Siste innspurt Flashcards
1
Q
Graafian follicle: størrelse
A
10-20 mm
2
Q
Mistanke om dermoid cyst (mature teratoma): hva gjør du?
A
Ultralyd (98% spesifikt)
Endelig diagnose skjer etter laparoskopisk reseksjon
3
Q
Ektopisk graviditet: recurrence rate?
A
15%
4
Q
Hvilken subenhet av hCG stimulerer tyroidea?
A
Alfa-subenheten (stimulerer TSH-reseptoren)
5
Q
Maternell DM: metaboliske avvik hos nyfødt
A
Hypoglykemi
Hypokalsemi
Hyperbilirubinemi
Polycytemi
(+ hypokalemi)
6
Q
Hvorfor får man DVT i venstre iliac vein i svangerskapet?
A
IVC og pelvic veins
Livmoren presser på LEFT ILIAC VEIN (May-Thurner-like syndrome)
7
Q
Hva er forskjellen på
- D og C
- Suction curettage
A
D og C: bruker curette
Suction curettage = vakuum-aspirasjon
8
Q
Behandling av complete mole:
D og C ELLER suction curettage
A
Suction curettage
9
Q
Snowstorm på ultralyd: hva skal du tenke?
A
Complete mole
10
Q
Behandling av hypertyreose i svangerskap
A
B-blokker til de med alvorlige adrenerge Sx (trapp ned så snart du kontrollerer sykdommen med anti-tyreotika)
PTU > metimazol i første trimester (bytt til metimazol i starten av andre trimester)
Månedlig kontroll av TSH og FT4
De som ikke tolererer PTU/metimazol: tyreoidektomi (i svangerskapet)
IKKE gi farmakologiske jod-doser (gir føtal goiter)
Radio-jod er ABSOLUTT KONTRAINDISERT
11
Q
Fetal lie:
A
barnets lengdeakse vs. morens lengdeakse
Longitudinal = same axis as mothers spine
Transverse = perpendicular to axis of mother’s spine
12
Q
WHO amenore: hvilken compartment er anoreksi
A
Compartment 1 (hypogonadotropisk hypogonadisme)
Lav FSH og LH
Funksjonell (anoreksi, atleter) eller organisk
13
Q
Hva skal du gjøre for BRCA-bærere
A
Breast awareness from age 18
Clinical breast exam every 6 months from 25
Annual breast MRI from 25-29
Annual mammogram from 30-75
Consideration of chemoprevention and risk-reducing mastectomy
Risk-reducing salpingo-oophorectomy after childbearing
14
Q
Kandidater for BRCA-testing
A
Brystkreft før 50 år
Trippel negativ brystkreft før 60 år
Menn med brystkreft
15
Q
Female pelvis - measurements
A
External conjugate: 18 cm
Interspinal: 25 cm
Intercristal: 28 cm
Intertrochanteric: 31 cm
16
Q
Abnormal first stage
A
Latent phase > 20 timer
Protraction disorders: less than 1.2 cm // 1.5 cm
Arrest = complete stop in progress
17
Q
Puerperium
A
Delivery to 6 weeks postpartum
18
Q
Treatment of congenital adrenal hyperplasia
A
Glucocorticoids (to suppress CRH and ACTH): corrects growth, sexual maturation and fertility
Mineralocorticoids to normalize electrolytes, ECV and plasma renin
19
Q
Causes of arrest of SECOND STAGE labor
1) Extension of fetal head
2) Arrest of dilation disorders
3) Obstruction of delivery canal (e.g. myoma)
4) 1 + 3
5) 1 + 2 + 3
A
A + C
Extension of fetal head
Obstruction of delivery canal (myoma)
20
Q
36 year old woman G2P1 in 13th week of pregnancy had a PAPP-A test. The risk of trisomy 21 is 1 to 20. What further diagnosis should you offer to this patient
MRI
CTG non stress test
Genetic amniocentesis
BPP
Cordocentesis
A
Genetic amniocentesis
21
Q
28 year old female. G1P0 was diagnosed with thrombophlebitis in her 31st week of pregnancy. No dyspnea.
Vaginal examination normal. USG fetal assessment normal. Chose the FALSE statement
1) start therapeutic dose of heparin
2) qualify patient for c-section
3) start compression therapy
4) order maternal echo
5) order spinal section
A
2) qualify patient for c-section
22
Q
Which is NOT a marker of chromosomal abnormalities in T1 genetic screening
1) NT
2) Nasal bone
3) Ductus venosus
4) Tricuspid valve
5) UAPI (umbilical artery pulsatile index)
A
UAPI (umbilical artery pulsatile index
23
Q
Lady with external conjugate diameter 16 cm: what to do?
A
Qualify for c-section due to CPD
24
Q
What is NOT correct treatment for PPROM
1) Strict bed rest
2) Start tocolysis
3) Collect vaginal and cervical swabs
4) Measure leukocytes and CRP
5) Administer oxytocin
A
5) Administer oxytocin
25
Gestational DM-woman in 27th week. Vaginal examintaion normal. What NOT to do
Do NOT start steroid therapy
26
Risikofaktorer for brystkreft (utenom FHx)
Tidlig menarche og sen menopause
Nulliparitet
Delayed childbearing
Alkohol
Overvekt
27
Når er prolaktin høyest?
Når du sover
28
Twin-twin transfusion syndrome
Ses i MoDi (monochorionic, diamniotic) tvillinger
AV-kommunikasjon
Treatment options
- Reductive amniocentesis
- Selective laser ablation
- Selective cord coagulation
29
Progestin challenge test: hvordan gjøres det? Hvordan tolkes det?
Medroxyprogesteron po/im i 10-14 dager
Dersom pasienten har adekvate østrogen-nivåer skal bortfallsblødning skje ila 2-7 dager
Bortfallsblødning tyder på anovulering (= adekvat østrogen, men manglende endogen progesteron)
Negativ test tyder på enten
- Lav østrogen (ovarie- eller HP-problem)
- Ikke-mottakelig livmor
- Obstruksjon
30
Blodtrykk som indikerer alvorlig pre-eklampsi
> 160/110 målt ved 2 anledninger, med minst 4 timers mellomrom
31
Endometriose - klassifisering
Minimal: isolerte implantater uten adheranser
Mild: overflatiske lesjoner under 5 cm, ingen adheranser
Moderat: multiple implanteter og arrdannelser (adheranser) rundt egglederne og ovariene
Alvorlig: multiple implantater, inkludert store sjokolade-cyster
32
Germ cell tumor: typer
Dysgerminoma
Dermoid cyst
Embryonal carcinoma
Choriocarcinoma
Endodermal sinus tumor
33
Delayed puberty: definisjon
No breast development at age 13
No menses 3 years after breast development (or by 16)
34
Når i menstruasjonssyklusen er FSH LAVEST??
Dag 10-12
35
Pre-eklampsi i uke 32 med BT 160/100 etter hydralazin, metyldopa og CCB. Hva skal du gjøre
Sjekk CTG og FHR hver 2. time (+ daglige NST/BPP)
Gi betametason og MgSO4
Vaginalfødsel hvis maternell/føtal kompromiss
36
Major cause of maternal death in US?
Major cause of maternal death worldwide?
Most common non-obstetric cause of maternal death in pregnancy?
US: Pulmonary embolism
Worldwide: PPH
Non-obstetric cause: MVA
37
Når er fundus høyest?
Uke 36
38
Når gjøres QUAD-test
Uke 15-19
39
Når rapporterer mødre fosterbevegelser?
Multipara: 16-18
Primigravida: 18-20
40
Presumptive sign of pregnancy =
Amenorrhea
41
Hvor sannsynlig er det at du leverer på EDD fra Naegle?
4%
42
Causes of decreased GI motility in pregnancy
Increased progesterone
Decreased motilin
43
Tyroideahormon som krysser placenta?
KUN!!! thyroid-stimulating immunoglobulin (anti-TSHR)
44
The first and second reductive divisions of female germ cells results in
23 chromosomes
45
Når er fundal height høyest?
Uke 36 (deretter går den tilbake til 32-36)
46
Prenatal diagnosis should be offered to:
- Teenage mom
- Mother > 35 years
- Mother with overt DM
Mother > 35 and mother with overt diabetes
47
Når skal du gøre CVS?
Uke 9-12
48
What is true about Naegle rule...
EDD (estimated due date) is adjusted to the duration of the follicular (proliferative) phase
49
Causes of second trimester pregnancy loss includes all of the following EXCEPT
- Abruptio placentae
- Uterine anatomical defect
- Incompetent cervix
- Immune hydrops
- Nonimmune hydrops
Abruptio placenta
50
Kleihauer-Betke test should be performed to evaluate
The volume of fetal blood in maternal circulation
51
300 mikrogram RhoGAM dekker
- Hvor mange mL føtalt fullblod
- Hvor mange mL føtale RBCs?
300 mikrogram RhoGAM dekker
- 30 mL føtalt fullblod
- 15 mL føtale RBCs
52
Risk factor for malignant GTN?
Bilateral theca-lutein cysts
OR
Age extremes
53
Metastatic GTN: good prognosis =
Metastases to pelvis and lungs
54
Primary management of cervical incompetence
Cerclage
Progestational agents
55
White classification: B, C and D
B = onset after 20 years old, or duration less than 10 years
C = onset 10-19 years, or duration 10-19 years
D = onset before 10 years, or duration > 20 years
56
Behandlingsmål for fastende glukose hos pasienter med gestasjonsdiabetes
Fastende glukose 60-90
57
Anemi i svangerskap: definisjon
Hb under 11
58
Causes of increased baseline variability includes all of the following EXCEPT
- Hypothermia
- Arrhyhtmia
- Fetal movements
- Prematurity
Prematurity
59
Normal fetal scalp pH =
Normal = pH 7.25 - 7.35
Borderline = pH 7.20 - 7.25
60
Common cause of prolonged latent phase
Anesthesia
61
Most significant risk factor for preterm delivery?
Previous preterm delivery
62
All of the following are used for cervical ripening EXCEPT
- PGE2
- Estrogen
- Mechanical stretching
- Progesteron
- Relaxin
Progesteron is NOT used for ripening
63
Within what time period should RhoGAM be given postpartum
Within 72 hours
64
Most common cause of puerperal fever
Endometritis
65
Most common STD in females
HPV > Trichomonas > klamydia
66
FIGO: cervical cancer pelvic wall is NOT invovled, but lower 1/3 of vagina is
Stage 3a
67
All of the following are indications for cervical cone biopsy EXCEPT:
- Cervical lesion cannot be fully visualized
- History of cervical dysplasia
- The endocervical curettage is positive
- Bx reveals microinvasive SCC
- Bx reveals adenocarcinoma in situ
History of cervical dysplasia
68
Prevensjon som har lavest pearl index (altså lavest failure rate på 1 år)
- IUD
- Medroxyprogesteron acetat
Medroxyprogesteron acetat
69
When in life does the hypothalamic-pituitary-gonadal axis become fully functional
- Neonatal
- Fetal
- Childhood
- Prepuberty
- Puberty
Fetal
70
Functional hyperprolactinemia is fully confirmed by
Oral metoclopramid (dopamine antagonist) test
71
Basic prolactin plasma level is 24. In the 60 min metoclopramide test it increases to 192. Diagnosis?
Functional hyperprolactinemia (because it increases x 6)
72
What is the most potent androgen
Dihydrotestosterone (DHT)
73
What is the most common underlying etiology of menopause
Ovarian follicle depletion
74
25 year old woman with negative hCG + 5 cm asymptomatic pelvic mass: most likely diagnosis?
Simple cyst: follicular or corpus luteum cyst
Complex: dermoid cyst
75
Complications of ovulation induction
Multiple gestation
Ovarian hyperstimulation
76
Hormone levels in anorectic: FSH, estradiol, prolactin
Low FSH (e.g. 2)
Low estradiol (e.g. 18)
Normal prolactin (e.g. 10)
77
Perimenopausal woman with FSH 14 and estradiol 101. What to do
FSH should be 3-9
Supplement progesterone in day 17-23
78
Normalverdi for FSH
3-9
79
Normalverdier
- FSH
- LH
FSH: 3-9
LH: 5-40
80
LH 9, FSH 4, estriol 130. Diagnose?
Normale hormonverdier
81
FSH 70, LH 120, estradiol 12 in a 23 year old woman with primary amenorrhea: next step?
Genetic evaluation
82
Typical sign of thyrotoxicosis in early pregnancy
Vomiting
83
City with highest rates of ectopic pregnancy
Kingston, Jamaica
84
The source of AFP in maternal serum at 18 weeks gestation is...
Fetal liver
85
Fetal lung maturation is ensured by presence of
Phosphatidylglycerol
86
A pregnant vegetarian is likely to be deficient in...
Vitamin B12
87
A woman smokes one pack of cigarettes a day. An ultrasound in week 32 is ordered to evaluate
Fetal size
88
Metimazole: teratogenisity
Aplasia cutis
Agranulocytosis
89
Which of the following is NOT a sign of severe pre-eclampsia
- Oligohydramnios
- Proteinuria > 3 g/day
- Thrombocytopenia
- Elevated serum creatinine
- Elevated transaminases
Proteinuria > 3 g/day
90
What animal is a common reservoir for toxoplasmosis
Cats
91
36 weeks GA. Vaginal bleeding, contractions and a very tender abdomen
Abruptio placentae
92
Which of the following is not a result of an insult during fetal development
- Death
- Malformation
- Growth retardation
- Dizygotic twinning
- Pregnancy-induced hypertension
Dizygotic twinning
93
Which is consistent with a partial mole:
- 46 chromosomes
- Villous edema
- Theca lutein cysts
- Uterus larger than dates
- Fetal parts
Fetal parts
94
Z-score: definition
A measure of difference between the average bone mass at the age of the patient and the present bone mass of the patient
95
T-score -0.75 and Z-score 0.25: what to do?
Normal results. No treatment needed
96
T-score -2.75 and Z-score 1.25: what to do?
Osteoporosis - start treatment
97
Most effective treatment of osteoporosis =
Bisphosphonates (alendronate)
98
Preconceptual care of a patient with DM
Reach HbA1c less than 6.1%
Switch to recombinant insulin
99
Iodine supplementation
- Preconcetpion
- In pregnancy
Preconception: 150 microgram
In pregnancy: 250 mikrogram
100
DOC for hyperthyroidism in pregnancy
Propylthiouracil
101
Preconceptional folic acid protects against
Neural tube defects
102
25 year old with irregular periods. LMP 7 weeks ago. B-hCG 7000. USG shows no signs of GS/fetus. Diagnosis?
Ectopic pregnancy
103
25 year old with irregular periods. LMP 7 weeks ago. B-hCG 700. USG shows no signs of GS/fetus. Diagnosis?
Ectopic pregnancy
OR
Intrauterine pregnancy, but too early to visualize GS (return to clinic after B-hCG > 1500)
104
Which is a confirmed adverse effect of estrogen deficiency
- Decreased cortical bone
- Decreased vaginal pH
- Increased serum LDL
- Increased bladder capacity
- Generalized chills
Increased serum LDL
105
The only choice of hormone therapy for a 52 year old hysterectomized woman with Hx of gallbladder stones
- Transdermal 17-beta-estradiol
- Transdermal 17-beta-estradiol with oral progesterone
- Transdermal 17-beta-estradiol with transdermal norethinone
- Oral 17-beta-estradiol
- Oral 17-beta-estradiol with transdermal norethinone
Transdermal 17-beta-estradiol
106
All of the following are risk factors for endometrial cancer, EXCEPT
- Hyperthyroidism
- Obesity
- Hypertension
- Nulliparity
- Diabetes
Hyperthyroidism
107
The highest level of prolactin occurs at
2 pm
108
The pregnancy-induced changes in thyroid gland is caused by
Alfa-subunit of hCG
109
Hormonal marker of fetal-placental unit
Estriol
110
OCP: for how long can you forget to take the pill
12 hours
111
GnRH antagonist: mechanism of action
Blocks GnRH-receptors in the pituitary
112
Doubling time of hCG in early pregnancy
48 hours
113
FSH
- Normalverdi
- Diminishing ovarian function
- Menopause
Normal: 3-9
Diminishing oviarian failure: > 10
Menopause: > 30
114
Bromokriptin: hvordan skal det tas
Med middag, og pasienten skal sove innen 2 timer
Bivirkning: søvningher
115
When the teratogen exerts its influence during the resistant period, what happens
Resistance period (1 week postovulatory) is ALWAYS teratogen resistant
116
FDA category C =
Animal studies showed the teratogenic effect or embryological effects of the fetus, but there are no human studies
117
DOC for chlamydia in patients that are NOT pregnant
Doxycycline (CONTRAINDICATED in pregnancy - use azithromycin)
118
Blood stained discharge from nipple...
Intraductal papilloma
119
All of the following are causes of IUGR except
- Anemia
- Pregnancy-induced hypertension
- Maternal heart disease
- Gestational diabetes mellitus
Gestational diabetes mellitus
120
Stage 3 of labor: definition
From delivery of baby to delivery of placenta
Should not last longer than 30 minutes
121
The lowest serum FSH during the menstrual cycle is at day
Day 1-3
122
The first and second reductive division of female germ cells
Results in chromosome number of 23
123
The major cause of maternal mortality in US is
Embolism
124
Uterine fundus is at its highest in week
36
125
Prenatal diagnosis should be offered to
- Teenage mother
- Mother over 35
- Mother with PIH
- Mother with essential hypertension
- A + B + C
Mother over 35
126
CVS should be performed at
Week 9-12
127
Primigravida report fetal quickening at
Week 18-20
128
A presumptive sign of pregnancy is..
- Hegar sign
- Palpation of fetal parts
- Uterine enlargement
- Amenorrhea
- Ausculation of fetal heart tones
Amenorrhea
129
The pituitary secretion of FSH is influenced by
Activin
Inhibin
Follistatin
GnRH
130
Androgens
1) In low concentrations enhance their own aromatization and contribute to estrogen production
2) increase the FSH receptor content of the follicle
3) at higher level causes follicular atresia
4) May serve as substrate for progesteron
1) In low concentrations enhance their own aromatization and contribute to estrogen production
3) at higher level causes follicular atresia
131
Inhibin
1) Is produced by FSH stimulated granulosa cells
2) Secretion is inhibited by GnRH and epidermal growth factor
3) exists in two isoforms (inhibin A and inhibin B)
4) Rises throughout the follicular phase to reach a midcycle peak followed by a greater midluteal peak
All 4 are correct
1) Is produced by FSH stimulated granulosa cells
2) Secretion is inhibited by GnRH and epidermal growth factor
3) exists in two isoforms (inhibin A and inhibin B)
4) Rises throughout the follicular phase to reach a midcycle peak followed by a greater midluteal peak
132
Ovulation
1) Is most reliable predicted by the onset of the LH surge which occurs 34-36 hours prior to rupture
2) Occurs approximately 10-12 hours after LH peak
3) Requires a threshold of LH concentration to be maintained for 14-27 hours in order for full maturation of the oocyte to occur
4) involves considerable variation in timing from cycle to cycle within the same woman
All 4 are correct
1) Is most reliable predicted by the onset of the LH surge which occurs 34-36 hours prior to rupture
2) Occurs approximately 10-12 hours after LH peak
3) Requires a threshold of LH concentration to be maintained for 14-27 hours in order for full maturation of the oocyte to occur
4) involves considerable variation in timing from cycle to cycle within the same woman
133
Menstraual cycle changes immediately prior to menopause are marked by
1) Elevated FSH
2) Decreasing inhibin
3) Slightly elevated levels of estradiol
4) Normal levels of LH
All 4 are correct
1) Elevated FSH
2) Decreasing inhibin
3) Slightly elevated levels of estradiol
4) Normal levels of LH
134
The main sexual changes which occurs in the ageing woman include
1) Loss of vaginal elasticity
2) Diminished libido
3) Reduction in the rate of production and volume of vaginal lubricating fluid
4) Diminished ability to have orgasm
1) Loss of vaginal elasticity
| 3) Reduction in the rate of production and volume of vaginal lubricating fluid
135
Following menopause
1) FSH is elevated
2) DHEAS is decreased
3) LH is elevated
4) Androstenedione is decreased
All 4 is correct
1) FSH is elevated
2) DHEAS is decreased
3) LH is elevated
4) Androstenedione is decreased
136
Primary management of cervical insufficiency
Cerclage
137
CTG signs of fetal well-being includes
1) Normal baseline heart rate
2) Early decelerations
3) Marked baseline variability
4) No variable decelerations
5) 1 and 4
1 and 4
Normal baseline heart rate
No variable decelerations
138
Laceration involving perineal body, but not anal sphincter =
Second degree
139
All of the following are used for ripening, EXCEPT
- PGE2
- Estrogen
- Progesterone
- Mechanical stretching
- Relaxin
Progesteron
140
MCC of puerperial fever
Endometritis
141
Most common STD in female
Chlamydia
142
Cervical cancer. Not to pelvic wall, but to lower 1/3 of vagina
3a
143
Which is NOT helpful in ectopic pregnancy
- Metotrexat
- Misoprostol
- Actinomycin-D
- Mifepriston
Misoprostol
144
Where does normal fertilization occur?
Ampulla of fallopian tube
145
The puerperium consist of...
First 6 weeks postpartum
146
Postpartum hemorrhage: excessive blood loss is:
More than 500 mL during first 24 hours postpartum
147
Accelerations =
Increase in baseline > 15 bpm lasting > 15 seconds
148
Which of these factors are associated with placenta previa
1) Maternal age
2) Maternal age, multiparity
3) Multiparity
4) Maternal age, multiparity, PIH
Maternal age and multiparity
149
Best confirmation of functional hyperprolactinemia is
Oral metoclopramide test
150
Which is the most potent androgen
Dihydrotestosterone (DHT)
151
8 am prolactin = 101: what is next step?
CT head
152
The only choice of HRT for a 52 yo hysterectomized woman with Hx of gallbladder disease is
Transdermal 17 B-estradiol
153
25 year old woman with negative hCG + asymptomatic 5 cm pelvic mass: diagnosis
Simple = functional cyst (follicular, corpus luteum)
Complex = dermoid cyst (mature teratoma)
154
Hormone levels in early pregnancy: FSH, estradiol, prolactin
Low FSH (1.0)
High estradiol (550)
Normal prolactin (10)
155
Hormone levels in anorectic: FSH, estradiol, prolactin
Low FSH (2.0)
Low estradiol (18.8)
Normal prolactin (10.7)
156
Perimenopausal woman: FSH, estradiol, prolactin
Sligthly increased FSH (14)
Estradiol low normal (100)
Normal prolactin (5.6)
157
7th day cycle results:
LH 9.6
FSH 4.8
Estradiol 139
Testosterone 1.3
Normal results
158
FSH 78, LH 140, estradiol 12,9 in a 23 year old patient with primary amenorrhea: next step
Genetic evaluation
159
Source of AFP in maternal serum at 18 weeks GA
Fetal liver
160
Fetal lung maturation is ensured by presence of
Phosphatidylglycerol
161
A pregnant vegeterian is likely to be deficient in
Vitamin B12
162
Woman smokes 1 pack daily. USG at 32 weeks to look at
Fetal size
163
36 weeks presenting with vaginal bleeding, contractions and a very tender abdomen: diagnosis
Abruptio placentae
164
Which of the following is NOT a result of insult during fetal development
- Death
- Malformation
- Growth retardation
- Dizygotic twinning
- Pregnancy-induced HTN
Dizygotic twinning
165
Which of the following is consistent with a partial mole?
- 46 chromosomes
- Villous edema
- Theca lutein cysts
- Uterus larger than dates
- Presence of a fetus
Presence of a fetus
166
T-score -0.75 and Z-score 0.25: next step?
Normal results, does not require treatment
167
Most effective Tx of osteoporosis
Bisphosphonates (alendronate)
168
Iodine supplementation
150 microgram preconception
250 microgram in pregnancy
169
25 year old woman. LMP 7 weeks ago. Irregular menses. B-hCG 10.000. Ultrasound revealed presence of gestational sac. Next hCG in 7 days showed 40.000. Diagnosis?
Normal pregnancy, located in proper place, but ultrasound should be repeated to look for fetal heart rate
170
How long does the resistant period (resistance to teratogens)
0-11 days gestation
171
If maternal blood group is A Rh negative and paternal group is A Rh positive
- The mother should receive RhoD within 3 hours of deliver
- The mother should receive RhoD within 24 hours of deliver
- The baby should receive RhoD within 72 hours of delivery
- The baby blood group and Rh factor should be evaluated
. The volume of fetal blood in maternal circulation should be evaluated
The baby blood group and Rh factor should be evaluated
172
Routine glucose screening with 50 g (1 hour glucose tolerance test) should not exceed (at 60 min)
7.8 mmol/L (140 mg/dL)
173
Bromocriptine should be given..
With dinner (and the patient should go to sleep within 2 hours)
174
Gir endometriose økt risiko for XU?
Ja
175
Ektopisk graviditet: kandidater for konservativ behandling (observasjon)
Under 4 cm
Under 100 mL i Douglasi
Under 1000 hCG
God allmenntilstand
176
Marginal placenta previa: definisjon
Mindre enn 2 cm fra os, men deker den ikke
177
Mean onset of placenta previa bleeding
30 weeks GA
178
Placenta previa på ultralyd i uke 16: neste steg
Revurder i uke 32
Deretter i uke 36
Hvis fortsatt placenta previa i 36: elektiv sectio i uke 36-37
179
Tidligere sectio øker risikoen for placenta...
Previa og accreta
180
Placenta previa: når skal du planlegge elektiv sectio
I uke 36-37
181
Placenta previa: sentinel bleed
Many pt first experience a sentinel bleed (spotting)
If they adhere to NPV and low activity, they should be fine
In case of a 2nd bleeding: hospitalize
182
Placenta previa: når kan man forsøke vaginalfødsel
Placenta > 2 cm fra kanten av os (= low-lying placenta)
183
Abruptio - er det assosiert med
- Nulliparity eller multiparity
- Ung mor eller gammel mor
Multiparity
Maternal age > 35
184
Hvor lenge etter abruptio skal mor ha RhoGAM
Innen 72 timer
185
Abruptio med fosterdød: hvordan skal man levere
Vaginalfødsel er foretrukket
Sectio kun hvis det er ukontrollert blødning eller kontraindikasjoner mot vaginalfødsel
186
Kan damer med Berry aneursimer levere vaginalt?
Nei
187
Første kliniske Sx på placenta accreta?
Massiv blødning når man prøver å fjerne placenta postpartum
188
Dersom du vet at kvinnen har placenta accreta: hva gjør du?
Elektiv fødsel i 34-36
189
Vasa previa: typer
Type 1 = vilamentous
Type 2 = succinturiate lobe
190
Apt test
Brukes ved mistanke om vasa previa
Blod blandes med NaOH (alkaline denaturation test)
Føtalt blod blir rosa, maternelt blod blir gult
191
Hvilke tester gjøres ifm vasa previa
Apt test (blod blandes med NaOH)
Wright stain (se etter nucleated RBCs)
192
Vasa previa: hvordan skal de forløses
Elektiv sectio i uke 35
193
Hva slags type prostaglandin er carbaprost (som brukes i PPH)
PGF2a
194
PPH: residivrate
10%
195
Anti-IgG toxoplasma med høy aviditet tyder på
At primærinfeksjonen skjedde 3-5 måneder siden
196
Dx av intrapartum toxoplasmose
Amniocentese og PCR for DNA
197
Behandling av intrapartum toxoplasmose
Spiramycin (macrolide)
Etter uke 14: pyrimetamin og sulfadiazin (folic acid antagonists)
198
Hvor mange svangerskap har CMV+
0.5%
199
Er amming kontraindisert ved CMV?
Nei
200
Kongenital CMV: hvor mange er symptomatiske? Hva slags symptomer har de?
10% er symptomatiske
Som regel hørselstap og/eller synstap
201
Behandling av CMV i svangerskap
Ingen behandling i svangerskapet
Ganciklovir til mor og barn postpartum
202
Hvordan smitter rubella
Nose secretions
Transplacentally
203
Rubella: reservoir
Kun mennesker
204
Hva er forskjellen på congential rubella infection og congential rubella syndrome
Congenital rubella infection = alle komplikasjoner
Congenital rubella syndrome = cataract, SNHL, PDA
205
Rubella: diagnose
4-fold increase in IgG
Positive IgM
Positive rubella culture
206
The only infection that is an indication for pregnancy termination
Rubella
207
Syfilis transmission in first trimester leads to
Nonimmune hydrops (50% mortality)
208
Når skal høyrisikopasienter screenes for syfilis
Første besøk
28-32 uker
209
Hva skal du gjøre med gravide kvinner som er HBsAb-negative
Vaksiner dem i svangerskapet
210
Når har man mest AF? Hvor mye?
800-2000 mL (32-34)
211
Bilateral nyreagenese: fostervannsvolum i T1 vs. T2
T1: normal AFI (huden er ikke keratinisert)
T2: oligohydramnios
212
Når i svangerskapet er det samsvar mellom fundal height og GA
Mellom 16-36
213
Oligohydramnios is associated with.. (komplikasjoner)
Meconium staining
Heart conduction abnormalities
Cord compression
214
Komplikasjoner av amnioinfusjon
Amniotic fluid embolism
Amniochorionic separation
Infection
215
Amniotic fluid abmormality seen with congenital arrhythmias?
Polyhydramnios
216
Amniotic fluid abmormality seen with fetal akinesia syndrome?
Polyhydramnios (lack of swallowing)
217
Late-term pregancy (40-41+6): valgmuligheter
Elektiv induksjon
Expectant management
Antenatal testing
218
Når skal du gjøre cervical ripening før IOL
Ved Bishop score 6 eller lavere
219
Methods of IOL
Oxytocin with amniotomy (in case of hyperstimulation: stop oxytocin - half-life 5-10 min)
Stripping/sweeping of fetal membranes: increaes PGF2a (delivery in 2-7 days)
Unprotected intercourse
220
In adolescents - management of
Simple cysts
Complex cysts
Simple cysts = observation and laparoscopic cystectomy
Complex cysts = cystectomy or oophorectomy (+ CA-125)
221
When does corpus luteum cysts normally rupture
Day 20-26 of the cycle
222
Normal menstrual period (lenght)
Those over 16
Those under 16
Over 16 years: 21-35 days
Under 16 years: 21-45 dasy
223
Amenorrhea - definition
No period by 14 without breasts
No period by 16 with breasts
Secondary: no menses for 3 cycles (3 months!!!)
224
Definisjon
Hypomenorrhea
Hypermenorrhea (menorrhagia)
Hypomenorrhea = less than 30 mL
Hypermenorrhea = more than 100 mL
225
Menstrual abnormality in hyperthyroidism
Polymenorrhea
226
Amenorrhea classification: compartment 6 and 7
6 = hyperprolactinemia wihtout tumor
7 = infection/Trauma (e.g. sarcoidosis)
227
Secondary amenorrhea with normal FSH =
anovulation
228
Treatment of androgen insensitivity syndrome
HRT (feel like a girl)
Remove testis (risk of cancer)
229
Treatment of anorexia amenorrhea (compartment 1)
HRT (17-B estradiol + progesterone)
230
Best biochemical marker for preterm delivery =
fibronectin (from vaginal or cervical swab)
231
Contraindications for tocolysis
Severe PIH, IUGR, bleeding
Abruptio
Chorioamnionitis
Dilataion > 5 cm
232
At which fetal Hb does hydrops occur?
Hb less than 7 g/dL below mean for GA (usually less than 5 mg/dL)
233
Hva skal du gjøre med en Rh-negativ med Coombs > 1:42
Screen hver 4. uke
234
Når kan du gjøre cell-free fetal DNA testing?
Etter uke 11
235
Initial screening for fetomaternal hemorhage
Rosette test
IF positive, do either
- Kleihauer-Betke
- Flow cytometry
236
Hva er cut-off for MCA PSV?
More than > 1.5 MoM (multiple of means)
237
Recurrent nonimmune hydrops: DDx
Storage diseases
Graves
238
Treatment of TTTS
Fetoscopic laser ablation of AV-communication
239
Mirror syndrome
Maternal edema with fetal hydrops
240
Rybak: two ABx used in pregnancy
Ampicillin and erythromycin
241
Difference between threatened and inevitable abortion
Threatened: closed cervical os
Inevitable: open cervical os
242
Bleeding in complete vs. incomplete abortion
Complete: bleeding stops after complete expulsion
Incomplete: continous bleeding wiht risk of hemorrhagic shock (Tx: D and C - NB! Risk of rupture)
243
Two potential USG findings in mised abortion
Empty GS with absent embryonic pole (blighted ovum)
GS with embryoic pole without visualized cardiac activity
244
Recurrent miscarriages in 2nd trimester: DDx
Cervical incompetence
Septate uterus
APS
245
After how many weeks GA should you always do D and C after abortion
After 6 weeks (no chance of complete abortion)
246
Diagnostic criteria for APS: spontaneous abortions (how many)
One after 10 weeks GA
OR
Three before 10 weeks GA
247
Treatment of APS
LMWH
Aspirin (until 36 weeks GA)
248
4 most common causes of infertility
1) Unexplained (28%)
2) Male factors (26%)
3) Ovulatory dysfunction (21%)
4) TUbal damage (14%)
249
How should you count number of days in cycle
From 1st day of MP to 1st day of MP
250
Hirsutism scale
Ferriman-Gallwey scale (> 8 points = hirsutism)
251
How do you detect ovulation
S-progesterone on day 21
Ultrasound (to see if follicle has ruptured)
252
Hva indikerer redusert ovariereserve
FSH
AMH
Høy FSH (> 10)
Lav AMH
253
Follicle count on USG: what indicates good reserve?
4-6 follicles
254
How do you assess tubal patency?
HSG > SHG
255
Which leiomyomas should be removed
Intramural myomas > 4 cm
SUbmucosal
256
Teratospermia
Less than 4% has normal morphology
257
Polyzoospermia
Hyperspermia
Polyzoospermia = high sperm concentraiton (> 200)
Hyperspermia = high volume (> 6 mL)
258
Menopause: normal age
40-60 (aveage 51)
259
HRT with liver disease or hypertriglyceridemia
Transdermal HRT
260
How do you give HRT in perimenopause and postmenopause
Perimenopause: intermittent HRT
Postmenopause: continuous HRT
