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1
Q

Are losartan and spironolactone contraindicated in pregnancy

A

Yes

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2
Q

Is afp elevated in gastroschisis

A

Yes

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3
Q

What abdo defects is trisomy 21 associated with

A

Umbilical hernia and duodenal atresia

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4
Q

Gastroschisis is usually an ___ event

A

Isolated

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5
Q

You can hear fetal heart tones at how many weeks gestation

A

10-12

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6
Q

When can you feel fetal movement

A

17-18 weeks

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7
Q

When does bhcg peak

A

Ten weeks ga

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8
Q

Bhcg in range of ___ is diagnostic of pregnancy

A

1000-1500

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9
Q

Does renal blood flow and gfr increase in pregnancy

A

Yes

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10
Q

Should preggos be taking iron

A

Yes

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11
Q

Change over course of pregnancy: heart rate

A

Gradually increases 20%

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12
Q

Change over course of pregnancy: bp

A

Gradually decreases by 10% by week 34 then increases to prepreg values

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13
Q

Change over course of pregnancy: stroke volume

A

Increases to maximum at 19 weeks then plateaus

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14
Q

Change over course of pregnancy: cardiac output

A

Rises rapidly by 20% then gradually increases an additional 10% by 28 weeks

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15
Q

Change over course of pregnancy: peripheral venous distention

A

Progressive increase to term

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16
Q

Change over course of pregnancy: peripheral vascular resistance

A

Progressive decrease to term

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17
Q

Change over course of pregnancy: tidal volume

A

Increases by 30-40%

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18
Q

Change over course of pregnancy: respiratory minute volume

A

Increases by 40%

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19
Q

Change over course of pregnancy: blood volume

A

Increases by 50%

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20
Q

Change over course of pregnancy: hematocrit

A

Decreases slightly

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21
Q

Change over course of pregnancy: fibrinogen

A

Increases

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22
Q

Change over course of pregnancy: sphincter tone

A

Decreases

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23
Q

Change over course of pregnancy: gastric emptying time

A

Increases

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24
Q

Four elements of a quad screen

A

Afp
Inhibin a
Estriol
B-hcg

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25
Q

Elevated afp (>2.5 moms) is associated with

A 
Nt defects
Abdo wall defects
Multiple gestation/incorrect gestational dating
Fetal death
Placental abnormalities
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26
Q

Reduced afp (0.5 mom) is associated with

A

Trisomy 21 and 18
Fetal demise
Incorrect dating

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27
Q

Afp, estriol, bhcg and inhibin a levels in trisomy 21

A

Low afp and estriol

High bhcg and inhibin

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28
Q

Afp, estriol, bhcg and inhibin a levels in trisomy 18

A

Low everything

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29
Q

Cvs is offered at how many weeks?

A

10-12

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30
Q

Amniocentesis is offered at how many weeks?

A

15-20

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31
Q

Cell free fetal dna is offered at how many weeks?

A

Ten

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32
Q

Cvs samples the

A

Placental tissue

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33
Q

Late congenital Syphillis sx

A

Saber shins
Saddle nose
Hutchinson triad: peg shaped central incisors, deafness, interstitial keratitis

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34
Q

Threatened abortion

A

Urine bleeding but no POc expulsion, closed os

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35
Q

Tx of threatened abortion

A

Pelvic rest for 24-48 hours and fu ultrasound

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36
Q

Tx of incomplete abortion

A

Manual uterine aspiration or d and c if <12 weeks

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37
Q

Incomplete abortion

A

Partial poc expulsion and bleeding, open os, visible tissue on exam

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38
Q

Inevitable abortion

A

Uterine bleeding, no poc expulsion, open os with possible rupture of membranes

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39
Q

Missed abortion

A

Baby dead inside but closed os

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40
Q

Intrauterine fetal demise

A

Absence of fetal cardiac activity >20 weeks ga

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41
Q

First stage of labor, latent: starts/ends?

A

Onset of labor to 3-4cm dilation

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42
Q

First stage of labor, active: starts/ends?

A

4cm-complete cervical dilation (10cm)

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43
Q

Latent first stage of labor takes how long in a primip?

A

6-11h

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44
Q

Latent first stage of labor takes how long in a multip?

A

4-8h

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45
Q

Active first stage of labor takes how long in a primip?

A

4-6h (1.2cm/hr)

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46
Q

Active first stage of labor takes how long in a multip?

A

2-3h (1.5cm/hr)

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47
Q

Define second stage of labor

A

Complete cervical dilation to delivery of infant

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48
Q

second stage of labor takes how long in primip

A

0.5-3h

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49
Q

second stage of labor takes how long in multip

A

5-30min

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50
Q

Define third stage of labor

A

Delivery of infant to delivery of placenta

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51
Q

Fetal hr under ___ is bradycardia

A

110

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52
Q

Fetal hr above __ is tachycardia

A

160

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53
Q

Normal fetal heart rate variability

A

6-25 bpm

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54
Q

Sinusoidal fetal heart rate variability indicates

A

Serious fetal anemia

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55
Q

When to do a c section on mom with hsv

A

Whenever she has active lesions

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56
Q

Early fetal heart decels indicates

A

Head compression from uterine contraction (normal)

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57
Q

Late fetal heart decels indicates

A

Uteroplacental insufficiency and fetal hypoxemia

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58
Q

Variable fetal heart decels indicates

A

Umbilical cord compression

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59
Q

Normal nonstress test in pregnancy

A

Reactive-2 accelerations >15 bpm above baseline lasting for at least 15 seconds over a 20min period

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60
Q

A negative contraction stress test is __ and a positive one is ___

A

Good

Bad

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61
Q

Five parameters of biophysical profile

A

Fetal tone, breathing, movement, amniotic fluid volume, and nonstress test

Good score: 8-10

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62
Q

When do you use umbilical artery Doppler velocimetry

A

Only when iugr is suspected

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63
Q

Oligohydramnios is what level

A

Amniotic fluid index <5cm

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64
Q

First step in dx of hyperemesis gravidarum

A

Rule out molar preg with ultrasound plus minus B-hcg

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65
Q

Tx of hyperemesis gravidarum

A

Vit b6, doxylamine, promethazine, metoclopramide and ondansetron if severe

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66
Q 
Three hour glucose tolerance test is positive at following levels:
Fasting
1 h
2 h
3 h
A

Fasting >95
1 h >180
2 h >155
3 h >140

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67
Q

In diabetic Mom, maintain blood glucose at __ during labor with ___

A

80-100

Iv insulin drip

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68
Q

C section should be considered when fetus is > __ g

A

4500g (ten pounds)

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69
Q

Define gestational hypertension

A

Idiopathic htn without sig proteinuria (<300 mg/L) after 20 weeks ga

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70
Q

Common complication of gestational htn

A

Preeclampsia

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71
Q

What are three antihypertensives commonly used in pregnancy

A

Methyldopa
Labetalol
Nifedipine

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72
Q

Triad of preeclampsia

A

Hypertension
Proteinuria (>300mg/24h)
Edema

After 20 weeks

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73
Q

Hellp syndrome

A

Hemolysis
Elevated lfts
Low platelets

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74
Q

Bp in mild preeclampsia

A

> 140/90 on two occasions >6h apart

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75
Q

Bp in severe preeclampsia

A

Bp>160/110 on two separate occasions > 6h apart

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76
Q

Signs of severe preeclampsia

A

Persistent headache, visual disturbances, persistent epigastric pain, hyperreactive reflexes

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77
Q

How do you prevent intrapartum seizures in preeclampsia

A

Continuous magnesium sulfate drip

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78
Q

Signs of magnesium tox

A

Loss of dtrs
Resp paralysis
Coma

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79
Q

How long to continue mag after babe is born in preeclampsia

A

24h postpartum

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80
Q

Tx mag tox with

A

Iv calcium gluconate

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81
Q

Recurrent seizures in eclampsia , tx with

A

Iv diazepam

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82
Q

Tx of asymptomatic bacteriuria and uti in preggo

A

3-7 days nitrofurantoin, cephalexin, or augmentin

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83
Q

Tx of Pyelo in preggo

A

Iv fluids, iv third gen cephalosporin

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84
Q

Painful, dark vaginal bleeding that doesn’t stop and fetal distress before labor, think

A

Placental abruption

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85
Q

Painless, bright red bleeding that stops after 1-2 hours with or without uterine contractions. No fetal distress, think

A

Placenta previa

86
Q

Painless bleeding at rom with bradycardia , think

A

Vasa previa

87
Q

Tx of vasa previa before bleeding

A

Steroids at 28-32 weeks for fetal lung maturity, hospitalize at 30-32 weeks for close monitoring and schedule a c-section at 35 weeks

88
Q

Planned c section for babes over ___g in moms without diabetes and over __g in moms with diabetes

A

5000g

4500g

89
Q

Polyhydramnios is > __ on ultrasound

A

25

90
Q

Etiologies of oligohydramnios

A

Fetal urinary tract abnormalities, chronic uteroplacental insufficiency, rom

91
Q

Mechanism of and karyotype of complete mole

A

Sperm fertilization of an empty ovum

46,xx

92
Q

Mechanism of and karyotype of incomplete mole

A

Normal ovum fertilized by two sperm

69,xxy

93
Q

Does complete or incomplete mole contain fetal tissue

A

Incomplete

94
Q

In molar pregnancies serum bhcg is usually

A

Really high (>100,000)

95
Q

Ultrasound of molar pregnancy

A

Snowstorm appearance with no gestational sac or fetus present

96
Q

D&c of molar pregnancy shows

A

Cluster of grapes tissue

97
Q

Tx of molar pregnancy

A

Evacuate uterus and follow with weekly bhcg

98
Q

Definition of failure to progress in latent first stage, primip

A

> 20h

99
Q

Definition of failure to progress in active first stage, primip

A

> 2h

100
Q

Definition of failure to progress in latent first stage, multip

A

> 14h

101
Q

Definition of failure to progress in active first stage, multip

A

> 2h after reaching 3-4 cm

102
Q

Arrest of fetal descent =>_h in primip

A

> 2h, >3h with epidural

103
Q

Arrest of fetal descent =>_h in multip

A

> 1h or >2h with epidural

104
Q

Define preterm premature rom

A

Rom occurring at <37 weeks

105
Q

Define prolonged rom

A

Rom occurring >18h prior to delivery

106
Q

Fever >38 deg within 36 h, uterine tenderness and malodorous lochia postpartum, think

A

Postpartum endometritis

107
Q

Define postpartum hemorrhage

A

> 500ml for vaginal delivery

>1000ml for c section

108
Q

Soft “boggy” uterus-most common cause of postpartum hemorrhage

A

Uterine atony

109
Q

Tx of uterine atony

A

Uterine massage, oxytocin infusion, methergine/methylergonovine, pgf2a

110
Q

Tx of postpartum infections

A

Broad spec empiric iv antibiotics (clinda, genta) until pts have been afebrile for 48h. Add amp in complicated cases.

111
Q

Complication of postpartum infection

A

Septic pelvic thrombophlebitis

112
Q

How does postpartum septic pelvic thrombophlebitis present

A

Abdo and back pain and “picket-fence” fever (normal to as high as 105.8 deg)

113
Q

Tx septic pelvic thrombophlebitis

A

Broad spec antibiotics and anticoagulation with heparin x 7-10 days

114
Q

Order of puberty in girls

A

Growth accel—>thelarche—>pubarche—>menarche

115
Q

Order of puberty in boys

A

Testicular growth—> penile growth—> pubarche —> facial hair

116
Q

Dx of menopause

A

High fsh and lh, high cholesterol and low hdl

117
Q

Tx for hot flashes

A

Ssris, clonidine and or gabapentin

118
Q

Define primary amenorrhea

A

Absence of menses by age 16 with secondary sexual characeteristics, or absence of secondary sexual characteristics by age 14

119
Q

Absence of secondary sexual characteristics indicates no production of

A

Estrogen

120
Q

Ses of depo shot

A

Wt gain, irregular bleeding, delayed fertility after discontinuation (up to ten months)

121
Q

How do ocps work

A

Inhibit fsh/lh, suppress ovulation, thicken cervical mucus, decidualize endometrium

122
Q

Ocp risk for smokers

A

Thromboembolism in smokers >35 years

123
Q

Mechanism of progestin only minipills

A

Thickens cervical mucus

124
Q

Presence of secondary sexual characteristics + absence of 2/3 of the vagina and uterine abnormalities, what am I?

A

Mullerian agenesis.

125
Q

Pt present with breast development but amenorrhea and lack of pubic hair

A

Complete androgen insensitivity

126
Q

Workup of secondary amenorrhea

A

Preg test
Tsh
Prolactin
Progestin challenge

127
Q

Tx of endometriosis

A

Inhibit ovulation (eg ocps) or surgically ablate

128
Q

Causes of abnormal uterine bleeding

A 
Palm coin
Polyp
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovulatory dysfunction
Iatrogenic 
Not known
129
Q

First line tx of abnormal uterine bleeding

A

NSAIDs to decrease blood loss

130
Q

When to do an endometrial biopsy

A

Abnormal uterine bleeding plus:

  • endometrium is >4 mm in postmenopausal woman or
  • if pt is >35 and has rfs for endometrial hyperplasia (obesity, diabetes)
131
Q

Problem in 21-hydroxylase deficiency

A

Can’t convert 17-hydroxyprogesterone to 11-deoxycortisol leading to decreases cortisol synth, increased adrenal stimulation and increased acth and androgens

132
Q

Etiology of 11B hydroxylase deficiency

A

Can’t convert 11 deoxycortisol to cortisol leading to increased acth and androgens

133
Q

21 hydroxylase deficiency presents with __tension whereas 11B hydroxylase and 17-hydroxylase deficiencies present with __tension

A

Hypo

Hyper

134
Q

Renin activity is ___ in 21 hydroxylase def but __ in 11B hydroxylase def

A

Increased

Decreased

135
Q

Gold standard for dx of 21 hydroxylase deficiency

A

Cosynotropin stimulation test (not necessary if 17-0h progesterone levels are really high)

136
Q

Ratio of lh to fsh in pcos

A

High

137
Q

What is mittelschmerz

A

Pain at ovulation, unilateral but can switch sides

138
Q

Tx of pcos in women who are not trying to get preg

A

Ocps, progestin and maybe metformin

139
Q

Tx of pcos in women who are trying to get preg

A

Clomiphene and maybe metformin

140
Q

Vaginal ph in B.V.

A

> 4.5

141
Q

With metronidazole what should you be careful of

A

Stay away from alcohol it can cause

A disulfiram like reaction

142
Q

What is the chandelier sign

A

Severe cervical motion tenderness that makes pt jump for the chandelier on examination

143
Q

Toxic shock syndrome is caused by

A

Preformed s aureus toxin

144
Q

Why are blood cultures negative in toxic shock syndrome

A

Because it’s caused by a preformed toxin

145
Q

Tx of toxic shock syndrome

A

Rapid rehydration, get foreign objects in vaginal canal, empiric antibiotics clinda and vanco (narrow to clinda and oxacillin or nafcillin if methicillin sensitive)

146
Q

Uterus is irregular and mobile think

A

Uterine myoma

147
Q

75% of endometrial cancers are __ cancers

A

Endometrioid

148
Q

25% of endometrial cancers are __ cancers

A

Serous

149
Q

Etiology of endometrioid endometrial cancer

A

Unopposed estrogen stim

150
Q

Etiology of serous endometrial cancer

A

Unrelated to estrogen; p53 mutation is present in most cases

151
Q

Two major risk factors of vulvar cancer

A

Hpv types 16, 18, 31

Lichen sclerosis

152
Q

Key words for lichen sclerosis

A

Atrophic

Paper-like skin

153
Q

Dx of Vulvar cancer

A

Vulvar punch biopsy for any suspicious lesions or persistent vulvar pruritus

154
Q

Vaginal cancer in postmenopausal women is usually due to what kind of cancer

A

Squamous cell carcinoma

155
Q

Do ocps increase or decrease risk of ovarian cancer

A

Decrease

156
Q

Radiation is effective for what kind of ovarian cancer

A

Dysgerminoma

157
Q

Infectious vulvovaginitis in a pediatric patient can be caused by what three things

A

Gas
Candida
STDs typically from abuse

158
Q

Bunches of grapes lesions in young girl in vagina

A

Sarcoma botryoides (rhabdomyosarcoma)

159
Q

In precocious puberty, signs of estrogen excess (breast dev and possibly vag bleeding) suggests

A

Ovarian cysts or tumors

160
Q

In precocious puberty, signs of androgen excess (pubic and or axillary hair, enlarged clitoris, and or acne) suggests

A

Adrenal tumors or cah

161
Q

Workup of precocious puberty

A

Determine bone age and conduct gnrh stim test to distinguish central from peripheral precocious puberty

162
Q

Causes f central precocious puberty

A

Cns tumor

Constitutional precocious puberty

163
Q

Causes of peripheral precocious puberty

A 
Ovarian cyst
Adrenal tumor
Gonadal tumor
Exogenous estrogen
Cah
164
Q

Tx of cah

A

Steroids

165
Q

Precocious puberty, cafe au lait spots, bony abnormalities (polyostotic fibrous dysphasia)

A

Mccune albright

166
Q

Tx of mccune Albright

A

Tamoxifen or estrogen synthesis blockers (ketoconazole)

167
Q

Differential of breast mass

A

CANdy’s Fat Flabby and Massive Boobs

Fibrocystic
Fibroadenoma
Fat necrosis
Mastitis
Abscess
Breast cancer
168
Q

How to dx discrete breast mass

A

Fine needle aspiration

169
Q

Two common causes of bloody nipple discharge

A

Intraductal papilloma

Mammary duct ectasia

170
Q

Define breast fibroadenoma

A

Proliferative breast lesion without atypia; benign slow growing breast tumor with epithelial and strolls components

171
Q

Most common breast lesion in women under thirty

A

Fibroadenoma

172
Q

Phyllodes breast tumor has a __ appearance

A

Leaf like

173
Q

When do you use trastuzumab for breast cancer tx?

A

For locally advanced cancer that is her2+ or her2/neu+

174
Q

When do you use tamoxifen for breast cancer tx?

A

All er/pr+ pts and premenopausal

175
Q

If pt is under thirty and identifies a breast mass what should you do

A

Us to distinguish a solid mass from a cyst

176
Q

Dexa screening for osteoporosis should start for women at age

A

65

177
Q

Do direct inguinal hernias enter the scrotum

A

No

178
Q

Hydrocele is painful or painless?

A

Painless

179
Q

Varicocele is painful or painless?

A

Painless

180
Q

Can you use oral nystatin for vaginal candidiasis

A

No only intravaginal nystatin, oral is only for thrush

181
Q

If a lady isn’t pregnant and has amenorrhea (no hx of prior uterine procedure) what’s next in workup

A

Prolactin, tsh, fsh

182
Q

What kind of medication is plan b

A

Oral levonorgestrel

183
Q

If you have gonorrhea what should you also test for? (4)

A

Chlamydia
Hiv
Syphillis
Hep b

184
Q

GnRH independent precocious puberty, irregular cafe au lait macules, polyostotic fibrous dysplasia (frequent bone fractures)

A

Mccune Albright

185
Q

Precocious puberty, long bone dysplasia, numerous cafe au lait macules, axillary freckling

A

Nf1

186
Q

Gi hamartomatous polyposis, small perioral pigmented macules

What am I?

A

Peutz-jeghers

187
Q

Intellectual disability, seizures, visual impairment, port wine stain over trigeminal nerve area
What am I?

A

Sturge Weber

188
Q

Define placenta accreta

A

Villi attached directly to myometrium instead of decidua. See villous lakes.

189
Q

Tx of placenta accreta if you identify it before delivery

A

Cesarean hysterectomy

190
Q

If placenta accreta isn’t diagnosed before delivery, what could happen in delivery

A

Cord evulsion necessitating manual extraction, complicated by placental adherence and severe hemorrhage

191
Q

Pde5 inhibitors are contraindicated in pp using what med

A

Nitrates

192
Q

Most effective emergency contraception

A

Copper iud

193
Q

Would a femoral hernia protrude into the scrotum?

A

No

194
Q

Femoral hernias occurs most commonly in what demographic

A

Older women

195
Q

Path of varicocele

A

Dilation of the pampiniform plexus

196
Q

Does varicocele increase in size with valsalva

A

Yes

197
Q

What do you see on urinanalysis in hyperemesis gravidarum

A

Ketones

198
Q

Is tb screening recommended in pregnancy?

A

Only if pt is at risk for tb

199
Q

Non sexual nocturnal erections are associated with what kind of erectile dysfunction?

A

Psychogenic

200
Q

In intraamniotic infections, what do you do after abx? Assuming pt is near term

A

C section if babe is unstable

Induction of labor if babe is stable

201
Q

Easy way to tell placenta previa from placental abruption

A

Previa has no pain; abruption is very painful

202
Q

Treatment of postpartum endometritis

A

Clinda + genta

203
Q

Gnrh agonists eg leuprolide are used for

A

Creating a hypoestrogenic state, used to suppress sx of endometriosis and uterine leiomyoma

204
Q

Untreated herpes infections will resolve and then recur with increasing or decreasing frequency?

A

Decreasing

205
Q

What happens to hemoglobin, pa02 and paco2 in pregnancy?

A

Hemoglobin- decreases due to dilutional anemia (increased plasma vol and rbc mass)

Pa02 increases
Paco2 decreases

206
Q

Acid base status in pregnancy

A

Chronic respiratory alkalosis with metabolic compensation

207
Q

Fetal tachycardia is defined as >__ bpm

A

160

208
Q

When pt displays signs of overt intraamniotic infection (chorioamnionitis), what should you do

A

Deliver the baby regardless of gestational age

209
Q

Give cell free dna test to what women at what weeks?

A

Women over 35

Week ten and beyond

210
Q

What is a myelomeningocele

A

Spina bifida

Step 2 (16 decks)

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