Aaron: OB Flashcards by Aaron Sircy

Polymicrobial, infection post C-section, what is the best abx course?

Clindamycin plus gentamicin

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What is a prominent post birth infection risk?

C-section

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Car accident
Uterine Tenderness
High amplitude contractions
What should I think about?

Abruptio Placenta

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If a child does not have ADHD symptom relief after methylphenidate medications after two months, what should happen?

Switch to a different medication

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Before starting methylphenidate, what are two things that must be done?

Cardiac history and physical exam, baseline weight

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With a history of pre-eclampsia, what should be started between 12-14 weeks?

Aspirin, prophylatically

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Woman under the age of 19, assuming no underlying risk factors are at an increased risk of what?

Pre-term birth

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During pregnancy, what hormone level can be increased due to elevated estrogen?

TBG and T4 and T3

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Advanced maternal age, over the 35 years old, what is a test that should be offered to all women?

Cell-free DNA fetal testing

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Can you breast feed on methadone?

yes you can

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If you take valproate during pregnancy, can you breast feed afterwards?

yes you can

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Methotrexate is contraindicated in patients with what two diseases?

Renal Disease or Hepatic Disease, meds cannot be cleared quickly enough

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Are GBS cultures done during labor?

When are GBS cultures done?

36-38 weeks

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GBS unknown plus preterm delivery (<37 weeks), ruptured membranes for > 18 hours, intrapartum fever (intraamniotic infection), what should be given?

Antibiotics

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Constant urinary dribbling, decreased perineum sensation (diabetic history), what is the most common cause?

Overflow Incontinence

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Placenta Previa is painless vaginal bleeding after how many weeks?

20 weeks

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Indomethacin is a uterine tocolytic that can be used when? How much time can it buy you?

< 32 weeks

48 hours

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Woman that has had a mechanical valve replaced, what is the anticoagulation scheme for pregnancy?

First Trimester has LMWH use
Second and Third trimester use Warfarin
Just before birth, use LMWH

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Unfractionated Heparin is cleared how?

Low Molecular Weight Heparin is cleared how?

Hepatically and Renally

LMWH is renally cleared, cannot use in bad renal patients

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Baby with a cleft lip, what are the three things that are needed to make a surgical repair?

Reconstruction at 10 weeks, weight 10lbs, and 10 g of hemoglobin

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Mammograms start at 50-74 and are how often?

Every 2 years

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Mammograms start early if breast cancer has what in the family?

Breast Cancer occurs in 2 first degree family members

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If a patient has bariatric surgery, how long should they wait to become pregnany?

1 year

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What two antibiotics are contraindicated in 1st semester pregnancy?

Nitrofuratonin
TMP-SMX

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What is the non-delusional belief that a woman is pregnant but she is not pregnant?

Pseudocyesis

What is an autoimmune inflammatory disease that can occur during pregnancy that is an antibody reaction to the basement membrane? What is the best treatment?

pemphigoid gestations Steroids

If a woman has intrahepatic cholestasis of pregnancy, what is the lab value going to show?

Increase in bile acids

Are there any screening tests that are required for Tamoxifen when being used?

No, only evaluate if symptoms start

Constant urine leaking and decreased perineal sensation is code for what?

Overflow Incontinence

Patient has an elevated AFP, unsure about fetal abnormalities, what is the next test that should be ordered?

Fetal Ultrasound

If a patient has PPROM, what condition is concerning regarding the baby?

Umbilical Cord Prolapse

At 28 weeks, what is the a standard blood test that pregnant woman should have, assuming nothing obviously wrong?

CBC

Overflow incontinence has what anatomical problem underlying the patient?

Impaired Detrusor contractility

Urge Incontinence has what anatomical problem underlying the patient?

Sudden, overwhelming urge to urinate

Stress Incontinence has what anatomical problem underlying the patient?

Decreased Urethral Sphincter Tone and Urethral Hypermobility

Urge incontinence will say what in the question STEM?

Sudden, Overwhelming urge to urinate

Untreated appendicitis can lead to what complication?

pylephlebitis or infective portal vein thrombosis

Preterm babies at risk of early delivery before week 32 weeks, what should be given? Preterm babies at risk of early delivery before week 34 weeks what should be given?

Magnesium, indomethacin, steroids Corticosteroids and Nifedipine (fetal lung development), no benefit for babies at week 34-37 week

If pregnant, have an exophytic mass (looks like cervical cancer), HIV+ viral load is super high, do I biopsy/investigate cervical cancer lesion?

yes, investigate, because the patient is immunocompromised

A woman has anti-phospholipid syndrome, a clot during pregnancy, heavy menstrual periods, chronic anticoagulation, and she would like to talk about contraception options. What is the best recommendation?

IUD with progesterone only Cu IUDs cannot be prescribed with a heavy bleeding history

Estrogen cause what to happen to the TBG?

Increased synthesis

High TSH levels can be due to high BHCG levels, this can cause hyperthyroid symptoms. What is the name of this disease?

Gestational Transient Thyrotoxicosis

Breastfeeding mom has metronidazole given for Trichomonas, what should she do with her breast milk?

Breast Milk should be discarded for 24 hours, then resume, MTZ is a one-time dose

Hemodynamically stable patients, what drug should be given?

Methotrexate

Mifepristone and misoprostol are used to help do what?

Prime the uterus for aborition

Sickle Cell Patients are a high risk of Pre-eclampsia, what is a necessary test at the patient's initial visit?

24 hour urine collection, looks at protein baseline

Do RH positive women need a Kleihauer-Betke test to evaluate for hemolytic disease of the new born?

Subchorionic hematomas are treated how? Increased risk of what?

Expectant Management Spontaneous Abortion

Pregnant woman gets bacterial vaginosis, what is the drug of choice? Will it affect the baby?

Clindamycin No baby impact

Patients that have acute cervicitis, IUD. ABX need to be given, does the IUD need to come out or cultures taken?

Given prophylactic abx and keep IUD in place

What gestational age is the oral glucose tolerance test done?

24-28 weeks

How is a urethral Diverticulum diagnosed?

MRI of the pelvis

Urethral Diverticulum can be described as what?

Tender fullness in the anterior vaginal wall, hx of multiple UTIs

What is the absolute smoking contraindications to OCPs?

Smoking more than 15 cigarettes a day and/or migraines Can still do OCPs if a few cigarettes a day, I know

High risk of pre-eclampsia, had before, what should patients do at 12-16 weeks?

Start Aspirin

Probability of a test that is positive over general population, what test should be evaluated?

Likelihood ratio

Ethical Principal: ensures that methods used to achieve a worthwhile goal are necessary, appropriate, and not excessive, is what?

Proportionality

Neonatal Chlamydia can cause conjunctivitis and pneumonia, but what other condition can it cause?

Preterm prelabor rupture of membranes

If pregnant patient has genital warts, what is the best pregnancy route?

Vaginal and Expectant management, no C-section benefit

1st line abx treatment in a complicated UTI (acute cystitis) is what?

Fosfomycin

Vulvodynia is what? Tx?

3 months or more of very sensitive vulva tenderness, sharp, raw burning pain with Q-tip contact Cognitive Behavioral Therapy, Pelvic Floor PT, Behavior Modification

In a 1st trimester woman, a patient has a slightly decreased TSH and increased T4, is this normal?

Yes, 2/2 estrogen during pregnancy

Postmenopausal patients, tamoxifen use, and pelvic radiation cause an increase for what?

Uterine Sarcoma, remove Uterus

After a woman has a cerclage placed, is she allowed to exercise?

No she cannot exercise

Normal Amniotic fluid index is between what two numbers?

5 to 24 cm

Gestational Diabetes will cause oligohydramnios or polyhydramniosis?

Polyhydramniosis

A pregnant woman with nausea and vomiting can be discharged. What are the best medications to give her?

Oral Vitamin B6 and H1 antihistamine

No glaring past medical history, when should mammograms start? Are breast self exams helpful when decreasing mortality?

Age 50 Not helpful with decreasing mortality

A nulliparious woman can push for how long with or without an epidural before a C-section can be discussed?

3 hours before C-section 4 hours before C-section with Epidural

If a patient is sexually assaulted, what is the best contraception opition?

Ulipristal therapy

Kidney Failure AMS Fever Abdominal Pain/Nausea Petechial Rash What is this?

TTP

Acute Fatty liver of pregnancy and HELLP syndrome show up in what trimester and what else?

3rd trimester and elevated liver enzymes

A stable methadone use patient can or cannot breastfeed after a baby's birth?

Can breastfeed, assuming she is stable

Amenorrhea before age 40, elevated FSH and low estrogen, what is the next best step?

Karotype Analysis

What medication types can decrease the patient's OCP efficacy?

Anti-seizure medications

Positive Pregnancy test, vaginal bleeding, pelvic pain/pressure, and birth 4 months ago, and an enlarged uterus, what could this be?

Gestational Trophoblastic Neoplasia/choriocarcinoma, can be malignant, should remove ASAP

A clinic can "fire" a patient as long as notice is given of how long?

30 day notice

What weeks is the anti-RH(D) immunization given if a person requires the transfusion?

1st prenatal visit, 28 weeks, and postbirth (within 72 hours)

External Cephalic Version can be done during what timeframe?

Greater than 37 weeks

What syndrome is a contraindication to pregnancy?

Eisenmenger Syndrome

Rh(d) + mom and Rh(D) negative Dad, will they have problems?

No, mom with Rh(D) + does not have problems

Motile, Flagellated organisms are what disease? What is the treatment?

Trichomonas Oral Metronidazole for both patient and partner

Is the flu vaccine recommended during pregnancy?

Yes

Internal Cephalic Version does what?

The maneuver moves a baby from breech position to a breech position, i.e. the head is moved towards the stomach and feet toward the vagina

What does Letrozole do?

Inhibits aromatase and decreases estrogen production from androgen conversation, then it stimulates ovulation

Melasma during pregnancy can be treated how?

Sunscreen and sun exposure avoidance

DTAP should be given during what part of the pregnancy?

27-36 weeks

Pelvic Inflammatory disease, what is the most likely risk factor?

Multiple Sexual Partners

Unexplained nipple discharge from breast, what test should be ordered next?

Mammogram plus ultrasound

Patient has a pale vagina and type 1 DM history, what is the most likely diagnosis?

Vitiligo

Group B strept treatment, what is the best tx when the patient is allergic to penicillin?

Cefazolin

Over what number is fetal tachycardia?

160 bpm plus

If a patient has platelets between 100 to 150k is that normal despite almost having double the value earlier? Previous pregnancy visit

Yes, this is normal

If a patient has elevated prolactin levels over 200, what should be done next?

Order a Brain MRI, medications only increase around 100

What is a common psych medication that can decrease the seizure threshold?

Clozapine

If a patient takes Lithium, 2 years, no relapses, and wants to change, what should be done?

Keep same dose, same routine

Preeclampsia Abruptio Placentae Uteroplacental Insufficiency Renal Anomalies NSAIDs These will do what to aminotic fluid index?

Oligohydramnios

Esophageal/duodenal atresia Anencephaly Multiple Gestation Congenital Infection Diabetes Mellitus These will do what to aminotic fluid index?

Polyhydramnios, increased preterm pre-labor rupture of membranes

Placenta Previa will have light or heavy bleeding? Vasa Previa will have light or heavy bleeding? Which one will a patient present with hemodynamic instability?

Both are light Placenta Previa will present with a mother hemodynamically unstable