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OB/GYN > Siste innspurt > Flashcards

Siste innspurt Flashcards

1
Q

Graafian follicle: størrelse

A

10-20 mm

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2
Q

Mistanke om dermoid cyst (mature teratoma): hva gjør du?

A

Ultralyd (98% spesifikt)

Endelig diagnose skjer etter laparoskopisk reseksjon

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3
Q

Ektopisk graviditet: recurrence rate?

A

15%

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4
Q

Hvilken subenhet av hCG stimulerer tyroidea?

A

Alfa-subenheten (stimulerer TSH-reseptoren)

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5
Q

Maternell DM: metaboliske avvik hos nyfødt

A

Hypoglykemi

Hypokalsemi

Hyperbilirubinemi

Polycytemi

(+ hypokalemi)

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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)

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7
Q

Hva er forskjellen på

  • D og C
  • Suction curettage
A

D og C: bruker curette

Suction curettage = vakuum-aspirasjon

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8
Q

Behandling av complete mole:

D og C ELLER suction curettage

A

Suction curettage

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9
Q

Snowstorm på ultralyd: hva skal du tenke?

A

Complete mole

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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

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11
Q

Fetal lie:

A

barnets lengdeakse vs. morens lengdeakse

Longitudinal = same axis as mothers spine

Transverse = perpendicular to axis of mother’s spine

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12
Q

WHO amenore: hvilken compartment er anoreksi

A

Compartment 1 (hypogonadotropisk hypogonadisme)

Lav FSH og LH

Funksjonell (anoreksi, atleter) eller organisk

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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

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14
Q

Kandidater for BRCA-testing

A

Brystkreft før 50 år

Trippel negativ brystkreft før 60 år

Menn med brystkreft

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15
Q

Female pelvis - measurements

A

External conjugate: 18 cm

Interspinal: 25 cm

Intercristal: 28 cm

Intertrochanteric: 31 cm

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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

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17
Q

Puerperium

A

Delivery to 6 weeks postpartum

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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

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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)

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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

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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

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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

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23
Q

Lady with external conjugate diameter 16 cm: what to do?

A

Qualify for c-section due to CPD

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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

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25
Q

Gestational DM-woman in 27th week. Vaginal examintaion normal. What NOT to do

A

Do NOT start steroid therapy

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26
Q

Risikofaktorer for brystkreft (utenom FHx)

A

Tidlig menarche og sen menopause

Nulliparitet

Delayed childbearing

Alkohol

Overvekt

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27
Q

Når er prolaktin høyest?

A

Når du sover

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28
Q

Twin-twin transfusion syndrome

A

Ses i MoDi (monochorionic, diamniotic) tvillinger

AV-kommunikasjon

Treatment options

  • Reductive amniocentesis
  • Selective laser ablation
  • Selective cord coagulation
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29
Q

Progestin challenge test: hvordan gjøres det? Hvordan tolkes det?

A

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
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30
Q

Blodtrykk som indikerer alvorlig pre-eklampsi

A

> 160/110 målt ved 2 anledninger, med minst 4 timers mellomrom

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31
Q

Endometriose - klassifisering

A

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

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32
Q

Germ cell tumor: typer

A

Dysgerminoma

Dermoid cyst

Embryonal carcinoma

Choriocarcinoma

Endodermal sinus tumor

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33
Q

Delayed puberty: definisjon

A

No breast development at age 13

No menses 3 years after breast development (or by 16)

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34
Q

Når i menstruasjonssyklusen er FSH LAVEST??

A

Dag 10-12

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35
Q

Pre-eklampsi i uke 32 med BT 160/100 etter hydralazin, metyldopa og CCB. Hva skal du gjøre

A

Sjekk CTG og FHR hver 2. time (+ daglige NST/BPP)

Gi betametason og MgSO4

Vaginalfødsel hvis maternell/føtal kompromiss

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36
Q

Major cause of maternal death in US?

Major cause of maternal death worldwide?

Most common non-obstetric cause of maternal death in pregnancy?

A

US: Pulmonary embolism

Worldwide: PPH

Non-obstetric cause: MVA

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37
Q

Når er fundus høyest?

A

Uke 36

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38
Q

Når gjøres QUAD-test

A

Uke 15-19

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39
Q

Når rapporterer mødre fosterbevegelser?

A

Multipara: 16-18

Primigravida: 18-20

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40
Q

Presumptive sign of pregnancy =

A

Amenorrhea

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41
Q

Hvor sannsynlig er det at du leverer på EDD fra Naegle?

A

4%

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42
Q

Causes of decreased GI motility in pregnancy

A

Increased progesterone

Decreased motilin

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43
Q

Tyroideahormon som krysser placenta?

A

KUN!!! thyroid-stimulating immunoglobulin (anti-TSHR)

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44
Q

The first and second reductive divisions of female germ cells results in

A

23 chromosomes

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45
Q

Når er fundal height høyest?

A

Uke 36 (deretter går den tilbake til 32-36)

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46
Q

Prenatal diagnosis should be offered to:

  • Teenage mom
  • Mother > 35 years
  • Mother with overt DM
A

Mother > 35 and mother with overt diabetes

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47
Q

Når skal du gøre CVS?

A

Uke 9-12

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48
Q

What is true about Naegle rule…

A

EDD (estimated due date) is adjusted to the duration of the follicular (proliferative) phase

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49
Q

Causes of second trimester pregnancy loss includes all of the following EXCEPT

  • Abruptio placentae
  • Uterine anatomical defect
  • Incompetent cervix
  • Immune hydrops
  • Nonimmune hydrops
A

Abruptio placenta

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50
Q

Kleihauer-Betke test should be performed to evaluate

A

The volume of fetal blood in maternal circulation

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51
Q

300 mikrogram RhoGAM dekker

  • Hvor mange mL føtalt fullblod
  • Hvor mange mL føtale RBCs?
A

300 mikrogram RhoGAM dekker

  • 30 mL føtalt fullblod
  • 15 mL føtale RBCs
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52
Q

Risk factor for malignant GTN?

A

Bilateral theca-lutein cysts

OR

Age extremes

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53
Q

Metastatic GTN: good prognosis =

A

Metastases to pelvis and lungs

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54
Q

Primary management of cervical incompetence

A

Cerclage

Progestational agents

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55
Q

White classification: B, C and D

A

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

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56
Q

Behandlingsmål for fastende glukose hos pasienter med gestasjonsdiabetes

A

Fastende glukose 60-90

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57
Q

Anemi i svangerskap: definisjon

A

Hb under 11

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58
Q

Causes of increased baseline variability includes all of the following EXCEPT

  • Hypothermia
  • Arrhyhtmia
  • Fetal movements
  • Prematurity
A

Prematurity

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59
Q

Normal fetal scalp pH =

A

Normal = pH 7.25 - 7.35

Borderline = pH 7.20 - 7.25

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60
Q

Common cause of prolonged latent phase

A

Anesthesia

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61
Q

Most significant risk factor for preterm delivery?

A

Previous preterm delivery

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62
Q

All of the following are used for cervical ripening EXCEPT

  • PGE2
  • Estrogen
  • Mechanical stretching
  • Progesteron
  • Relaxin
A

Progesteron is NOT used for ripening

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63
Q

Within what time period should RhoGAM be given postpartum

A

Within 72 hours

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64
Q

Most common cause of puerperal fever

A

Endometritis

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65
Q

Most common STD in females

A

HPV > Trichomonas > klamydia

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66
Q

FIGO: cervical cancer pelvic wall is NOT invovled, but lower 1/3 of vagina is

A

Stage 3a

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67
Q

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
A

History of cervical dysplasia

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68
Q

Prevensjon som har lavest pearl index (altså lavest failure rate på 1 år)

  • IUD
  • Medroxyprogesteron acetat
A

Medroxyprogesteron acetat

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69
Q

When in life does the hypothalamic-pituitary-gonadal axis become fully functional

  • Neonatal
  • Fetal
  • Childhood
  • Prepuberty
  • Puberty
A

Fetal

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70
Q

Functional hyperprolactinemia is fully confirmed by

A

Oral metoclopramid (dopamine antagonist) test

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71
Q

Basic prolactin plasma level is 24. In the 60 min metoclopramide test it increases to 192. Diagnosis?

A

Functional hyperprolactinemia (because it increases x 6)

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72
Q

What is the most potent androgen

A

Dihydrotestosterone (DHT)

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73
Q

What is the most common underlying etiology of menopause

A

Ovarian follicle depletion

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74
Q

25 year old woman with negative hCG + 5 cm asymptomatic pelvic mass: most likely diagnosis?

A

Simple cyst: follicular or corpus luteum cyst

Complex: dermoid cyst

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75
Q

Complications of ovulation induction

A

Multiple gestation

Ovarian hyperstimulation

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76
Q

Hormone levels in anorectic: FSH, estradiol, prolactin

A

Low FSH (e.g. 2)

Low estradiol (e.g. 18)

Normal prolactin (e.g. 10)

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77
Q

Perimenopausal woman with FSH 14 and estradiol 101. What to do

A

FSH should be 3-9

Supplement progesterone in day 17-23

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78
Q

Normalverdi for FSH

A

3-9

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79
Q

Normalverdier

  • FSH
  • LH
A

FSH: 3-9

LH: 5-40

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80
Q

LH 9, FSH 4, estriol 130. Diagnose?

A

Normale hormonverdier

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81
Q

FSH 70, LH 120, estradiol 12 in a 23 year old woman with primary amenorrhea: next step?

A

Genetic evaluation

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82
Q

Typical sign of thyrotoxicosis in early pregnancy

A

Vomiting

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83
Q

City with highest rates of ectopic pregnancy

A

Kingston, Jamaica

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84
Q

The source of AFP in maternal serum at 18 weeks gestation is…

A

Fetal liver

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85
Q

Fetal lung maturation is ensured by presence of

A

Phosphatidylglycerol

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86
Q

A pregnant vegetarian is likely to be deficient in…

A

Vitamin B12

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87
Q

A woman smokes one pack of cigarettes a day. An ultrasound in week 32 is ordered to evaluate

A

Fetal size

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88
Q

Metimazole: teratogenisity

A

Aplasia cutis

Agranulocytosis

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89
Q

Which of the following is NOT a sign of severe pre-eclampsia

  • Oligohydramnios
  • Proteinuria > 3 g/day
  • Thrombocytopenia
  • Elevated serum creatinine
  • Elevated transaminases
A

Proteinuria > 3 g/day

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90
Q

What animal is a common reservoir for toxoplasmosis

A

Cats

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91
Q

36 weeks GA. Vaginal bleeding, contractions and a very tender abdomen

A

Abruptio placentae

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92
Q

Which of the following is not a result of an insult during fetal development

  • Death
  • Malformation
  • Growth retardation
  • Dizygotic twinning
  • Pregnancy-induced hypertension
A

Dizygotic twinning

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93
Q

Which is consistent with a partial mole:

  • 46 chromosomes
  • Villous edema
  • Theca lutein cysts
  • Uterus larger than dates
  • Fetal parts
A

Fetal parts

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94
Q

Z-score: definition

A

A measure of difference between the average bone mass at the age of the patient and the present bone mass of the patient

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95
Q

T-score -0.75 and Z-score 0.25: what to do?

A

Normal results. No treatment needed

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96
Q

T-score -2.75 and Z-score 1.25: what to do?

A

Osteoporosis - start treatment

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97
Q

Most effective treatment of osteoporosis =

A

Bisphosphonates (alendronate)

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98
Q

Preconceptual care of a patient with DM

A

Reach HbA1c less than 6.1%

Switch to recombinant insulin

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99
Q

Iodine supplementation

  • Preconcetpion
  • In pregnancy
A

Preconception: 150 microgram

In pregnancy: 250 mikrogram

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100
Q

DOC for hyperthyroidism in pregnancy

A

Propylthiouracil

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101
Q

Preconceptional folic acid protects against

A

Neural tube defects

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102
Q

25 year old with irregular periods. LMP 7 weeks ago. B-hCG 7000. USG shows no signs of GS/fetus. Diagnosis?

A

Ectopic pregnancy

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103
Q

25 year old with irregular periods. LMP 7 weeks ago. B-hCG 700. USG shows no signs of GS/fetus. Diagnosis?

A

Ectopic pregnancy

OR

Intrauterine pregnancy, but too early to visualize GS (return to clinic after B-hCG > 1500)

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104
Q

Which is a confirmed adverse effect of estrogen deficiency

  • Decreased cortical bone
  • Decreased vaginal pH
  • Increased serum LDL
  • Increased bladder capacity
  • Generalized chills
A

Increased serum LDL

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105
Q

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
A

Transdermal 17-beta-estradiol

106
Q

All of the following are risk factors for endometrial cancer, EXCEPT

  • Hyperthyroidism
  • Obesity
  • Hypertension
  • Nulliparity
  • Diabetes
A

Hyperthyroidism

107
Q

The highest level of prolactin occurs at

A

2 pm

108
Q

The pregnancy-induced changes in thyroid gland is caused by

A

Alfa-subunit of hCG

109
Q

Hormonal marker of fetal-placental unit

A

Estriol

110
Q

OCP: for how long can you forget to take the pill

A

12 hours

111
Q

GnRH antagonist: mechanism of action

A

Blocks GnRH-receptors in the pituitary

112
Q

Doubling time of hCG in early pregnancy

A

48 hours

113
Q

FSH

  • Normalverdi
  • Diminishing ovarian function
  • Menopause
A

Normal: 3-9

Diminishing oviarian failure: > 10

Menopause: > 30

114
Q

Bromokriptin: hvordan skal det tas

A

Med middag, og pasienten skal sove innen 2 timer

Bivirkning: søvningher

115
Q

When the teratogen exerts its influence during the resistant period, what happens

A

Resistance period (1 week postovulatory) is ALWAYS teratogen resistant

116
Q

FDA category C =

A

Animal studies showed the teratogenic effect or embryological effects of the fetus, but there are no human studies

117
Q

DOC for chlamydia in patients that are NOT pregnant

A

Doxycycline (CONTRAINDICATED in pregnancy - use azithromycin)

118
Q

Blood stained discharge from nipple…

A

Intraductal papilloma

119
Q

All of the following are causes of IUGR except

  • Anemia
  • Pregnancy-induced hypertension
  • Maternal heart disease
  • Gestational diabetes mellitus
A

Gestational diabetes mellitus

120
Q

Stage 3 of labor: definition

A

From delivery of baby to delivery of placenta

Should not last longer than 30 minutes

121
Q

The lowest serum FSH during the menstrual cycle is at day

A

Day 1-3

122
Q

The first and second reductive division of female germ cells

A

Results in chromosome number of 23

123
Q

The major cause of maternal mortality in US is

A

Embolism

124
Q

Uterine fundus is at its highest in week

A

36

125
Q

Prenatal diagnosis should be offered to

  • Teenage mother
  • Mother over 35
  • Mother with PIH
  • Mother with essential hypertension
  • A + B + C
A

Mother over 35

126
Q

CVS should be performed at

A

Week 9-12

127
Q

Primigravida report fetal quickening at

A

Week 18-20

128
Q

A presumptive sign of pregnancy is..

  • Hegar sign
  • Palpation of fetal parts
  • Uterine enlargement
  • Amenorrhea
  • Ausculation of fetal heart tones
A

Amenorrhea

129
Q

The pituitary secretion of FSH is influenced by

A

Activin

Inhibin

Follistatin

GnRH

130
Q

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

A

1) In low concentrations enhance their own aromatization and contribute to estrogen production
3) at higher level causes follicular atresia

131
Q

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

A

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
Q

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

A

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
Q

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

A

All 4 are correct

1) Elevated FSH
2) Decreasing inhibin
3) Slightly elevated levels of estradiol
4) Normal levels of LH

134
Q

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

A

1) Loss of vaginal elasticity

3) Reduction in the rate of production and volume of vaginal lubricating fluid

135
Q

Following menopause

1) FSH is elevated
2) DHEAS is decreased
3) LH is elevated
4) Androstenedione is decreased

A

All 4 is correct

1) FSH is elevated
2) DHEAS is decreased
3) LH is elevated
4) Androstenedione is decreased

136
Q

Primary management of cervical insufficiency

A

Cerclage

137
Q

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

A

1 and 4

Normal baseline heart rate

No variable decelerations

138
Q

Laceration involving perineal body, but not anal sphincter =

A

Second degree

139
Q

All of the following are used for ripening, EXCEPT

  • PGE2
  • Estrogen
  • Progesterone
  • Mechanical stretching
  • Relaxin
A

Progesteron

140
Q

MCC of puerperial fever

A

Endometritis

141
Q

Most common STD in female

A

Chlamydia

142
Q

Cervical cancer. Not to pelvic wall, but to lower 1/3 of vagina

A

3a

143
Q

Which is NOT helpful in ectopic pregnancy

  • Metotrexat
  • Misoprostol
  • Actinomycin-D
  • Mifepriston
A

Misoprostol

144
Q

Where does normal fertilization occur?

A

Ampulla of fallopian tube

145
Q

The puerperium consist of…

A

First 6 weeks postpartum

146
Q

Postpartum hemorrhage: excessive blood loss is:

A

More than 500 mL during first 24 hours postpartum

147
Q

Accelerations =

A

Increase in baseline > 15 bpm lasting > 15 seconds

148
Q

Which of these factors are associated with placenta previa

1) Maternal age
2) Maternal age, multiparity
3) Multiparity
4) Maternal age, multiparity, PIH

A

Maternal age and multiparity

149
Q

Best confirmation of functional hyperprolactinemia is

A

Oral metoclopramide test

150
Q

Which is the most potent androgen

A

Dihydrotestosterone (DHT)

151
Q

8 am prolactin = 101: what is next step?

A

CT head

152
Q

The only choice of HRT for a 52 yo hysterectomized woman with Hx of gallbladder disease is

A

Transdermal 17 B-estradiol

153
Q

25 year old woman with negative hCG + asymptomatic 5 cm pelvic mass: diagnosis

A

Simple = functional cyst (follicular, corpus luteum)

Complex = dermoid cyst (mature teratoma)

154
Q

Hormone levels in early pregnancy: FSH, estradiol, prolactin

A

Low FSH (1.0)

High estradiol (550)

Normal prolactin (10)

155
Q

Hormone levels in anorectic: FSH, estradiol, prolactin

A

Low FSH (2.0)

Low estradiol (18.8)

Normal prolactin (10.7)

156
Q

Perimenopausal woman: FSH, estradiol, prolactin

A

Sligthly increased FSH (14)

Estradiol low normal (100)

Normal prolactin (5.6)

157
Q

7th day cycle results:

LH 9.6

FSH 4.8

Estradiol 139

Testosterone 1.3

A

Normal results

158
Q

FSH 78, LH 140, estradiol 12,9 in a 23 year old patient with primary amenorrhea: next step

A

Genetic evaluation

159
Q

Source of AFP in maternal serum at 18 weeks GA

A

Fetal liver

160
Q

Fetal lung maturation is ensured by presence of

A

Phosphatidylglycerol

161
Q

A pregnant vegeterian is likely to be deficient in

A

Vitamin B12

162
Q

Woman smokes 1 pack daily. USG at 32 weeks to look at

A

Fetal size

163
Q

36 weeks presenting with vaginal bleeding, contractions and a very tender abdomen: diagnosis

A

Abruptio placentae

164
Q

Which of the following is NOT a result of insult during fetal development

  • Death
  • Malformation
  • Growth retardation
  • Dizygotic twinning
  • Pregnancy-induced HTN
A

Dizygotic twinning

165
Q

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
A

Presence of a fetus

166
Q

T-score -0.75 and Z-score 0.25: next step?

A

Normal results, does not require treatment

167
Q

Most effective Tx of osteoporosis

A

Bisphosphonates (alendronate)

168
Q

Iodine supplementation

A

150 microgram preconception

250 microgram in pregnancy

169
Q

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?

A

Normal pregnancy, located in proper place, but ultrasound should be repeated to look for fetal heart rate

170
Q

How long does the resistant period (resistance to teratogens)

A

0-11 days gestation

171
Q

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

A

The baby blood group and Rh factor should be evaluated

172
Q

Routine glucose screening with 50 g (1 hour glucose tolerance test) should not exceed (at 60 min)

A

7.8 mmol/L (140 mg/dL)

173
Q

Bromocriptine should be given..

A

With dinner (and the patient should go to sleep within 2 hours)

174
Q

Gir endometriose økt risiko for XU?

A

Ja

175
Q

Ektopisk graviditet: kandidater for konservativ behandling (observasjon)

A

Under 4 cm

Under 100 mL i Douglasi

Under 1000 hCG

God allmenntilstand

176
Q

Marginal placenta previa: definisjon

A

Mindre enn 2 cm fra os, men deker den ikke

177
Q

Mean onset of placenta previa bleeding

A

30 weeks GA

178
Q

Placenta previa på ultralyd i uke 16: neste steg

A

Revurder i uke 32

Deretter i uke 36

Hvis fortsatt placenta previa i 36: elektiv sectio i uke 36-37

179
Q

Tidligere sectio øker risikoen for placenta…

A

Previa og accreta

180
Q

Placenta previa: når skal du planlegge elektiv sectio

A

I uke 36-37

181
Q

Placenta previa: sentinel bleed

A

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
Q

Placenta previa: når kan man forsøke vaginalfødsel

A

Placenta > 2 cm fra kanten av os (= low-lying placenta)

183
Q

Abruptio - er det assosiert med

  • Nulliparity eller multiparity
  • Ung mor eller gammel mor
A

Multiparity

Maternal age > 35

184
Q

Hvor lenge etter abruptio skal mor ha RhoGAM

A

Innen 72 timer

185
Q

Abruptio med fosterdød: hvordan skal man levere

A

Vaginalfødsel er foretrukket

Sectio kun hvis det er ukontrollert blødning eller kontraindikasjoner mot vaginalfødsel

186
Q

Kan damer med Berry aneursimer levere vaginalt?

A

Nei

187
Q

Første kliniske Sx på placenta accreta?

A

Massiv blødning når man prøver å fjerne placenta postpartum

188
Q

Dersom du vet at kvinnen har placenta accreta: hva gjør du?

A

Elektiv fødsel i 34-36

189
Q

Vasa previa: typer

A

Type 1 = vilamentous

Type 2 = succinturiate lobe

190
Q

Apt test

A

Brukes ved mistanke om vasa previa

Blod blandes med NaOH (alkaline denaturation test)

Føtalt blod blir rosa, maternelt blod blir gult

191
Q

Hvilke tester gjøres ifm vasa previa

A

Apt test (blod blandes med NaOH)

Wright stain (se etter nucleated RBCs)

192
Q

Vasa previa: hvordan skal de forløses

A

Elektiv sectio i uke 35

193
Q

Hva slags type prostaglandin er carbaprost (som brukes i PPH)

A

PGF2a

194
Q

PPH: residivrate

A

10%

195
Q

Anti-IgG toxoplasma med høy aviditet tyder på

A

At primærinfeksjonen skjedde 3-5 måneder siden

196
Q

Dx av intrapartum toxoplasmose

A

Amniocentese og PCR for DNA

197
Q

Behandling av intrapartum toxoplasmose

A

Spiramycin (macrolide)

Etter uke 14: pyrimetamin og sulfadiazin (folic acid antagonists)

198
Q

Hvor mange svangerskap har CMV+

A

0.5%

199
Q

Er amming kontraindisert ved CMV?

A

Nei

200
Q

Kongenital CMV: hvor mange er symptomatiske? Hva slags symptomer har de?

A

10% er symptomatiske

Som regel hørselstap og/eller synstap

201
Q

Behandling av CMV i svangerskap

A

Ingen behandling i svangerskapet

Ganciklovir til mor og barn postpartum

202
Q

Hvordan smitter rubella

A

Nose secretions

Transplacentally

203
Q

Rubella: reservoir

A

Kun mennesker

204
Q

Hva er forskjellen på congential rubella infection og congential rubella syndrome

A

Congenital rubella infection = alle komplikasjoner

Congenital rubella syndrome = cataract, SNHL, PDA

205
Q

Rubella: diagnose

A

4-fold increase in IgG

Positive IgM

Positive rubella culture

206
Q

The only infection that is an indication for pregnancy termination

A

Rubella

207
Q

Syfilis transmission in first trimester leads to

A

Nonimmune hydrops (50% mortality)

208
Q

Når skal høyrisikopasienter screenes for syfilis

A

Første besøk

28-32 uker

209
Q

Hva skal du gjøre med gravide kvinner som er HBsAb-negative

A

Vaksiner dem i svangerskapet

210
Q

Når har man mest AF? Hvor mye?

A

800-2000 mL (32-34)

211
Q

Bilateral nyreagenese: fostervannsvolum i T1 vs. T2

A

T1: normal AFI (huden er ikke keratinisert)

T2: oligohydramnios

212
Q

Når i svangerskapet er det samsvar mellom fundal height og GA

A

Mellom 16-36

213
Q

Oligohydramnios is associated with.. (komplikasjoner)

A

Meconium staining

Heart conduction abnormalities

Cord compression

214
Q

Komplikasjoner av amnioinfusjon

A

Amniotic fluid embolism

Amniochorionic separation

Infection

215
Q

Amniotic fluid abmormality seen with congenital arrhythmias?

A

Polyhydramnios

216
Q

Amniotic fluid abmormality seen with fetal akinesia syndrome?

A

Polyhydramnios (lack of swallowing)

217
Q

Late-term pregancy (40-41+6): valgmuligheter

A

Elektiv induksjon

Expectant management

Antenatal testing

218
Q

Når skal du gjøre cervical ripening før IOL

A

Ved Bishop score 6 eller lavere

219
Q

Methods of IOL

A

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
Q

In adolescents - management of

Simple cysts

Complex cysts

A

Simple cysts = observation and laparoscopic cystectomy

Complex cysts = cystectomy or oophorectomy (+ CA-125)

221
Q

When does corpus luteum cysts normally rupture

A

Day 20-26 of the cycle

222
Q

Normal menstrual period (lenght)

Those over 16

Those under 16

A

Over 16 years: 21-35 days

Under 16 years: 21-45 dasy

223
Q

Amenorrhea - definition

A

No period by 14 without breasts

No period by 16 with breasts

Secondary: no menses for 3 cycles (3 months!!!)

224
Q

Definisjon

Hypomenorrhea

Hypermenorrhea (menorrhagia)

A

Hypomenorrhea = less than 30 mL

Hypermenorrhea = more than 100 mL

225
Q

Menstrual abnormality in hyperthyroidism

A

Polymenorrhea

226
Q

Amenorrhea classification: compartment 6 and 7

A

6 = hyperprolactinemia wihtout tumor

7 = infection/Trauma (e.g. sarcoidosis)

227
Q

Secondary amenorrhea with normal FSH =

A

anovulation

228
Q

Treatment of androgen insensitivity syndrome

A

HRT (feel like a girl)

Remove testis (risk of cancer)

229
Q

Treatment of anorexia amenorrhea (compartment 1)

A

HRT (17-B estradiol + progesterone)

230
Q

Best biochemical marker for preterm delivery =

A

fibronectin (from vaginal or cervical swab)

231
Q

Contraindications for tocolysis

A

Severe PIH, IUGR, bleeding

Abruptio

Chorioamnionitis

Dilataion > 5 cm

232
Q

At which fetal Hb does hydrops occur?

A

Hb less than 7 g/dL below mean for GA (usually less than 5 mg/dL)

233
Q

Hva skal du gjøre med en Rh-negativ med Coombs > 1:42

A

Screen hver 4. uke

234
Q

Når kan du gjøre cell-free fetal DNA testing?

A

Etter uke 11

235
Q

Initial screening for fetomaternal hemorhage

A

Rosette test

IF positive, do either

  • Kleihauer-Betke
  • Flow cytometry
236
Q

Hva er cut-off for MCA PSV?

A

More than > 1.5 MoM (multiple of means)

237
Q

Recurrent nonimmune hydrops: DDx

A

Storage diseases

Graves

238
Q

Treatment of TTTS

A

Fetoscopic laser ablation of AV-communication

239
Q

Mirror syndrome

A

Maternal edema with fetal hydrops

240
Q

Rybak: two ABx used in pregnancy

A

Ampicillin and erythromycin

241
Q

Difference between threatened and inevitable abortion

A

Threatened: closed cervical os

Inevitable: open cervical os

242
Q

Bleeding in complete vs. incomplete abortion

A

Complete: bleeding stops after complete expulsion

Incomplete: continous bleeding wiht risk of hemorrhagic shock (Tx: D and C - NB! Risk of rupture)

243
Q

Two potential USG findings in mised abortion

A

Empty GS with absent embryonic pole (blighted ovum)

GS with embryoic pole without visualized cardiac activity

244
Q

Recurrent miscarriages in 2nd trimester: DDx

A

Cervical incompetence

Septate uterus

APS

245
Q

After how many weeks GA should you always do D and C after abortion

A

After 6 weeks (no chance of complete abortion)

246
Q

Diagnostic criteria for APS: spontaneous abortions (how many)

A

One after 10 weeks GA

OR

Three before 10 weeks GA

247
Q

Treatment of APS

A

LMWH

Aspirin (until 36 weeks GA)

248
Q

4 most common causes of infertility

A

1) Unexplained (28%)
2) Male factors (26%)
3) Ovulatory dysfunction (21%)
4) TUbal damage (14%)

249
Q

How should you count number of days in cycle

A

From 1st day of MP to 1st day of MP

250
Q

Hirsutism scale

A

Ferriman-Gallwey scale (> 8 points = hirsutism)

251
Q

How do you detect ovulation

A

S-progesterone on day 21

Ultrasound (to see if follicle has ruptured)

252
Q

Hva indikerer redusert ovariereserve

FSH

AMH

A

Høy FSH (> 10)

Lav AMH

253
Q

Follicle count on USG: what indicates good reserve?

A

4-6 follicles

254
Q

How do you assess tubal patency?

A

HSG > SHG

255
Q

Which leiomyomas should be removed

A

Intramural myomas > 4 cm

SUbmucosal

256
Q

Teratospermia

A

Less than 4% has normal morphology

257
Q

Polyzoospermia

Hyperspermia

A

Polyzoospermia = high sperm concentraiton (> 200)

Hyperspermia = high volume (> 6 mL)

258
Q

Menopause: normal age

A

40-60 (aveage 51)

259
Q

HRT with liver disease or hypertriglyceridemia

A

Transdermal HRT

260
Q

How do you give HRT in perimenopause and postmenopause

A

Perimenopause: intermittent HRT

Postmenopause: continuous HRT

OB/GYN (21 decks)

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