Uworld OB Flashcards
1
Q
should HIV positive use combination antiretrovirals in pregnancy
A
yes. immediately
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
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
4
Q
what is the management for intrauterine fetal demise between 20-23 weeks
A
dilation and evacuation
5
Q
what is the management for intrauterine fetal demise between >24 weeks
A
vaginal delivery
6
Q
what does gyn surgery put the patient at risk for
A
ureter damage due to close proximity f
7
Q
what is a potential SE of bupivicaine epidural
A
systemic toxicity and seizrue
8
Q
uterine procidentia is what and treated how
A
when the uterus prolaspes through the vagina. treated with pessary fitting and surgery
9
Q
what is leiomyata uteri
A
uterine fibroids.
10
Q
what is the presentation of uterine fibroids
A
heavy flow, globular mass in the abdomen and failure to conceive
11
Q
what is pseudothrombocytopenia
A
a lab error
12
Q
what is the presnetation of glanzman thrombocytopenia
A
bleeding due to platelet aggregation
13
Q
what is a good test for risk of preterm labor
A
transvaginal ultrasound for cervical length
14
Q
what is fetal fibronectin
A
fetaql fibronectin is a test for preterm labor, but after 20 weeks gestation
15
Q
risks of preterm labor
A
previous preterm labor, multiple gestations, history of cervical surgery,
16
Q
does colposcopy risk preterm labor
A
yes. cervical incompetence
17
Q
if there is a risk for preterm labor what is given to ward off preterm labor
A
progesterone injections
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.
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)
20
Q
chancroid
A
H. ducreyi. multiple deep ulcers with yellow exudate, lesion is painful
21
Q
granuloma inguinale
A
klebsiella granulomatis, extensive and progressive lesion without lymphadenopathy. base has granulation tissue. painless lesion
22
Q
lymphogranuloma venerum
A
chlamydia. small and shallow ulcers. large and painful inguinal lymph nodes. not painful lesion to begin
23
Q
syphillis
A
single ulcer, not painful, swollen inguinal nodes, clean base, single indurated well-circumscribed ulcer
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
25
what are some other features of hypothyroidism
hyponatremia and high cholesterol
26
what is postpartum hypothyroidism
effects 7-8% of women within the first 6 months. brief phase of hyperthyroidism due to release of preformed hormone
27
what is the management of placenta previa
C section is indicated after 36-37 weeks
| even with minimal bleeding and stable vital signs
28
what are the causes of 2nd and third trimester oligohydramnios
uteroplacental insufficiency (with fetal growth restriction), or maternal dehydration, or rupture of membranes (normal fetal growth).
29
what nerves are involved in erb-duchene palsy
| treatment
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
30
when can preeclampsia begin
fgreater than 20 weeks
31
what is the presentation of vulvar lichen planus
women 50-60, vulvar pain or pruritus, dyspareunia; if erosive patten then will present with oral lesions erosive glazed lesions with white border
32
what is the treatment for vulvar lichen planus
high dose corticosteroids
33
what do the oral lesions in lichen planus look like
lace like reticular lesions
34
what is the managment for someone with CIN3
if not pregnant then LEEP/cold knife conization/cryablation
| PAP with HPV cotest 1 and 2 years postprocedure
35
what polyhydramnios complications
PPROM (more susceptible to rupture), preterm labor, umbilical cord collapse, fetal malposition
36
what are the causes of polyhydramnios
esophageal/duodenal atresia, diabetes, congenital infection, anencephaly, multiple gestation
37
when do we test for GBS
35-37 weeks
38
what tests are required at initial and 3rd trimester if <25 and high risk STI (prior STI/sex worker)
HIV, Syphillis, Hep B, gonorrhea, chlamydia
39
are OCPs associated with HTN
yes. they are actually recommended against in women with HTN
40
def of oligohydramnios
single pocket less than 2cm or AFI ≤ 5
41
what is placental insufficiency on BPP scoring
0-4/10. also could indicate hypoxia
42
what are the risk factors for placental insufficiency
advanced maternal age, tobacco use, hypertension, diabetes
43
what are the best steps to reduce vertical transmission of HIV
C section if viral load > 1000, zidovudine intrapartem, and continuation of daily antiretroviral regimen
44
is weight gain associated with OCPs
no. several studies have shown no gain especially in low dose formulations
45
what is aromatase def
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
46
what is the presentation of CAH
ambiguous genitalia and normal internal organs. they will have hyponatremia
47
why do androgen insensitive patients have breasts
because there is high testerosterone which is aromatized into estrogen which only effects the breast tissue
48
do you repeat a urine culture after treatment in pregnancy
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
49
management of shoulder dystocia
```
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
```
50
what is the presentation of listeriosis in an immunocompetent host
febrile gastroenteritis
51
what is the most likely cause of painless bleeding in pregnancy
placenta previa or vasa previa
52
what is used for preeclampsia prevention
low dose aspirin at > 12 weeks gestation
53
what is the management of late decels
positioning and o2.
C-section
54
what is the etiology of late decelerations
placental insufficiency
55
when do you use amnioinfusion
when there is variable decelerations. because this may relieve umbilical cord compression
56
what does DES exposure in utero puts the patient at risk for
clear cell vagianl carcinoma
| its clear what DES does
57
Can menopause change the vaginal pH
yes. can increase the pH.
58
how is the diagnosis of menopause made
clinical manifestations and increased FSH
59
what is the most common cause of active phase protraction
cephalopelvic disproportion
60
what is the management of uterine bleeding after labor
bimanual uterine massage, high dose oxytocin and tranexamic acid, then second line uterotonics such as carboprost tromethamine
61
what is the best indicator of uterine rupture
loss of fetal station
62
what does chemotherapy do to female hormone axis
it causes primary ovarian failure with decreased estrogen and high FSH LH
63
what do prolactin levels do in primary ovarian failure
nothing. normal
64
what is the treatment for lichen sclerosis
topical corticosteroids
65
what is the presentation of lichen sclerosis
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
what is the management for PPROM
if there are no complications expectant management with latency antibiotics corticosteroids and fetal surveillance..
67
what latency antibiotics are given for PPROM
azithromycin and amipicilliin
68
def of gestational hypertension
new onset at greater than 20 weeks gestation
69
what are the risks of hypertension in pregnancy to the mothewr
superimposed preeclampsia. hemorrhage, gestational diabetes, C section, placental abruption
70
what risks does hypertension pose to the baby
fetal growth restriction, perinatal mortality, preterm delivery, oligohydramnios
71
what does an elevated AFP usually indicate for pregnancy
open neural tube defects, ventral wall defects, multiple gestations
72
what does a decreased AFP usually indicate
aneuploidy 18 or 21
73
what is the Down syndrome profile for prescreen
low AFP and estriol, increased beta-HCG and inhibin A
| Are you DOWN with AFP, yeah you know E (estrogen). increased inhibin A
74
how can you tell the difference between vaginismus and another organic cause of pelvic pain
inserting the speculum will hurt vaginismus
75
urethral diverticulum
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
what is the presentation of vasa previa
painless vaginal bleeding with ROM or contractions. fetal heart rate abnormalities, fetal exsanguination and demise
77
what is a culdocentesis
fluid removal from the pouch of douglas
78
boggy, tender, symmetrically enlarged uterus with painful menstruation. vitals normal
adenomyosis
79
what is the presentation of acute fatty liver
fulminant liver failure, epigastric/RUQ pain, scleral ictrerus/jaunice, DIC with hemolytic anemia and thrombocytopenia,
80
what is the management of acute fatty liver
immediate delivery regardless of gestational age
81
what are the indications to treat endometriosis
pelvic pain, dysmenorrhea worse throughout menses and not relieved by NSAIDs, dyspareunia, infertility
82
what are the unsafe exercise practices for pregnancy
hot yoga, fall risk, contact sports and scuba diving
83
what is the management of placenta previa
no iuntercouse, no digital cervical exam and inpatient admissions for bleeding episodes
84
what is the most common risk factor for placental abruption
hypertension
85
what are the findings of hyperandrogenism
hirsutism, nodulocystic acne, androgenic alopecia, increased testosterone.
86
what is the differential for hyperenadrogenism
PCOS, androgen secreting tumor, cushing, nonclassical CAH
87
what is the treatment for baratholin gland cyst
expectant management; if they are symptomatic cysts or abscesses then draining them is appropriate
88
what is the presentation of round ligament pain
sharp pain that radiates to the groin
89
what do women with SCD have more of in pregnancy
pain crises
90
when is a circlage placed fro cervical insufficiency
during the first trimester
91
what is klumke palsy
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
what is erb-duchenne
waiters tip hand:
| extended elbow, pronated forearm, flexed wrist and fingers. intact grasp reflex
93
what is short inter pregnancy interval
less than 18 months between children
94
what are the risks of short interpregnancy interval
low birth weight, anemia, PPROM, preterm delivery
95
what are the risks of SCD to the baby
fetal growth restriction, oligohydramnios, preterm birth
96
do copper containing IUD cause amenorrhea
no. they usually increase flow
97
do we screen for hep C
no. unless high risk
98
do we perform wet mount testing during pregnancy
not unless indicateds
99
when do we screen for diabetes
24-28 weeks; unless high risk
100
what type of tumor in a young girl causes increased bone age and percocious puberty
granuloma cell tumor
101
how long do medroxyprogesterone shots last for
DEPO lasts for three months
102
what are the SE for DEPO
amenorrhea, weight gain, fatigue, nausea, breast tenderness. they typically last throughout usage and will not go away
103
do we give NSAIDs in pregnancy
generally avoided in the 1st and 3rd trimesters
104
how is back pain managed in pregnancy
conservatively. massage, heating pads, exercise, behavioral modification
105
what is pubic symphysis diaphysis
difficulty ambulating, radiating suprapubic pain, pubic symphysis pain, intact neurological exam.
106
what are the risk factor for pubic sym diaphysis
fetal macrosomia, multiparty, precipitous labor, operative delivery
107
pubic symphysis diaphysis treatment
conservative management. NSAIDs, physical therapy.
108
what are the risk factors for uterine sarcoma
tamoxifen, radiation, postmenopausal
109
can you use lamotrigine for bipolar in pregnancy
yes
110
what is the presentation of intrahepatic cholestasis of pregnancy
high bilirubin, pruritus, transaminitis
111
condyloma acuminata
this is HPV, usually caused by the low risk strains. 6, 11.
| they are fleshy colored, verrucous nontender, friable and bleed on manipulation
112
condyloma lata
this is syphilis. these are raised grey white lesions they are smooth and have a broader base.
113
what is indicated for a late term pregnancy that is complicated by oligohydramnios
induction of labor
114
what is a common cause of magnesium toxicity
renal insufficiency
115
what are the symptoms of hypermagnesemia
nausea, flushing, headache, hyporeflexia, areflexia, hypocalcemia, somnolence, respiratory paralysis, cardiac arrest
116
what is the treatment for toxic shock syndrome
vancomycin and clindamycin. Vanco provides coverage of the bacterial while clindamycin is highly effective at reducing toxin production
117
what cells cause fibroids
smooth muscle cells in the myometrium
118
lichen sclerosis management
biopsy first and if benign then topical steroids
119
what is the etiology of HELLP
thought to be systemic inflammation
120
cure for HELLP
delivery
121
what does elevated testosterone with normal DHEAS indicate
ovarian source of tumor
| most likely a sertoli leydig
122
what is the typical presentation of CAH
infancy. salt wasting crises
123
what is rapid onset virilization with constitutional symptoms of weight loss with elevated DHEAS
adrenal tumor
124
what is the best next step after maternal sensation of reduced fetal movement
NST.
125
what is a hysterosalpingogram
a study to look at the anatomy of the Fallopian tubes and the uterus for the purposes of infertility
126
which vaccines are recommended in pregnancy
Tdap, inactivated influenza, RhoD immunoglobulin.
127
which vaccines are contraindicated in pregnancy
varicella, live flu, MMR, HPV
128
which vaccines are indicated for high risk pregnancy
hep A, B, C, pneumococcus, H flu, minigococcus, varicella zoster immunoglobulin
129
clinical features of sheehan
lactation failure, amenorrhea, vaginal atrophy, fatigue, bradycardia, anorexia, weight loss, hypotension, decreased lean body mass
130
does malnutrition effect the quality or quantity of breast milk
not usually
131
what are the risk factors for vulvovaginal candidiasis
DM, immunosuppression, pregnancy, OCPs, antibiotic use
132
what is the presentation of candidiasis
pseudohyphae and normal pH
133
what is the treatment for vulvocandida
fluconazole
134
what is the presentation of herpes simplex
round ulcerations or vesicles that are painful. mild lymphadenopathy.
135
what are the painful genital lesions
herpes or chancroid.
136
what is the presentation of chancroid
larger deep ulcers with gray/yellow exudate. well-demarcated border and soft friable tissue. severe lymphadenopathy that may be suppurative.
137
what are the painless genital lesions
syphillis and lymphogranuloma venereum (C. trachoma's servars L1-3
138
what is the presentation of von willebrands
increased bleeding time. other parameters normal
139
what is a clue cell indicative of
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
malodorous green and frothy discharge is indicative of what
this is trichomoniasis. this is green frothy, vaginal inflammation with pH >4.5. motile trichomonads
141
what is the treatment for bacterial vaginosis
metro or clindamycin.
142
what is the treatment for trichromatis
metro for patient and partner
143
what is the treatment for trichromatis
metro for patient and partner
144
what is the presentation of candida
vulvar and vaginal erythema/itching and discharge. pH 3.5-4.5
145
what is the management for a breech presentation pregnancy
contraindication to vaginal delivery
146
what is the presentation of acute fatty liver of preganncy
nausea, vomiting, abdominal pain, jaundice.
147
what is preeclampsia with severe features
Sup > 160 or DBP>110. thrombocytopenia, elevated creatinine or transaminases, pulmonary edema, visual or cerebral symptoms
148
what is the most appropriate med for BP control in a severely hypertensive pregnant patient
hydralazine
149
first line drugs for maternal hypertensive crisis are
hydralazine, labetalol, nifedipine
150
can you use estrogen containing OCPs in migraine
NO. risk of stroke
151
what birth control is easy, lasts up to three years and can reduce or cause amenorrhea
implantable. progestin releasing subdermal
