Tocolytics

Question 1

Patient w/ myocardial damage, heart block, diabetic coma, myasthenia gravis cannot use which tocolytic? Class? MoA? Complications?

Answer 1

Mg
minerals
competitively inhibits Ca
Pulmonary edema, respiratory depression

Question 2

Patient w/ arrhythmia, HTN, seizure, diabetes cannot use which tocolytic? cannot use which tocolytic? Class? MoA? Complications?

Answer 2

terbutaline, ritodrine
b-agonist
activates b2-receptors -> relaxes smooth muscles
pulmonary edema, increased pulse pressure, hyperglycemia, hypokalemia, tachycardia

Question 3

Patient w/ hypotension or currently on Mg cannot use which tocolytic? Class? MoA? Complications?

Answer 3

Nifedipine
CCB
inhibits Ca influx into vascular smooth muscle cells
CHF, MI, pulmonary edema, severe hypotension

Question 4

Patient in 3rd trimester of pregnancy cannot use which tocolytic? Class? MoA? Complications?

Answer 4

Indomethacin
NSAID
decreases prostaglandin synthesis
closure of fetus ductus arteriosus -> pulmonary HTN and oligohydramnios

Question 5

Patient w/ undiagnosed vaginal bleeding cannot use which tocolytic? Class? MoA? Complications?

Answer 5

17-a-hydroxyprogesterone
synthetic progesterone
inhibits pituitary gonadotropin release -> maintains regnancy
breast pain, tenderness, dizziness, abd pain, intermittent bleeding

Question 6

Noonan’s

Answer 6

Turner’s but with normal karyotype

Question 7

PPROM @ 36wks

Answer 7

augment labor

Question 8

tx for hydrosalpinx

Answer 8

salpingectomy

Question 9

goal DBP in pre-eclampsia patients

Answer 9

90-95

Question 10

gestational vs. pregestational diabetes

Answer 10

macrosomia vs. IUGR (both have polyhydramnios)

Question 11

contraindications to estrogen

Answer 11

estrogen dependent neoplasia
DVT, PE, MI, stroke
liver disease
pregnancy
undiagnosed genital bleeding
smoking in >35yo

Question 12

definitive tx for endometriosis

Answer 12

hysterectomy + BSO

Question 13

elective c/s

Answer 13

ok - counsel and plan for 39wks

Question 14

chemo vs. radiation during pregnancy

Answer 14

chemo ok but radiation is not

Question 15

premature menses before breast and pubic hair

Answer 15

McCune Albright

Question 16

nipple pain w/o mastitits

Answer 16

candida

Question 17

cause for UTI vs. vaginal discharge in a child

Answer 17

child abuse vs. foreign body

Question 18

dose of folic acid

Answer 18

0.4 in non-risk
4 in women w/ previous preg w/ NTD
preconception through 1st trimester

Question 19

nerve entrapments:
over the lower abd
over the inner thigh
inability to adduct the thigh

Answer 19

iliohypogastric
ilioinguinal
obturator

Question 20

twin A breech and twin B vtx -> anticipated mode?

Answer 20

c/s

Question 21

measurement for severity of Rh disease

Answer 21

bilirubin in amniotic fluid

Question 22

tx for warts

Answer 22

TCA

Question 23

diffuse vulvar lesion

Answer 23

laser ablation (vulvectomy if patient doesn’t care about sexual fct since it removes clitoris)

Question 24

What’s most helpful in determining prognosis of ovarian cancer?

Answer 24

tumor stage

Question 25

what’s bloody show?

Answer 25

friable highly vascularized cervix bleeding during pregnancy - clinically insignificant

Question 26

bilateral complex adnexal masses + fever

Answer 26

ascending infection -> TOA

Question 27

Type I diabetes -> anomalies in babies?

Answer 27

cardiac and NTD

Question 28

postterm complications for baby

Answer 28

macrosomia, oligohydramnios, meconium aspiration, uteroplacental insufficiency

Question 29

drug classes during pregnancy

Answer 29

A - well documented safe
B - documented safe
C - documented risk
D - well documented risk
X - well documented harm