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Ob/Gyn > UWorld OB > Flashcards

UWorld OB Flashcards

0
Q

Serious side effects of OCPs?

A
  1. Thromboembolus
  2. Hypertension
  3. Hypertriglyceridemia
  4. Diabetes
  5. Cholestasis/cholecystitis
    6, MI in smokers over 35
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1
Q

OCP is protective against?

A
  1. Benign breast disease
  2. Ovarian cysts /cancer
  3. Endometrial cancer
    4 Dysmenorrhea
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2
Q

Acute fatty liver pregnancy – Trimester? Symptoms? Labs? Histology? Can lead to?

A

Third;

nausea, abdominal pain, headache

Prolonged prothrombin time and elevated transaminases

Micro vesicular deposition in about a site without inflammation or necrosis

Acute renal failure

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3
Q

Risk factors for cervical insufficiency during pregnancy?

A
  1. Procedures - elective abortions, LEEP procedure or cone biopsy
  2. Obstetrical trauma
  3. Multiple gestation
  4. History of second trimester pregnancy loss
  5. Mullerian abnormalities
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4
Q

Risk factors for placental abruption?

A
  1. Maternal disease – Diabetes, SLE
  2. Hypertension
  3. Maternal drugs - smoking, Cocaine, alcohol
  4. External cephalic version
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5
Q

Risk factors for uterine rupture?

A
  1. Multiparity
  2. Advanced maternal age
  3. Previous C-sections/myomectomies
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6
Q

Risk factors for polyhydramnios?

A
  1. Fetal malformations/genetic disorders
  2. Diabetes
  3. Multiple gestation
  4. Fetal anemia
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7
Q

Cervical length at 24 weeks? Gold standard for evaluating Surbex for cervical incompetence?

A

25 mm; transvaginal ultrasound

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8
Q

Patient with septic abortion – treatment?

A
  1. Cervical/blood cultures
  2. Antibiotics
  3. Gentle suction curettage (Vigorous curettage may perforate uterus)
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9
Q

Postterm pregnancy associated with an increased risk for?

A

Oligohydramnios

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10
Q

UTI drugs contraindicated in pregnancy? Use instead?

A

Tetracyclines, fluoroquinolones, Bactrim

Use nitrofurantoin, amoxicillin, cephalexin

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11
Q

Risperidone – used to treat? Mechanism of action? Side effects in women?

A

Schizophrenia bipolar; dopamine antagonist

Increases serum prolactin levels causing oligomenorrhea, galactorrhea

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12
Q

Pregnant patient comes in complaining of brown vaginal discharge – Suspect? Test? If positive, tx?

A

Missed abortion; pelvic ultrasound

D&C, misoprostol/mifepristone or expectant management for POC elimination

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13
Q

TSH and thyroid hormone in pregnancy?

A
  1. Estrogen in pregnancy increases thyroid binding globulin, increasing TDG-bound T3 and T4. Free T3 and T4 remain normal. Therefore total T3 and T4 are elevated
  2. HCG in pregnancy can mildly stimulate TSH receptor, resulting in a small increase in free T3/T4. Levels are slightly elevated and remain within normal range
  3. TSH remains the same
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14
Q

Patient with suspected lichen sclerosis - next step? (Why?)

Tx?

A

Punch biopsy (r/o vulvar squamous cell carcinoma)

Topical steroids

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15
Q

Premature ovarian failure – FSH to LH ratio?

A

FSH increases more than LH

FSH/LH ratio >1

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16
Q

Tests for every pregnant patient?

A

FRIED (flu, Rh/type and screen/CBC, infection, exam, down syndrome screening)

  1. Cervical psychology
  2. Rh type and antibody screen
  3. Hematocrit, hemoglobin, MCV
  4. Rubella, varicella, hepatitis B screening
  5. STI – syphilis, HIV
  6. Flu vaccine during flu season
  7. Screening for down syndrome, cystic fibrosis
17
Q

Test for specific, at risk pregnant patients?

A

CHLamydia TTTrachomatis

  1. Thyroid function
  2. TB
  3. Toxoplasmosis
  4. Hemoglobin electrophoresis
  5. Lead levels
  6. Chlamydia
18
Q

Indications for GBS prophylaxis if status is unknown?

A
  1. Delivery under 37 weeks
  2. Duration of membrane rupture over 18 hours
  3. Any amount of GBS bacteriuria
  4. Prior history GBS sepsis
19
Q

Intrauterine fetal demise may cause? Mechanism? Early sign?

A

DIC; due to release of tissue factor from the placenta into maternal circulation which triggers intrinsic pathway

Low normal fibrinogen (~160)

20
Q

Emergency contraception is offered up to how long after intercourse? Plan B a.k.a.?

Second trimester abortifacient?

A

120 hrs; levonorgestrel

Prostaglandin E2 suppositories

21
Q

NST – when to conduct?

A

Over 32 weeks with decreased fetal movements

22
Q

Contraction stress test?

A

Mother given oxytocin infusion until three contractions every 10 minutes.

Effect of contractions fetal heart activity is recorded. Test is positive and delivery recommended if late decelerations are present

23
Q

Most important risk factor squamous cell carcinoma the vagina?

A

HPV

24
Q

Female offspring of women who ingest DES during pregnancy are at an increased risk for developing?

A
  1. Clear-cell adenocarcinoma of vagina/cervix
  2. Cervical anomalies
  3. Uterine malformations
25
Q

Amniotic fluid embolism Sx?

A

Sudden respiratory failure, seizures, cardiogenic shock, DIC

26
Q

Immediately postpartum, possibly worrisome symptoms that are actually normal?

A

Low-grade fever, leukocytosis, vaginal discharge, chills

27
Q

Patient given epidural for labor – side effect? Mechanism?

A

Hypotension from Venus pooling

28
Q

Ideal range for maternal glucose?

A

75-90

29
Q

Gestational diabetes – Child at increased risk for?

A

Macrosomia, hypoglycemia, hypocalcemia, polycythemia, respiratory difficulties, heart failure

30
Q

Contraception can be used postpartum?

A

Sterilization, barrier methods, IUD, progestin-only

OCP may decrease milk production and pass into milk

31
Q

Patient with cytologic specimens suggesting HSIL – next step? If pregnant?

A

Colposcopy and biopsy

If not pregnant and colposcopy positive - LEEP excision

If pregnant and Biopsy negative, second biopsy six weeks after delivery

32
Q

Preferred way to screen for gestational diabetes? If positive?

A

One hour 50 g glucose tolerance test

Either:

  1. 75 g oral glucose tolerance test
  2. Three hour 100 g oral glucose tolerance test
33
Q

Gestational diabetes is diagnosed if three hour test values are?

A

Fasting glucose > 95
One hour glucose >180
Two hour glucose >155
Three-hour glucose >140

34
Q

hCG doubles until? Alpha versus beta subunits?

A

6-8 weeks

Also similar structure to TSH, LH, FSH

Beta subunits unique to HCG

35
Q

Roles of hCG in pregnancy?

A
  1. Maintenance of corpus luteum
  2. Promotion of male sexual differentiation
  3. Stimulation of maternal thyroid gland
36
Q

Down syndrome markers?

A 
Alphabetical order:
AFP low
Beta hCG high
estriol low
Inhibin high
37
Q

When to give RhoGAM? When will Standard dose need to be adjusted?

A

At 28 weeks of first pregnancy and immediately postpartum

Maternal-feel hemorrhage (placental abruption) – will need to increase dose of RhoGAM based on Kleihaur-Betke

38
Q

Why is Rh incompatibility worse than ABO incompatibility?

Why can ABO incompatibility happen in the first pregnancy?

A

ABO has fewer IgM antibodies that cross placenta, causing only mild disease

A & B antigens are found in food and bacteria in the environment

39
Q

Discharge consistent with ovulation?

A

“Egg white like” thickening

40
Q

Management after biophysical profile?

A

8-10: normal

6 without oligohydramnios: deliver if greater than 37 weeks (Repeat BPP in 24 hours if less than 37 weeks, and deliver if no improvement)

6 with oligohydramnios – deliver if above 32 weeks (daily monitoring less than 32 weeks)

4 or less – deliver if greater than 26 weeks

41
Q

Infection post pregnancy?

A 
0 days - wind
1-2 - water
2-3 - womb (endometritis)
4-5 - wound
7+ - walking (septic thrombophlebitis)

Ob/Gyn (64 decks)

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