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Secrets - Obstetrics Flashcards

1
Q

Hegar sign?

A

Sign of pregnancy: Softening and compressibility of the lower uterine segment

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2
Q

Chadwick sign?

A

Sign of pregnancy: Dark discoloration of the vulva and vaginal walls

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3
Q

Melasma (Chloasma)?

A

Sign of Pregnancy: Hyperpigmentation of facial skin 2/2 hormonal changes

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4
Q

Ballottement of fetus?

A

Sign of Pregnancy: Examiner uses finger to tap against the uterus, through the vagina, to cause the fetus to bounce within the amniotic fluid and feel it rebound

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5
Q

When to screen for gestational diabetes in patient w/o risk factors (obese, + FHx, >30yo)?

A

24-28 weeks gestational age

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6
Q

When to screen for Group B- beta hemolytic streptococcus?

A

Screen at 35-37 wks w/ a swab of lower vagina and rectum.

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7
Q

At 12 wks GA, where can the uterus be palpated?

A

Pubic symphysis.

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8
Q

At ~20 wks GA, where can the uterus be palpated?

A

Umbilicus.

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9
Q

When is u/s most accurate at estimating fetal age?

A

At 16-20wks (2nd trimester anatomy screen), the bi-parietal diameter gives the most accurate estimate of fetal age.

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10
Q

Fetal Biometry consists of: ______, which are used to calculate EFW and EDD (+/- 7 days).

A
  • Head circumference
  • Biparietal diameter
  • Abdominal circumference
  • Femur length
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11
Q

Antenatal soft u/s markers (fetal sonographic findings that are generally not abnormalities but at indicative of an increased age adjusted risk of an underlying fetal aneuploidic or some non-chromosomal abnormalities).

A
  • Increased nuchal thickness >6mm
  • Fetal ventriculomegaly >10mm
  • Hypoplastic nasal bone
  • Echogenic intracardiac focus (EIF)
  • Choroid plexus cysts
  • Echogenic bowel
  • Shortened fetal long bones (femur or humerus)
  • Aberrant right subclavian artery
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12
Q

If after D&C, serial hCG levels do not fall to zero or rises…

A

Patient has either invasive mole or choriocarcinoma requiring chemo w/ methotrexate or dactinomycin.

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13
Q

Normal fetal strip during a non-stress test.

A

Normal FHR 110-160, 2 accelerations of HR each at least 15 bpm above baseline and lasting at least 15 seconds.

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14
Q

Biophysical profile includes:

A

1) Non-stress test
2) MSK Tone
3) General Fetal movements
4) Fetal breathing movements
5) Amniotic Fluid Index (4 quadrants) to r/o Oligo vs Poly

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15
Q

Contraction Stress test?

A

Low score on the Biophysical profile is an indication. Allows assessment of utero-placental dysfunction. Oxytocin given (stimulates uterine contractions) and fetal heart strip is monitored. If Late Decelerations are seen, then POSITIVE for uteroplacental insufficiency, so must to C-section.

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16
Q

ASA should be avoided during pregnancy except in patients w/ ?

A

Antiphospholipid syndrome

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17
Q

First trimester

A

week 1 - week 12

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18
Q

Second trimester

A

week 13 - week 27

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19
Q

Third trimester

A

week 28 - week 40

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20
Q

Premature delivery

A

Delivery before week 37

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21
Q

Fetal viability

A

24 weeks

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22
Q

Postterm pregnancy

A

greater than 42 weeks

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23
Q

What 2 rare disorders are associated with prolonged gestation?

A

1) Anencephaly
2) Placental sulfatase deficiency ( key enzyme of estrogen biosynthesis in placenta; benign; r/o fetal adrenal hypoplasia)

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24
Q

Montgomery tubercles

A

Sebaceous glands in the areola

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25
Q

Marker used to screen for neural tube defects?

A

Materal AFP

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26
Q

When is maternal AFP measured?

A

B/n 15-20 weeks of gestation.

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27
Q

Low mAFP

A
  • Down syndrome
  • Fetal demise
  • Inaccurate dates
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28
Q

High mAFP

A
  • Neural tube defects (e.g. anencephaly, spina bifida)
  • Ventral wall defects (e.g. omphalocele, gastroschisis)
  • Multiple gestation
  • Inaccurate dates
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29
Q

If mAFP high …

A

1) U/S to confirm gestational age, # fetuses, fetal viability, r/o NTD vs. other anomaly,
2) AFP level and Acetylcholinesterase in Amniotic fluids [if elevated and present then positive test]
3) Amniocentesis

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30
Q

Presence of acetyl cholinesterase in AF

A

Consistent with open NTD over ventral wall defects

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31
Q

First trimester combined test

A
  • Performed b/n 11-13wks
  • Components:
  • Nuchal translucency by u/s
  • serum PAPP-A
  • serum hCG
32
Q

Integrated tests

A

Includes:

  • First trimester combined test
  • AFP
  • Unconjugated estradoil (uE3)
  • Inhibin A @ 15-18weks

Results not available
‘til 2nd trimester

33
Q

Contingent testing

A

1) Invasive prenatal testing, offered to women at very high risk of Down after 1st trimester testing
2) No additional testing, offered to women at very low risk are provided with their risk estimate for Down
3) 2nd trimester testing, offered to women with intermediate risk for Down

34
Q

Quadruple test

A

Performed at 15-18wks (2nd trimester)

  • AFP
  • uE3
  • hCG
  • Inhibin A
35
Q

Maternal plasma-based tests

A

Includes:
-NIPS [Non-invasive prenatal screening]

Basically, cell-free fetal DNA testing, that basically detects fetal DNA in maternal circulation, Detection rate 98% and FP rate

36
Q

If first trimester testing is positive, offer..

A

Chronic villus sampling [CVS] for fetal karyotype determination

37
Q

If positive screening test for Down syndrome in 2nd trimester, offer..

A

Amniocentesis for fetal karyotype determination

38
Q

Amniocentesis vs CVS: which is done earlier?

A

CVS done at 9-12wks

39
Q

Amniocentesis vs CVS: which carries greater miscarriage rate?

40
Q

Teratogen: Thalidomide…effect

A

Phocomelia [absence of long bones and flipper-like appearance of hands]

41
Q

Teratogen: Tetracyclines

A

Yellow or brown teeth

42
Q

Teratogen: Aminoglycosides

43
Q

Teratogen: Valproic acid

A

Spina bifida, hypospadias

44
Q

Teratogen: Progesterone

A

Masculinization of female fetus

45
Q

Teratogen: Cigarettes

A

IUGR, low birth weight, prematurity

46
Q

Teratogen: OCPs

A

VACTERL syndrome

47
Q

Teratogen: Lithium

A

Cardiac (Ebstein) anomalies

48
Q

Teratogen: Radiation

A

IUGR, CNS defects, eye defects, malignancy (leukemia)

49
Q

Teratogen: Alcohol

A

Fetal alcohol syndrome

50
Q

Teratogen: Phenytoin

A

Cranio-facial, limb and cerebrovascular effects; MR

51
Q

Teratogen: Warfarin

A

Cranio-facial defects, IUGR, CNS malformation, stillbirth

52
Q

Teratogen: Carbamazepine

A

Fingernail hypoplasia, cranio-facial defects

53
Q

Teratogen: Isotretinion

A

CNS, cranio-facial, ear and cardiovascular defects

54
Q

Teratogen: Iodine

A

Goiter, neonatal hypothyroidism

55
Q

Teratogen: Cocaine

A

Cerebral infarcts, MR

56
Q

Teratogen: Diazepam

A

Cleft lip and/or palate

57
Q

Teratogen: Diethylstilbesterol

A

Clear cell vaginal cancer, adenosis [enlarged breast lobes with greater # of glands], cervical incompetence

58
Q

Common teratogenic effects of maternal diabetes

A 
Cardiovascular malformations
Cleft lip and/or palate 
Caudal regression (lower half of the body is incompletely formed) 
NTD
Macrosomia
59
Q

What does TORCHHES stand for?

A 
TOxoplasmosis
Rubella
CMV
HIV
HErpes simplex virus 3
Syphilis
60
Q

Congenital Toxoplasmosis maternal vs. neonatal manifestations.

A

Maternal:

  • exposure to cats
  • asymptomatic; lymphadenopathy rare
Neonatal:
-Chorioretinitis 
-Hydrocephalus
-Intracranial calcifications 
\+/- Blueberry muffin rash
61
Q

Congenital Rubella maternal vs. neonatal manifestations.

A

Maternal:

  • Rash
  • Lymphadenopathy
  • Arthritis
Neonatal:
-PDA or pulmonary artery hypoplasia
-Cataracts 
-Deafness 
\+/- blueberry muffin rash
62
Q

Congenital CMV maternal vs. neonatal manifestations.

A

Maternal:
-Mononucleosis-like illness

Neonatal:

  • Hearing loss
  • Seizures
  • Petechial rash, blueberry muffin rash
  • Periventricular calcifications
63
Q

Congenital HIV maternal vs. neonatal manifestations.

A

Maternal:
-Variable

Neonatal:
-Recurrent infections, chronic diarrhea

64
Q

Congenital HSV2 maternal vs. neonatal manifestations.

A

Maternal:
-Herpetic vesicular lesions

Neonatal:

  • Encephalitis
  • Herpetic vesicular lesions
65
Q

Congenital Syphilis maternal vs. neonatal manifestations.

A

Maternal:

  • Chancre (primary)
  • Disseminated rash (secondary)

Neonatal:

  • Stillbirth, hydrops fetalis
  • Notched Hutchinson teeth, saddle nose, short maxilla
  • saber shins
  • rhinitis, interstitial keratitis
  • CN VIII deafness
66
Q

HIV prophylaxis for neonate.

A

Zidovudine given for 6wks after birth; direct HIV DNA PCR test at birth (often positive) then again at 4-6wks of age, then 2 months after second test.

67
Q

Edema of hands and face concerning for…

A

Preclampsia

68
Q

Apt Test

A

Performed on vaginal blood to differentiate fetal from maternal blood during third trimester vaginal bleeding workup.

69
Q

Kleihauer-Betke test

A

Quantifies the amount of fetal blood in the maternal circulation, used to calculate dose of RHOGAM give to Rh(D) negative moms AFTER delivery.

70
Q

Examples of Tocolytic drugs.

A
  • Beta2-agonists: Terbutaline, ritodrine
  • Magnesium sulfate
  • Indomethicin
  • Nifedipine (Ca2+ channel blocker)
71
Q

What is fetal fibronectin?

A

ECM protein that helps attach the amniotic membranes to the uterine lining, and can be found in vaginal secretions of some women presenting with signs and symptoms of PRETERM labor.

72
Q

Fetal hydrops is characterized by…

A

Edema, ascites, pleural and/or pericardial effusions

73
Q

Methylergonovine

A

Uterotonic drug that causes smooth muscle constriction, uterine contraction and vasoconstriction; SE: Vasoconstriction causes HTN so do not give to pt w/ h/o HTN

74
Q

Carboprost

A

Synthetic prostaglandin that stimulates uterine contraction; SE: Broncho-constriction, so don’t give to pt w/ h/o asthma

75
Q

T or F? Once pt is Group B Strep + early in the pregnancy, pt is considered persistently colonized?

A

TRUE, PCN should be administered during labor for these patients.

Obstetrics/Gynecology (3 decks)

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