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True Learn Wrongs Flashcards

1
Q

increased risk for PPH

A

PreE w sF (cause for atony)

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2
Q

most common complex adnexal mass found during prgnancy

A

mature teratoma/dermoids

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3
Q

soft markers downs

A 
NT (first tri only) 
cystic hygroma (first tri only)
Nuchal fold (second tri only) 
echogenic bowel
echogenic focus
mild ventriculomeglay
chorioid plexus
shortened femur
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4
Q

amount folic acid needed

A

4 mg if prior problem (4000ug)

4mcg if no prior prob (400ug)

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5
Q

APLS dx and treatment

A

one:
- vascular thrombosis
- preg morbility (death fetus >10w, premature delivery due to pre e shit, three unexplained losses

one:
- lupus anticoag 12w apart x2
- anticardiolipin antibody IgG or IgM 12w aparment x2
- anti-b2-glycoprotein IgG or IgM 12w apartmet x2

unfractionated heparin

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6
Q

tiem to wait for intercourse

A

unknown

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7
Q

most liekly outcome acute parvo virus infection

A

normal pregnancy

(most commonly pregoblematic if infected >20w

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8
Q

MLO of physical abuse in pregn

A

preterm labor

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9
Q

adequate contraction stress test

A

3 contractions, 40 seconds each, in a 10m period

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10
Q

echogenic bowel on US

A
  • subchroinic collection can cause echogenic bowel because fetal injection of blood
  • can’t be eval in first tri and is normal in third tri 9only matters in second tri)
  • 80-90% have normal outcomes
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11
Q

US and LMP rules

A 
<9w: >5 d off
9-15.6: >7d off
16-21.6: >10d
22-27.6: >14d
28w: >21d
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12
Q

perimortum

A

do it after 4 failed miutes of resusictation with hopes of delivery at 5 minutes

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13
Q

HIE dx:

A
  • apgar <5 at 5 and 10
  • fetul umbilical acidemia
  • multisystem organ failure
  • spastic quadripleegia and dyskinectic cerebral palsy

(seizures are not par tof this most commonly)

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14
Q

glyburide

A

reasonspible for more hypoglycemia in infants compared to insulin

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15
Q

leukorrhea in pregnancy due to which hormones

A

estrogen

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16
Q

FHT which mostly predictis acid/base status

A
  • accelerations
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17
Q

scheudle CS for HIV+ high viral load

A

38w

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18
Q

MLO of fiboirds in pregnancy

A

pain due ot degradation

NOT assocaited with PPROM

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19
Q

reason to die from UAE

A

sepicemia

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20
Q

BPP negative and postitive predeictve values

A

high negative predictibe
low positive predictibe

this is true of all antepartum tests

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21
Q

NST false positive rate

A

55-90%

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22
Q

screen is anti-kell antibody positive

yo ushoudl do what

A
  • check paternal antigen status
  • causes severe hemolytic disease of fetus and newborn
  • if dad antigen negative then no work up is necessary
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23
Q

rate of shoudler dystocias in vaginal deliveries

A

3%

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24
Q

ACE I side effects pregnancy

A

oligo and calvarium maldevleopement

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25
Q

danzol preg effects

A

virilization

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26
Q

US finding congenital rubella syndrome

A
  • cafdiac anomlaies
  • CNS defects
  • heptosplenomegaly
  • microcephaly
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27
Q

twinning is high and low in hwat countires

A

high : nigeria, united states > englahd, india, japan

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28
Q

obese weight gqin recs in preg

A

11-20 lbs

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29
Q

acute fatty liver in pregnancy - dx criteria that i cannot care aout rih now .

A

.

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30
Q

pp thyroiditis

A
  • transient distruction of thyroid tissue
  • autoimmune
  • treatment includes beta blocker becuase it’s transient (and other meds wont help because its autoimmune and breaking down shit)
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31
Q

PTU SE

A

heptotoxicity

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32
Q

methimazone SE

A

aplasia cutis

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33
Q

cryopercipitate includes what factos

A
  • factor 8, 13
  • vWF
  • fibrinogen
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34
Q

fetal heart arryhtmia with worst outcome

A
  • atrial flutter
  • difficult to treat
  • often requries lots of meds to prevent fetal hydrops
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35
Q

which screen is not reliable in pregnancy

A

proetin S

shitty screen

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36
Q

ITP, you give IVIG, when shoudl the patlets start to go up?

A

1-3 d

peak response 2-7d

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37
Q

% of fetuses with increased NT will have aneupoloidly

A

50%

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38
Q

% twin gestations that go into PTB

A

60% before 37w

10% before 32w

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39
Q

MCC CS in US

A

failure to progress

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40
Q

steriliztion benefits

A
  • reduce PID

- reduce ovarian cancer rates

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41
Q

normal fetal acid-base status at delivery

A
  • pH 7.28
  • PCO2= 498 (+- 8)
  • PO2 18 (+- 6)
  • HCO2 22 (+- 3)
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42
Q

asympotmatic BV in pregnancy

A
  • no treatment rec
  • is associated with low birth weight, PPROM, PTB
  • treating asymptomatic women doesn’t help though
  • treat asumptomatic if hx prior PTB
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43
Q

most sensitive test for chorio on amnio

A
  • IL-6

- gold standard is fluid culture

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44
Q

% of neonates born 23w who will be normal afterwards

A
  • 13%
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45
Q

endometritis

  • how long abx after afebrile
  • what abx:
A

run abx for 24h post fever

gent/clinda

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46
Q

methimzale

  • SE
  • MOA
A

SE: aplasia cutis (absence of skin, usually on top of head, possibly with no bone underneath)

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47
Q

risk of post term delivery

A

oligo, increase lacerations, operative deliveries, increased CS, increased PPH, inscreased infection

fetaL: convulsions, meconium aspiration, NICU admission, macrosomnia, low agars, post maturity syndrome (essentially malnourishment due to shitty placenta)

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48
Q

measurement used to diagnose FGR

A
  • EFW

- or AC alone

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49
Q

MC cancer in pregnancy

second most common in preg

A

breast (common and diagnosed)

second: thyroid cancer

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50
Q

Vit D deficiency risks

A
  • darker skin
  • not outdoors
  • malnutrition issues
  • vegetarians
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51
Q

stress dose steroids during delivery indciations

A
  • not indicated fr 7 day taper
  • DONT need it if:
    • taken any dose fr less than 3w
    • <5mg morning dose for any amount of time
    • <10mg every other day for any amount of time
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52
Q

neonatal alloimmune thrombocytopenia

A
  • due to differences between maternal and paternal antigens
  • first pregnancy at risk (different then Rh)
  • MCC neonatal thrombocytopenia
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53
Q

MC congenital infection worldwide

A

CMV

  • women can be asymptomatic
  • fetus usually severely affected with IQ, hearing loss, visual impairment, cerebral calcifications, intraparaenchymal cysts, cerebellar abnormalities, microcephaly, bentriculomegaly, hepatospemomegaly, dydrops, FGR
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54
Q

MC thrmobophilia

Worse thrombophilis

A

Factor 5 Lieden

Antithrombyn 3 deficiency

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55
Q

tranfuse in PPH for

A
  • 1500 blood loss with continued bleeding
  • hemodynamic instability
  • DIC needs more than just blood transfusion
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56
Q

MCC non-immune fetal hydrops

A
  • cardiac issues (it’s CHF)

- also this is the MCC overall (immune isn’t that common)

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57
Q

BPP 6/10

A
  • more monitoring and repeat testing tomorrow for <37w
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58
Q

BV diagnosis

A
  • pH > gREATER than 4.5
  • grey discharge
  • > 20% clue cells
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59
Q

later term

post term

A
  • 41

- 42

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60
Q

2h pp glucose test amount

A

75

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61
Q

LMWH vs Unfractionated heparin during delivery (w/wo epidural)

A

LMWH
- better tolerated dosing, less likely HIT, less bleeding problems, preferred

Unfractionated hep:
- shorter half life, can reverse, can monitor with PTT

REcs same for LMWH and Unfractionated heparin

  • ppx: hold 12h prior to anticipated del
  • thera: hold 24h prior to anticipated del
  • pp: 4-6h after sVD
  • pp: 6-12h after CS

Only different with epidural sp del

  • Unfractionated:
  • —-ppx: restart 1h after placement or removal of catheter
  • —-thera: 1h after placement or removal of catheter
  • LMWH:
  • —ppx 12 after placement or 4 hours after removal
  • —thera: 24h after placement or 4 hours after removal
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62
Q

the earlier you get PreE, what is the risk of next preg

A 
higher. 
26w = 50%
27-30: 40%
31-36: 30%
term: 20%
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63
Q

risk accrete with previa

A
  • primary CS: 3% > 11 > 40 > 61> 67 > 67
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64
Q

MCC genetic first trim abortion

A
  • trisomy
  • most specific kind is not tri, it’s XO
  • most common trisomy is 16 however (but not more than XO when taken alone)
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65
Q

accertino def

A

10 increase over 10 sec

15 increase over 15 sec

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66
Q

post menopausal asymptomatic increased lining

A

no biopsy ever

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67
Q

goals BG after meals

A

fasting: <95
1h pp: <140
2h pp: <120

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68
Q

early onset infant group B infection s/sx

late onset infant group B infection s/sx

A

early:
<7d after birth
vertical transmission
sepsis, pneumonia, meningitis

late:
>7d - 3m after birth
horizontal transmission
bacteremia, meningitis, organ/soft tissue infection
(not caused by maternal status and ppx maternal does not prevent it)

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69
Q

erythema infectiosum is also called….

A

parvo virus

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70
Q

NTD prevalence

A

5 in 10,000 all deliveries

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71
Q

what % of women with preG diabetes also have cHTN

A

5-10%

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72
Q

estimated fetal weight for singleton breech del

A

2500

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73
Q

weed poor neonatal outcome

A

FGR mosty (less like is still birth, IQ deficients, behavioral changes)

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74
Q

uncontrolled hyperthyroidism increase your risk for ___

A

PreE

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75
Q

how long does it take for the uterus to get back to normal size after SVD

A

4w

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76
Q

twins with short cervix

A

no management required. no studies support giving anything

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77
Q

risk vertical transmission HIV >1000 not on treatment with SVD

A

25%

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78
Q

amount of Rh positive fetal blood needed to cause alloimmnization in Rh neg mother

A

0.1mL

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79
Q

negative CST means

A

no decels

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80
Q

treatment during pregnancy for latent TB (neg chest)

A
  • begin after first trimester
  • continue for 9 months
  • treat with isoniazid for 9 months if reason to suspect will progress (immunosuppression, recent exposure <2 years ago, HIV infection)
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81
Q

cephalic presenting means

A

vertex

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82
Q

iron def anemia in pregnancy

A
  • physiologic blood cell mass and volume expansion
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83
Q

macrosomnia is defined by

A

4000-4500

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84
Q

days opioid use after CS recommend

A

4d

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85
Q

hetero factor 5 lieden managment

A

survillence without intervention

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86
Q

after CNS infection with herpes, infants will have XX percent change long erm seuqele

A
  • 20%
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87
Q

first tri screen

A
  • NT

- PaPPA, free/total bhcg

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88
Q

sequential forceps/vaccum are problematic. because

A
  • neonatal outcomes are poor
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89
Q

modi screenign for TTTS by US should be how frequently?

A

q14d

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90
Q

vasectomy truths

A
  • wrose than nexplanon
  • better, less expensive, safer than abodminal sterilizatoin of women
  • 98% azospermia at 6m
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91
Q

herpes infection suppression doses

  • acyclovir
  • valacyclovir
A

acyclovir: 400 TID @36w
valacylovir: 500 BID @36w

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92
Q

eclampsi aMRI findings

A

parietal and occipital lobe edema

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93
Q

waht kind of fish are you not supposed to eat

A

king mackeral, marlin, tuna, bigeye, tilefish, orange roughe, swordfish

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94
Q

tranfusion associated citrate toxicity

A

calcium CHLORIDE (not carbonate)

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95
Q

rate of uteirne rupture one prior CS, vs 2 prior CS, vs classical

A
  • 0.5%
  • 1-2%
  • 10%
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96
Q

greatest risk postterm dates

A

nulliparity

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97
Q

bishop score makes IOL same as spontaneous labor

A

8

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98
Q

recommended iodine intake for

  • reproductive aged women
  • pregnant women
  • breast feedig woman
A
  • 150
  • 220 mcg
  • 290 mcg
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99
Q

amniotic fluid embolisms

A
  • avoid large scale volume resussitaiton
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100
Q

gas emobolism

A

left decubitus position

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101
Q

most accurate test for venous thrombus in pregnancy

A
  • promthrombin G20210A mutation
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102
Q

PTL caused by vaginal infections

A
  1. BV before 16w
  2. gonorrhea
  3. asymptomatic bacteriuria
  4. clamydia
  5. trich
  6. urea plams
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103
Q

listeria monocytogenes findings

treatment

A
  • foul smelling abscess placenta
  • hispanic women at higher risk
  • head ache, fatigue, myalgias, backache, gastrointestinal symptoms. (most common in third tri)
  • spread hematogenously
  • abcess of the fetus

treatment is nothing if asymptomatic

  • expectedly manage if mildly sx but no fever
  • febrile: blood cultures, high dose IV amp/gent (allergic penicillin: sulfamethoaxazole)
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104
Q

epidural placement location

A

L4-5

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105
Q

AFP sensitivty NTD

A

75%

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106
Q

nausea treatment in preg

A

B6 vitamen

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107
Q

partuition

A

Phase 1: quiescense of uterus
Phase 2: uterine preparedness of labor, cervical ripening
Phase 3: stimulation of uterus, cervical dilation, fetal and placental expulsion
Phase 4: uterine involution, cervical repair, breast feeding

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108
Q

prenatal testing and downs

A
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109
Q

hydral protocol

A
  • 5/10, 10, 10 administration
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110
Q

varicella active in pregnancy, treatment

A
  • oral acyclovir start 24h oral
  • IV acyclovir if pneumonia
  • VZIG given to neonates
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111
Q

Risk of still birth for FGR

A
  • 1.5%
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112
Q

prolonged latent phase nullip vs multiparous

A
  • 20 nullip, 14h multiparous
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113
Q

delivery rec for placenta previa

A

36-37.6w

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114
Q

toxo infection in first trimester work up

A
  • check serologic toxoplasmosis IgG and IgM
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115
Q

vacuum cannot be placed belwo what GA

A

34 (but forceps can)

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116
Q

HIV course in pregnancy

A
  • no change, no increase in viral load expected for associated diseases
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117
Q

heterozygous factor 5 lieden with personal hx of VTE (wht is chance of vTE in pregnancy)

A

10%

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118
Q

who needs to be screen for thyroid disease in preg

A
  • people with personal hx of thyroid disease
  • family hx of thryoid diesease
  • type 1 diabetes pts
  • clincal suspicion for thyroid dieaes (not include mild enlargement, but does include nodules etc)
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119
Q

things that are high while delivering (liek werid proteins called contraction - associated - proteins)

A
  • oxytocin receptos
  • calium receptos
  • connexin 43
  • PGF2 a receptors
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120
Q

possible effects of oxytocin bolus

A
  • maternal hypotension (relaxation of smooth muscle)
  • would then cause tachycardia
  • hyponatremia can occur after long administrations of oxytocin
  • can alos cause arrhythmias
  • water intoxication
  • analypyalsix
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121
Q

risk of verticel transmissino HSV primary outbreak at time of delivery

A

40-80%

122
Q

personal hx of VTE raises risk for VTE in pregnancy by how much

A

3.5 times (3-4 fold)

123
Q

CST satisfactory parameteres

negative, positive, equioval, unsat

A
  • 3 ctx in 10 minutes at least
  • each contrctions is 40 second long at least
  • neg: no late or sig variables
  • positive (bad): late after 50% even if ctx less than 3/10 m
  • equivocal: intermittent late or sig variable decels
  • unsat: fewer than 3 ctx in 10 minutes or uniterpretable strip
124
Q

treatment ITP in pregnancy first line

definition

A

prednisone

  • <150 x109
  • treatment rec if <30, or if >30 and symptomatic
  • if preg not helpful, then IVIG if plts <100,000
125
Q

definition latent labor

A

maternal perception of regular contractions

126
Q

NT that needs wu

A
  • 3mm
127
Q

TXA and PPH

A

helpful if within 3h of pph and if other meds fail

128
Q

siezure meds are associated with what fetal anomaly

A
  • NTD increased
  • therefore need AFP measurements
  • folic acid supplementation isn’t actually hepful
129
Q

diagnose PE in pregnancy

A
  • CT (angio)
130
Q

outlet forceps

A
  • fetal skull that has reached the pelvic floor, fetal sclap that is visible at teh introitus without spreading the labia
131
Q

low forcepts

A
  • lead poitn of fetal skull +2 station or more and not on the pelvic floor (modify with vs without rotation, which is related to 45 degrees)
132
Q

mid forceps

A

station above +2 but head is engaged

133
Q

vacuum related del compliqcations

A

brain bleeding (intracranial hem, subgaleal hematoma, hyperbilirubinemiia, retinal hemorrhage

134
Q

shakling a pt may cause

A 
fall problems
delay in dx of abruption.
seizure not safely treated in cuffs
can't walk
cna't be moved for emergency CS
recommend baby remain wth mother after delivery for bonding
135
Q

resusitat preg in cardiac arrest

A

left lateral decubiuts (same with gas embolis)

136
Q

endometritis treatment

A
  • gent/clinda
137
Q

B lynch is doen with what sturue

A

1 chromic

138
Q

TTTS US screenign starts when

A

16w + every 2w thereafter

139
Q

4th degree repair meds

A
  • abx x1 (ancef) or clinda
140
Q

most commoon way to get toxo

A

pork and lamb undercooked

141
Q

VTE is most likely when in preg

A

pp

142
Q

when is uterus no longer palpible abdominally pp

A

2w sp del

143
Q

TB test positive when how big for various diseases

A

HIV/organ transplant, recent contacts with active TB pt - 5mm
IV drug users, high risk setting resident, <4yo = 10 mm
everyone else without risk factors = 15

144
Q

rates of NTD

A
  • 1 parent ith NTD = 4.5 %
  • 1 parents, 1 sibling NTD = 12%
  • 2 parents with NTD = 30%
  • 2 parents, 1 sibling NTD = 33%
145
Q

endocarditis and pregnancy

A
  • need ppx abx n preg and vaginal del with high risk features:
  • prostetic cardiac valve
  • previous episode of infective endocarditis
  • unrepaired cyanoitc cardiac diease with palliative shunts
  • cardiac tranplant with valve regurgitation due to structually abnoral valve
146
Q

epidural and T6 spinal cord injury

A
  • Up to T 10 level to prevent autonomic dysregulation.

- CS would be at T4 so taht doesn’t matter really

147
Q

s/sx of amniotic fluid embolism

A
  • DIC, hemodrynamic compromise, respiratory compromise
148
Q

risk PPROM united states

A

3%

149
Q

hemoglobinopathies wu

A
  • black women should get CBC and electrophoresis
  • South asian/medeterianian CBC and electrophoresis if needed
  • all women CBC
150
Q

HSV with recurrent herpes outbreaks, how likely get outbreak during pregnancy

A

75%

151
Q

waht does mag prevent for fetus

A

CP

152
Q

define IAI

A
  • fetal tachy, maternal leukocytosis, maternal fever
153
Q

what is most likely cause of fetal/maternal hemorrhage

A

delivery (SVD and CS)

154
Q

dysmaturity syndrome

A

post dates risk

155
Q

MCC of pyelso

A

anemia

156
Q

Rec Vit D def during pregnancy

A

600 international units

157
Q

clinical features of congenital varicella

A

LIMB ABNORMALITIES

  • low birth weight
  • IQ , hydrocephalus, microcephaly, seizures
  • eye stuff
  • GI: reflux, stenotic bowel, atretic bowel
  • Skin: cutanoue scars
158
Q

consequence of inadequatesly treated hypothyroidism in pregn

A
  • PTB

- fetal demise, spontaneous abortion, low birth weight, IQ delays

159
Q

sickle cell hgb goals

A

10.0 nad HbS 40% is what you transfuse up to once you decide to you need to tranfuse them

160
Q

negative predictive value of neg nitrazine

A

99%

161
Q

nucle transulcency is most sensitive at what gestation

A

13 w

available 11-14w

162
Q

most likely verticle transmission hep C

A

prolonged rupture of membranes

163
Q

TTP treatment pregnancy

A

plasma pheresis

164
Q

stage 1-5 TTTS

A

1: oli/poly
3: ab dopplers
5 dead

165
Q

Rh negative most likey race

A

white

166
Q

endometritis treatment for extended fever

A

gent/clinda + amp for ENTEROCOCCUS

167
Q

lwo risk maternal cardiac issue in pregnancy

A

mild pumonary stenosis

168
Q

upper limit of safe to take Vit D in preg

A

4000 international units

169
Q

increased calorie intake in pregnancy

A

1: none
2: 350
3: 450

170
Q

syphilis screening

A

VDRL & RPR (and both have titers so you can tell if old infection and trated or new infection)

171
Q

persistent locia 12w pp, first step wu is

A

TVUS (not a CBC, but should get a b-hcg)

  • normal duration is 8w
  • persistent locia could be PSTT
  • you need to evlautat sp 8w
172
Q

breast abscess for mastitis treatment

A
  • I&D (some would suggest IV abx vanc 1g q12h

- normal mastitis is dicloxacillin 500 mg QID 10-14d

173
Q

varicella worst outcomes when contract when

A

48h from del

- this is chicken pox

174
Q

vaginal progesterone good for which pts to prevent PTD

A
  • 16-24w
  • current with singleton
  • prior PTD spontaneous singleton
175
Q

PPH can occur how far out from pregnancy

A

12w

176
Q

severe range BP recheck for labetalol

A

10 minutes (not 20)

177
Q

cerclage indications

A
178
Q

acute appendicitis during prengnancy

A

give steriods and then do surgery without delay

179
Q

tell between primary or recurrent HSV pock

A
  • viral culture and HSV IgG antibody testing

- primary: +culture or PCR & NEGATIVE serologic tests

180
Q

breakdown of 3rd or 4th degree repair NOT severely infected

A
  • 1w outpt abx prior to surgery scheduled
181
Q

expected weight gain for normal pregnancy

A
  • 25-35lbs
  • overweight BMI 25-30, (15-25)
  • obese BMI 30 (11-20lbs)
182
Q

alloimmunization and fetal hydrops is associated with which red blood cell antigens

A
  • c, C, D, E, K, e

- MCA indicated for 1:8

183
Q

BPP in order of disappearance for distress

A

First to disappear > last to disappear

- heart rate reactivity > breathing > gross movement > tone > amniotic fluid

184
Q

active mangement of third stage of delv

A
  • uterotonics
  • uterine massage
  • umbilical cord TRACTION
185
Q

known complication of massive transfusion

A

HYPER kalemia
HYPO calcemia
metabolic aciodsis (from lactic acid and decreased removal of citrate)

186
Q

CI of progesterone implants

A
  • pregnancy
  • pst hx of thrombosis
  • liver tumors
  • active liver lesions
  • hx breast cancer
  • allergic reaction to component of implant
187
Q

meconium aspiration syndrome risk factor for it would be

A
  • NRFHT
  • the infant shits, aspirates it, causes respirtory distress
  • occurs in 2-10% of infants with meconium
188
Q

fetal growth slowing twins vs singelton

timing of twin delivery

A

Slowing:
twins 28w
singletons 32w

delivery:
di/di 38w
mo/di: 34-37w
mo/mo: 32-34w

189
Q

postmaturity syndrome is seen in what percentage of post term deliveries

A

15-20%

190
Q

NT 3.5mm at 11w. what is diagnostic testing to follow

A

CVS

191
Q

massive transfusion infcludes

A

FFP, plts, RBC

192
Q

ITP approaching del, when start treating

A
  • CS/other surgical procedure : 50K
  • Treat 30K even if unsymptomatic
  • treat with steiods taper (IVIG if steriods not okay)
  • treat with plts in emergency situation
  • splenectomy only for refractory cases
193
Q

rate of SAB if IUD is left in place

A
  • 50%
194
Q

earlierst you can use a vaccum

A

34w

195
Q

appropriate time to resume anticoagulation after CS

A

6-12h

if epidural was used, then 24h afterwards

196
Q

ITP if pregnisone is gong to work, plts shoudl start increasing when?

A
  • 4-14d after administration

- max effect 2-3 w after admin

197
Q

CMV recent vs old infection

A

IgM positive, IgG positive with low avidity
(IgM is immediate in first month, IgG comes in the months to follow)
(avidity

198
Q

incidence of shoulder dystocia

A

3%

199
Q

early pp IUD defined as

A

<10m after del to >1w pp

200
Q

ovulation after del starts how many week pp

A

4

201
Q

estrogen contraception can start how many weeks pp

A

3

202
Q

mirena vs copper immediate pp IUD expulsion rates

A

mirena 2x expulsed more

203
Q

most serious long term fetal vacuum complication

A
  • intracranial hemorrhag (fetal daeth and brain damange)
  • subgaleal hematoma can cause hemorrahgic shock cuase 1/2 fetal blood can collect, but with intervention resolves and doesnt have long term consequecnes
204
Q

hep C risk inreased most with

A

IV drug use

205
Q

penicillin rash and spyhilis dx in pregnancy

- treatment

A
  • no desentiziatin needed for maculpapular rask, just give penicillin
  • if uticaria, broncospams, angioedems then densit
  • primary syph: 2.4 million uins IM x1
  • latent syph 2.4 million units IM x3w
206
Q

:which hemolobinpathies is assocated wtih fetal hydrops

A
  • alpha thal deletion severe
207
Q

varicilela findings

A
  • fetal hydrops
  • FGR
  • microcephaly
  • limb malformations
  • hyperechogine foci bowel and liver
  • cardiac malformations
208
Q

featl hearting loss associatedw ith what infection

A

CMV

209
Q

periventricular calcifications associatedw ith wht featl infection

A

toxo

210
Q

wAth shoudl you use for anticognatulion if pt has HIT

A

fondaprinux (syntheitc pentasaccaride

211
Q

waht hormone prevents lactations during pregnancy

A

progesterone

212
Q

Rate PPH after
svd
cs

A

4%

6%

213
Q

MCC secondary PPH

A

retained POC

214
Q

iron requirement in pregnacy

A

1000 mg total

daily you take 27 mg to supplment cause 1000 isn’t found in food stores

215
Q

2nd tri

most sensitive and specific US finding for DS

A
  • thickened nuchal fold
216
Q

twin chorioniscity

A

if the placenta is seen as one with a large piece going upwards towards the bags, then this is a lambda sign and it’s di/di

217
Q

gold tandard for dx BV?

A
  • gram stain

(MC way to dx is actually differet: two criteria of the following: thing/white/grey discharge, pH >4.5, KOH fishy oder, clue cell on microscopiy

218
Q

PPV of fetal fibronectin

A

30%

219
Q

annual percentage of PTB

A

10%

220
Q

3rd tri IUFD IOL/TOLAC

A
  • no prostaglindins beacuse rupture risk increased

IO- L vs spontaneous labor has increased rutpure risk but absolute risk is low

221
Q

term PROM IOL method

A

pit

cytotec increases rate of chorio

222
Q

GDM puts a woman at what percentage risk T2DM

A

70%

223
Q

rate of twinning

A

3/1000 (0.3%)

224
Q

reason to screen fro inherited thrombophilia

A

first degree relaive with thrombophilias

225
Q

KB is 1.8% adn pt has 5000mL blood, standard does is 300 mcg, how many vials shoudl be given

A

1.8% x 5000 = 0.018 X 5000 = 90
ALso 300 mcg covers 30 mL fetal whole blood (or 15 featl red cells)
therefore 90 / 30 = 3 vials

226
Q

GDM & >4500, the rate of shoulder dystocia is

A

20-50%

227
Q

rubella non-immune and is exposed to rubella in pregnancy. what do you do

A
  • expected management

- if symptoms then, IgG and IgM (IgM 7-10d, IgG for 1y)

228
Q
  • risk of brachial plexus injurty with current shoulder dystoochia
  • % of brachial plexus injuries asociated with normal deliveries
A
  • 10-20%

- 50% are just normal SVD

229
Q

MCC acute pancreatitis

A

gallsteones, just like outside of pregnancy

230
Q

which genetic disease is most associated with ashkenzi ancestry

A
  • CF (1:29)

- tay-sachs (1:30)

231
Q

CA-125 elevation

A
  • protein found in many locations throughout the body including genitals, pancreas, gall bladder, stomach, kidney,lung, breast, heart.
  • inflammation of these srufces causes elevations
  • brain isnt’ one of these, likely a blood/brain barrier issue therefore primary brain cnacer wont elevate this.
232
Q

cervical cancer and OCP assocaition

A
  • long term use increases risk for cervical cancer
  • risk also decreases with cessataion of use of OCPs
  • those wtih HPV who have never used OCPs are at lower risk than women who HPV+ and HAVE used OCPs
233
Q

association tumor markers and choriocarcinoma

A

+hcg
neg everything else

contains syncytiotrophoblasts (who make hcg)

234
Q

association tumor markers and dysgerminoma

A

+hcg, +LDH
neg: AFP, CA-125

MCC germ cell tumor
10% associated wth gonadoblastomas
MCC tumor in peope lwith gonadal dysgenesis

235
Q

association tumor markers and enbryonal carcinoma

A

+hcg, AFP
Neg: LDH, CA 125

  • extremely rare seen in ovary, 14 cases every reported in last 30 years
  • syncytiotrophoblasts cells may be present (therefore +hcg)
236
Q

association tumor markers and endodermal sinus tumor

A

+AFP
neg: everything else

  • germ cell tumor
  • AKA yolk sac tumor, which makes AFP
  • also contain schiller duval bodies
237
Q

association tumor markers and immature teratoma

A

+AFP, LDH, CA 125

neg: hcg

238
Q

chart of cancer tumors and assoicated markers

A
239
Q

cervical cancer figo wu includes:

THIS CARD ISNT: ACTUALLY ACCURATE

A

SEeems that it can be clinically staged: exam, +biopsy + limited endoscopy and limited imaging but what this actually means is unclear to me. Catn’ get actual figo paper cause you have to pay for it.

Below is uptodate but this will give you the wrong answers too

  • PE: palpate bimunual
  • Biopsy: colpo, ECC, conization (extension is by visual assessment, biospy not needed)
  • Endoscopy: hysteroscopy, cystoscopy, proctoscopy (and biopsy as needed)
  • Imgaing: CT, MRI, or IVP (IV pyelogram) & CXR
240
Q

risk GTN following evacuation of complete mole

A

15%

241
Q

risk breast/ovarian cancer with BRCA types

A

BRCA 1: Breast 55-65%, ovarian 39%
BRCA 2: Breast 45%, ovarian 15%
BRCA 1/2: ovarian 85%

242
Q

FIGO cervical cancer staging per review course

A
243
Q

indications for onc referral

  • post meno
  • pre meno
A

post meno

  • CA 125 >35
  • US suggestive of malignancy
  • ascities
  • evidence abnormal distant mets

premeno

  • fixed pelvic mass
  • a very eleated CA 125 (there is no cut off for this, so
  • US suggestive of malignancy
  • ascites
  • evdience of malignancy other places

Simple cysts <10cm do not need referral to gyn onc and can be monitored.

US signs concerning fro malignancy:

  • ascites
  • cyst larger than 10 cm
  • papillary projections or solid components
  • high color flow doppler
244
Q

HPV strain for

  • squamous cell cervical cancer
  • adenocarcinoma with cervical cancer
A

16

18

245
Q

MC cell in epithelial ovarian cancer

A

serous cells – serous cystadenocarcinoma

  • epithelial cell cancer is the most common ovarian cancers
  • serous tumors cause large ascites when progressed
  • most epithelial cancers are diagnosed at stage III
246
Q

vaginal cancer staging

A
  • clinical staging (no hyst/LN etc for surgical staging)
  • acceptible studies include: EUA, cysto, procto, CXR, IVP
  • extremly rare cancer
  • early stages are treated with surgery, however, most advnaced stages are treated with chemo/radiation
247
Q

mature teratoma other name is

A

dermoid cyst

248
Q

MC ovrian cancer diagnosed in pregnancy is

A
  • dysgerminomas
  • note: MC benign ovarian tumor is mature cystic teretoma (desmoid tumor)
  • 5-10% are associated with gonadoblastoma
249
Q

most importnat risk factor for epithelial ovarian cancers for the standard population

A

age

- increases after menopause (68% diagnosed after 55 years)

250
Q

Risk underlying carcinoma in the surrounding areas of atypical ductal hyperplasia?

A
  • 30%
  • 5x higher risk of sugsequent breast cancer
  • 30% of pts have either carinoma insitu or invasive carvinoma on excision of the mass of atypical ductal hyperplasia
251
Q

Endometrial staging

A

-

252
Q

DCIS is what

A
  • precancerous or non-invasive cancerous lesions of the breast
  • asymptomatic usually
  • srugical removal w/wo radioation or tamoxifen is recommended
  • lumpectomy or mastectomy are appropriate (neither is better)
253
Q

GTN staging

A
  • treat with methotrexate if lower rsk
  • treat with EMA/CO if higher risk
  • honeslty would need to memorize WHO grading criteria in addition to staging if you want ot ocrrectnly predict treatment needs
254
Q

US findings adnexal mass concerning for malignancy

A
  • 4 or more papillary strucutres
  • irregular multilocular solid tumor with greast diamtere >10 CM
  • very high color content on color doppler
255
Q

BRCA carrier and risk reducing BSO and bilateral masterctomy, by how much is their risk reduced?

A
  • bilateral mastectomy: 85-100% reduction in breast cancer
  • BSO:
  • –40-100% reduction breast cancer (50% if done before 50 yo)
  • –80% for ovarian cancer
  • –100% in HNPCC pt’s for ovrian cancer
  • –r68% all cuase mortality reduction
256
Q

mucinous adenocarcinoma

A
  • rare cancer
  • most important to removal appendix because it’s the most likley source of extra-mullerian origin. THis helpful to figure out how to treat them to make sure it’s gyn in origin.
  • less common to have contralateral ovary (5%)
257
Q

PSTT path finding

Treatment

A
  • intermediate trophoblasts with syncytial elements, no villi (therefore low levels of hcg are expressed compared to chorio)
  • treatment: hysterectomy
  • slight elevation of hcg and placental lactogen
258
Q

choriocarcinoma features on path

A
  • abnormal tropholastic hyperplasia and anaplaisa
  • no villi
  • hemorrhage/necrosis
259
Q

EIN treatment recs

A
  • total hysterectomy if completed child bearing
  • 40% EIN pts have concurrently early stage endometrial cancer, so hysterectomy is preferable when possible
  • removal of ovaries is individualized and not required
  • if not completed child bearing then can do progesterone oral, IM, or IU (nexplanon isnt’ approved yet)
260
Q

common presneting symtpoms of fallopian tube cancer

A
  • hydrops tubae profluens (copiuos serosangiunous vaginal discharge)
261
Q

BRAC 1/2 recs on BSO

A

BRAC 1: 35-40 yo

BRCA 2: 40-45 yo

262
Q

most comon type of uterine sarcoma

A
  • leiomyosarcoma
263
Q

simple or complex hyperplasia without atypica who want FUTURE (not now) feritlity should be treated with

A

progestine therapy

264
Q

staging uterine SARCOMAs

A
265
Q

chance of devleloping GTN after a

  • complete mole
  • partial mole
A

15-20%

1-5%

266
Q

DCIS main treatment

A
  • aka intraductal carcinoma
  • most common non-invassive breast caancer currnetly
  • 30% DCIS develops into breast cancer in 10 years if not treated
  • treat with wide local excision
267
Q

MC sym[tom of rhabdomyosarcoma

A
  • embryonal rhabdomyosarcoma
  • rare
  • young girls
  • presnting s/sx is VB
  • treated with VAC chemo acronym
  • usually no surgery and they can be fertile after treatment
268
Q

inflammatory breast cancer details

A
  • red, peau d’orange appearance

- biopsy will show thrombi in dermal lyphatic channels but often shows nothing therefore DIAGNOSIS IS CLINICAL

269
Q

cervical cancer has three main types

A
  1. squamous (70%)
  2. adenocarcomina (25%)
  3. other (5%)
270
Q

actual deinition of radical hysterectomy

A
  • mainstay of cervical cancer treatment 1A2
  • includes:
  • –cardinal ligmenta to the pelvic side wall
  • –complete resection of the USL to the insertin
  • –resection of upper 1/3 of vagina
  • –uterine artery at it’s origin afrom anterior dvision of th ehypogastric artery

(modified radical hysterectomy – parametrial tissue medial to the ureter)

271
Q

waht % of mature teratomas will devlope in to squamous cell cancers?
- risk factors

A

0.2-2%

  • risk factors for malignant transformation
  • –older than 45yo
  • –tumor size greater than 10cm
  • –rapid growth
272
Q

WHO scoring system GTN

A

0-6 low risk (methotrexate)

7-32 high risk (EAC/MO)

273
Q

Pt wtih ER/PR+ breast cancer then goes into menopause and wants help. waht do you give her

A

Venlafaxine (SNRI). Dont give SSRI with tamoxifen for theroretchial concern that it wont work as well

  • -note ER/PR+ means estrogen negative, progesterone positive
    • these pts are usually on tamoxifen 5 years (for both pre/post menopausal)
274
Q

MC partial mole karyotype

complete mole karyltyoe

A

partial: 69, XXX (XXY is second most common, note 47 XXY is kleinfelters and unrelated…. due to 47 not 69)
cmplete: 46 XX (90%)

275
Q

ovarian recurrenace adn chemo

A

palliative only, no improvement in outcomes.

276
Q

most common dx stage of endometrial cancer

A

1B

277
Q

ancef flip dosage preop

A

120 kg

278
Q

slapingostomy vs saplpingecotmy fertililty rates

A

same

279
Q

ruptured ectopic is or is nto allowed to be treated with salpingostomy

A

contraindicated (

280
Q

COPD LSC is acidotic because

A
  • they have airflow limitation from scaring, inflammation, secretion in the lungs that isnt’ completely reversible wtih intubation.
  • risk for HYPER CARBIA and respiratory acidsosi from OC2 gas absortion. beacuse they have fewer underlying abilities to compensate to eliminate CO2 dru to underlying diseased tiddue that reduces tissue for gas exchange. Hyperventilation to remove CO2 gas maybe not be possible due to need for prolonged expiraroty time patients with COPD
  • also at risk for bradyarrhythmias and tacyarrhythmias
  • alternative reason for resp acidosis in heavy pt is **obesity hypovbentilation syndrome OSH defined as daytime hypoventiliation (PaCO2 45) in pt without central, pulmonary, neuromuscular, or chest wall dieasese that expalins hypercarbia (BMI 30, OSA)
281
Q

jehovah’s witness refusal of autologous blood. they will refuse and accept what

A
  • their own blood (can be included in refusal of all blood)
  • they will also refuse: RBC, plts, plasma, WBC, whole blood

they will accept:
- immunoglobulins, albumin, and coagulation factors concentrates and recombinant coagulation factors.

282
Q

ectopic pregnancy due when

A
  • hcg >3500, adnexal mass, empty uterus, (free fluid suggests rupture)
  • lsc salpingectomy: prefered with severe rubal damange and sig bleeding
  • lsc salpingostomy: preferred with desried future futurility and contralateral tube damage, coudl consider single ppx dose of methotrexate
  • lapartomy: unstable pt, large amounts of intraperitoneal bleeding, compromised visualization
283
Q

hysteroscopy removal polyp, with continued bleeding, how do you stop the bleeding intraop

A
  • resection loop on coag (already usign resection loop)
  • you can’t do rollerball coagulation (monopolar) with electrolyte rich medium like normal saline (which is true, i’ve never seen roller ball used on something other than cervix)
284
Q

MC complication with LSC surgery

A

bleedign problems/anemia

285
Q

lsc BTL approach that casues teh most tissue damage

A
  • monopolar coagulation because doesn’t use a closed circuit like bipolar coagulation
286
Q

risk PTB after CKC

A
  • 2x as high PTB rates
287
Q

suture types and tensile stregnth

  • non-absorbable natural/synthetic
  • absorbale natural/synthetic
A
  • most tensile strenght initially is absorbable synthetic

- absorbable is the most, synthetic is the most. See chart

288
Q

why do you close fat people fascia wtih PDS

A

absorbable synthetic – most initial tensile stregnth to prevent wound dehiscence

289
Q

what suture is used for longest lasting tensile strength

A

PDS (polydioxanone) lasts forever. at 6m there is 25% tensile strength

290
Q

submucosal fibroids and infertility

A

removal doubles fertility rates

291
Q

abdominal prep in surgery

A

chlorhexidine

- requires 3 minutes to dry to have best decomtanination effects

292
Q

chemical peritonitis

A
  • chronic and acute abdominal pain
  • sebaceous spill from mature teratomas
  • those have hyperechoic lines, rokitansky protuberance (solid component that forms an acute angle with the cyst wall), tips of the iceberg (when solid compoennts in forground shadow on the background), point (colid complents lie hair, seen at orthoganal angle from hyperechoic points.
293
Q

salpingectomy vs ostomy

A
  • same fertility rates afterwards

- but higher ectopic rates afterwards with ostomy

294
Q

suture used for cerclage placement

A
  • need permanet suture
  • uncoated polymer/polyester (ethibond)
  • mersaline suture also permanent
295
Q

gold standard for tubal patency test

A

chromo actually

296
Q

ectopic hemodynamic INstability

A
  • LSC + salpingectomy (ostomy not recommended)
297
Q

CKC and LEEP risks

A

CKC

  • PPROM 16%
  • PTB 11%
  • FG <2500g 10%

LEEP

  • PPROM 8%
  • PTB 5%
  • FG <2500 6% at time of delivery
298
Q

way to avoid inferior epigastric vessel injury with trochar placement

A
  • driect visualizaiton tranperitoneally of inferior epiastric vessel (aka you look at the abodminal wall and figure out where teh inferior epigasric artery is
299
Q

TLH with risk factors

A

needs SCDs and heparin started 2h before surgery and contineud until ambulating…

300
Q

abx septic abortion

A

amp/gent/clinda

301
Q

ectopic rate highest for process of sterilization

A
  • bipolar coagulation
302
Q

POP-Q where anterior prolpase extends 1cm below the hymen

A

stage II

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