HTN in pregnancy?

A

uteroplacental ischemia may be central to development of dz. release of toxins enter circulation -> vasospasm.
renal BF, GFR lower.

Med School Year 2 Flash Cards (18 decks)

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