Rosh Material #2 Flashcards
fundal height in landmarks for gestational age
pubic symphysis: 12 weeks
umbilicus: 20 weeks
xiphoid process: 36 weeks
regression below 36-32 cm: 37-40 weeks
comorbidities associated w. preterm labor
T1DM
HTN
thyroid dz
asthma
kidney insufficiency
anemia
MDD
PCOS increases risk for what type of cancer
endometrial
first line med for ovulation induction (ex to treat infertility w. PCOS)
letrozole
rf for endometrial ca
ENDOMET:
elderly
nulliparity
DM
obesity
menstrual irregularity
estrogen monotherapy
tension (HTN)
skin condition associated w. syphilis that causes pale-brown, flat, verrucous lesions w. foul smelling mucus
condyloma lata
most specific test for syphilis when active chancre or condyloma is present
darkfield microscopy
when will VDRL and RPR be positive for syphilis
1-4 weeks after infxn
all pt’s presenting w. first episode of genital HSV should be started on what med regimen asap
acyclovir 400 mg tid x 7-10 days
vs
famciclovir 250 mg tid x 7-10 days
vs
valacyclovir 1,000 mg bid x 7-10 days
which strain of HPV is associated w. oorpharyngeal and anal cancers
16
painless genital ulcer
LGV
chancre
preferred skin surgical incision approach for c section
pfannenstiel
pyuria w. no organisms on gram stain
chlamydia
change in microbiota w.reduced concentration of lactobacilli
BV
growth on thayer martin agar
gonorrhea
3 mc complications of PID
tubo ovarian abscess
chronic pelvic pain
ectopic pregnancy
7 cardinal movements of fetal descent
engagement
descent
flexion
internal rotation
extension
external rotation
expulsion
what maneuver is used to determine fetal position
leopold
dx criteria for chorioamnionitis
fever >/= 39 (102.2) w.o clear source
fever 38 (100.4) to 38.9 (102.2)
PLUS
maternal leukocytosis > 15,000
fetal tachy >160
purulent or malodorous amniotic fluid
initial diagnostic study for evaluating suspicious breast masses in women < 40
core needle bx
not mammogram due to increased breast density
describe lesions associated w. vulvar ca
red and white ulcerative lesions
most important rf for endometritis
c section
USTFPS rec for breast ca screening for average risk women
starting at 50 yo q 2 years
mc region for breast ca to occur
upper outer quadrant
what is the T sign
monochorionic, diamniotic gestation
serious complication of monochorionic multiple gestations
twin-twin transfusion syndrome
4 contraindications to epidural
-preload cardiac conditions: aortic stenosis, HOCM
-coagulopathy
-infxn of lower back
-increased intracranial pressure
what do you think when you see a pt w. at least 2 consecutive second trimestr pregnanc losses or early premature births (<28 weeks)
cervical insufficiency
3 rf for cervical insufficiency
prior cervical trauma
ehlers danlos syndrome
in utero DES exposure
tx for chlamydia in pregnant women
- azithromycin
- test of cure 3-4 weeks after tx
- repeat testing 3 months after test of cure
fetal station numbers
-5: highest position
0: ischial spine
+3: ischial tuberosity
+5: perineum
what does GTPAL stand for
gravida: total # of pregnancies
term pregnancies (37-40 weeks)
preterm deliveries (20-36 weeks)
abortions/miscarriages: before 20 weeks
living children
tx of endometritis: vaginal delivery vs c section
vaginal: ampicillin PLUS gentamicin
c section: clindamycin PLUS gentamicin
what PE test is used to monitor therapeutic levels of Mg sulfate
patellar reflex
what test is a quantitative measurement of fetal RBC in maternal blood
kleihauer-betke
when is it safe to not administer Rh IgG in an Rh negative mother
if the father is also Rh negative
tx for bloating, fluid retention, and breast tenderness for PMS
spironolactone
variable decelerations
compression of the umbilical cord
late decelerations
any decrease in uterine bloodflow
placental disruption
tx for late decelerations
c section
early decelerations
compression of the fetal head
normal benign finding during labor
earliest a molar pregnancy can be diagnosed
8 weeks
mc cause of cervicitis
chlamydia
IUD recommended for nulliparous women
13.5 levonorgestres-releasing IUD
IUD that will stop menstrual bleeding
52 mg levonorgestrel-releasing IUD
preferred type of episiotomy to minimize risk of anal sphincter laceration
mediolateral
5 vaccines contraindicated in pregnancy
MMR
varicella
polio
BCG (TB)
live attenuated flu
what is this showing
gonorrhea
combined menopausal hormone therapy increases risk for
breast ca
tx for choriocarcinoma/invasive mole
no metastasis: single agent chemo (MTX)
metastasis/older age/higher hCG levels: MTX PLUS uterine wedge resection vs hysterectomy
tx for PCOS sx related to menstrual dysfxn and hyperandrogenism
combined OCP
what 2 meds induce ovulation
clomiphene citrate
letrozole
safest/most effective method for termination of pregnancies up to 12 weeks
suction curretage
what incision is a contraindication for a trial of labor in a woman with a prev hx of c section
vertical uterine incision
first line tx for non pre eclampsia HTN in pregnancy
methyldopa
uterus becomes firm, there is a sudden gush of blood from the vagina, the umbilical cord moves down out of the vagina
normal placental separation
best time to draw maternal alpha fetoprotein
15-18 weeks
5 contraindications for cervical cerclage
bleeding of unknown etiology
infxn
labor
ruptured membranes
fetal anomalies
hormones indicative of menopause:
FSH:
LH:
androstenedione:
FSH: increased
LH: increased
androstenedione: no change
what do you think when you see: very firm, 8 cm ovarian mass
what is your first step in tx
endometrioid
surgical consult
erythematous uticarial patches and plaques (clasically periumbilical) that progess to tense vesicles and blisters in a pregnant woman
herpes gestationis (pemphigoid gestationis)
what are the four classic biometric parameters of fetal growth
cerebellar diameter
abdominal circumference
femur length
biparietal diameter of skull
risk of chorionic villus sampling if performed < 10 weeks gestation
limb reduction defects
t/f: gestational thrombocytopenia resolves postnatally and requires no tx
t!
first line tx for pt’s who are vaginal or perianal carriers of GBS
intrapartum penicillin
2 absolute contraindications for combined OCP
> /= 35 and smoke
/= 35 and have migraines w. aura
in a pt w. irregular menstrual cycles, or unknown date of LMP, what should be used as a marker for repeating urine pregnancy test
14 days after last intercourse
most sensitive pregnancy test
serum
factors associated w. decreased risk of endometriosis
multiple births
omega 3
late menarche
extended lactation
exercise
major difference between pms and pmdd
pmdd: presence of symptoms for most of the preceding year
what 2 things must be present for dx of postpartum hemorrhage
blood loss >/= 1,000 mL
s/sx of hypovolemia w.in 24 hr of birth
when is external version typically attempted
37 weeks
management of suspected breech presentation before 37 weeks
US
mc rf for transverse lie
prematurity
what do you think when you palpate the uterus and feel the head in the LUQ
transverse lie
mc cause of infant morbidity and mortality in the industrialized world
spontaneous preterm birth
pathway behind spontaneous preterm birth
- increased cortisol -> increased CRH
- PG’s activated -> cervical ripening -> ROM
what type of deceleration is this showing
variable:
onset to nadir < 20 sec
relationship to contraction is variable
criteria for admission for labor
cervical dilation > 4 cm
uterine bleeding
abnormal FHR
ruptured membrane
phases of first stage of labor based on cervical dilation:
latent phase:
active phase:
latent: slow cervical change to ~5 cm
active: rapid cervical change from 6-10 cm
which shoulder is delivered first in normal labor and delivery
anterior
physiologic changes in pregnancy: increases
fibrinogn
co
proteinuria
blood volume
wbc
gfr
rbc mass
hr
clotting
changes in pregnancy: decreases
bun:cr
albumin
svr
hgb
hct
antithrombin III
gut motility
ureteral activity
pco2/hco3
frequency of digital cervical exam to document cervical dilation, effacement, and fetal station
admit
first stage: q 2-4 hr
prior to anesthesia
second stage: q 1-2 hr
FHR abnormalities
t/f: pt’s pregnant w. twins need to double up on most supplements during 2nd and third trimester
t!
with the exception of vit D, DHA/EPA, vit C/E
protective factors against ovarian ca
hormonal contraception
tubal ligation
hysterectomy
preferred first line chemo for ovarian ca
IV:
carboplatin
PLUS
paclitaxel
factors associated w. lower external cephalic version success rates
nulliparity
anterior placenta
lateral/cornual placenta
decreased amniotic fluid volume
low birth weight
descent of the breech into the pelvis
obesity
posterior fetal spine
frank breech
ROM
tense uterus
fetal head not palpable thinner myometrium
management of a patient you suspect has been abused
directly ask patient about specific forms of abuse when he/she is alone
screening guidelines for abuse
USPSTF: all women of reproductive age
ACOG: all pregnant women at first prenatal visit, once every trimester, and postpartum checkup
abd pain or bleeding in first 20 weeks
os closed
no passage of fetal contents
threatened abortion
abd pain or bleeding in first 20 weeks
os open
no passage of fetal contents
inevitable abortion
abd pain or bleeding in first 20 weeks
os open
some fetal products passed
incomplete abortion
abd pain or bleeding in first 20 weeks
os closed
complete passage of fetal contents
complete abortion
in utero death of embryo/fetus prior to 20 weeks
retention of fetal contents
os closed
no products passed
missed/delayed abortion
cutoff for CA125 in premenopausal women that indicates need for referral (with ovarian mass)
> 200
what do you think when you see: 16 weeks gestation, morning sickness that was worse than with prev 2 pregnancies, normal vitals, fundal height 18 cm, elevated Hcg and AFP
think multiple gestations -> ordere US
baden-walker grading of uterine prolapse
1: halfway to the hymen
2: to the hymen
3: halfway past hymen
4: max descent
management of unstable pt w. heavy AUB
- uterine curettage
- IV estrogen
groove sign
LGV
management of delayed emergent c-section
trendelenburg position
knee-chest position
bladder filling
elevation of presenting fetal part
terbutaline (tocolytic)
women from _ have high rates of Rh(D) negative
basque country (northern spain/western france)
really Rosh?
prominent fibroglandular tissue w. small cysts but no disernable mass
fibrocystic breast changes
most accurate method of determining EDD
crown rump length
