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OB/GYN > Simmons studying > Flashcards

Simmons studying Flashcards

1
Q

What are the relative contraindications for methotrexate for abortifacient (4)

A

1) mass >4cm
2) fetal cardiac activity
3) b-hCG >5,000
4) refusal to accept blood products

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2
Q

what are the absolute contraindications for methotrexate use for abortive (10)

A

1) intrauterine pregnancy
2) elevated liver enzymes
3) decreased renal function
4) breast feeding
5) poor follow up
6) immunocompromise
7) pulmonary disease
8) peptic ulcer
9) ruptured cyst/ ectopic
10) sensitivity to metho

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3
Q

How do we give metho?

A

single dose IM injection
If ineffective, usually another dose given
if thats ineffective surgery is option

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4
Q

How to follow up with metho treatment for abortive

A

Need repeat beta in 4 and 7 days. from day 4-7 we expect 15% decrease to claim effectiveness.

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5
Q

What should the patient expect for metho treatment?

A

nausea, pain at the site of ectopic because of retraction of the mass, vaginal spotting.

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6
Q

what should the patient avoid after given metho treatment

A

vitamin C/prenatal vitamins and sunlight

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7
Q

Why avoid Folic acid after metho?

what about vitamin C?

A

The mechanism of action is deplete folic acid. thus it could counteract methotrexate’s mechanism of action.
Vitamin C may increase the metho action making it more toxic.

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8
Q

Discriminatory zone for ultrasound detection of ectopic pregnancy?

A

b-hCG >2,000

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9
Q

what are the most common causes for fetal meningitis

A

1) beta-strep
2) listeria
3) E. coli

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10
Q

what is the importance of Rh factor?

A

Rhesus factor is always tested. If mother is negative then she will produce antibodies to the red blood cell antigen causing hemolysis. If she has a baby that is Rh (+) then the baby will die of hydrops fetalis

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11
Q

increased number of pregnancies puts the mother at risk for what?

A

hemorrhage and prolapse.

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12
Q

How do we treat Rh negative mothersd

A

RhoGAM

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13
Q

what is rhogam

A

immunoglobulin

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14
Q

what is the definition of labor?

A

cervical change/time

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15
Q

When must you have placental delivery?

A

within 30 min

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16
Q

what is the normal dose of folic acid

A

400ug daily

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17
Q

what percentage of pregnancies are unplanned

A

50%

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18
Q

what age is too old for pregnancies?

A

34 for multiple pregnancies and 35 for single pregnancy

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19
Q

what is the most accurate way to determine pregnancy?

A

1st trimester ultrasound

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20
Q

what is the another way to determine pregnancy date?

A

Neagles rule: last menstrual period. add one week and 1 year and then subtract 3 months

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21
Q

Are serological tests used to determine gestational age?

A

No. They are GA non-specific

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22
Q

Whats the best indicator of gestational if only doing one test

A

second trimester ultrasound

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23
Q

What is fundal height

A

the length in cm from the pubic bone to the top of the uterus. Good indicator of the size fo the baby and how far along the pregnancy is.
The fundal height should be +/-2 of the weeks gestation. Thus, if 30 weeks along the fundal height should be 28/32.

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24
Q

what is APGAR

A

appearance, pulse, grimmace, activity, respiration

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25
Q

what are the causes of AUB?

A

structural and nonstructural. PALM-COEIN

polyp, adenomyoma, leimyoma, malignancy, cogulopathy, endometrial, iatrogenic, not-yet specified.

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26
Q

When do women feel fetal movements?>

A

usually around 20 weeks

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27
Q

Decelerations type and causes

A

variable-cord compression, early-head compression, accelerations-good, late decel-placental insufficiency

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28
Q

define early deceleration

A

If the decel occurs with contractions.

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29
Q

Variability at gestational ages –what do we expect to see?

A

28wks–any variability
28-32wks –10sec X 10bpm
>32wks –15sec X 15bpm

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30
Q

prolonged accelerations vs deceleration s

A

accels good. Decels bad –could indicate cord compression due to oligohydramnios

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31
Q

normal range of fetal heart beats

A

110-160

32
Q

what can inhibit contractions

A

terbutaline

33
Q

G and P

A

gravida and paragravida
Gravida is the number of pregnancies
para is the number of times the uterus is emptied.

34
Q

how is para separated

A

full term, preterm, abortions, living.

35
Q

how frequently does bHCG double?

A

every 48 hours

36
Q

what is misoprostal used for (4)

A

1) abortifacient
2) postpartum hemorrhage
3) gastritis
4) induction of labor

37
Q

What dose of miso do we give for postpartum hemorrhage>

A

large rectal dose (4-5 pills)

38
Q

What dose of miso do we give for abortive

A

1/4 pill oral. 24-48 hours after mifepristone

39
Q

what does misoprostal do

A

causes myometrial contractions

40
Q

mefipristone type of drug and what does it do

A

progrestational glucocorticoid inhibits progresterone, induces bleeding.

41
Q

what does progesterone do?

A

prepares the uterine lining for implantations and contributes to overall fetal health.

42
Q

what do we give magnesium for?

A

to stop seizures in preeclampsia

43
Q

how do we check for Mag toxicity

A

headache? vision changes? ringing in the ears? trouble breathing? upper right quardant pain? dizziness? then we check their heart, lungs, reflexes and dystonia.

44
Q

preeclampsia definition

A

1) systolic blood pressure greater than equal to 140 and a diastolic greater than or equal to 90 on two occasions at least 4 hours apart or
2) a systolic greater than 160 or a diastolic greater than 110 or higher.

45
Q

what is the anitdote for magnesium toxicityf

A

calcium gluconate

46
Q

what is the therapeutic dose for magnesium

A

> 4

47
Q

what are the risks of misoprostal overdose

A

uterine atony and rupturing of intact uterus

48
Q

why not give a previous C-section pitocin?

A

rupture.

49
Q

why not give a previous C-section misoprostol?

A

rupture

50
Q

what labs do we order for preeclampsia work up and why

A

CBCd (schistocytes, platelets), LDH (cell rupture/tissue damage), comprehensive metabolic panel (for kidney and liver function), uric acid (cell breakdown)

51
Q

how do we test if you have broken your water

A

ultrasound (AFI), alkaline pH testing, slide for test –slide test for ferning.

52
Q

what is HELLP

A

hemolysis, elevated liver and low platelets

53
Q

how do we treat for GBS

A

ampicillin

54
Q

what tests do we perform at 28wks?

A

gestational diabetes, TDAP, RhoGAM

55
Q

what tests do we preform at 35 wks?

A

GBS

56
Q

How often do we do pap smears?

A

depends on age
21-30 every 3 years
30-65 3 years, or with cotest 5 years.

57
Q

when can stop doing paps?

A

65 if the last 10 years have been adhered to.

58
Q

when to start paps if immunocompromised?

A

immediately upon diagnosis and continue annually. If immunocompromised from birth (maternal transference) then begin screening at the onset of sexual activity

59
Q

definition of hypersystolic uterus

A

> 5 contractions/10 min

60
Q

questions for triage?

A

contractions? rush of fluid? bloody? fetal movements?

61
Q

what are the criteria for administration of pitocin

A

<200 montevideo units (since 200 is sufficient)

62
Q

how to calculate montevideo units?

A

sum of the amplitudes of contractions-baseline multiplied by the number of contractions at 10 min.

63
Q

post op questions

A

how are you feeling? are you in any pain? tolerate food or drinking? gone to the bathroom? have you gotten up and moved, yet?

64
Q

what are the types of leiomyomas

A

subserosal, submucosal, peduculated, intramural, abdominal

65
Q

what are some of the non-medical causes of anovulation?

A

PCOS, pregnancy, hypothyroidism, pituitary dysfunction, turner’s syndrome

66
Q

What are the treatments for AUB

A

IV equine estrogen, progesterone, combined contraceptives, tranexamic acid

67
Q

what is the adenexal size that can cause torsion>

A

> 5cm

68
Q

what ultrasound findings are suggestive of cancer

A

increased vascularity, multiceptated, papillary or solid component, ascites, >10cm

69
Q

tumor markers for germline tumors

A

beta-hCG, LDH, AFP, inhibin A, CA-125

70
Q

what is the mutation rate for a mature teratoma

A

0.2-3% low

71
Q

list some non-malignant masses

A

teratoma, ectopic pregnancy, serous cystadenoma, endometrioma, corpus luteum

72
Q

what is first line treatment of nausea in pregnancy

A

doxylamine and pyridoxine

73
Q

what are the components of the quad screen?

A

Inhibin A, b-hCG, AFP, estriol

74
Q

what are the bone related adverse side effects of bisphosphonates?

A

osteonecrosis of the jaw

75
Q

what are the values and interpretations of progesterone in pregnancy?

A

> 20 normal, <5 abnormal, 5-20.

76
Q

What is the rate of tubal ligation failure

A

1:300

77
Q

What do oral contraceptives do to the ovary, endometrial lining and the cervix (cervical mucous)?

A

inhibit ovulation, thin the endometrial lining and thicken the cervical mucous

OB/GYN (39 decks)

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