uworld1 Flashcards
how are bpp scores evaluated?
8/10 = L
6/10 = equivocal
< 4 = deliver
what is def. of oligohydramnios?
AFI < 5 cm
deepest vertical pocket < 2 cm
what is def. of polyhydramnios?
AFI > 24 cm
deepest vertical pocket > 8 cm
in metabolic compromise, what is order of abnormalities?
HR decels
absent fetal breathing
dec. body mov’t / tone
which macrolide may cause acute cholestatic hepatitis in preegnancy?
erythromycin
what is a nL NST?
> 2 accelerations in 20 min
what is abnl NST?
< 2 accels
recurrent variable / late decels
contraction stress test
external FHR w/ spontaneous / induced uterine contractions (oxytocin/nipple stimulation)
nL CST result
no late recurrent variable decels
abnl CST
late decles in > 50% of contractions
what do late decels mean?
uteroplacental insufficiency
umbilical artery doppler velocimetry
used for IUGR
nL = high velocity, diastolic low in umbilca artery
abnl = dec, absent, reversed end diastolic flow
what meds cause a non reactive NST?
mgSO4, narcotics, steroids
meaning of nL CST results
no late / recurrent variable decles –> low likelihood of stillbirth 1/1000 w/in 1 wk
unsatisfacotry CST?
< 3 contractions of 40 seconds in 10 min
unequivocal CST?
recurrent variable decels
intermittent late decels
decels on contractions > 90 s of q2 min
systemic effects of tamoxifene?
dec. osteoporosis
incr. risk of endometrial cancer
hormone profile of turner’s?
incr. FSH, low E
bilateral renal agenesis fetus prognosis?
will die
what is contraindicated w/ endometrial hyperplasia?
endometrial ablation contraindicated
prevents future eval by biopsies
how to treat hyperplasia w/o atypia?
3% chance of cancer
treat w/ progestin
repeat biopsy in 3 mo to assess response
how to treat hyperplasia w/ atypia?
1) hysterectomy
2) future pregnancy
lichen sclerosis progresses to?
squamous cell carcinoma of the vulvar
treatment for lichen sclerosis?
chronic inflammatory condition - vulvar itching + flaking
treatment: high-potency topical steroids (twice daily, 4 wks) –> less potent topical steroid / topical calcineurin inhibitor
radical vulvectomy, when is it used?
invasive squamous cell carcinoma / melanoma
if basal cell carcinoma / = less disfiguring
what is pathophysiology of pre-eclampsia?
placental endothelial cell dysfunction / vasospasm
what are drawbacks of methyldopa in pregnancy for acute HTN episodes?
slow onset
sedating
nitroprusside + HTN crisis?
last resort: cyanide = byproduct
effect of hyperglycemia on fetus (mechanism)
hyperinsulinemia –> fetal hypoxia –> incr. erythropoiesis –> polycythemia –> ischemia/infarction
effects of hyperglycemia on fetus post partum (lab values)
hypocalcemia (PTH suppression)
hypoglycemia
hyperbilirubinemia
polycythemia
features of severe pre-eclampsia
BP > 160/110 thrombocytopenia < 100K serum creatinine > 1.1 elevated transaminases pulmonary edema new onset visual/cerebral symptoms
how does pregnancy incr. the likelihood of carpal tunnel?
estrogen –> incr. interstitial edema –> incr. carpal tunnel pressure
what are features suggesting malignant discharge?
unilateral
bloody/serous
palpable skin changes
what are the lab derangements in hyperemesis gravidarum?
hypokalemia, ketonuria
clinical presentation of hyperemesis gravidarium?
severe, persistent vomiting
ketonuria
>5% loss of pre-pregnancy weight
what is treatment for hyperemesis gravidarum?
hydration
ginger
pyridoxine +/- doxylamine
what are risk factors for hyperemesis gravidarium (when does it present)
multifetal gestation / molar pregnancy
incr. placental mass –> highest hcg @ 10-12 wks (true for all women)
what are causes of elevated maternal serum AFP?
produced by: fetal yolk sac, liver, GI tract
open neural tube defects
fetal abdominal wall defects (gastroschisis / omphalocele)
multiple gestation
fetal congenital nephrosis + benign obstructive uropathy
what are some treatments for urge incontinence?
oxybutynin - anticholinergic
for what type of incontinence is urethropexy used?
stress
early decel - visual finding + etiology?
symmetric to contraction
gradual (> 30s from nadir to onset)
fetal head compression (possibly normal)
late decel - visual finding + etiology?
occurs after contraction
cause: uteroplacental insufficiency
variable decel - visual?
not necessarily assoc. w/ contractions
abrupt (< 30s from nadir)
(duration > 15 s, < 2 min)
variable decel etiology
cord compression
oligohydrmanios
cord prolapse
med treatment for acute abnL uterine bleeding?
high dose IV/oral estrogen high dose combined OCP high-dose progestin (if E contraindication) tranexamic acid (if both P/E contraindicated)
what is mechanism of high E for acute uterine bleeding?
rapidly regrow endometrium from prolonged heavy bleeding
fetal hydantoin syndrome
midfacial hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsuitism, dev’t delay
signs of congenital syphilis
rhinitis (snuffles) + skin lesions
later: keratitis, hutchinson, saddle nose, deafness
fetal hydantoin syndrome vs. fetal alcohol syndrome
fetal alcohol doesn’t have cleft palate / excess hair
where does placental abruption occur?
bleeding b/w decidua & placental interface –> placental detachment –> no exchange to fetus
how to manage placental abruption?
- IV access
- if stable vitals + > 37 wks –> vaginal delivery (maybe w/ oxytocin augmentation)
what must be r/o w/ placental abruption?
placental previa
how does ABO incompatibility occur & how does it present?
group O mother w/ a group A / B
mild anemia / neonatal jaundice - treatable w/ phototherapy
milder response than Rh(D) incompatibility
what is treatment for adenomyosis?
hysterectomy
no other options
molar pregnancy progression to choriocarcinoma
20%
molar pregnancy + ovary findings
theca lutein cysts
pregnancy markers
progesterone > 25
betamethasone what do you use it for?
- fetal lung maturity
- prevents respiratory
- prevents intercerebral hemorrhage
- nec. entero
when is Mg contraindicated
Myasthenia gravis -
poor renal function
nL endometrial thickness post menopausal
<5mm
when might IUDs be contraindicated?
in a fibroid uterus with changes to the cavity (i.e.: submucosal fibroids
what are absolute contraindications to estrogen OCP?
DVT, PE, cardiovascular disease, stroke, breast/endometrial cancer, melanoma, hepatic tumor, abnL liver fuxn
