Uwise - Unit 2: Obstetric Pathology

Question 0

Pt with suspected ruptured ectopic pregnancy - tx?

Answer 0

Surgery

Question 1

Criteria for giving methotrexate for ectopic pregnancy?

Answer 1

1. Hemodynamic stability
2. Nonruptured
3. Less than 4 cm in size without heart rate or less than 3.5 cm with heart rate.
4. Normal liver enzymes, renal function, WBC count

Question 2

Medical conditions that cause first trimester abortions?

Answer 2

Diabetes, SLE, chronic renal disease

Question 3

Treatment for spontaneous loss of pregnancy due to cervical incompetence?

Answer 3

Cervical cerclage

Question 4

Missed abortion – treatment?

Answer 4

First trimester – nothing needs to be done (at least for a couple of weeks)

Second trimester – D & E

Question 5

Highest risk for mortality in pregnancy?

Answer 5

Maternal mortality over 25%

Question 6

Screening for gestational diabetes?

Answer 6

Without hx of glucose intolerance - 24-28 weeks

With hx (obesity, family hx), screen ASAP

Question 7

Bronchial breath sounds suggest?

Answer 7

Consolidation

Question 8

Antidepressant contraindicated in pregnancy?

Answer 8

Paroxetine (fetal cardiac malformations)

Question 9

Management of nephrolithiasis in pregnancy?

Answer 9

1. Aggressive hydration
2. Antimicrobials
3. If no resolution in 72 hours, double-J stent
4. If need long term stenting, do percutaneous nephrostomy

Question 10

When to emergency deliver from a preeclampsia mother?

Answer 10

Thrombocytopenia, elevated LFTs, CNS symptoms, Oliguria

Question 11

Mag levels and related toxicity?

Answer 11

4-7 normal
7-10 loss of DTR
12+ respiratory depression

(Pulmonary edema is a side effect, not a toxicity)

Question 12

Zone 3 Liley curve tx?

Answer 12

Severe hemolytic Rh disease (risk of hydrops and fetal death in next week)

Give fetal transfusion (plasmapheresis is transfusion not possible)

Question 13

Non-invasive test to determine fetal anemia?

Answer 13

Middle cerebral artery Doppler

Question 28

G1 pt with unexpected fetal demise. Chronic condition that could be the cause?

Answer 28

Diabetes

Question 29

Pt undergoing suction D&C when bowel comes out - next step?

Answer 29

Laparoscopy

Question 30

Premenstrual dysphoric disorder?

Answer 30

Depressive symptoms in the luteal phase (absent and beginning of follicular phase)

Question 31

Pregnant pt with suspected IUGR - monitoring?

Answer 31

1. Amniotic fluid measurement (for oligohydramnios)
2. Systolic/diastolic ratio (increase suggests increased vascular resistance seen in IUGR)
3. NST

Question 32

Process that can lead to IUGR and poor neurological outcome?

Answer 32

Severe vascular resistance

Question 33

Cause of asymmetric growth restriction versus symmetric growth restriction?

Answer 33

Uteroplacental insufficiency versus intrinsic growth failure/early event (organ system anomaly, aneuploidy, infection)

Question 34

Organisms that cause growth restriction? Organisms that do not call cause growth restriction?

Answer 34

Viral – CMV, rubella, Syphilis, varicella
Protozoa – toxoplasmosis

No bacterial causes of growth restriction

Question 35

Vaginal tears – classification?

Answer 35

1 – vaginal mucosa
2 – vaginal fascia and perineum
3 – rectal sphincter
4 – external anal sphincter, internal anal sphincter, rectal mucosa

Question 36

Gynecologic factor that indicates C-section?

Answer 36

Fibroids

Question 37

advantage of vacuum assisted delivery versus forceps for mother?

Answer 37

Less incidence of maternal lacerations

Question 38

When is external cephalic version contraindicated? Do instead?

Answer 38

Acting labor; C-section

Question 39

Non-Contraceptive health benefits of female sterilization?

Of OCP?

Answer 39

Reduced risk of ovarian cancer

Reduced breast cancer, ovarian cancer, endometrial cancer

Question 40

Patient progressing during labor – steps before considering C-section?

Answer 40

1. Ptosin

2. IUPC

Question 41

Patient with close cervix who wishes induction of labor – use?

Answer 41

Cytotec (cervdil)

Question 42

Patient with uterine fibroids – potential labor complication?

Answer 42

Breech presentation

Question 43

When to rupture membranes artificially?

Answer 43

Arrest in the active phase of labor

Question 44

Effect of smoking on baby?

Answer 44

Small sick baby peeing blood

IUGR, infection, preeclampsia, placental abruption, placenta previa

Question 45

Friable cervix without dilation?

Friable cervix with dilation?

Answer 45

Cervicitis

Bloody show

Question 46

4 effects of steroids during pregnancy?

Answer 46

1. Lung maturity
2. Decreased respiratory distress syndrome
3. Decreased intraventricular hemorrhage
4. Decreased necrotizing enterocolitis

Question 47

Management of the patient over 34 weeks with spontaneous rupture of membranes without labor?

Answer 47

Induce labor

Question 48

Physical finding that is an indication for delivery?

Answer 48

Tender uterine fundus

Question 49

Patients with uterine atony – most appropriate next step?

Answer 49

Prostaglandin F2-Alpha

Question 50

Patients with chronic asthma – contraindicated uteroonic agent?

Answer 50

Prostaglandin F2

Question 51

Most serious type of postpartum bleeding?

Answer 51

placenta accreta

Question 52

Newly breast-feeding mother develops a low-grade fever – cause?

Answer 52

Breast engorgement

Question 53

Classic presentation of septic thrombophlebitis? Tx?

Answer 53

Postpartum fever unresponsive to antibiotics

Heparin