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OB/GYN > uwise studying > Flashcards

uwise studying Flashcards

1
Q

what are the testing intervals for pap smears and cotests

A

begin testing at 21 regardless of sexual activity
21-65 every 3 years
30-65 every 5 years if cotest.
stop at 65 if never had abnormal and been compliant for 10 years

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2
Q

what do you do if you have an ASCUS on pap

A

reflex repeat pap with cotest

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3
Q

what do you do if you have a positive repeat pap with cotest

A

colposcopy –furhter investigation is required.

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4
Q

whats the next step for woman that have a positive pap for HSIL

A

Need further intervention. colposcopy or diagnostic excisional procedure.

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5
Q

what are the findings for PID

A

abdominal pain, adnexal tenderness, fever, cervical motion tenderness, vaginal discharge.

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6
Q

what is the classical presentation of gonorrhea

A

mucopurulent cervicitis with exacerbation of symptoms during cycles

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7
Q

what does chlamydia cause

A

frequently associated with gonorrhea and causes cervicitis and PID.

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8
Q

How does trichomonas present

A

yellow frothy discharge but not typically with fever or abdoinal pain

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9
Q

how does candida present

A

thick white cottage cheese like discharge. not typically associated with fever or abdominal pain

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10
Q

cervicitis presentation

A

increased vaginal discharge, dysuria, urinary frequency, postcoital bleeding

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11
Q

classical syphilis and what test to confirm

A

macular rash on palms and soles, described as copper penny lesions. need treponemal-specific antibody test to confirm. darkfield can be used but availability is low.

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12
Q

If a patient has an STI what should we do?

A

screen for all STIs/

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13
Q

what are clue cells indicative of

A

bacterial vaginosis. this does not usually cause irritation. clue cells are seen on a wet mount slide. they are adherent coccobacillary bacteria on the edges of the cells.

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14
Q

what is the presentation of trichomaniasis

A

yellow-green frothy discharge. these are protozoans and have flagella that allow them to spin across the slide. they also cause inflammation and irritation (strwberry cervix).

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15
Q

Does bacteria vaginanosis smell/

A

yes, fishy odor. KOH test reveals amines and a fishy odor.

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16
Q

when is it best to test for herpes?

A

very early in the outbreak. the vesicle is broken open and thr culture is taken.

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17
Q

Why can herpes tests come back negative

A

they are highly specific, but not very sensitive. 10-20% false negative rate.

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18
Q

what is the next step if ASCUS, then positive high-risk on reflex in a 21 yr old

A

21-24 is a special population, in that there is a high incidence of HPV in this group and typing is not recommended. the management would be expectant and repeat cytology in 12 months.

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19
Q

when do we start colon cancer screening and what are the screens

A

45-50. Annual hemoccult testing, flexible sigmoidoscopy 5 years, colonoscopy every ten years

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20
Q

when do we start DEXA scans?

A

onloy started <65 when the patient has risk factors.

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21
Q

when do we start mammograms

A

40 and annually.

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22
Q

when do we offer breast MRI?

A

when there is >20% risk of developing breast cnacer

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23
Q

when is a breast ultrasound used?

A

adjunct to mammography it is useful in evaluating inconclusive findings.

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24
Q

is ultrasound a primary screening tool for breast cancer

A

NO.

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25
Q

what are the criteria for BRCA testing

A

a combination of first and second degree relatives on the same side of the family

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26
Q

what are the most reliable methods of brith control

A

LARCs, DEPO, sterilization all have <1% failure rate

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27
Q

which birth control methods have a failure rate of 3-5%

A

OCPs,

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28
Q

what contraceptive method has a failure rate of 12%

A

male condomds

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29
Q

what is the failure rate of nuva ring? a contraceptive ring? how often do you have to change it?

A

8%.

once a month

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30
Q

what to test for in patient with fat and hyperpigmented regions on the skin

A

diabetes. this is highly indicative of acanthosis nigricans

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31
Q

why prescribe folate to vegetarians especially if hthey plan on pregnancy

A

because they do NOT get enough folate
Diet alone in people with normal diets is insufficient to ward off neural tube defects, which is why folic acid is prescribed.

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32
Q

what is the strongest predictor of osteoporosis, what are some other risk factors

A

family history.
age >50.
gender (women 4X more likely)
small, petite and thin women are at higher risk.
heavy alcohol consumption is also a risk factor

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33
Q

what is the best way to lower your risk for osteoporosis

A

exercising regularly weight-bearing exercises 3-4 a week are the best for preventing osteoporosis

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34
Q

physiologic dyspnea of pregnancy

A

present in up to 75% of pregnant women in the third trimester.

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35
Q

what are the signs of PE

A

tachycardia, tachypnea, hypoxia, chest pain, signs of DVT

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36
Q

what are the signs of mitral stenosis

A

diastolic murmur, signs of heart failure

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37
Q

what happens to the respiratory system during pregnancy

A

1) inspiratory capacity increases (15%)
2) increases in tidal volume and inspiratory reserve capacity.
3) respiratory rate does not change
4) there is increased minute ventilation and this causes compensated respiratory alkalosis.
5) functional residual capacity is reduced to 80%.
this leads to shortness of breath often experienced in the third trimester.

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38
Q

what happens to the plasma osmolality in pregnancy

A

it is reduced.

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39
Q

what happens when we fluid overload pregnancy women

A

their osmolality becomes normalized and they begin to have pulmonary edema

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40
Q

what type of murmur is always abnormal

A

diastolic

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41
Q

how much does the cardiac output increase in pregnancy

A

33%

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42
Q

what happens to the SVR

A

it falls

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43
Q

why does the cardiac output increase in pregnancy

A

due to both HR and SV.

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44
Q

what percentage of women have a systolic murmur in pregnancy and why

A

95%. because of the increased volume.

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45
Q

is the systemic vascular resistance more or less than the pulmonary vascular resistance

A

the systemic vascular resistance is always greater than the pulmonary. if the opposite then there is a right to left shunt and cyanosis will develop in the context of a VSD.

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46
Q

what happens to the ureters in pregnancy

A

come degree of dilation in the ureters and renal pelvis occurs in a majority of women. the dilation is often unequal due to the cushioning of the sigmoid colon on the left and greater on the right due tothe dextrorotation of the uterus.
this can cause mild hydronephrosis

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47
Q

what happens to the thyroid axis in pregnancy

A

the thyroid binding globulin is increased due to increases in circulating estrogen and this causes an increase in the total thyroxine levels, but t4 free will remain the same. similar effects occur for T3. the thyroid also increases in size by approx 10% in pregnancy

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48
Q

If someone has a molar pregnancy on ultrasound what is the next step?

A

chest X ray is indicated because the lungs are the most common site of metastatic trophoblastic disease.

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49
Q

what screening measures do you take for african american couples? Even when non-symptomatic

A

screening for alpha and beta thalassemia is possible by RBC indices. hemoglobin electrophoresis is the best for hemoglobin C and thalassemia minor

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50
Q

what genetic diseases are important for Jewish populations

A

fanconic anemia, tay-sachs, cystic fibrosis, niemann-pick

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51
Q

what population is affected by thalassemia

A

mediterranean population

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52
Q

what populations are at risk for cystic fibrosis

A

non-hispanic whites, Jews.

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53
Q

which populations are at risk for tay-sachs

A

ashkenazi jews, french-canadians

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54
Q

what other diseases are Ashkenazi Jews at risk for?

A

Gaucher’s, Canavan, and Bloom. cystic fibrosis, tay sachs.

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55
Q

what does valproic acid put the fetus at risk for

A

neural tube defects, hydrocephalus, craniofacial abnormalities.

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56
Q

are insulin and methyldopa linked to fetal anomalies

A

NO.

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57
Q

what are women with poorly controlled diabetes putting fetus at risk for?

A

4-8-fold risk of structural anomaly, neural tube defects, and cardiovascular defects. genitourinary and limb deefects have been reported

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58
Q

what is chorionic villus sampling able to dtect?

A

karyotype. but the sample can be used for biochemical, DNA-based studies, including cystic fibrosis testing

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59
Q

what test has the highest detection rate for T21

A

cell free DNA screen has a detection rate of 99% at a 0.2% fasle-positive rate.
the other tests have a 5% false positive rate.

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60
Q

what are the tests for T21 and T18

A

cell-free DNA screen,

quad test, triple test, sequential screen and serum integrated screen with nucal translucency

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61
Q

first trimester combined test T21

A

nucal translucency, PAPP-A (pregnancy associated protein A), beta-hCG. has an 85% detection rate.

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62
Q

triple screen test for T21

A

second trimester AFP, beta-hCG, uE3 (estriol test), 69% detection rate.

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63
Q

quad screen for T21

A

triple screen with inhibin A, 81% detection rate

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64
Q

sequential screen for T21

A

first trimester NT andPAPP-A with second trimester quad 93% detection rate

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65
Q

serum integrated screen when unable to determine nucal translucency

A

first trimester PAPP-A and second trimester quad screen 88% detection rate

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66
Q

what is the most common cause of inherited intellectual disability

A

fragile X

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67
Q

what is the most effective screening tool for down syndrome

A

cell free DNA. performed as early as nine weeks.

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68
Q

when a patient fails a blood glucose test in pregnancy what is the first step

A

counseling on diet and glucose monitoring

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69
Q

Is IUGR seen in women with gestational diabetes?

A

NO. it is seen in pre-existing diabetes however.

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70
Q

what are the risks associateed with gestational diabetes

A

shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios, fetal macrosomia

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71
Q

what is the recommended dose of folic acid

A

4mg daily before conception and through the first trimester

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72
Q

valproic acid can cause what?

A

1-2% incidence of neural tube defects, specifically lumbar meningiomyelocele. spina bifida, cardiac defects, facial clefts, hypospadius, craniosynostosis, limb defects. lung hypoplasia and omphalacele

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73
Q

what is the most common cause of an elevated maternal serum AFP

A

90-95% of cases of elevated AFP are due to things other than neural tube defects, including, underestimation of gestational age, fetal demise, multiple gestations, ventral wall defects and tumor or liver disease in the paitent.

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74
Q

Is warfarin okay during pregnancy

A

No. it is a known teratogen. low molecular weight heparin the drug of choice during pregnancy

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75
Q

what aneuploidy test is offered for women of normal risk

A

quad screen

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76
Q

when is amniocentesis offered

A

for women over 35 and in the setting of an abnormal screening test.

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77
Q

when is chorionic villus sampling offered

A

during the first trimester

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78
Q

what are the first trimester screens

A

nuchal translucency, serum hCG, and PAPP-A.

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79
Q

is serum AFP offered for aneuploidy

A

NO. this is insufficient for aneuploidy. it is good for neuroal tube or abdominal wall

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80
Q

what are braxton-hicks

A

short duration, less intense contractions that cause bearable pain in the lower abdomen and groin region. they can cause some nausea and discomfort.

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81
Q

what are some clinical findings for trisomy 21 p

A

flattened nasal bridge, small and rotated ears, sandal gap toes, hypotonia, protruding tongue, short broad hands, epicanthic folds, and oblique palpebral fissures

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82
Q

what is the most likely finding for a baby born to a type 1 diabetic

A

small and hypoglycemic

NOTE: gestational diabetics are bigger!

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83
Q

what are the warning signs for fetal sepsis

A

tachycardia and minimal variability. septic infants appear pale, lethargic and with high temperature

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84
Q

what is a common complication of twin-twin transfusion syndrome

A

polycythemia of the plethoric twin. (the bigger more robust twin)
the smaller one is usually at risk for IUGR and oligohydramnios while the plethoric twin is at risk for volume overload and polyhydramnios that may lead to heart failure and hydrops.

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85
Q

what are babies born to diabetic mothers at risk for in the context of blood diseases

A

hypoglycemia, polycythemia, hyperbilirunbinemia, hypocalcemia, and respiratory distress. isolated anemia and thrombocytopenia are not risks.

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86
Q

Do you use naloxone on infants?

A

No. any substance abuse/use at all is a contraindication for naloxone use since it could put the baby in life-threatening withdrawal.

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87
Q

when an infant is born to a mother that is HIV positive what is the next step?

A

immediately upon delivery begin zidovudine (AZT). HIV testing begins at 24 hours. breast feeding is NOT encouraged.

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88
Q

how to calculate APGAR

A 
activity
respiration
pulse
grimmace
appearance 
all get two points each
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89
Q

how does sheehan’s syndrome present

A

significant blood loss causes anterior pituitary hypoperfusion and ischemic necrosis leading to loss of gonadotropin, TSH, and ACTH. signs are slow mental function, weight gain, fatigue, difficulty staying warm, no milk production, hypotension and amenorrhea

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90
Q

what is the most common cause of postpartem fever

A

endometritis

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91
Q

what is the most common causal agent of endometritis

A

polymicrobial. both aerobic and anaerobic species. staphylococcus and strep are the most common.

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92
Q

what is postpartem blues

A

feelings of depression with symptoms that only last less than two weeks.

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93
Q

what symptom is useful in deciphering between postpartem blues and depression

A

inability to connect with family or ambivalence to the newborn is indicative of postpartem depression.

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94
Q

what is the most significant risk factor for postpartem depression

A

personal history of depression

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95
Q

what are the risk factors of postpartem depression

A

history of depression, social isolation, lack of support, marital conflict, considering termination, stressful life situations,

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96
Q

what is the safest way to suppress lactation

A

breast binding, ice packs and analgesics.

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97
Q

what cancer does breast feeding reduce the risk of?

A

ovarian cancer and a decreased incidence of breast cancer

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98
Q

why do we not prescribe EP contraception postpartem

A

can increase difficulties in lactation and breast feeding.

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99
Q

what is the proper positioning for breast feeding

A

belly to belly is the most effective position

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100
Q

what causes mastitis and how do we treat

A

strep from babies mouth causes it. antibiotics easily trats it

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101
Q

Do you stop breast feeding for mastitis?

A

No.

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102
Q

how dos simple mastitis presetn

A

breast feeding mother with pain and mild fever and redness in the breast

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103
Q

what can help mothers that want to exclusively breast feed

A

getting baby on breast within 20 min of delivery and rooming with the baby (unlimited access)

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104
Q

what hormones increase on birth of the baby that effect milk production

A

profound increase of progesterone and estrogen. this inhibits alpha-lactalbumin.

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105
Q

what does candida of the nipple present like

A

pink, shiny, nipples that are irritated when breast feeding. have flaking skin on the periphery. usually no fever since this is superficial. this should prompt inspection of the babies mouth. the nipple fissures can also become infected with bacteria and thus anitbiotics should be apart of the treatment plan.

106
Q

how many stools should an adequately fed baby have

A

3-4 in 24 hours

107
Q

how many times should an adequately fed baby urinate

A

4-6 times in 24 hours

108
Q

what strategies should be considered for breast engorgement

A

frequent nursing, warm shower, compresses, massaging and hand expressing the milk wearing a good support bra. using analgesics 20 min before feeding.

109
Q

which hormone is responsible for milk production

A

prolactin

110
Q

which hormone is responsible for milk ejection

A

oxytocin

111
Q

what is the best first step to diagnosing a breast feeding mother who’s baby is losing weight

A

assess breast feeding technique directly.

112
Q

what the increase in risk for someone that has had an ectopic

A

10-fold

113
Q

what two things do we look at to decipher between intrauterine and ectopic pregnancy on ultrasound

A

the level to rise by 50% (or double ) in 24hrs and be greater than the discriminatory zone. >2,000

114
Q

what is standard of care for a ruptured ectopic in the fallopian tube

A

salpingectomy

115
Q

how does uterine perforation present

A

abdominal pain, nausea, scant bleeding, fever, immediately after a surgical procedure

116
Q

what is the most common abnormal karyotype encountered in spontaneous abortions

A

autosomal trisomy

117
Q

what diseases are assocaited with early pregnancy loss

A

systemic diseases, such as diabetes, lupus, chronic renal disease

118
Q

is it safe for patient’s experiencing early pregnancy loss to be managed expectant

A

Yes. You can manage them expectantly

119
Q

women experiencing first trimester losses should be tested for what?

A

systemic diseases, such as lupus, diabetes, thyroid diseases

120
Q

what is a benefit of misoprostol in the use of abortifacient

A

it reduces the time to expulsion for pregnancy

121
Q

what will oxytocin do?

A

increase the strength and frequency of contractions

122
Q

do you ever wait until 42 weeks of gestation?

A

no. this may increase the risk of perinatal mortality

123
Q

If full term is it reasonable to induce labor if the patient is in back pain?

A

yes/

124
Q

when is misoprostol used prior to oxytocin

A

when the cervix is unfavorable.

125
Q

what is associated with breech presentation

A

prematurity, multiple gestation, genetic disorders, polyhydramnios, hydrocephaly, anencaphaly, placenta previa. unterine anomalies, and fibroids

126
Q

what are the risk factors for shoulder dystocia

A

fetal macrosomia, maternal obesity, diabetes mellitus, post-term pregnancy, a prior delivery, complicated by shoulder,

127
Q

what is backup transverse lie presentation associated with?

A

cord prolapse

128
Q

what are the risk factors for cord prolapse

A

rupture of membranes, polyhyramnios, premature or small fetus

129
Q

what is turtle sign indicative of

A

shoulder dystocia.

130
Q

what is the first maneuver in shoulder

A

McRoberts maneuver –hyperflexing her legs to her abdomen

131
Q

what is contraindicated in shoulder

A

fundal pressure and operative vaginal delivery

132
Q

what is the major symptom of uterine fibroids

A

heavy menstrual bleeding secondary to increase in uterine size and/or obstructive effect on uterrine vasculature that ultimately leads to more bleeding. other symptoms are pain and pressure which may cause pressure against bladder bowel and pelvic floor.

133
Q

what do we do about fibroids in pregnancy

A

nothing. no need to treat.

134
Q

what type of fibroid is associated with miscarriage

A

In general, fibroids are infrequent cause of miscarriage or subfertility, but submucosal or intracavitary myomas are most likely to cause lower pregnancy and implantation rate.

135
Q

what are the mechanisms of fibroid miscarriage

A

focal endometrial vascular disturbance, endometrial inflammation, secretion of vasoactive substances.

136
Q

When you have a patient that has AUB and a uterus that is oversized, what is the next step for treatment? e

A

endometrial sampling

137
Q

A patient with fibroids that needs conservative therapy for fertility should get what management

A

First treat with NSAIDs and OCPs. GnRH agonists (leurpolide) are a great management tool.

138
Q

how long for GnRH treatment for maximal response from fibroids

A

3 months. if treatment is discontinued then the fibroid will return to its pretreatment size in 3-4 months.

139
Q

what is the typically presentation for uterine fibroids

A

progressively heavier periods and longer menstrual periods over the past year with increased uterine size.

140
Q

when is GnRH treatment indicated

A

before surgery to shrink the tumor or when the onset of menopause is expected.

141
Q

If a younger patient with fertility issues presents with intramural fibroids what is the management

A

myomectomy is warranted in younger patients with infertility if the fibroid is sufficient in size or location to be a probable cause of infertility, including distorting the uterine cavity

142
Q

what is the risk for isoimmunization

A

> 20% —2% antepartem, 7% after full term delivery, 7% with subsequent pregnancy loss.

143
Q

what ultrasound is indicative of fetal hydrops

A

it is defined as a collection of fluid in two or more body cavities, such as ascites, pericardial, and or pleural fluid and scalp edema.

144
Q

what volume of fetal blood is neutralized by the standard dose of RhoGAM?

A

the standard dose is 300mcg, 30cc of fetal blood.

145
Q

how do we detect Rh-D

A

indirect coomb’s test

146
Q

what measurement is needed to scale the severity of fetal anemia and disease for Rh-isoimmunization

A

amniotic billirubin.
in the presence of severe erythroblastic fetus, the amniotic fluid will become stained yellow. this is billirubin and can be quantified by spectrophotometric measurements of optical density 420-460. if there is a deviation from linearity this indicates the presence of severe hemolysis.

147
Q

what does zone three of the Liley curve indicate

A

this is severe hemolytic disease with hydrops and fetal death likely within 10 days. the baby needs a transfusion

148
Q

what is the most common cause of post partem hemorrhage

A

uterine atony.

149
Q

what are the risk factors for post partem hemorrhage

A

macrosomia, precipitous labor, multiparity, general anesthsia, oxytocin use, prolonged labor, twins, and chorioamnitis

150
Q

what medications are used to increase uterine contractions and reduce post partem hemorrhage

A

methergine, prostaglandins, misoprostol, oxytocin,

151
Q

what is prostaglandin E1

A

misoprostol

152
Q

what is prostaglandin E2

A

dinoprost, avoid use in hypotensive patients

153
Q

what is prostaglandin F2-alpha

A

“hemabate”, avoid using in asthmatic patients

154
Q

another name for methregine

A

methylergonovine

155
Q

How is oxytocin delivered

A

IV with fluids. NO IV PUSH

156
Q

what do methergine, oxytocin, prostaglandins all do

A

contract the uterus

157
Q

If post partem bleeding is an issue but you find no atony or retained placenta then what do you look for and what do you do?

A

look for lacerations first. then potentially move to uterine artery embolization.

158
Q

what to look for with placenta that is low-lying and anterior with multiple C-sections

A

placenta accreta

159
Q

what is a B-Lynch suture

A

this is a uterine compression suture used to control bleeding in the context of retractable atony

160
Q

what is delayed postpartem hemorrhage

A

when bleeding begins 48-72 hours after delivery.

161
Q

what are common findings for abruption

A

vaginal bleeding, painful contractions with rapid progression of labor, clotting on the placenta

162
Q

how does a septic abortion present

A

fever, bleeding and a dilated cervix.

163
Q

what is the management for septic abortion

A

broad spectrum antibiotics and uterine evacuation.

164
Q

why not use single-agent antibiotics for septic abortion

A

because there are typically a wide-range of organisms that are involved in septic abortions

165
Q

which has more blood loss, surgical or medical abortion

A

medical abortions have more blood loss.

166
Q

What is the upper limit of gestational age for manual vacuum aspiration

A

8 weeks

167
Q

when do you use mifepristone and misoprostol

A

can use up to 9 weeks of pregnancy.

168
Q

if a patient is experiencing heavy bleeding after medical abortion what is the next management

A

D and C

169
Q

what do we do after a surgical abortion

A

always give broad spec antibiotics. there is a 42% reduction in infections when antibiotics are administered

170
Q

Why do oral contraceptives reduce dysmenorrhea

A

because the progestrin in the OCP will induce endometrial atrophy. prostaglandins are produced in the endometrium and thus would be reduced. which should improve dysmenorrhea

171
Q

when should we test for G/C?

A

in all sexually active patients that are 25 and younger

172
Q

what are the contraindications for OCPs

A

older than 35 and smokers.

173
Q

How effective is hysterectomy for relieving dysmenorrhea

A

> 80%

174
Q

what needs to be performed in any woman over age 45 with AUB

A

endometrial sampling or biopsy to rule out carcinoma.

175
Q

What needs to be done for the diagnosis of leiomyomata uteri

A

endometrial biopsy to rule out cancer

176
Q

what is the exact definition of a fibroid

A

well-circumscribed, non-encapsulated myometrium

177
Q

what is the definition of endometrial polyps.

A

localized hyperplastic overgrowth of glands/stroma

178
Q

what is the definition of endometrial hyperplasia

A

crowding of endometrial glands with an increase in the gald to stroma ratio

179
Q

definition of endometriosis

A

endometrial glands/stroma and hemosiderin-laden macrophages outside of the uterine cavity.

180
Q

adenomyosis definition

A

invasion of the endometrial glands into the myometrium

181
Q

how do uterine polyps present

A

heavy menstruation, intermenstrual bleeding, dysmenorrhea, increased cramping

182
Q

what is the first line therapy for dysmenorrhea

A

NSAIDs

183
Q

secondary dysmenorrhea causes

A

endometriosis, adenomyosis, uterine fibroids, infection.

184
Q

Restricted uterine motion on exam can be due to what

A

endometriosis, scarring

185
Q

what are some signs of magnesium toxicity

A

respiratory depression, muscle weakness, loss of deep tendon reflexes, nausea, and if given in really high doses cardiac arrest.

186
Q

what level of magnesium is therapeutic and what levels cause issues?

A

therapeutic: 4-7mEq/L
loss of deep tendon reflexes: 7-10
cardiac arrest: 15

187
Q

IN the context of preeclampsia and HELLP, what is the indication to deliver immediately

A

low platelets is the contraindication to expectant management. uncontrolled hypertension, non-reassuring fetal traces, liver function tests > 2X, eclampsia, persistent CNS symptoms and oliguria.

188
Q

what are the most serious risk factors for preeclampsia

A

Chronic renal disease (20:1), chronic hypertension (10:1), family history (5:1), nullparity, BMI > 30 and age>40 all have 3:1. odds ratios.

189
Q

what is the most common abnormal karyotype encountered in spontaneous abortions

A

autosomal trisomy 40-50% of cases.
monosomy X (45X,O) 15-25%
triploidy -15%
tetraploidy -5%

190
Q

what is the most common chromosomal aneuploidy

A

trisomy 16

191
Q

what is the most accurate measurement of the fetus for assessing dates?

A

femur length or long-bone length

192
Q

factor V Leiden is associated with what in pregnancy

A

still birth, preeclampsia, placental abruption, IUGR…remember look for a history of clots/DVT/PE (even if taking oral contraceptives, etc)

193
Q

what should be checked on all women that have vaginal bleeding during pregnancy

A

maternal blood type for Rh factors

194
Q

what are some risks for placental abruption

A

polyhydramnios with rapid decompression of uterine, cavity. smoking

195
Q

what are risk factors for placenta acreta

A

(this occurs when the placenta grows into the myometrium) previous C-sections and a low anterior placenta. the scar tissue prevents proper implantation, so it grows into the myometrium….thus acreta can be caused by previous c-sections

196
Q

what is the bloody show

A

during pregnancy the cervix becomes vascular and when it dilates bleeding can occur.

197
Q

what trimester does threatened abortion occur

A

first trimester

198
Q

what is the most common cause of preterm labor

A

idiopathic.

other causes are dehydration, uterine distortion

199
Q

what is nifedipine

A

a tocolytic

200
Q

do we use tocolytics for amniotic fluid infection?

A

no.

201
Q

what is a contraindication for magnesium

A

myastenia gravis

202
Q

should we use terbutaline on diabetic patients?

A

no.

203
Q

why is indomethacin contraindicated >33 weeks

A

because it closes the ductus arteriosis

204
Q

what is associated with betamethasone treatment of the newborn

A

decreased risk of intracerebral hemorrhage and necrotizing enterocolitis.

205
Q

how does magnesium affect uterine contractions

A

it competes with calcium

206
Q

if ascus and hpv negative then

A

resume 3 years

207
Q

if ascus then what

A

HPV testing or repeat cytology in 12 months

208
Q

Do we ever use a pap smear for excluding cancer

A

NO. this is a screening test, not a diagnostic test. If cancer is suspected, need a biopsy.

209
Q

what do obvious cervical lesions require?

A

biopsy.

210
Q

what is the diagnosis and what do you do if you find a white plaque on the cervical os

A

this is leukoplakia and should be biopsied directly or under colposcopy as soon as possible, regardless of pap test outcome.

211
Q

what is the false-negative rate of pap tests

A

20-30%

212
Q

what do you do if you have taken a biopsy and pap test and they come back normal

A

resume normal testing

213
Q

what is an ectropion

A

an area of columnar epithelium that has not yet undergone squamous metaplasia.

214
Q

what do punctuations and mosaicism represent

A

they are representative of new blood vessels on end and on their sides. this represents angiogenesis and typically a more aggressive lesion.

215
Q

what is more important to consider acetowhite findings or vascular changes

A

vascular changes.

216
Q

what is the sensitivity of endocervical curettage

A

low. not that good of a test.

217
Q

how llong does it take for HPV exposure to cause cancer

A

15 years

218
Q

is cervical cancer genetically inherited

A

no

219
Q

microinvasive cancer is defined how

A

cancer that invades less than 3mm

220
Q

if a patient has a positive endocervical curettage, what is the next step

A

conization

221
Q

what is an expected side effect of the DEPO shot

A

bleeding

222
Q

who are the ideal candidates for progestin-only contraceptive

A

women that have had thromboembolic disease and estrogen-sensitive cancers, women who are lactating, women over 35 who smoke or who develop nausea with combined pills

223
Q

what do copper IUDs do to mensuration

A

they can make them worse. but they last longer…

224
Q

what do progesterone IUD do to periods

A

they make them better or stop them all together.

225
Q

which contraceptives reduce the risk for ovarian cancer

A

OCPs.

226
Q

what is the strongest predictor of regret of sterilization

A

age

227
Q

levonorgestral IUD is what and does what

A

it is a progestrin-IUD. it has less of a failure rate than oral contraceptives and will eventually cause amenorrhea in most women (although the periods are heavier to start). it is protective against endometrial cancers

228
Q

the patch is what? what is the contraindication

A

the patch is a transdermal application that releases estradiol and is contraindicated in woman over 198 lbs.

229
Q

what form of emergency contraception can be used in a person with a history of DVT

A

NOT PLAN B. this person should get copper IUD. it can act as emergency contraception is applied up to five days after intercourse.

230
Q

from where do you take a swab for assessing nitrazine test

A

the vagina, NOT the cervix

231
Q

if someone presents with PPROM do you give tocolysis

A

yes. in order to give a round of steroids in hopes of improving the outcomes for the baby’s lungs;

232
Q

what causes variable decelerations and what is a common context

A

cord compression and this can occur in PROM due to a lack of amniotic fluid.

233
Q

what is ruptured membranes and a tender fundus indicate

A

chrioamnionitis

234
Q

what is the greatest risk associated with delivering a baby before 24 weeks?

A

pulmonary hypoplasia

235
Q

what medication can reduce the risk of PPROM

A

17-alpha-hydroxyprogresterone

236
Q

how common is PROM

A

occurs in approximately 10-15 percent of all pregnancies

237
Q

what can give a false positive nitrazine test?

A

sperm

238
Q

when do you give magnesium for neuroprotection

A

<32 weeks and PPROM WITH LABOR that will occur within 24 hours

239
Q

what signs are indicative of abruption

A

painful contractions and bleeding and PPROM.

240
Q

what is the relationship between abruption and PPROM

A

2-5% of PPROM involve abruption

241
Q

what do we give for PPROM

A

antibiotic therapy with ampicillin and erythromycin has been shown to prolong the latency period by 5-7 days as well as reduce the risk of maternal chorioanionitis and neonatal sepsis

242
Q

what antibiotics do we give for endometritis

A

gentamycin and ampicillin

243
Q

what is the most likely cause of cystitis

A

e. coli. other causes are klebsiellia and proteus mirabilis

244
Q

what is breast engorement and what can it cause

A

it is an exaggerated response to the lymphatic and venous congestion associated with lactation. when the baby is not feeding well the breast become overfilled and can cause a fever.

245
Q

when does milk let-down usually occur

A

during postpartem day two or three

246
Q

how are C-section incisions managed

A

open drainage of the wound is appropriate

247
Q

septic pelvic thrombophlebitis

A

thrombosis of the venous system of the pelvis. this is a diagnosis of exclusion. treatment is anticoagulants and antibiotics

248
Q

what do you consider for a patient that was under general anasthesia?

A

aspiration pneumonia –always look to the lungs

249
Q

what is the gold standard for treating post-cesarean endometritis

A

clindamycin and gentamycin

250
Q

why dont we give cefalosporins or doxycyclines postpartem

A

they would provide great coverage for the organisms of post partem infection, but wee dont give them to nursing mothers

251
Q

Do we give prostaglandins to VBACs

A

No. These are mainly used for cervical ripening, but can increase the risk of uterine rupture.

252
Q

what does prostaglandin E1 do?

A

this is misoprostol and it is used for induction of labor based on uterine tonics and cervical ripening

253
Q

fetal tachycardia is indicative of what

A

fetal distress, can be caused by maternal infection

254
Q

what is prostaglandin E2

A

this is dinoprostol or CERVIDIL. this is a ripening agent

255
Q

what is the initial measure to treat fetal hypoperfusion (late decels).

A

changing maternal position to the left lateral can help perfuse the fetus

256
Q

what do we do if the fetal tracing has reduced variability and no accelerations during labor

A

digital fetal scalp stimulation. If an acceleration results then this is highly correlated with a fetal pH greater than 7.20 in over 90% of cases.

257
Q

what is the next step in attempting to elicit an acceleration if the digital fetal scalp test fails

A

then further assessment such as allis clamp or fetal scalp pH is required

258
Q

what are the findings for postdates and uteroplacental insufficiency

A

growth restriction, oligohydramnios, placental calcifications, and fetal demise

259
Q

what are late term pregnancies associated with

A

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

260
Q

what is amnioinfusion and what does it accomplish?

A

this is saline infusion into the uterine cavity. this is a reasonable approach to treat variable decelerations.

261
Q

what is the presentation for fetal dysmaturity

A

10% over 43 weeks. the fetus has peeling skin, long finger nails, thin and long body, meconium stained skin and small placenta

OB/GYN (39 decks)

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