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OBGYN > UWise > Flashcards

UWise Flashcards

1
Q

How should a finding of ASC-US be managed?

A
  • for most cases, perform reflex HPV testing; if HPV testing is performed and negative, repeat co-testing in 3 years, but if HPV testing is performed and positive, perform colposcopy
  • the exception is women age 21-24 since HPV is quite common in this age group; HPV testing is unnecessary and repeat cytology should be performed in one year
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2
Q

What cervical cancer screening recommendation exists for women 30-65 who have no history of abnormal pap smears?

A

perform co-testing every five years (preferred) or cytology every three years (acceptable)

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3
Q

How should a finding of HSIL on cervical cytology be managed?

A

with colposcopy

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4
Q

What is the advantage of a LEEP procedure over cryotherapy?

A

LEEP provides a tissue sample for post-procedure analysis, which cryotherapy does not do

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5
Q

How should a finding of HSIL on cervical cytology be managed if the colposcopy that follows is deemed inadequate?

A

they should have an excisional procedure performed such as a LEEP

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6
Q

What are the symptoms of PID?

A

lower abdominal pain, adnexal and cervical motion tenderness, fever, and vaginal discharge

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7
Q

What are the classic findings associated with trichomoniasis?

A

a yellow, frothy, vaginal discharge and a strawberry cervix

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8
Q

What are the microscopic findings associated with herpes infection?

A

multinucleated giant cells and inflammation

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9
Q

What is the preferred method for testing for genital herpes?

A

culture is the gold standard

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10
Q

What would cause a herpes culture to be negative in someone with recurrent genital herpes?

A

culture has a relatively high false negative rate because while specificity is very high, sensitivity is somewhat low; furthermore, culture is best performed early in the course of the lesions rather than late

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11
Q

How should a finding of LSIL on cervical cytology be managed?

A
  • in women 21-24, repeat cytology in one year
  • in women over 24, perform reflex HPV testing; if testing is positive, perform a colposcopy, otherwise, repeat cotesting in one year
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12
Q

How should abnormal pap smear findings be managed?

A
  • in women 21-24 with low grade findings (LSIL, ASC-US) repeat cytology in one year without performing HPV testing
  • in women over 24 with low grade findings, reflex HPV testing should be performed; if this is negative repeat cotesting in three years if ASC-US and in one year if LSIL; if testing is positive, consider it a high grade finding
  • high grade findings (HSIL, ASC-H, AGC, or HPV-pos) should always be followed with a colposcopy
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13
Q

For whom is DEXA screening recommended?

A

women over age 65 and those under 65 with significant risk factors

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14
Q

What is ACOG’s recommendation for mammography in patients with normal risk?

A

annual screening beginning at age 40

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15
Q

Patients with normal risk for CRC receive colonoscopies every 10 years. What qualifies patients as being of higher risk and what screening recommendation is in place for those individuals?

A
  • individuals with a family member who developed CRC before age 60 are at greater risk
  • they should undergo colonoscopy every 5 years beginning at age 40 or 10 years before the youngest affected family member
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16
Q

What is the strongest predictor of osteoporosis in a woman?

A

her family history

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17
Q

What is the normal acid-base change observed in pregnant women?

A

increased minute ventilation during pregnancy leads to a compensated respiratory alkalosis

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18
Q

Why does minute ventilation increase during pregnancy?

A

although there is no change in respiratory rate, the tidal volume increases

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19
Q

Describe expected changes in the following PFT parameters during normal pregnancy:

  • inspiratory capacity
  • tidal volume
  • respiratory rate
  • minute ventilation
  • functional reserve capacity
  • expiratory reserve capacity
  • residual volume
A
  • inspiratory capacity: increased
  • tidal volume: increased
  • respiratory rate: unchanged
  • minute ventilation: increased
  • functional reserve capacity: decreased
  • expiratory reserve capacity: decreased
  • residual volume: decreased
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20
Q

Why are pregnant women at greater risk for edema?

A

because their plasma osmolality decreases

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21
Q

Name four common causes of pulmonary edema in preganncy?

A
  • tocolytic use
  • cardiac disease
  • fluid overload
  • pre-eclampsia
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22
Q

Are systolic or diastolic murmurs in pregnancy always abnormal?

A
  • diastolic are always abnormal

- up to 95% of pregnant women will have a systolic murmur due to increased plasma volume

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23
Q

What is the most common location for metastatic disease in those with gestational trophoblastic disease? How does this affect management of a molar pregnancy?

A

the lungs, so those with a molar pregnancy should have CXR done to look for mets

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24
Q

What are the current recommendations for weight gain during pregnancy?

A
  • underweight: gain 28-40 pounds
  • normal weight: gain 25-35 pounds
  • overweight: gain 15-25 pounds
  • obese: gain 11-20 pounds
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25
Q

What is the preferred method for screening patients for HbS carrier status? Why?

A

hemoglobin electrophoresis is the preferred method rather than solubility testing because electrophoresis can detect other hemoglobinopathies

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26
Q

Those of Ashkenazi Jewish heritage should receive what carrier screening tests?

A

those for Fanconi anemia, Tay-Sachs, Niemann Pick disease, and CF

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27
Q

What is the carrier frequency of CF for non-Hispanic whites?

A

1/25

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28
Q

Valproate is associated with what congenital anomalies?

A

hydrocephalus, neural tube defects, and craniofacial abnormalities

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29
Q

Uncontrolled diabetes primarily increases the risk of congenital anomalies affecting which systems?

A
  • primarily cardiac and CNS

- secondarily limbs and genitourinary

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30
Q

Describe chorionic villus sampling.

A
  • it is a sampling of the chorionic frondosum, which contains the most mitotically active villi in the placenta
  • this is performed at 10-12 weeks gestation
  • it can be used to detect chromosomal abnormalities or for DNA testing; it will not detect congenital anomalies
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31
Q

What is the best method for detecting trisomy 21? When can it be performeD?

A

cell free DNA testing is the most accurate and can be performed from 9 weeks until delivery

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32
Q

What are first trimester combined testing and sequential testing?

A
  • first trimester combined includes an NT with B-hCG and PAPP-A levels
  • sequential testing includes an NT and PAPP-A level followed by a quad screen
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33
Q

What testing is available for trisomy 21 during the second trimester?

A
  • in the second trimester, triple and quad screening are available
  • triple examines B-hCG, estriol, and AFP levels; quad screening adds an inhibin A level
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34
Q

What is the most accurate assessment of gestational age?

A

a first trimester ultrasound

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35
Q

Under what circumstances should ultrasound rather than LMP be used to estimate gestational age?

A
  • if ultrasound performed between 14-16 weeks differs from LMP by more than 7 days
  • if ultrasound performed between 16-22 weeks differs from LMP by more than 10 days
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36
Q

What is the recommended daily dose of folic acid for low and high risk patients?

A
  • low risk: 0.4 mg/day

- high risk: 4.0 mg/day

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37
Q

What is the most common cause of an elevated msAFP during pregnancy?

A

underestimation of gestational age, only 5-10% of cases are attributable to neural tube defects

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38
Q

What is the risk to a pregnancy with ibuprofen?

A

it is contraindicated after 32 weeks because of the risk for premature closure of the ductus arteriosus

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39
Q

Who is amniocentesis offered to for aneuploidy screening?

A

women over age 35 and those in whom a quad screen is abnormal

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40
Q

How should GBS be managed during pregnancy?

A
  • screening should be performed at 35-37 weeks in all but those who already have a history of GBS
  • if the culture comes back positive or the patient has a GBS history, intrapartum antibiotic prophylaxis is needed
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41
Q

How is maternal diabetes likely to affect the baby’s size?

A
  • gestational and type II diabetes are more likely to lead to an LGA baby being born
  • type I diabetes is associated with SGA babies
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42
Q

What affect does twin-twin transfusion typically have on the two twins in utero?

A
  • the donor is likely to experience oligohydramnios and IUGR

- the recipient is likely to experience polyhydramnios and fluid overload leading to heart failure and hydrops

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43
Q

Gestational diabetes carries what risks in the neonatal period?

A
  • hypoglycemia
  • polycythemia
  • hypocalcemia
  • hyperbilirubinemia
  • RDS
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44
Q

How should a neonate be treated if the mother is HIV positive?

A

administer zidovudine immediately after birth and then begin HIV testing at 24 hours

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45
Q

Describe Sheehan’s Syndrome.

A
  • a pregnancy-related infarction of the anterior pituitary, limiting future production of TSH, gonadotropin, and ACTH
  • typically follows significant PPH because during pregnancy the gland grows without complementary growth of the vasculature; during labor and delivery, blood loss can precipitate ischemia and infarction
  • presents with poor lactation, loss of pubic hair, and fatigue after delivery
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46
Q

What is the greatest risk factor for postpartum endometritis? What are other risk factors?

A
  • the mode of delivery plays the most significant role with c/s increasing the prevalence compared with vaginal delivery
  • with vaginal delivery, however, PROM, prolonged labor, multiple vaginal exams, internal fetal monitoring, and manual removal of the placenta are associated with higher rates of endometritis
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47
Q

What is the most common cause of postpartum fever?

A

endometritis

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48
Q

Postpartum Endometritis

A
  • the most common cause of postpartum fever
  • typically presents with uterine fundal tenderness and fever
  • most commonly caused by a polymicrobial infection of aerobes and anaerobes
  • risk is highest following c-section but with a vaginal delivery, PROM, prolonged labor, multiple vaginal exams, manual removal of the placenta, and internal fetal monitoring are all significant risk factors
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49
Q

How are postpartum blues and postpartum depression differentiated?

A
  • blues last less than 2 weeks whereas depression begins somewhere between 2 weeks and 6 months after delivery
  • more importantly, depression, and not blues, is associated with ambivalence to the newborn
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50
Q

What is given to reverse the pulmonary toxicity associated with magnesium infusions?

A

calcium gluconate

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51
Q

What 24-hour urine protein level serves as the threshold for pre-eclampsia with and without severe features?

A
  • greater than 0.3 grams is without severe features

- greater than 5.0 grams constitutes severe features

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52
Q

What role does hydralazine play in the treatment of hypertensive disease during pregnancy?

A

it is predominately used to control BP in the acute setting

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53
Q

How should pre-eclampsia be managed?

A
  • with delivery if greater than 34 weeks gestation or unstable
  • with expectant management if less than 34 weeks and stable
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54
Q

What is the therapeutic serum level of magnesium? What happens at higher levels?

A
  • 4-7 mEq/L is therapeutic
  • loss of DTRs tends to occur at 7-10 mEq/L
  • pulmonary depression from 11-15 mEq/L
  • cardiac arrest from 15+ mEq/L
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55
Q

What are contraindications to expectant management of severe pre-eclampsia?

A
  • inability to control BP with maximal doses of two agents
  • non-reassuring fetal status
  • LFTs more than two times normal
  • platelet counts less than 100K
  • eclampsia
  • persistent CNS symptoms
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56
Q

What is the most significant risk factor for pre-eclampsia?

A

chronic renal disease

57
Q

What is the most significant risk factor for pre-eclampsia?

A

chronic renal disease

58
Q

What is the risk of isoimmunization if a fetus is Rh+ and the mother is Rh-?

A

2% antepartum and 7% after full term delivery

59
Q

What is the best non-invasive test to assess fetal anemia in utero?

A

middle cerebral artery peak systolic flow velocity

60
Q

How is the dosage of Rhogam determined?

A

300 mcg is sufficient to neutralize 30 cc of fetal whole blood or 15 cc of fetal RBCs

61
Q

What mnemonic is used to recall the risk posed by atypical antibodies?

A

Lewis Lives, Duffy Dies, and Kell Kills

62
Q

Which amniotic fluid measurement is the best for assessing the severity of Rh hemolytic disease?

A

amniotic fluid bilirubin level

63
Q

What progesterone level is consistent with a healthy pregnancy?

A

25 ng/mL

64
Q

What are the requirements for use of methotrexate to treat an ectopic pregnancy?

A
  • patient is hemodynamically stable
  • mass is less than 4 cm and without a fetal heart rate or less than 3.5 cm with a fetal heart rate
  • normal LFTs, renal function, and WBC count
  • the ability to follow-up if the patient’s status should change
65
Q

What presenting features would suggest that an ectopic pregnancy has rupture?

A
  • peritoneal signs

- signs of hypovolemia including hypotension and tachycardia

66
Q

When is a salpingostomy appropriate care for an ectopic pregnancy and when is salpingectomy appropriate?

A
  • salpingostomy is appropriate when the tube is still intact

- salpingectomy is the preferred treatment for a ruptured ectopic

67
Q

Describe the signs and symptoms of a uterine perforation.

A
  • lower abdominal pain, uterus tender to palpation, rebound tenderness, and guarding
  • nausea and fever
  • scant vaginal bleeding
68
Q

What is the most common abnormal karyotype discovered in spontaneous abortions?

A

an autosomal trisomy, specifically trisomy 16

69
Q

Name three systemic maternal diseases associated with early pregnancy loss?

A
  • lupus
  • diabetes mellitus
  • chronic renal disease
70
Q

What is the main benefit of medical abortion compared with expectant management?

A

it shortens the time to expulsion

71
Q

Describe a non-medical intervention that can be used to protect against dyspareunia.

A

continued sexual activity improves blood flow and guards against atrophy

72
Q

What is the primary source for female vaginal lubrication during intercourse?

A

a transudate of fluid across the vaginal mucosa as the tissue becomes increasingly engorged with blood

73
Q

What is the preferred treatment for vaginismus?

A

use of vaginal dilators

74
Q

What findings, when found in the setting of an elevated AFP, would suggest multiple gestations?

A

a B-hCG or fundal height larger than expected

75
Q

What ultrasound findings are consistent with a dizygotic twin gestation?

A
  • a dividing membrane thickness greater than 2 mm
  • twin peak (aka lambda) sign
  • different fetal genders
  • separate placentas
76
Q

What are the risks associated with a twin gestation compared to a singleton?

A
  • greater risk for prematurity
  • greater risk for mortality
  • higher rates of cerebral palsy and IUGR
  • congenital anomalies, particularly amongst monozygotic twins
77
Q

What intervention has been shown to be effective at reducing the risk of having a preterm, low birth weight twin gestation?

A

early, adequate weight gain

78
Q

Twin twin transfusion syndrome is more likely in what category of twin gestation?

A

monochorionic, diamniotic gestations

79
Q

Which complication of multiple gestations is associated with the most fetal/neonatal morbidity and mortality?

A

preterm delivery

80
Q

What would cause an intrapartum placental abruption?

A

polyhydramnios could lead to a distended uterus and with rupture of membranes, the decompression can lead to placental abruption, presenting as bleeding

81
Q

Which two STDs may require repeated testing to look for seroconversion after a sexual assault? How long after the incident can it take before these two infections are identified?

A
  • Syphillus may take up to 6 weeks

- HIV may take up to 6 months

82
Q

What is ulipristal?

A

an emergency contraceptive, effective for up to 5 days

83
Q

Where is the best place to distribute literature related to intimate partner violence?

A

in a private area such as the restroom; otherwise, the partner may see the information and prevent the patient from accessing resources

84
Q

What are two important rules to follow when providing information about or screening for intimate partner violence?

A
  • offer resources in private

- avoid use of stigmatizing words like abuse, rape, etc.

85
Q

During what period of gestation are toxic exposures most likely to cause microcephaly or intellectual disability?

A

weeks 8-15

86
Q

Factor V Leiden mutation is associated with what obstetric complications?

A

stillbirth, pre-e, placental abruption, and IUGR

87
Q

How is cervical insufficiency likely to present?

A
  • history or risk factors for such an event

- presenting as painless cervical dilation leading to a feeling of pelvic pressure with bulging membranes and fetal loss

88
Q

AMA is a risk for what obstetric complications?

A
  • still birth
  • pre-e
  • IUGR
  • gestational diabetes
89
Q

What are the typical stages of grief and their respective order?

A
  • denial
  • anger
  • bargaining
  • depression
  • acceptance
90
Q

What are the ultrasound criteria for a missed abortion?

A

crown rump length of greater than 7 mm with no cardiac activity

91
Q

List risk factors for breech presentation.

A
  • prematurity
  • uterine anomalies or fibroids
  • hydrocephaly and anencephaly
  • placenta previa
  • polyhydramnios
  • multiple gestations
92
Q

How is prolonged latent phase defined and treated?

A
  • defined as a latent phase more than 20 hours in a nulliparous woman and more than 14 hours in a multiparous woman
  • treated with rest or augmentation of labor
93
Q

What fetal presentation is most associated with cord prolapse?

A

a back up transverse lie

94
Q

What is the McRobert’s maneuver?

A
  • the first maneuver attempted in cases of shoulder dystocia

- it involves hyper flexing the mothers hips, which has the effect of widening the pelvis and flattening he lumbar spine

95
Q

How is terbutaline used in labor and delivery?

A

it serves as a tocolytic

96
Q

How is GBS treated intrapartum?

A

ampicillin is the preferred medication

97
Q

What contraindications exist for the following tocolytics:

  • magnesium sulfate
  • terbutaline
  • ritodrine
  • indomethacin
A
  • magnesium sulfate: myasthenia gravis
  • terbutaline: diabetes and to stop preterm labor
  • ritodrine: diabetes
  • indomethacin: after 33 weeks due to premature closure of the ductus arteriosus
98
Q

What are the benefits of administering btmz during preterm labor?

A

reduces the risk of intracerebral hemorrhage, RDS, and necrotizing enterocolitis

99
Q

What role does fibronectin level play in the assessment of preterm labor?

A
  • it is used in women with symptoms of preterm labor between 24-35 weeks gestation and as a screening tool for asymptomatic women between 22-30 wesk
  • it has a high negative predictive value; symptomatic patients with a negative test are unlikely to deliver in the next 14 days and asymptomatic patients are unlikely to deliver before 35 weeks gestation
100
Q

How does magnesium sulfate act as a tocolytic?

A

it competes with calcium for entry into cells

101
Q

How does atosiban act as a tocolytic?

A

it is an oxytocin receptor antagonist

102
Q

What role do tocolytics play in PPROM?

A

they are only used for 48 hours in order to administer corticosteroids, use beyond that time period increases risk for things like infection

103
Q

What causes variable decelerations?

A

cord compression, frequently due to diminished fluid levels as in PPROM

104
Q

Which antibiotics are used in cases of PPROM? What are the advantages of this?

A

ampicillin and erythromycin are used because they can prolong the latency phase and reduce the risk of infection, including choiorioamnionitis and neonatal sepsis

105
Q

What antibiotics are used to treat suspected chorioamnionitis?

A

gentamicin and clindamycin

106
Q

What drug has been shown to reduce the risk of premature labor? How is it used?

A

17a-hydroxyprogesterone is given weekly from 16 or 20 weeks until 36 weeks gestation

107
Q

When is delivery indicated in patients with PPROM?

A

34 weeks at the latest

108
Q

What is the goal for patients with pre-e without severe features and those with PPROM with are stable and not in labor?

A

delay delivery until 34 weeks

109
Q

What are two possible causes of a false positive nitrazine test?

A

semen or blood in the vaginal vault

110
Q

At what point is magnesium no longer recommended for neuroprotection?

A

after 32 weeks

111
Q

Why do obstetricians use the left lateral position?

A

it improves maternal circulation, including uterine and thus placental blood flow

112
Q

What measures should be taken in response to late decelerations?

A
  • left lateral positioning and treatment of maternal hypotension
  • maternal oxygen supplementation
  • discontinuation of pitosin
  • intrauterine resuscitation with tocolytics and IV fluids
113
Q

What is the appropriate management for a fetal heart tracing with minimal variability and no accelerations?

A
  • begin with digital fetal scalp stimulation

- then progress to vibroacoustic stimulation, scalp pH testing, or an allis clamp test

114
Q

Which patients are at risk for postpartum hemorrhage due to a genital laceration?

A

those who experience precipitous labor, have a macrosomic child, or undergo operative vaginal delivery

115
Q

What is the use of and typical contraindication of PGF-2a?

A

it is a uterotonic agent contraindicated in patients with asthma

116
Q

What is the use of and contraindication to methylergonovine?

A

it is a uterotonic agent contraindicated in patients with hypertension or pre-e because it will also cause vasoconstriction

117
Q

What are the risk factors for uterine inversion?

A

factors that lead to uterine distension and most importantly, excessive traction on the umbilical cord when attempting to deliver the placenta

118
Q

How is postpartum hemorrhage defined?

A

more than 500cc or more than 1000cc blood loss following a vaginal or c-section, respectively

119
Q

What is the first step in management of postpartum hemorrhage?

A
  • assure appropriate back up, establish IV access, and stabilize the patient
  • ensure there are no genital lacerations or retained placenta and check to see if the uterine fundus is firm and contracted
120
Q

Ligation of which two arteries is most likely to benefit a woman experiencing postpartum hemorrhage?

A

ligation of the uterine or internal iliac artery

121
Q

What is the most common cause of delayed postpartum hemorrhage?

A

vWF deficiency

122
Q

Which antibiotics are used to treat postpartum endometritis?

A

clindamycin and gentamicin because it is a polymicrobial infection with anaerobes and aerobes

123
Q

What physiologic change can lead to a fever without any other symptoms or signs in the postpartum period?

A

breast engorgement if there is milk let down but the baby is not yet feeding well

124
Q

How is septic pelvic thrombophlebitis treated?

A

add anticoagulation to antibiotic therapy

125
Q

What is the most common cause of fever on post-op day 1?

A

the lungs, specifically, atelectasis can be associated with fever but aspiration pneumonia must also be considered

126
Q

What is the most significant side effect of fluoxetine?

A

sleep disturbance, particularly insomnia

127
Q

What effects is in utero exposure to SSRIs associated with?

A

exposure during the third trimester is associated extrapyramidal signs and with withdrawal symptoms

128
Q

List four things that postterm pregnancy has been associated with?

A

placental sulfatase deficiency, fetal adrenal hypoplasia, anencephaly, and inaccurate dating

129
Q

What complications have been associated with late term and postterm pregnancy?

A

macrosomia, oligohydramnios, meconium aspiration, uteroplacental insufficiency, and dysmaturity

130
Q

Describe an infant who has suffered from dysmaturity.

A
  • they are typically born postterm
  • they are described as withered, meconium stained (yellowish-green skin), long fingernails, and fragile
  • there is often a small placenta
131
Q

How does blood loss after a medical abortion compare to that after a surgical abortion?

A

medical abortions are associated with greater blood loss

132
Q

At what point in a pregnancy can medical and manual aspiration abortion no longer be offered?

A
  • medical can be offered during the first 7 weeks

- manual aspiration can be offered during the first 8 weeks

133
Q

Why can oxytocin not be used as an abortifacient early in pregnancy?

A

because there has not yet been an up-regulation of oxytocin receptors to stimulate

134
Q

What is the most likely cause of excessive bleeding following a medical abortion? How should this be treated?

A

it is most likely the result of retained products of conception and should be treated with surgical evacuation of that material

135
Q

What is the proper follow up after a suction DnC?

A

post-procedural antibiotics, usually 200 mg doxycycline

136
Q

What antibiotic regimen is typically used when performing a suction DnC?

A
  • 100 mg doxycycline before the procedure

- 200 mg doxycycline after the procedure

137
Q

What are the two best treatments for stress incontinence?

A
  • a mid urethral sling has the highest success rate for those with stress incontinence secondary to hypermobility
  • urethral bulking has the highest success rate for those with stress incontinence secondary to inherent sphincter deficinecy
138
Q

What are B3-adrenergic agonists used for?

A

detrusor relaxation

OBGYN (21 decks)

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