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DIT STEP 2 > OBSTETRICS > Flashcards

OBSTETRICS Flashcards

1
Q

Changes in thyroid hormone observed during pregnancy

A

Since TBG increases, total T4 will increase but free T4 remains unchanged. TSH will also decrease slightly during early pregnancy but remains within normal limits.

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2
Q

Why is metabolic alkalosis seen during pregnancy?

A

PCO2 decreases to about 30 mm Hg which makes sense because mom wants to release more oxygen to baby.

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3
Q

Tidal volume changes in pregnancy

A

Tidal volume increases 40% with associated increase in minute ventilation due to stimulation by progesterone.

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4
Q

Glucose-related changes during pregnancy

A

Non-diabetic hyperinsulinemia with associated mild glucose intolerance.
Production of human placental lactogen contributes to glucose intolerance by interfering with insulin activity

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5
Q

Treatment of GERD during pregnancy

A

CAlcium carbonate. H2 blockers and PPIs are also safe. The only thing that is NOT safe is milk of magnesia (recall magnesium induces tocolytic effects)

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6
Q

At what gestational age is physiologic anemia of pregnancy most apparent?

A

Second trimester due to greater increase in plasma volume as compared to BC mass.

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7
Q

When should anemia in pregnancy be treated with oral iron?

A

If Hb falls below 11 in first or third trimesters OR when less than 10.5 in second trimester.

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8
Q

What is Goodell’s sign?

A

Softening and cyanosis of cervix at 6 weeks gestation

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9
Q

What is Chadwicks sign

A

Bluish discoloration of the vagina due to vascular congestion at 8-12 weeks gestation

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10
Q

What is Hegars sign

A

Softening of the uterus at 6 weeks gestation

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11
Q

Folic acid requirement in all women of childbearing years

A

.4 mg daily

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12
Q

IF previous child wit neural tube defect, recommended folic acid intake?

A

Starting the mont prior to pregnancy, 4 mg daily.

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13
Q

When do you do Group B strep screening?

A

36 weeks gestation. Thats because its only good for 4 weeks.

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14
Q

Increased nuchal translucency

A

Down syndrome
Turner syndrome
Congenital heart defects

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15
Q

MCC of abnormal quad screen

A

Incorrect dating

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16
Q

Serum AFP is only valid if performed during what window

A

16-18 weeks gestation

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17
Q

High aFP

A

Increased risk of neural tube defects or multiple gestations

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18
Q

Low aFP

A

Increased risk of trisomies 21 and 18

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19
Q

Low PAPP-A
Elevated hCG
Elevated nuchal traslucency

A

Trisomy 21

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20
Q

Very low PAPP-A, very low hCG, increased nuchal translucency

A

Trisomy 18

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21
Q

Very low PAPP-A, low hCG, increased nuchal translucency

A

Trisomy 13

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22
Q

Low AFP, uE3

High hCG, Inh A

A

Trisomy 21

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23
Q

Low AFP

VERY LOW uE3, hCG

A

Trisomy 18

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24
Q

Which test has lowest false-positive rate for non-invasive tests in pregnancy

A

Full integrated test. US measurement of nuchal translucency, serum measurement of pregnancy-associated plasma protein A in first trimester and quad screen in second trimester

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25
Q

What does the quad screen consist of

A

Maternal serum aFP
Estriol (uncojugated)
hCG
Maternal serum inhibin A

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26
Q

Which screening test is performed in all pregnant women at 16-18 weeks gestation

A

Quad screen

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27
Q

Which screening can determine karyotype

A

Amniocentesis

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28
Q

When is chorionic villi sampling performed

A

Early detection of chromosomal abnormalities in higher risk patients (advanced age, hx of children wit genetic defects)

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29
Q

What are the indications for percutaneous umbilical blood sampling/cordocentesis

A

Second and third trimester when karyotype results are required within a few days
Diagnosing fetal hyper- or hypothyroidism
Diagnosing and managing fetal thrombocytopenia

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30
Q

Nagele’s rule

A

LMP + 7 days - 3 months + 1 year = estimated delivery date.

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31
Q

Cardiac defect associated with gestational DM

A

Transposition of great vessels

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32
Q

BP i npre-eclampsia

A

> 140/90

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33
Q

A rise in creatinine during pregnancy should make you consider?

A

Pre-eclampsia

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34
Q

BP meds used in pregnancy

A 
Methyldopa
Labetalol
Hydralazine
Nifedipine/amlodipine
Thiazides (Avoid volume depletion!)
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35
Q

Why is mag sulfate used in pre-eclampsia

A

Prevent seizures (NOT FOR BP!!!)

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36
Q

What do we use to treat eclampsia?

A

Mag sulfate and IV diazepam and continue for 48 hours following delivery!!

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37
Q

What happens if your patient is on mag sulfate and starts having seizures?

A

Give more mag sulfate

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38
Q

How long do we continue mag sulfate in PRE eclampsia

A

24 hours post-delivery

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39
Q

Epilepsy tx in pregnancy

A

Keep them on their AED but also should be given supplemental vitamin K (only during last month of pregnancy to prevent PPH) and folate.

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40
Q

How is hyperemesis gravid arum distinguished from normal morning sickness

A

Weight loss exceeding 5% of pre pregnancy body weight and detection of ketonuria due to starvation

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41
Q

Workup in a patient wit hyperemiis gravidarum

A

WEight, orthostatic
Serum free T4, serum electrolytes, urine ketones
Ulrasound to detect gestational trophoblastic disease and multiple gestations

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42
Q

Expected non worrisome lab abnormalities associated with vomiting in prego

A

Elevated AST and ALT (but

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43
Q

Tx of UTI in pregnancy

A

Amoxicillin
Nitrofurantoin
Ceftriaxone

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44
Q

Which opioid is more likely to have increased teratogenic effects in neonate

A

Methadone

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45
Q

How do you treat migraines in pregnancy

A

Hydrocodone (opioids!) I HAD THIS Q ON COMLEX LEVEL 1

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46
Q

Radiation dose considered safe in pregnancy

A

Less than 0.05 (5 rads)

Risk of malformations increases after 0.10 gray

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47
Q

Which AED causes fingernail hypoplasia

A

Carbamazepine

48
Q

Which rx drug associated with cleft palate

A

Diazepam (maybe also phenytoin)

49
Q

Effect of sulfonamides during pregnancy

A

Kernicterus

50
Q

Which rx drug associated with Dandy Walker malformation

A

Warfarin

51
Q

Which rx drug associated with hypospadias

A

Valproic acid

52
Q

Anti-viral contraindicated in prego

A

Ribavirin

53
Q

Which congenital infection associated with high risk of neonatal death if disease transmission occurs?

A

Rubeola (measles)

54
Q

When should you provide intrapartum antibiotic prophylaxis for GBS

A

GBS bacteriuria during current pregnancy
History of early onset GBS in a previous infant
Intraoartum fever
Preterm labor (18 hrs)

55
Q

When can methotrexate be used in the treatment of ectopic pregnancy rather than surgical removal?

A

Hemodynamicaly stable
Reliably compliant with post-treatment monitoring
Pretreatment serum hCG

56
Q

At what hCG level should you be able to see an intrauterine pregnancy on transabdominal US

A

6500 mIU/mL

57
Q

At what hCG level should you be able to see transvaginal US intrauterine preg

A

1500 mIU/mL

58
Q

Which congenital infection is initially asymptomatic but later develops a unilateral hearing loss

A

CMV

59
Q

Which congenital infection associated wit hhydrocephalus, intracranial calcifications and chorioretinitis

A

Toxo classically but also could be CMV

60
Q

Which congenital infection associated with hearing loss, chorioretinitis, and intracranial calcifccations

A

CMV

61
Q

Which congenital infection associated with PDA or pulmonary artery stenosis

A

Rubella

62
Q

1st line tx for hyperemesis gravidarum

A

Vitamin B6
Docsalamine (unasom)
Hydration

63
Q

Which teratogen gives craniofacial defects, IUGR, CNS malformation and stillbirth

A

Warfarin

64
Q

Which teratogen causes hydrocephalus, CNS defects, craniofacial, ear and cardiovascular defects

A

Isotretinoin

65
Q

Which teratogen causes cerebral infarcts, mental retardation

A

cocaine

66
Q

Initial US finding for IUGR

A

Abdominal circumference

67
Q

Definition of oligohydramnios

A

AFI

68
Q

Definition of polyhydramnios

A

AFI>25 cm on ultrasound

69
Q

Oligohydramnios in 3rd trimester

A

premature rupture of membranes

70
Q

Mag sulfate is contraindicated when?

A

In myasthenia gravis

71
Q

Reversal agent for mag sulfate

A

Calcium gluconate

72
Q

Early decels are a sign of

A

Head compression

73
Q

LAte decals are a sign of

A

uteroplacental insufficiency

Fetal hypoxia

74
Q

Variable decals are a sign of

A

Umbilical cord compression

75
Q

What should you do if you see variable decels

A

Change moms position

76
Q

What should you do if you see late decels

A

Test fetal blood from scalp sample to dx hypoxia or acidosis

Recurrent late decals or fetal hypoxia direct PROMPT DELIVERY

77
Q

Nml fetal heart rate

A

120-160 bpm

78
Q

Non-stress test – what is moms position

A

Left lateral supine

79
Q

Define a reactive nonstress test

A

two or more 15 bp accelerations of fetal heart rate lasting at least 15 seconds within 20 minutes

80
Q

Non-reactive nonstress test prompts?

A

Biophysical profile

81
Q

Components of biophysical profile

A

Nonstress test repeated
Ultrasound to measure AFI
Fetal breathing, movement, and tone (extension of fetal spine or limb with return to flexion)

82
Q

Reassuring biophysical profile

A

8-10

83
Q

Reassuring contraction stress test

A

Beat to beat variability of ~5 bp
Long-term heart rate variability
Occasional heart rate accelerations (2+ access of 15 bp lasting at least 15 seconds within a 20 minute period)

84
Q

Abnormal 3 hour 100 g fasting glucose test

A

95 mg/dL

85
Q

Abnormal 1 hour 50 g oral glucose test

A

140 mg/dL

86
Q

Abnormal 3 hour 100 g oral glucose test at 1, 2, and 3 hours

A

180 mg/dL
155 mg/dL
140 mg/dL

87
Q

Cervical dilation: bishop scoring

A

For 0 cm: 0 points
For 1-2 cm: 1 point
For 3-4 cm: 2 points
For 5-6: 3 points

88
Q

Effacement: bishop scoring

A

For 0-30%: 0 points
For 40-50%: 1 point
For 60-70%: 2 points
For 80%: 3 points

89
Q

Station: bishop scoring

A

For -3 station: 0 points
For -2 station: 1 point
For -1 and 0 station: 2 points
For +1 and +2 station: 3 points

90
Q

Consistency: bishop scoring

A

For firm: 0 points
For medium: 1 point
For soft: 2 points

91
Q

Position: bishop scoring

A

Posterior: 0 points
Mid: 1 point
For anterior: 2 points

92
Q

Normal cervical dilation for primp during active phase

A

1.2 cm per hour

93
Q

Normal cervical dilation for multi during active phase

A

1.5 cm/hr

94
Q

Normal latent phase length in primip

A

20 hours

95
Q

Normal latent phase length for multip

A

14 hours.

96
Q

What causes the changes in the cervix during labor

A

Breakage of disulfide bonds in collagen (mediated by prostaglandin E2, stimulated by engagement)

97
Q

What is the station when the fetal head has engaged the cervix?

A

-2. This is engagement, when the fetal head contacts the cervix and tells it to start ripening.

98
Q

Frank breech

A

Knees are extended, hips flexed

99
Q

Adequate contractions

A

CTX 3 in 30 min

>40 mm Hg

100
Q

A prolonged phase III in labor puts mom at higher risk for ?

A

PPH. If the uterus is too tired to push out a placenta, its probably too tired to calm down and prevent PPH.

101
Q

Most common cause of premature ROM?

A

Ascending infection. Give her abx.

102
Q

Most common cause of ppROM?

A

Ascending infection. If

103
Q

Define prolonged ROM

A

> 18 hours from ROM to delivery. Increased risk of GBS infection.

104
Q

Abx used for prom/pprom + fever

A

Broad spec, usually pip-tazo

105
Q

4 things that can delay delivery

A

Mag sulf
B agonists (like terbutaline)
CCB (like nifedipine)
Prostaglandin inhibitors like ketorolac or indomethacin

106
Q

Next step if you think baby might be post-date?

A

If you’re unsure of dates, perform biophys profile.

107
Q

In twin gestation, with 2 placentas, the twins are ?

A

Monozygotic
Diamniotic
Dichorionic

108
Q

What if theres only 1 plant in twin gestation?

A

Check the septum which would separate the sacs.

109
Q

If there is one placenta, and at least 1 septum in a twin gestation, the twins are?

A

MONO zygotic
MONO chorionic
DIamniotic

110
Q

If there is 1 placenta and NO sept in a twin gestation, the twins are ?

A

Monozygotic
Monochorionic
MMonoamniotic

111
Q

When did split occur for monozygotic, dichorionic, diamniotic twins?

A

0-3 days after fertilization, in the tubal phase.

112
Q

When did split occur for monozygotic, monochorionic diamniotic twins?

A

4-8 days after fertilization, in blastocyst phase

113
Q

Extra risk associated with monozygotic monochorionic diamniotic twins?

A

Twin twin transfusion, since they share a placenta.

114
Q

When did split occur for mono mono mono twins?

A

9-12 days after fertilization.

If > day 12, most likely conjoined :(

115
Q

Extra risk associated with mono mono mono twins?

A

Cord entanglement.

116
Q

Tx of uterine inversion

A

Tack down fornices, give pitocin since its bleeding.

117
Q

Next step after an in-between BPP and baby is

A

Contraction stress test using pitocin. Looking for LATE DECELS.

DIT STEP 2 (17 decks)

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