Repro Flashcards
1
Q
Are losartan and spironolactone contraindicated in pregnancy
A
Yes
2
Q
Is afp elevated in gastroschisis
A
Yes
3
Q
What abdo defects is trisomy 21 associated with
A
Umbilical hernia and duodenal atresia
4
Q
Gastroschisis is usually an ___ event
A
Isolated
5
Q
You can hear fetal heart tones at how many weeks gestation
A
10-12
6
Q
When can you feel fetal movement
A
17-18 weeks
7
Q
When does bhcg peak
A
Ten weeks ga
8
Q
Bhcg in range of ___ is diagnostic of pregnancy
A
1000-1500
9
Q
Does renal blood flow and gfr increase in pregnancy
A
Yes
10
Q
Should preggos be taking iron
A
Yes
11
Q
Change over course of pregnancy: heart rate
A
Gradually increases 20%
12
Q
Change over course of pregnancy: bp
A
Gradually decreases by 10% by week 34 then increases to prepreg values
13
Q
Change over course of pregnancy: stroke volume
A
Increases to maximum at 19 weeks then plateaus
14
Q
Change over course of pregnancy: cardiac output
A
Rises rapidly by 20% then gradually increases an additional 10% by 28 weeks
15
Q
Change over course of pregnancy: peripheral venous distention
A
Progressive increase to term
16
Q
Change over course of pregnancy: peripheral vascular resistance
A
Progressive decrease to term
17
Q
Change over course of pregnancy: tidal volume
A
Increases by 30-40%
18
Q
Change over course of pregnancy: respiratory minute volume
A
Increases by 40%
19
Q
Change over course of pregnancy: blood volume
A
Increases by 50%
20
Q
Change over course of pregnancy: hematocrit
A
Decreases slightly
21
Q
Change over course of pregnancy: fibrinogen
A
Increases
22
Q
Change over course of pregnancy: sphincter tone
A
Decreases
23
Q
Change over course of pregnancy: gastric emptying time
A
Increases
24
Q
Four elements of a quad screen
A
Afp
Inhibin a
Estriol
B-hcg
25
Elevated afp (>2.5 moms) is associated with
```
Nt defects
Abdo wall defects
Multiple gestation/incorrect gestational dating
Fetal death
Placental abnormalities
```
26
Reduced afp (0.5 mom) is associated with
Trisomy 21 and 18
Fetal demise
Incorrect dating
27
Afp, estriol, bhcg and inhibin a levels in trisomy 21
Low afp and estriol
| High bhcg and inhibin
28
Afp, estriol, bhcg and inhibin a levels in trisomy 18
Low everything
29
Cvs is offered at how many weeks?
10-12
30
Amniocentesis is offered at how many weeks?
15-20
31
Cell free fetal dna is offered at how many weeks?
Ten
32
Cvs samples the
Placental tissue
33
Late congenital Syphillis sx
Saber shins
Saddle nose
Hutchinson triad: peg shaped central incisors, deafness, interstitial keratitis
34
Threatened abortion
Urine bleeding but no POc expulsion, closed os
35
Tx of threatened abortion
Pelvic rest for 24-48 hours and fu ultrasound
36
Tx of incomplete abortion
Manual uterine aspiration or d and c if <12 weeks
37
Incomplete abortion
Partial poc expulsion and bleeding, open os, visible tissue on exam
38
Inevitable abortion
Uterine bleeding, no poc expulsion, open os with possible rupture of membranes
39
Missed abortion
Baby dead inside but closed os
40
Intrauterine fetal demise
Absence of fetal cardiac activity >20 weeks ga
41
First stage of labor, latent: starts/ends?
Onset of labor to 3-4cm dilation
42
First stage of labor, active: starts/ends?
4cm-complete cervical dilation (10cm)
43
Latent first stage of labor takes how long in a primip?
6-11h
44
Latent first stage of labor takes how long in a multip?
4-8h
45
Active first stage of labor takes how long in a primip?
4-6h (1.2cm/hr)
46
Active first stage of labor takes how long in a multip?
2-3h (1.5cm/hr)
47
Define second stage of labor
Complete cervical dilation to delivery of infant
48
second stage of labor takes how long in primip
0.5-3h
49
second stage of labor takes how long in multip
5-30min
50
Define third stage of labor
Delivery of infant to delivery of placenta
51
Fetal hr under ___ is bradycardia
110
52
Fetal hr above __ is tachycardia
160
53
Normal fetal heart rate variability
6-25 bpm
54
Sinusoidal fetal heart rate variability indicates
Serious fetal anemia
55
When to do a c section on mom with hsv
Whenever she has active lesions
56
Early fetal heart decels indicates
Head compression from uterine contraction (normal)
57
Late fetal heart decels indicates
Uteroplacental insufficiency and fetal hypoxemia
58
Variable fetal heart decels indicates
Umbilical cord compression
59
Normal nonstress test in pregnancy
Reactive-2 accelerations >15 bpm above baseline lasting for at least 15 seconds over a 20min period
60
A negative contraction stress test is __ and a positive one is ___
Good
| Bad
61
Five parameters of biophysical profile
Fetal tone, breathing, movement, amniotic fluid volume, and nonstress test
Good score: 8-10
62
When do you use umbilical artery Doppler velocimetry
Only when iugr is suspected
63
Oligohydramnios is what level
Amniotic fluid index <5cm
64
First step in dx of hyperemesis gravidarum
Rule out molar preg with ultrasound plus minus B-hcg
65
Tx of hyperemesis gravidarum
Vit b6, doxylamine, promethazine, metoclopramide and ondansetron if severe
66
```
Three hour glucose tolerance test is positive at following levels:
Fasting
1 h
2 h
3 h
```
Fasting >95
1 h >180
2 h >155
3 h >140
67
In diabetic Mom, maintain blood glucose at __ during labor with ___
80-100
| Iv insulin drip
68
C section should be considered when fetus is > __ g
4500g (ten pounds)
69
Define gestational hypertension
Idiopathic htn without sig proteinuria (<300 mg/L) after 20 weeks ga
70
Common complication of gestational htn
Preeclampsia
71
What are three antihypertensives commonly used in pregnancy
Methyldopa
Labetalol
Nifedipine
72
Triad of preeclampsia
Hypertension
Proteinuria (>300mg/24h)
Edema
After 20 weeks
73
Hellp syndrome
Hemolysis
Elevated lfts
Low platelets
74
Bp in mild preeclampsia
>140/90 on two occasions >6h apart
75
Bp in severe preeclampsia
Bp>160/110 on two separate occasions > 6h apart
76
Signs of severe preeclampsia
Persistent headache, visual disturbances, persistent epigastric pain, hyperreactive reflexes
77
How do you prevent intrapartum seizures in preeclampsia
Continuous magnesium sulfate drip
78
Signs of magnesium tox
Loss of dtrs
Resp paralysis
Coma
79
How long to continue mag after babe is born in preeclampsia
24h postpartum
80
Tx mag tox with
Iv calcium gluconate
81
Recurrent seizures in eclampsia , tx with
Iv diazepam
82
Tx of asymptomatic bacteriuria and uti in preggo
3-7 days nitrofurantoin, cephalexin, or augmentin
83
Tx of Pyelo in preggo
Iv fluids, iv third gen cephalosporin
84
Painful, dark vaginal bleeding that doesn’t stop and fetal distress before labor, think
Placental abruption
85
Painless, bright red bleeding that stops after 1-2 hours with or without uterine contractions. No fetal distress, think
Placenta previa
86
Painless bleeding at rom with bradycardia , think
Vasa previa
87
Tx of vasa previa before bleeding
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
Planned c section for babes over ___g in moms without diabetes and over __g in moms with diabetes
5000g
| 4500g
89
Polyhydramnios is > __ on ultrasound
25
90
Etiologies of oligohydramnios
Fetal urinary tract abnormalities, chronic uteroplacental insufficiency, rom
91
Mechanism of and karyotype of complete mole
Sperm fertilization of an empty ovum
46,xx
92
Mechanism of and karyotype of incomplete mole
Normal ovum fertilized by two sperm
69,xxy
93
Does complete or incomplete mole contain fetal tissue
Incomplete
94
In molar pregnancies serum bhcg is usually
Really high (>100,000)
95
Ultrasound of molar pregnancy
Snowstorm appearance with no gestational sac or fetus present
96
D&c of molar pregnancy shows
Cluster of grapes tissue
97
Tx of molar pregnancy
Evacuate uterus and follow with weekly bhcg
98
Definition of failure to progress in latent first stage, primip
> 20h
99
Definition of failure to progress in active first stage, primip
>2h
100
Definition of failure to progress in latent first stage, multip
>14h
101
Definition of failure to progress in active first stage, multip
>2h after reaching 3-4 cm
102
Arrest of fetal descent =>_h in primip
>2h, >3h with epidural
103
Arrest of fetal descent =>_h in multip
>1h or >2h with epidural
104
Define preterm premature rom
Rom occurring at <37 weeks
105
Define prolonged rom
Rom occurring >18h prior to delivery
106
Fever >38 deg within 36 h, uterine tenderness and malodorous lochia postpartum, think
Postpartum endometritis
107
Define postpartum hemorrhage
>500ml for vaginal delivery
| >1000ml for c section
108
Soft “boggy” uterus-most common cause of postpartum hemorrhage
Uterine atony
109
Tx of uterine atony
Uterine massage, oxytocin infusion, methergine/methylergonovine, pgf2a
110
Tx of postpartum infections
Broad spec empiric iv antibiotics (clinda, genta) until pts have been afebrile for 48h. Add amp in complicated cases.
111
Complication of postpartum infection
Septic pelvic thrombophlebitis
112
How does postpartum septic pelvic thrombophlebitis present
Abdo and back pain and “picket-fence” fever (normal to as high as 105.8 deg)
113
Tx septic pelvic thrombophlebitis
Broad spec antibiotics and anticoagulation with heparin x 7-10 days
114
Order of puberty in girls
Growth accel—>thelarche—>pubarche—>menarche
115
Order of puberty in boys
Testicular growth—> penile growth—> pubarche —> facial hair
116
Dx of menopause
High fsh and lh, high cholesterol and low hdl
117
Tx for hot flashes
Ssris, clonidine and or gabapentin
118
Define primary amenorrhea
Absence of menses by age 16 with secondary sexual characeteristics, or absence of secondary sexual characteristics by age 14
119
Absence of secondary sexual characteristics indicates no production of
Estrogen
120
Ses of depo shot
Wt gain, irregular bleeding, delayed fertility after discontinuation (up to ten months)
121
How do ocps work
Inhibit fsh/lh, suppress ovulation, thicken cervical mucus, decidualize endometrium
122
Ocp risk for smokers
Thromboembolism in smokers >35 years
123
Mechanism of progestin only minipills
Thickens cervical mucus
124
Presence of secondary sexual characteristics + absence of 2/3 of the vagina and uterine abnormalities, what am I?
Mullerian agenesis.
125
Pt present with breast development but amenorrhea and lack of pubic hair
Complete androgen insensitivity
126
Workup of secondary amenorrhea
Preg test
Tsh
Prolactin
Progestin challenge
127
Tx of endometriosis
Inhibit ovulation (eg ocps) or surgically ablate
128
Causes of abnormal uterine bleeding
```
Palm coin
Polyp
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovulatory dysfunction
Iatrogenic
Not known
```
129
First line tx of abnormal uterine bleeding
NSAIDs to decrease blood loss
130
When to do an endometrial biopsy
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
Problem in 21-hydroxylase deficiency
Can’t convert 17-hydroxyprogesterone to 11-deoxycortisol leading to decreases cortisol synth, increased adrenal stimulation and increased acth and androgens
132
Etiology of 11B hydroxylase deficiency
Can’t convert 11 deoxycortisol to cortisol leading to increased acth and androgens
133
21 hydroxylase deficiency presents with __tension whereas 11B hydroxylase and 17-hydroxylase deficiencies present with __tension
Hypo
| Hyper
134
Renin activity is ___ in 21 hydroxylase def but __ in 11B hydroxylase def
Increased
| Decreased
135
Gold standard for dx of 21 hydroxylase deficiency
Cosynotropin stimulation test (not necessary if 17-0h progesterone levels are really high)
136
Ratio of lh to fsh in pcos
High
137
What is mittelschmerz
Pain at ovulation, unilateral but can switch sides
138
Tx of pcos in women who are not trying to get preg
Ocps, progestin and maybe metformin
139
Tx of pcos in women who are trying to get preg
Clomiphene and maybe metformin
140
Vaginal ph in B.V.
>4.5
141
With metronidazole what should you be careful of
Stay away from alcohol it can cause
| A disulfiram like reaction
142
What is the chandelier sign
Severe cervical motion tenderness that makes pt jump for the chandelier on examination
143
Toxic shock syndrome is caused by
Preformed s aureus toxin
144
Why are blood cultures negative in toxic shock syndrome
Because it’s caused by a preformed toxin
145
Tx of toxic shock syndrome
Rapid rehydration, get foreign objects in vaginal canal, empiric antibiotics clinda and vanco (narrow to clinda and oxacillin or nafcillin if methicillin sensitive)
146
Uterus is irregular and mobile think
Uterine myoma
147
75% of endometrial cancers are __ cancers
Endometrioid
148
25% of endometrial cancers are __ cancers
Serous
149
Etiology of endometrioid endometrial cancer
Unopposed estrogen stim
150
Etiology of serous endometrial cancer
Unrelated to estrogen; p53 mutation is present in most cases
151
Two major risk factors of vulvar cancer
Hpv types 16, 18, 31
| Lichen sclerosis
152
Key words for lichen sclerosis
Atrophic
| Paper-like skin
153
Dx of Vulvar cancer
Vulvar punch biopsy for any suspicious lesions or persistent vulvar pruritus
154
Vaginal cancer in postmenopausal women is usually due to what kind of cancer
Squamous cell carcinoma
155
Do ocps increase or decrease risk of ovarian cancer
Decrease
156
Radiation is effective for what kind of ovarian cancer
Dysgerminoma
157
Infectious vulvovaginitis in a pediatric patient can be caused by what three things
Gas
Candida
STDs typically from abuse
158
Bunches of grapes lesions in young girl in vagina
Sarcoma botryoides (rhabdomyosarcoma)
159
In precocious puberty, signs of estrogen excess (breast dev and possibly vag bleeding) suggests
Ovarian cysts or tumors
160
In precocious puberty, signs of androgen excess (pubic and or axillary hair, enlarged clitoris, and or acne) suggests
Adrenal tumors or cah
161
Workup of precocious puberty
Determine bone age and conduct gnrh stim test to distinguish central from peripheral precocious puberty
162
Causes f central precocious puberty
Cns tumor
| Constitutional precocious puberty
163
Causes of peripheral precocious puberty
```
Ovarian cyst
Adrenal tumor
Gonadal tumor
Exogenous estrogen
Cah
```
164
Tx of cah
Steroids
165
Precocious puberty, cafe au lait spots, bony abnormalities (polyostotic fibrous dysphasia)
Mccune albright
166
Tx of mccune Albright
Tamoxifen or estrogen synthesis blockers (ketoconazole)
167
Differential of breast mass
CANdy’s Fat Flabby and Massive Boobs
```
Fibrocystic
Fibroadenoma
Fat necrosis
Mastitis
Abscess
Breast cancer
```
168
How to dx discrete breast mass
Fine needle aspiration
169
Two common causes of bloody nipple discharge
Intraductal papilloma
| Mammary duct ectasia
170
Define breast fibroadenoma
Proliferative breast lesion without atypia; benign slow growing breast tumor with epithelial and strolls components
171
Most common breast lesion in women under thirty
Fibroadenoma
172
Phyllodes breast tumor has a __ appearance
Leaf like
173
When do you use trastuzumab for breast cancer tx?
For locally advanced cancer that is her2+ or her2/neu+
174
When do you use tamoxifen for breast cancer tx?
All er/pr+ pts and premenopausal
175
If pt is under thirty and identifies a breast mass what should you do
Us to distinguish a solid mass from a cyst
176
Dexa screening for osteoporosis should start for women at age
65
177
Do direct inguinal hernias enter the scrotum
No
178
Hydrocele is painful or painless?
Painless
179
Varicocele is painful or painless?
Painless
180
Can you use oral nystatin for vaginal candidiasis
No only intravaginal nystatin, oral is only for thrush
181
If a lady isn’t pregnant and has amenorrhea (no hx of prior uterine procedure) what’s next in workup
Prolactin, tsh, fsh
182
What kind of medication is plan b
Oral levonorgestrel
183
If you have gonorrhea what should you also test for? (4)
Chlamydia
Hiv
Syphillis
Hep b
184
GnRH independent precocious puberty, irregular cafe au lait macules, polyostotic fibrous dysplasia (frequent bone fractures)
Mccune Albright
185
Precocious puberty, long bone dysplasia, numerous cafe au lait macules, axillary freckling
Nf1
186
Gi hamartomatous polyposis, small perioral pigmented macules
What am I?
Peutz-jeghers
187
Intellectual disability, seizures, visual impairment, port wine stain over trigeminal nerve area
What am I?
Sturge Weber
188
Define placenta accreta
Villi attached directly to myometrium instead of decidua. See villous lakes.
189
Tx of placenta accreta if you identify it before delivery
Cesarean hysterectomy
190
If placenta accreta isn’t diagnosed before delivery, what could happen in delivery
Cord evulsion necessitating manual extraction, complicated by placental adherence and severe hemorrhage
191
Pde5 inhibitors are contraindicated in pp using what med
Nitrates
192
Most effective emergency contraception
Copper iud
193
Would a femoral hernia protrude into the scrotum?
No
194
Femoral hernias occurs most commonly in what demographic
Older women
195
Path of varicocele
Dilation of the pampiniform plexus
196
Does varicocele increase in size with valsalva
Yes
197
What do you see on urinanalysis in hyperemesis gravidarum
Ketones
198
Is tb screening recommended in pregnancy?
Only if pt is at risk for tb
199
Non sexual nocturnal erections are associated with what kind of erectile dysfunction?
Psychogenic
200
In intraamniotic infections, what do you do after abx? Assuming pt is near term
C section if babe is unstable
Induction of labor if babe is stable
201
Easy way to tell placenta previa from placental abruption
Previa has no pain; abruption is very painful
202
Treatment of postpartum endometritis
Clinda + genta
203
Gnrh agonists eg leuprolide are used for
Creating a hypoestrogenic state, used to suppress sx of endometriosis and uterine leiomyoma
204
Untreated herpes infections will resolve and then recur with increasing or decreasing frequency?
Decreasing
205
What happens to hemoglobin, pa02 and paco2 in pregnancy?
Hemoglobin- decreases due to dilutional anemia (increased plasma vol and rbc mass)
Pa02 increases
Paco2 decreases
206
Acid base status in pregnancy
Chronic respiratory alkalosis with metabolic compensation
207
Fetal tachycardia is defined as >__ bpm
160
208
When pt displays signs of overt intraamniotic infection (chorioamnionitis), what should you do
Deliver the baby regardless of gestational age
209
Give cell free dna test to what women at what weeks?
Women over 35
| Week ten and beyond
210
What is a myelomeningocele
Spina bifida
