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step II > Uworld OB > Flashcards

Uworld OB Flashcards

1
Q

should HIV positive use combination antiretrovirals in pregnancy

A

yes. immediately

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2
Q

what are the causes of fetal growth restriction if it is symmetric and in the first trimester

A

chromosomal abnormalities or congenital infection

global growth lag

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3
Q

what are the causes of fetal growth restriction if it is asymmetric and in the 2nd or 3rd trimester

A

uteroplacental insufficiency or maternal malnutrition
this is usually head sparing growth lag

very common cause is maternal hypertension

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4
Q

what is the management for intrauterine fetal demise between 20-23 weeks

A

dilation and evacuation

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5
Q

what is the management for intrauterine fetal demise between >24 weeks

A

vaginal delivery

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6
Q

what does gyn surgery put the patient at risk for

A

ureter damage due to close proximity f

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7
Q

what is a potential SE of bupivicaine epidural

A

systemic toxicity and seizrue

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8
Q

uterine procidentia is what and treated how

A

when the uterus prolaspes through the vagina. treated with pessary fitting and surgery

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9
Q

what is leiomyata uteri

A

uterine fibroids.

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10
Q

what is the presentation of uterine fibroids

A

heavy flow, globular mass in the abdomen and failure to conceive

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11
Q

what is pseudothrombocytopenia

A

a lab error

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12
Q

what is the presnetation of glanzman thrombocytopenia

A

bleeding due to platelet aggregation

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13
Q

what is a good test for risk of preterm labor

A

transvaginal ultrasound for cervical length

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14
Q

what is fetal fibronectin

A

fetaql fibronectin is a test for preterm labor, but after 20 weeks gestation

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15
Q

risks of preterm labor

A

previous preterm labor, multiple gestations, history of cervical surgery,

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16
Q

does colposcopy risk preterm labor

A

yes. cervical incompetence

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17
Q

if there is a risk for preterm labor what is given to ward off preterm labor

A

progesterone injections

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18
Q

if a mother is Rh negative and Coombs test is negative is baby at risk for hydrops

A

no. indirect test is negative.

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19
Q

what does tamoxifen put the patient at greatest risk of

A

hot flashes, venous thromboembolism and endometrial hyperplasia/carcinoma (this is tamoxifen only)

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20
Q

chancroid

A

H. ducreyi. multiple deep ulcers with yellow exudate, lesion is painful

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21
Q

granuloma inguinale

A

klebsiella granulomatis, extensive and progressive lesion without lymphadenopathy. base has granulation tissue. painless lesion

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22
Q

lymphogranuloma venerum

A

chlamydia. small and shallow ulcers. large and painful inguinal lymph nodes. not painful lesion to begin

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23
Q

syphillis

A

single ulcer, not painful, swollen inguinal nodes, clean base, single indurated well-circumscribed ulcer

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24
Q

what to do if clinically patient has syphillis but the blood tests are negative

A

empirically treat. syphillis tests have a high false negative rate

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25
Q

what are some other features of hypothyroidism

A

hyponatremia and high cholesterol

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26
Q

what is postpartum hypothyroidism

A

effects 7-8% of women within the first 6 months. brief phase of hyperthyroidism due to release of preformed hormone

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27
Q

what is the management of placenta previa

A

C section is indicated after 36-37 weeks

even with minimal bleeding and stable vital signs

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28
Q

what are the causes of 2nd and third trimester oligohydramnios

A

uteroplacental insufficiency (with fetal growth restriction), or maternal dehydration, or rupture of membranes (normal fetal growth).

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29
Q

what nerves are involved in erb-duchene palsy

treatment

A

weakness of the deltoid and infraspinatus C5, biceps C6 and wrist and finger extensors C7. this is waiters tip hand
observation. most recover in 3 months

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30
Q

when can preeclampsia begin

A

fgreater than 20 weeks

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31
Q

what is the presentation of vulvar lichen planus

A

women 50-60, vulvar pain or pruritus, dyspareunia; if erosive patten then will present with oral lesions erosive glazed lesions with white border

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32
Q

what is the treatment for vulvar lichen planus

A

high dose corticosteroids

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33
Q

what do the oral lesions in lichen planus look like

A

lace like reticular lesions

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34
Q

what is the managment for someone with CIN3

A

if not pregnant then LEEP/cold knife conization/cryablation

PAP with HPV cotest 1 and 2 years postprocedure

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35
Q

what polyhydramnios complications

A

PPROM (more susceptible to rupture), preterm labor, umbilical cord collapse, fetal malposition

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36
Q

what are the causes of polyhydramnios

A

esophageal/duodenal atresia, diabetes, congenital infection, anencephaly, multiple gestation

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37
Q

when do we test for GBS

A

35-37 weeks

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38
Q

what tests are required at initial and 3rd trimester if <25 and high risk STI (prior STI/sex worker)

A

HIV, Syphillis, Hep B, gonorrhea, chlamydia

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39
Q

are OCPs associated with HTN

A

yes. they are actually recommended against in women with HTN

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40
Q

def of oligohydramnios

A

single pocket less than 2cm or AFI ≤ 5

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41
Q

what is placental insufficiency on BPP scoring

A

0-4/10. also could indicate hypoxia

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42
Q

what are the risk factors for placental insufficiency

A

advanced maternal age, tobacco use, hypertension, diabetes

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43
Q

what are the best steps to reduce vertical transmission of HIV

A

C section if viral load > 1000, zidovudine intrapartem, and continuation of daily antiretroviral regimen

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44
Q

is weight gain associated with OCPs

A

no. several studies have shown no gain especially in low dose formulations

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45
Q

what is aromatase def

A

normal internal anatomy, some external virilization such as clitoralmegaly, with undetectable estrogen levels and elevated testosterone. there will be high LH and FSH, ovarian cysts

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46
Q

what is the presentation of CAH

A

ambiguous genitalia and normal internal organs. they will have hyponatremia

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47
Q

why do androgen insensitive patients have breasts

A

because there is high testerosterone which is aromatized into estrogen which only effects the breast tissue

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48
Q

do you repeat a urine culture after treatment in pregnancy

A

yes. because it is hard to know the difference between the normal pregnancy symptoms and urinary tract symptoms. there is an increased risk for pyelonephritis and 1/3 patients do not resolve after treatment

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49
Q

management of shoulder dystocia

A 
BE CALM
breathe (do no push)
elevate legs and flex hips against abdomen (McRoberts) 
CALL FOR HELP
Apply suprapubic pressure 
enLarge Vaginal opening with episiotomy 
Manuveurs
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50
Q

what is the presentation of listeriosis in an immunocompetent host

A

febrile gastroenteritis

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51
Q

what is the most likely cause of painless bleeding in pregnancy

A

placenta previa or vasa previa

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52
Q

what is used for preeclampsia prevention

A

low dose aspirin at > 12 weeks gestation

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53
Q

what is the management of late decels

A

positioning and o2.

C-section

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54
Q

what is the etiology of late decelerations

A

placental insufficiency

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55
Q

when do you use amnioinfusion

A

when there is variable decelerations. because this may relieve umbilical cord compression

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56
Q

what does DES exposure in utero puts the patient at risk for

A

clear cell vagianl carcinoma

its clear what DES does

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57
Q

Can menopause change the vaginal pH

A

yes. can increase the pH.

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58
Q

how is the diagnosis of menopause made

A

clinical manifestations and increased FSH

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59
Q

what is the most common cause of active phase protraction

A

cephalopelvic disproportion

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60
Q

what is the management of uterine bleeding after labor

A

bimanual uterine massage, high dose oxytocin and tranexamic acid, then second line uterotonics such as carboprost tromethamine

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61
Q

what is the best indicator of uterine rupture

A

loss of fetal station

62
Q

what does chemotherapy do to female hormone axis

A

it causes primary ovarian failure with decreased estrogen and high FSH LH

63
Q

what do prolactin levels do in primary ovarian failure

A

nothing. normal

64
Q

what is the treatment for lichen sclerosis

A

topical corticosteroids

65
Q

what is the presentation of lichen sclerosis

A

thin white wrinkled skin over the labia with atrophic changes, excoriations erosions, fissures, and severe pruritus. dysuria, dyspareunia, painful defecation. punch biopsy to exclude malignancy

66
Q

what is the management for PPROM

A

if there are no complications expectant management with latency antibiotics corticosteroids and fetal surveillance..

67
Q

what latency antibiotics are given for PPROM

A

azithromycin and amipicilliin

68
Q

def of gestational hypertension

A

new onset at greater than 20 weeks gestation

69
Q

what are the risks of hypertension in pregnancy to the mothewr

A

superimposed preeclampsia. hemorrhage, gestational diabetes, C section, placental abruption

70
Q

what risks does hypertension pose to the baby

A

fetal growth restriction, perinatal mortality, preterm delivery, oligohydramnios

71
Q

what does an elevated AFP usually indicate for pregnancy

A

open neural tube defects, ventral wall defects, multiple gestations

72
Q

what does a decreased AFP usually indicate

A

aneuploidy 18 or 21

73
Q

what is the Down syndrome profile for prescreen

A

low AFP and estriol, increased beta-HCG and inhibin A

Are you DOWN with AFP, yeah you know E (estrogen). increased inhibin A

74
Q

how can you tell the difference between vaginismus and another organic cause of pelvic pain

A

inserting the speculum will hurt vaginismus

75
Q

urethral diverticulum

A

out pouching of the urethral mucosa that when pressed causes expression of bloody fluid from the meatus. can be palpated in the anterior vagina

76
Q

what is the presentation of vasa previa

A

painless vaginal bleeding with ROM or contractions. fetal heart rate abnormalities, fetal exsanguination and demise

77
Q

what is a culdocentesis

A

fluid removal from the pouch of douglas

78
Q

boggy, tender, symmetrically enlarged uterus with painful menstruation. vitals normal

A

adenomyosis

79
Q

what is the presentation of acute fatty liver

A

fulminant liver failure, epigastric/RUQ pain, scleral ictrerus/jaunice, DIC with hemolytic anemia and thrombocytopenia,

80
Q

what is the management of acute fatty liver

A

immediate delivery regardless of gestational age

81
Q

what are the indications to treat endometriosis

A

pelvic pain, dysmenorrhea worse throughout menses and not relieved by NSAIDs, dyspareunia, infertility

82
Q

what are the unsafe exercise practices for pregnancy

A

hot yoga, fall risk, contact sports and scuba diving

83
Q

what is the management of placenta previa

A

no iuntercouse, no digital cervical exam and inpatient admissions for bleeding episodes

84
Q

what is the most common risk factor for placental abruption

A

hypertension

85
Q

what are the findings of hyperandrogenism

A

hirsutism, nodulocystic acne, androgenic alopecia, increased testosterone.

86
Q

what is the differential for hyperenadrogenism

A

PCOS, androgen secreting tumor, cushing, nonclassical CAH

87
Q

what is the treatment for baratholin gland cyst

A

expectant management; if they are symptomatic cysts or abscesses then draining them is appropriate

88
Q

what is the presentation of round ligament pain

A

sharp pain that radiates to the groin

89
Q

what do women with SCD have more of in pregnancy

A

pain crises

90
Q

when is a circlage placed fro cervical insufficiency

A

during the first trimester

91
Q

what is klumke palsy

A

claw hand: brachial plexus injury that results in C8 and T1 nerve damage with a claw hand and horners syndrome
extended wrist, hyperextended metacarpophalengeal joints, flexed interphalangeal joints, absent grasp reflex

92
Q

what is erb-duchenne

A

waiters tip hand:

extended elbow, pronated forearm, flexed wrist and fingers. intact grasp reflex

93
Q

what is short inter pregnancy interval

A

less than 18 months between children

94
Q

what are the risks of short interpregnancy interval

A

low birth weight, anemia, PPROM, preterm delivery

95
Q

what are the risks of SCD to the baby

A

fetal growth restriction, oligohydramnios, preterm birth

96
Q

do copper containing IUD cause amenorrhea

A

no. they usually increase flow

97
Q

do we screen for hep C

A

no. unless high risk

98
Q

do we perform wet mount testing during pregnancy

A

not unless indicateds

99
Q

when do we screen for diabetes

A

24-28 weeks; unless high risk

100
Q

what type of tumor in a young girl causes increased bone age and percocious puberty

A

granuloma cell tumor

101
Q

how long do medroxyprogesterone shots last for

A

DEPO lasts for three months

102
Q

what are the SE for DEPO

A

amenorrhea, weight gain, fatigue, nausea, breast tenderness. they typically last throughout usage and will not go away

103
Q

do we give NSAIDs in pregnancy

A

generally avoided in the 1st and 3rd trimesters

104
Q

how is back pain managed in pregnancy

A

conservatively. massage, heating pads, exercise, behavioral modification

105
Q

what is pubic symphysis diaphysis

A

difficulty ambulating, radiating suprapubic pain, pubic symphysis pain, intact neurological exam.

106
Q

what are the risk factor for pubic sym diaphysis

A

fetal macrosomia, multiparty, precipitous labor, operative delivery

107
Q

pubic symphysis diaphysis treatment

A

conservative management. NSAIDs, physical therapy.

108
Q

what are the risk factors for uterine sarcoma

A

tamoxifen, radiation, postmenopausal

109
Q

can you use lamotrigine for bipolar in pregnancy

A

yes

110
Q

what is the presentation of intrahepatic cholestasis of pregnancy

A

high bilirubin, pruritus, transaminitis

111
Q

condyloma acuminata

A

this is HPV, usually caused by the low risk strains. 6, 11.

they are fleshy colored, verrucous nontender, friable and bleed on manipulation

112
Q

condyloma lata

A

this is syphilis. these are raised grey white lesions they are smooth and have a broader base.

113
Q

what is indicated for a late term pregnancy that is complicated by oligohydramnios

A

induction of labor

114
Q

what is a common cause of magnesium toxicity

A

renal insufficiency

115
Q

what are the symptoms of hypermagnesemia

A

nausea, flushing, headache, hyporeflexia, areflexia, hypocalcemia, somnolence, respiratory paralysis, cardiac arrest

116
Q

what is the treatment for toxic shock syndrome

A

vancomycin and clindamycin. Vanco provides coverage of the bacterial while clindamycin is highly effective at reducing toxin production

117
Q

what cells cause fibroids

A

smooth muscle cells in the myometrium

118
Q

lichen sclerosis management

A

biopsy first and if benign then topical steroids

119
Q

what is the etiology of HELLP

A

thought to be systemic inflammation

120
Q

cure for HELLP

A

delivery

121
Q

what does elevated testosterone with normal DHEAS indicate

A

ovarian source of tumor

most likely a sertoli leydig

122
Q

what is the typical presentation of CAH

A

infancy. salt wasting crises

123
Q

what is rapid onset virilization with constitutional symptoms of weight loss with elevated DHEAS

A

adrenal tumor

124
Q

what is the best next step after maternal sensation of reduced fetal movement

A

NST.

125
Q

what is a hysterosalpingogram

A

a study to look at the anatomy of the Fallopian tubes and the uterus for the purposes of infertility

126
Q

which vaccines are recommended in pregnancy

A

Tdap, inactivated influenza, RhoD immunoglobulin.

127
Q

which vaccines are contraindicated in pregnancy

A

varicella, live flu, MMR, HPV

128
Q

which vaccines are indicated for high risk pregnancy

A

hep A, B, C, pneumococcus, H flu, minigococcus, varicella zoster immunoglobulin

129
Q

clinical features of sheehan

A

lactation failure, amenorrhea, vaginal atrophy, fatigue, bradycardia, anorexia, weight loss, hypotension, decreased lean body mass

130
Q

does malnutrition effect the quality or quantity of breast milk

A

not usually

131
Q

what are the risk factors for vulvovaginal candidiasis

A

DM, immunosuppression, pregnancy, OCPs, antibiotic use

132
Q

what is the presentation of candidiasis

A

pseudohyphae and normal pH

133
Q

what is the treatment for vulvocandida

A

fluconazole

134
Q

what is the presentation of herpes simplex

A

round ulcerations or vesicles that are painful. mild lymphadenopathy.

135
Q

what are the painful genital lesions

A

herpes or chancroid.

136
Q

what is the presentation of chancroid

A

larger deep ulcers with gray/yellow exudate. well-demarcated border and soft friable tissue. severe lymphadenopathy that may be suppurative.

137
Q

what are the painless genital lesions

A

syphillis and lymphogranuloma venereum (C. trachoma’s servars L1-3

138
Q

what is the presentation of von willebrands

A

increased bleeding time. other parameters normal

139
Q

what is a clue cell indicative of

A

bacterial vaginosis. the pH will be >4.5 with clue cells and a positive whiff test. thin off-white discharge with a fishy odor.

140
Q

malodorous green and frothy discharge is indicative of what

A

this is trichomoniasis. this is green frothy, vaginal inflammation with pH >4.5. motile trichomonads

141
Q

what is the treatment for bacterial vaginosis

A

metro or clindamycin.

142
Q

what is the treatment for trichromatis

A

metro for patient and partner

143
Q

what is the treatment for trichromatis

A

metro for patient and partner

144
Q

what is the presentation of candida

A

vulvar and vaginal erythema/itching and discharge. pH 3.5-4.5

145
Q

what is the management for a breech presentation pregnancy

A

contraindication to vaginal delivery

146
Q

what is the presentation of acute fatty liver of preganncy

A

nausea, vomiting, abdominal pain, jaundice.

147
Q

what is preeclampsia with severe features

A

Sup > 160 or DBP>110. thrombocytopenia, elevated creatinine or transaminases, pulmonary edema, visual or cerebral symptoms

148
Q

what is the most appropriate med for BP control in a severely hypertensive pregnant patient

A

hydralazine

149
Q

first line drugs for maternal hypertensive crisis are

A

hydralazine, labetalol, nifedipine

150
Q

can you use estrogen containing OCPs in migraine

A

NO. risk of stroke

151
Q

what birth control is easy, lasts up to three years and can reduce or cause amenorrhea

A

implantable. progestin releasing subdermal

step II (22 decks)

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