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MTB STEP 2 (R) > MTB 2 CK - Obstetrics > Flashcards

MTB 2 CK - Obstetrics Flashcards

1
Q

Definition of embryo

A

Fertilization - 8 weeks

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2
Q

Definition of fetus

A

8 weeks - birth

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3
Q

Definition of infant

A

Birth to 1 yo

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4
Q

Developmental age

A

Number of days since fertilization

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5
Q

Gestational age

A

Number of days since LMP

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6
Q

Nagele rule

A

Est day of delivery by taking LMP - 3 mo + 7 d

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7
Q

First trimester def

A

Fert - 14 w GA

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8
Q

Second trimester def

A

14 w GA - 26 w GA

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9
Q

Third trimester def

A

26 w GA - delivery

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10
Q

Previable

A

Born before 24 w

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11
Q

Preterm

A

25-37 weeks

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12
Q

Early term

A

37 - 38.6

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13
Q

Full term

A

39 - 40.6

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14
Q

Late term

A

41 - 41.6

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15
Q

Postterm

A

42 w +

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16
Q

First sign of pregnancy on PE

A

Goodell sign (softening of cervix at 4 w)

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17
Q

Ladin sign

A

Softening of midline uterus at 6 w

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18
Q

Chadwick sign

A

Blue discoloration of vagina and cervix at 6-8 w

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19
Q

Chlosama

A

Mask of pregnancy on forehead, nose, and cheeks at 16 w

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20
Q

What makes B HCG

A

Placenta

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21
Q

When does BHCG peak

A

10 weeks

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22
Q

When should gestational sac be evident

A

5 w or BHCG of 1000-1500

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23
Q

Cardiology changes in pregnancy

A

Increased CO

Lower BP

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24
Q

What are GI changes in pregnancy

A

Morning sickness
GERD
Constipation

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25
Q

What are renal changes in pregnancy

A

Pyelo from ureter compression
Increased GFR
Decreased BUN/Cr

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26
Q

What are heme changes in pregnancy

A

Anemia

Hypercoagulability

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27
Q

What to do in first trimester

A 
q4-6 week checks
US at 11-14 w (GA, nuchal trans)
FHR at end of first tri
Blood tests, Pap, GC
First tri noninvasive screen
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28
Q

How to confirm GA in first tri

A

US

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29
Q

What to do in second trimester

A

Triple or quad at 15-20
FHR
Quickening
US for fetal malformation

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30
Q

What is a triple screen

A

MSAFP
BHCG
Estriol

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31
Q

What is a quad screen

A

MSAFP
BHCG
Estriol
Inhibin A

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32
Q

High MSAFP

A

Dating error
Neural tube defect
Abdominal wall defect

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33
Q

What to do in third trimester

A 
q2-3 w visits until 36 w, qweekly >36
At 37 w, examine cervix qvisit
27 w CBC
24-28 w glucose load
36 week repeat GC, do GBS
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34
Q

What is glucose load test

A

Give 50 g glucose and check after 1 hr

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35
Q

What is glucose tolerance test

A

Get fasting glucose
Give 100 g glucose
Check at 1, 2, 3 hours
(Elevation at any 2 is GDM)

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36
Q

How to interpret 3rd tri CBC

A

If hgb

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37
Q

When to get glucose tolerance test

A

If load >140 at 1 h

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38
Q

What is chorionic villus sampling

A

10-13 week for fetal karyotype

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39
Q

What is amnio

A

11-14 week for fetal karyotype

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40
Q

What is fetal blood sampling

A

Perc umb blood sample for Rh isoimm

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41
Q

Most common site of ectopic pregnancy

A

Ampulla

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42
Q

Risk factors for ectopic pregnancy

A

PID
IUD
Previous ectopic

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43
Q

Pres ectopic pregnancy

A

Unilateral pelvic pain
Vaginal bleeding
Hypotx if ruptured

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44
Q

How to dx ectopic

A

BHCG
US
Laparoscopy

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45
Q

Tx ectopic preg

A

If HDUS, IVF and immediate surgery

If stable, CBC, type and screen, LFTs, BHCG then methotrexate

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46
Q

How to follow medical treatment of ectopic pregnancy

A

Follow BHCG for 15% decrease in 4-7 d
If none, second dose methotrexate
If not decreasing after second dose, surgery

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47
Q

Who shouldn’t get methotrexate

A 
Immunodeficiency
Noncompliant
Liver dz
>3,5 cm ectopic
Fetal heartbeat can be heard
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48
Q

Sfx methotrexate

A

Hepatotox

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49
Q

Surgery in ectopic

A

Salpinostomy (preserves tube)

Salpingectomy (no preservation)

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50
Q

Definition of abortion

A

Pregnancy that ends before 20 weeks

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51
Q

Cause of abortions

A 
Csomal abnormalities >>>
Anatomic abnormalities
STDs
Immunological factors (APL)
Endocrine factors
Malnutrition
Trauma
Rh isoimm
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52
Q

Pres abortion

A

Crampy pain

Vaginal bleeding

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53
Q

How to dx abortion

A

CBC
Blood type and Rh screen
US

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54
Q

Complete abortion

A

No products of conception

Office f/u

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55
Q

Incomplete abortion

A

Some products of conception

D&C, medical

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56
Q

Inevitable abortion

A

Products of conception intact but IU bleeding and cervical diln
D&C, medical

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57
Q

Threatened abortion

A

Products of conception intact but IU bleeding

Bed rest

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58
Q

Missed abortion

A

Death of fetus with products in uterus

D&C, medical

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59
Q

Septic abortion

A

Infection of uterus and surrounding area

D&C and IV Abx

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60
Q

Medical treatment of abortion

A

Misoprostol

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61
Q

Who should receive Rhogam

A

Rh negative moms that have trauma

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62
Q

First clue for multiple gestations

A

High BHCG and MSAFP

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63
Q

Complications of multiple gestations

A

Spontaneous abortion of one
Premature L&D
Placenta previa
Anemia

64
Q

Risk factors for premature labor

A 
PROM
Multiple gestations
Previous preterm labor
Placental abruption
Uterine abnls
Infx
PreE
Intrabdominal surgery
65
Q

When should premature labor not be stopped with tocolysis

A 
Severe HTN
Cardiac dz
Diln >4 cm
Maternal hemorrhage
Fetal death
Chorio
66
Q

What are some tocolytics

A

Mag sulfate
CCB
Terbutaline

67
Q

Sfx mag

A

Flushing
HA
Diplopia
Fatigue

68
Q

Sfx CCB

A

HA
Flushing
Dizzy

69
Q

Sfx terb

A

Palps

Hypotx

70
Q

Monitor mag

A

DTRs frequently

71
Q

How to confirm amniotic fluid

A

Pool
Nitrazine paper = blue
Fern

72
Q

WHat is PPROM

A

Early and >24 h

73
Q

Complications of PROM

A

Preterm labor
Cord prolapse
Abruption
Chorio

74
Q

Manage PROM

A

Chorio = deliver
No chorio, at term = wait 6-12 h for spont delivery, then induce
Preterm = steroids, tocolytics, ampicillin and azithro x 1 (cefazolin or clinda if allergic)

75
Q

What increases the risk of placenta previa

A

Previous C sections
Previous uterine surgery
Multiple gest
Previous previa

76
Q

First step in third tri bleeding

A

TRANSABDOMINAL US (DO NOT DO DIGITAL VAGINAL EXAM OR TRANSVAGINAL US)

77
Q

Pres of placenta previa

A

Painless vaginal bldg

78
Q

When to tx previa

A

Large volume bldg

Drop hct

79
Q

How to tx previa

A

Strict pelvic rest

80
Q

When to deliver in previa

A

> 4 cm diln
Severe hemorrhage
Fetal distress

81
Q

Risk factors for abruption

A 
HTN
Prior abruption
Cocaine
External trauma
Smoking
82
Q

Pres of abruption

A

Third tri bleeding
Severe pain
Ctx
Possible fetal distress

83
Q

Complications of concealed abruption

A

DIC
Uterine tetany
Fetal hypoxia, death
Sheehan

84
Q

Do C section in abruption with

A

Uncontrolled hemorrhage
Rapidly expanding concealed hem
Fetal distress
Rapid separation

85
Q

Do vaginal delivery in abruption with

A

Limited separation
Reassuring FHR
Extensive separation with dead fetus

86
Q

Risk factors for uterine rupture

A 
C section
Trauma
Myomectomy
Polyhydramnios
Multiple gestations
Placenta percreta
87
Q

Pres of uterine rupture

A

Extreme abdominal pain
Abnl bump in abdomen
No ctx
Regression of fetus (moving away from vagina)

88
Q

Tx uterine rupture

A

Immediate LAPAROTOMY

89
Q

Cause of Rh incompatibility

A

Rh negative mom with Rh positive baby

90
Q

How to screen for Rh incompatibility

A

If Rh negative, check antibody titer for sensitization

91
Q

What does Rh incompatibility cause

A

Hemolytic dz of newborn

92
Q

What is hemolytic dz of newborn

A

Fetal anemia
Extramedullary prodn of RBCs (HSM)
High hgb and bilirubin
Erythroblastosis fetalis (CHF)

93
Q

How to manage Rh incomp

A

If unsensitized, give Rhogam at 28 weeks and at delivery if baby is positive
If sensitized, get titer, if >1:16, serial amnio for bili
If high bili, do IU transfusion

94
Q

Chronic HTN in preg

A

> 140/90 before 20 week GA

95
Q

How to tx chronic HTN in preg

A

Methyldopa
Labetalol
Nifedipine

96
Q

Gest HTN in preg

A

> 140/90 after 20 week GA with no proteinuria or edema

97
Q

Risk factors for preE

A

Chronic HTN

Renal dz

98
Q

Difference btwn mild and severe preE

A 
140/90 vs 160/110
1-2+ (300mg) vs 3-4+ (5g)
Facial, hand, feet edema vs generalized
Normal mental status vs changes
No vision changes vs yes
No LFT changes vs yes
99
Q

What is eclampsia

A

TC seizure in preE

100
Q

Manage mild preE

A

Deliver if at term

BMZ and Mag if preterm

101
Q

Manage severe preE

A

Deliver if at term

Mag and hydralazine if preterm to stabilize, BMZ and mag if can’t stabilize

102
Q

What is HELLP

A

Hemolysis
Elevated liver enzymes
Low platelets

103
Q

Comps of pregestational DM

A 
PreE
Spont abt
Increased infx
Increased postpartum hem
More congenital problems
Macrosomia/dystocia
Preterm labor
104
Q

Addl tests to do in pregest DM

A

EKG
24 h Cr
A1C
Optho exam

105
Q

Fetal testing needed in pregest DM

A

32-36 w: Weekly NST and US
>36 w: Weekly NST, BPP
37 w: L/S ratio

106
Q

What is the definition of IUGR

A

Weight in the bottom 10%

107
Q

What does symmetric IUGR baby look like

A

Brain in proportion with rest of body

108
Q

When does symmetric IUGR occur

A

Before 20 w

109
Q

What does asymmetric IUGR baby look like

A

Brain weight is not decreased (big head)

110
Q

When does asymmetric IUGR occur

A

After 20 w

111
Q

What are causes of IUGR

A 
Chromosomal abnormalities
Neural tube
Infx
Multiple gestation
Renal dz
112
Q

Complications of IUGR

A 
Premature labor
Stillbirth
Fetal hypoxia
Low IQ
Seizures
MR
113
Q

What is the definition of macrosomia

A

4500 g

114
Q

Risk factors for macrosomia

A

Maternal DM
Maternal obesity
Postterm pregnancy

115
Q

When to do an US for larger than expected fundal height

A

> 3 cm

116
Q

Complications of macrosomia

A

Dystocia
Birth injuries
Low Apgars
Hypoglycemia

117
Q

How to manage macrosomia

A

If lungs are mature, IOL before 4500g

If >4500g, C section

118
Q

What is a reactive NST

A

2 fetal movements

Acceleration >15 bpm lasting 15-20 seconds within 20 mins

119
Q

What to do if NST is nonreactive

A

VIbroacoustic stimulation

120
Q

What is BPP

A 
NS
Fetal chest expansion (1x in 30 min)
Fetal movement (>3 in 30 mins)
Flexion of an extremity
AFI
121
Q

What is normal BPP

A

> 8

122
Q

What is normal fetal HR

A

110-160

123
Q

What is fetal bradycardia

A
124
Q

What is fetal tachycardia

A

> 160

125
Q

Cause of early decels

A

Head compressions

126
Q

Cause of variables

A

Cord compression

127
Q

Cause of late decels

A

Hypoxia

128
Q

What is lightening

A

Fetal descent to pelvic brim

129
Q

What is bloody show

A

Bloody mucus released with cervical effacement

130
Q

How long should phase 1 last

A

Primip: 6-18
Multip: 2-10

131
Q

How long should latent phase last

A

6-7, 4-5

132
Q

How long should active phase last

A

1 cm/h

1.2 cm/h

133
Q

How long should stage 2 last

A

30 min - 3 h

5-30 min

134
Q

How long should stage 3 last

A

30 min

135
Q

Signs of placenta separation

A

Fresh vaginal bleeding
Umb cord lengthening
Uterine fundus rising
Uterus becoming firm

136
Q

Meds for IOL

A

Prostaglandin E2 for cervical ripening

Oxytocin

137
Q

Who to avoid prostaglandin E2 in

A

Asthma

138
Q

What defines arrest of cervical dilation

A

No dilation for >2 h

139
Q

What defines a prolonged latent stage

A

> 20 h for primip

>14 h for multip

140
Q

What causes prolonged latent stage

A

Sedn
Unfavorable cervix
Uterine dysfx with irreg/weak ctx

141
Q

Tx prolonged latent stage

A

Rest and hydration

142
Q

What defines protracted cervical dilation

A
143
Q

Causes of protracted cervical diln

A

Power
Passenger
Passage

144
Q

Tx protracted cervical diln

A

C section or oxytocin

145
Q

What is arrest of fetal descent

A

No descent for 1 h

146
Q

What causes arrest disorders

A

Cephalopelvic disproportion
Malpresentation
Excessive sedn/anesthesia

147
Q

First step in presumed breech

A

US

148
Q

What are Leopold manuevers

A

Estimate fetal wt and presenting parts

149
Q

What is frank breech

A

Hips are flexed with extended kneew

150
Q

What is complete breech

A

Hips and knees are flexed

151
Q

What is footling breech

A

Feet first

152
Q

When can you perform cephalic version

A

After 36 weeks

153
Q

Steps of tx shoulder dystocia

A

McRoberts (flexion of knees, suprapubic pressure)
Rubin (push posterior shoulder toward fetal head)
Woods (push posterior shoulder toward fetal back)
Deliver posterior arm
Fracture clavicle
Zavanelli (push head back in)

154
Q

What defines PPH

A

> 500 ml

155
Q

What defines early vs late PPH

A

24 h

156
Q

Risk factors for atony

A 
Anesthesia
Uterine overdistension
Prolonged labor
Lac
Retained placenta
Coagulopathy
157
Q

Tx PPH

A

Bimanual exam for rupture, retained placental
If normal, bimanual compression and massage
Oxytocin

MTB STEP 2 (R) (12 decks)

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