ABOG Flashcards
(401 cards)
1
Q
At what week is amniotic fluid composed of urine?
A
20w
before that it comes through fetal skin
2
Q
How much does atypical ductal hyperplasia increase the risk of breast cancer?
A
4-5 fold risk
3
Q
What percentage of patients with atypical ductal hyperplasia have concurrent cancer?
A
30%
4
Q
Clinical diagnostic factors of APAS?
A
personal h/o VTE or pregnancy morbidity:
missed at >10w
delivery at <34w d/t PIH
3+ SABs at <10w
5
Q
Lab diagnositc factors of APAS?
A
Anti-cardiolipin antibodies
Anti beta 2 glycoprotein
lupus anticoagulant
(x2 12 w apart- same lab abnormality)
6
Q
How do you dx APAS?
A
one lab abnormaility (12w apart) and 1 clinical factor
7
Q
What medication should patients take when pregnant with APAS? Which is most helpful?
A
heparin and aspirin from pregnancy through 6w PP
Heparin reduces VTE and fetal loss
8
Q
At what spinal level does the abdominal aorta exist?
A
T12 to L4
9
Q
What is the order of vessels off the abdominal aorta from top to bottom
A
Celiac Trunk
SMA
Ovarians
IMA
10
Q
What do the ovarian veins drain into?
A
Right ovarian > IVC
Left ovarian > left renal
11
Q
What is add back therapy?
A
Norethindrone 5 mg daily
Prolongs use of lupron from 6 mo to 12 mo
12
Q
What is the biggest worry with prolonged lupron use?
A
decrease in bone density
13
Q
Definition of arrest of labor
A
> 6 cm with ROM
with adequate ctx x4h (200 MVU)
without adequate ctx x6h
14
Q
What is the definition of prolonged latent phase of labor?
A
Nullip: >20h
Multip: > 14h
15
Q
3 signs of AFE
A
hypoxia
hypotension
coagulopathy
16
Q
What happens to the heart in an early stage AFE? Late phase AFE?
A
Early phase: right ventricular failure
Late phase: left ventricular failure
17
Q
What should you limit in management of an AFE?
A
Limit excessive fluid resuscitation to avoid pulmonary edema
18
Q
How do you calculate an anion gap? What is normal?
A
Na - (Cl+HCO3)
Normal: 12 +/- 4
19
Q
What is the risk of ovarian cancer in the general public?
A
1.5%
20
Q
What is the risk of ovarian cancer in a BRCA1 patient? BRCA2 patient?
A
Ovarian cancer
BRCA1 40%
BRCA2 15%
21
Q
What is the risk of breast cancer in a BRCA1 patient? BRCA2 patient?
What types of breast cancer develop?
A
Breast cancer
BRCA1 60%- triple negative
BRCA2 50%= ER/PR +
22
Q
What percentage of term pregnancies will be breech?
A
2-3%
23
Q
Breech maneuvers: what is the pinnard manuever?
A
Deliver legs
24
Q
Breech maneuvers: What is the Loveset maneuver?
A
resolve nuchal arm
25
Breech maneuvers: What is the Mauiceau-Smelli-Veit maneuver?
maxillary pressure
26
Breech maneuvers: What is the Prague maneuver?
flexing neck by supporting body
27
Criteria for breech delivery of second twin?
EFW >1500g
| A larger than B
28
EFW cut off for breech delivery of singleton?
EFW > 2500g
29
Most common "mortal complication" of laparoscopy?
1) anesthesia
2) vessel injury
3) bowel injury
30
Repair of bowel injury at time of laparoscopy: serosal abrasion
no repair
31
Repair of bowel injury at time of laparoscopy: serosal and muscularis injury
oversew
32
Repair of bowel injury at time of laparoscopy: Veress needle
conservative management
33
Repair of bowel injury at time of laparoscopy: Defect <6 mm
closure in layers with 3-0 vicryl or PDS
34
Repair of bowel injury at time of laparoscopy: Full thickness defect > 2cm
double layer closure
35
Repair of bowel injury at time of laparoscopy: injury >1/2 of lumen or affecting mesenteric blood supply
bowel resection
36
Repair of bowel injury at time of laparoscopy: thermal injury
resection with 5 cm margin to prevent future perforation
37
Repair of bowel injury at time of laparoscopy: needle stick
irrigation, suction, ABX
38
Amsel's criteria for BV
3 out of 4:
1) thin grey discharge
2) pH >4.5
3) + whiff amine test (10% KOH)
4) clue cells on >20% of epithelial cells
39
True or false. It is inappropriate to screen or treat asymptomatic pregnant women for BV w/o h/o PTD.
true
40
Contraindications to breast feeding
```
active herpes on breast (continue to pump)
HIV
Ebola
Infant with galactossemia
Meth use
```
41
Which aspect of the BPP indicates chronic fetal well being?
MVP
42
BPP. At what week GA does tone develop?
8w
43
BPP. At what week GA does gross movements develop?
9w
44
BPP. At what week GA does breathing develop?
21w
45
BPP. At what week GA does FHR reactivity develop?
26-32w
46
What is the order of disappearance in BPP?
breathing, FHR
decrease movement
decreased tone
47
At what BPP score should you deliver? At what score should you crash?
deliver at 4/10
| crash at 0 or 2/10
48
Components and definitions of aspects of BPP
```
Breathing: 1+ episode >30 seconds
Movement: 3+ limb movements
Tone: 1+ extend/flex ext or open/close hand
MVP >2 cm
NST reactive
```
49
What is needed for a contraction stress test?
3 ctx (lasting 40 sec) per 10 minutes
50
What is a + CST?
FAIL
| lates after >50% of ctx
51
What is an equivocal CST?
If ctx last too long or occur too often > decels
52
What is an equivocal-suspicious CST?
"occasional" decels
53
What is a negative CST?
PASS!
54
What kind of virus is CMV?
Double stranded DNA
55
What is the incubation period of CMV?
28-60 days
56
How do you test a mother who might have CMV?
maternal IgG and IgM (M can be elevated x9-12 mo)
57
How does CMV manifest in fetuses?
```
Intracranial calcifications
Hydrocephalus
Microcephaly
Hepatosplenomegaly
FGR
Echogenic bowel
Hydrops
```
58
What percentage of deliveries are affected by chorio?
2-5%
59
What is the treatment for chorio (with dose)
amp 2g q6h +
| gent 5 mg/kg daily
60
What are the most common presentations of chorio in order?
1) maternal fever
2) leukocytosis (supportive but not diagnostic)
3) maternal tachycardia
4) fetal tachycardia
61
What is the most common type of fetal malformation?
VSD (accounts for 50%)
62
What is the least common type of fetal cardiac anomaly?
Truncus arteriosus
63
What fetal anomalies does T2DM put you at risk for the most (in order)
1) Cardiac
2) spina bifida
3) sacral agenesis
64
What affect does uncontrolled T2DM have on the risk of fetal anomalies?
HgbA1c 10+ = 20-25%risk of fetal cardiac anomalies
65
How is cervical cancer staged?
clinically
66
What is a rad hyst?
taking uterines at their origin
all ligaments at their attachments
top 1/3 of vagina
67
What are normal cord gases?
```
pH 7.28 +/- 0.05
pCO2 50 +/- 8
pO2 20 +/- 16
HCO3 20 +/- 2
Base deficit 4 +/-3
```
68
What level of base deficit indicates metabolic acidosis?
12
69
Which cardiac disease is most associated with death during delivery? when?
aortic stenosis. (often from bicuspid aorta)
| at CLE placement (2/2 decrease in preload)
70
NY class of CHF
1: normal
2: no symptoms at rest, starts at 2 blocks
3: dyspnea with any activity, okay at rest
4) dyspnea at rest
71
Karyotype of CAH
46 XX
72
How is CAH inherited?
Autosomal recessive
73
Most common cause of CAH?
21-hydroxylase deficiency causes increase in 17-OHP
74
Cholestasis of pregnancy presentation?
intense pruitis without rash
75
What increases your chance of cholestasis? by how much?
Hep c by 20%
76
How is CF inherited?
AR
77
Which chromosome is CF mutation on?
Chromosome 7, delta 508
78
What is CF?
mutated CL channel in epithelial cells
79
Cerclage indications:
1) Hx indicated: h/o 2t SAB without labor or abruption OR h/o cerclage due to cervical insufficiency
2) Physical exam: rescue cerclage. Cervical insufficiency in 2T
3) US indicated: h/o PTD <34w AND CXL <25mm at <24w
80
How long will a rescue cerclage prolong pregnancy?
4w
81
Cardinal Movements of labor
```
Engagement
Descent
Flexion
Internal Rotation
Extension
External rotation (restitution)
Expulsion
```
82
At what glucose level should you check ketones?
200
83
What is the goal potassium during DKA? How to keep it there?
K= 3.3-5.3
if <3.3 hold insulin and give K
if >5.3 trend q2h
84
What does insulin do to potassium?
drives K into cells, so in DKA patient's K will look okay, but will actually need repletion
85
What is the dose (bolus and maintenence) of insulin for a patient in DKA?
Bolus: 0.1 unit/kg
Maintainence: 0.1 unit/kg/hr
86
Goal glucose for patient in DKA
<200
87
Soft Markers for Down's Syndrome on 1T scan
cystic hygroma
| thickened nuchal tranlucency
88
Soft Markers for Down's Syndrome on 2T scan
```
echogenic cardiac focus
pyelectasis
echogenic bowel
ventriculomegaly
choroid plexus cyst
short femur
```
89
When is the highest risk for DVT?
6 weeks PP
90
How long should a patient stay on AC for a provoked DVT/ Unprovoked DVT?
Provoked: 3 months
| Unprovoked (or with active cancer): indefinitely
91
How long does lovenox need to be help prior to CLE placement?
PPX dose: 12h
| Therapeutic dose: 24h
92
What is the immediate treatment for an acute DVT?
IV heparin: bolus 80u/kg + maintenance 18u/kg/hr
Then transition to warfarin (or lovenox 1 mg/kg BID)
- DVT x3 mo
- PE x6 mo
93
What percentage of US adults have T2DM?
15%
94
When should screening for T2DM start?
at age 45yo
| OR in patient with BMI >25 with other risk factors (sedentary life style)
95
How oftern do you screen for T2DM?
q3y
96
What lab values are diagnostic of T2DM?
HgbA1c 6.5%+
fasting >126
2h >200
random >200* only if pt has polyuria/polydypsia
97
HgbA1c cut offs?
normal: <5.7
Pre-DM: 5.7-6.5
DM: 6.5
98
Delivery timing for diabetic who is CONTROLLED by insulin?
up to 39w6d, not past 40w
99
How much does obesity increase your risk of endometrial cancer?
2-4x
100
What is the false negative rate of an EBx?
1%
101
What percent of the endometrial cavity does an EBx sample?
5-15%
102
Compare Type 1 endometrial cancer to Type 2
Type 1:
- endometrioid (adeno)
- low grade, less aggressive
- white women
- estrogen dependent
Type 2:
- clear cell, pap serous
- high grade, aggressive
- non-white women
- p53 mutation
103
What cell is present in clear cell?
hob nail
104
What is the most common diagnosis associated with echogenic bowel as an isolated finding?
normal pregnancy (80-90%)
105
First line treatment for endo? 2nd line? Then what?
1st: NSAIDs
2nd: continuous OCP's or progesterone only
3rd: dx l/s
106
What percent of women with endometriosis will still have symptoms after surgery?
15%
107
Where is the most common endometriosis implant?
Ovary (50%)
108
What is ulipristal? How long does it work? How does it work?
form of emergency contraception
effective up to 5 days
inhibits follicular rupture
109
How is levonorgestrel used as emergency contraception? dose, how long does it work, MOA
levonorgestrel 1.5 mg once of 0.75 mg x2
effective up to 3 days
delays follicular development
110
What is the most effective form of emergency contraception? How does it work and for how long?
Copper IUD
up to 5 days
affects sperm viability
111
How to measure EDD?
<14 weeks by CRL
| >14w by growth scan
112
When to change EDD?
```
<9w: if 5+ days
9-16w: 7 days
16-22w: 10 days
22-28w: 14 days
>28w: 21 days
```
113
Most common cause of endocarditis
staph aureus (>50%)
114
When would a woman need ABX PPD for vaginal delivery or dental procedures?
if she has a prosthetic valve to prevent endocarditis
115
Indications for EBx in post-menopausal women?
with VB and ES > 4mm
| without VB and ES> 11mm
116
Indications for EBx in pre-menopausal women?
```
if >45yo any AUB
if <45yo: obese with AUB
- obese with extra estrogen exposure
- Lynch syndrome
- anovulatory > 6 months
```
117
When to perform EBx on patient with AGUS?
only if they are >35yo
118
What kind of mutation is Fragile X?
trnucleotide repeats on FMR1 mutation (CGG)
119
What is considered a premutation of Fragile X (vs a mutation) and why is this clinically significant?
Pre-mutation: 55-200 repeats
- 25% develop POF (<40 yo)
Mutation: 200+ repeats (not associated with POF)
- hypermethylation causes gene inactivation
120
What is the definition of FGR?
EFW or AC < 10%Ile
121
When to deliver FGR baby?
Isolated: 38-39w6
If < 3%ile: 37w
If complicated by oligo or abnormal dopplers: 32-37w6d
122
What is a common pregnancy outcome of women with flu?
PTD
123
Oseltamivir, when to give, dose
give to pregnant women with the flu within 48h of onset and + test.
75 mg x 5d
124
Dose of folic acid for pregnant women?
normal: 400 mg daily
| h/o NTD (personal or fam hx): 4 mg (4k mcg)
125
How much does appropriate folic acid supplementation decrease the risk of a NTD in a high risk woman?
decrease risk by 70%
126
What is fetal SVT? First line treatment?
FHR > 200 bpm
| 1st line: digoxin (50% success rate)
127
Chance of VTE in pt with factor V leiden?
h/o VTE: 17%
| without h/o VTE: 1%
128
What is the most common inherited thrombophilia?
Factor V Leiden
129
Diagnostic for failed IUP
CRL > 7 mm without CA
Mean sac diameter > 25 without embryo
No embryo with CA 14 days after GS without YS
No embryo with CA 11 days after GS with YS
130
Most common aneuploidy associated with failed IUP
trisomy 16
131
What percentage of women with gDM will develop T2DM?
in PP period: 1/3
| in lifetime: 70%
132
Risk of GTN in complete mole? In incomplete mole?
complete mole: 15%
| incomplete mole: 1%
133
How to treat GTN?
very chemosensitive:
if WHO score< 7 MTX
if WHO score > 7 EMA/CO
134
How to diagnose GTN?
Hcg plateau over 4w (+/- 10%)
| Hcg rise 10% over 3 values in 3w
135
What is needed after dx of GTN?
CXR, check TSH
136
Which GTN has a different treatment and what is it?
Placental site trophoblastic tumor is not chemosensitive, needs hyst
137
When would you expect to see treatment response for genital warts?
3w
138
What is the treatment for genital warts in a pregnant woman?
Trichloroacetic acid
139
Pregnancy outcomes for women with Grave's dz?
medically indicated preterm delivery
| babies can be hyper- or hypo-thyroid
140
Doses of gardasil
if <15yo= 2 doses
0 and 6-12 mo
if >15yo = 3 doses
0, 1-2 mo and 6 mo
141
Which strains of HPV does gardasil cover?
6, 11, 16, 18, 31, 33, 45, 52, 58
142
Which aneuploidy is associated with holoprosencephaly?
Trisomy 13
143
How does holoprosencephaly present?
```
fused thalami
single ventricle
no CSP or midline facial structures
cyclopia
nasal agenesis
```
144
When is hysteroscopy best performed?
Early proliferative phase
145
Examples of electrolyte poor fluid
glycine 1.5%
sorbitol 3%
mannitol 5%
146
What is the max fluid deficit for electrolyte poor fluid in hysteroscopy?
1L
147
What is an advantage to electrolyte poor fluid in hysteroscopy?
use of monopolar energy
148
What is an example of high viscosity fluid in hysteroscopy and what is an adverse event it can cause?
Dextran can cause DIC
| fluid deficit is 300 cc
149
Examples of electrolyte rich fluid
NS
| LR
150
What is the max fluid deficit for electrolyte rich fluid in hysteroscopy?
2.5 L
151
Mechanism of active of heparin
binds anti-thrombin 3, indirectly inhibits thrombin
152
How to reverse heparin
Protamine sulfate
153
What is FDA approved for hair growth associated with hirsutism? MOA?
Eflornithine (topical)
| inhibits ornithine decarboxylase
154
What kind of virus is Herpes?
double stranded DNA
155
What is the incubation period for herpes?
2-12 day
156
What is the treatment for herpes?
Acyclovir 400mg PO TID x 5 days
157
How much does suppressive treatment during pregnancy decrease herpes outbreaks at time of delivery?
decrease by 75%
158
What percentage of women will develop genital herpes in their lifetime?
20%
159
What percentage of women with herpes will have a recurrence during pregnancy?
75%
160
What is the gold standard diagnostic tool for herpes?
PCR of vesicular fluid
161
What is the percentage of herpes transmission to baby in an active outbreak? Both primary and recurrent?
Primary: 40-80%
Recurrent: 1-3%
162
What pregnancy outcomes can uncontrolled hyperthyroidism have during pregnancy for mom? For baby?
maternal: CHF, PIH
fetal: hydrops
163
What meds do you use for hyperthyroidism in pregnancy?
1T: PTU
2T: Methimazole
164
What adverse outcomes does PTU cause?
maternal hepatotoxicity
165
What adverse outcomes does methimazole cause?
cutis aplasia
| esophageal atresia
166
What kind of virus is HPV?
double stranded DNA virus
167
What percentage of cervical cancer are HPV 16 and 18 responsible for?
together: 70% of cervical cancer
16: 60% of sqCC and 40% of adeno
18: 40% of adeno and 15% of sqCC
168
What is E6 and how does it work?
E6: oncoprotein
| inhibits p53> tumor suppressor gene
169
What is E7 and how does it work?
E7 inhibits Rb
| Rb normal induces apoptosis for damaged DNA
170
How fast will a woman with a normal immune system clear HPV?
90% of women will clear in 8-24 mo
171
Normal HgB electophoresis
HgB A: 95%
HgB A2: 3%
HgB F: 2%
172
Who should have a HgB screen in pregnancy?
Black women should have electrophoresis with their CBC
| Mediterranean or southeast Azn need electrophoresis if their CBC is abnormal
173
What causes Hypoxic Ischemic Encephalopathy?
an acute hypoxic event before delivery
174
How do you diagnose hypoxic ischemic encephalopathy?
apgar <5 at 10 minutes
fetal umbilical arterial acidemia
multi-system organ failure
quadriplegia or CP
175
What imaging is used to help diagnose hypoxic ischemic encephalopathy?
MRI 2h after birth
176
APGAR score
Appearence: cyanotic 0/ peripheral cyanois 1/ pink 2
Pulse: 0=0/ <100=1/ 100-140=2
Grimace: no response to stimuli=0/ weak cry= 1/ cry when stimulated=2
Activity (tone): floppy: 0/ some flexion=1/ well flexed, resist extension=2
Respiration: apneic=0/ slow irreg breathing=1/ strong cry=2
177
What is the viral load threshold for HIV?
1000
178
Delivery planning for woman with HIV, viral load >1k?
CS at 38w
179
When is vaginal delivery okay for a woman with HIV?
viral load <1k
180
What is the transmission of HIV in a vaginal delivery of a woman with a viral load <1k?
1-2%
181
What is the vertical transmission of HIV in a woman with viral load >1k?
25%
182
What is the most common hemolytic dz of the newborn and how does it present?
ABO incompatibility
| presents as jaundice
183
Which hemolytic dz of the newborn is most deadly?
Kell. Causes fetal hemolysis and anemia
184
What to do if a woman tested positive for Kell ab?
test dad.
| if + : MCA Dopplers to assess for fetal anemia
185
Which anti-body does not cause hemolytic dz of the newborn and why not?
Lewis (l), IgM can't cross placenta
186
Contra-indications to HRT
h/o DVT or stroke
estrogen dependent cancers
liver dz
undiagnosed vaginal bleeding
187
Branches of the anterior branch of the internal iliac artery
```
Uterine
Umbilical
Superior vesical
Obturator
Internal Pudendle
Inferior Gluteal
Middle Rectal
Vaginal
```
188
Branches of the posterior branch of the internal iliac artery
Iliolumbar
Lateral Sacral
Superior gluteal
189
How to induce an IUFD with h/o CS
<28w: prostaglandins (miso 200-400 PV)
| >28w: pit (OB protocol)
190
Best cells to send for microarray in the setting of an IUFD?
amniocentesis
191
Pathogenesis of ITP
IgG anti-platelet
192
When to treat ITP
if PLT <30
if PLT <70 before CLE
if PLT <50 before surgery
symptomatic (epistaxis)
193
What is the treatment regimen for ITP?
1st line: Prednisone 10-20 mg daily x21 days, then taper
OR
dexamethasone 40mg daily x4 days (no taper)
2nd line: IVIG 1 mg/kg x1 dose
194
When do you expect PLT to rise in a patient with ITP after treatment?
Steroid treatment: will rise over 2w
| IVIG treatment: with rise over 1-3 days, peak at 1w
195
Where does the iliohypogastric nerve innervate?
sensory to skin over superior lateral glutes
196
Where does the ilioinguinal nerve innervate?
sensory to skin over labia majora and mons
197
How to avoid injuring iliohypogastric nerve and iliolumbar nerve in CS?
"smile" fascia
keep incision within borders of rectus
incision 3 cm above pubic symphysis
avoid cautery of small vessels in SubQ
198
What is the major cause of decreased UOP in laparoscopy?
decrease in Renin
199
Which entry in laparoscopy is the safest?
no data to support this
200
What advantage does entering laparoscopically with the Hassan (open) technique provide?
lowest vascular injury rate
201
What muscles make up the levator ani?
pubococcygeus
ileococcygeus
puborectalis
202
What causes leukorrhea of pregnancy?
increase in estrogen
203
What anti-bodies are associated with neonatal lupus?
anti-Ro (SSA)
anti-La (SSB)
[normally associated with Sjogren's]
204
When is a lupus flare most predicative of how lupus during pregnancy will go?
within 6 months of conception.
| flare within this time period is predictive of severity in pregnancy
205
Medication for lupus during pregnancy?
Continue plaquenil (hydroxycholoroquine)
206
How is Lynch syndrome inherited?
Autosomal dominant
207
What genes carry Lynch syndrome?
MLH1, MSH2, MSH6, PMS2, or EPCAM
| *micro-satellite instability
208
What percentage of patient with Lynch syndrome get colon ca? endometrial ca?
Lynch syndrome
Colon Ca: 50%
Endo ca: 2%
209
Cancer screening for patients with Lynch syndrome
Colonoscopy q1-2y starting at 20-25 yo (or 2-5 years before earliest dx)
EBx q1-2y starting at 30-35yo
210
What test can you run (and when) to ensure your lovenox dosing is correct?
Anti-Xa 4 hours after administration
| Goal: 0.6-1.0
211
Which patients need testing to make sure they are getting the right dose of Lovenox?
morbidly obese or with renal dz
212
When should you switch from lovenox to heparin in pregnancy?
at 36-37w
213
How does listeria present?
headache, fatigue, myalgias
| can cause abscesses in placenta or fetus
214
What type of bacteria is listeria?
gram +
215
What is the treatment for listeria in a pregnant woman?
amp IV x14d
| if PCN ALL: bactrim
216
What percent of lactating women will get mastitis?
5-10%
217
What is the most common bacteria in mastitis?
staph aureus (40%)
218
Treatment for mastitis? What if no response?
dicloxacillin 500 mg PO QID x10-14 days
| if no response in 48-72h, US for abscess
219
When does mastitis present?
3-4 w PP
220
If you think a patient might have MRSA mastitis, what is the treatment?
clindamycin 450 PO TID x10-14d
221
What is another name for Mullerian Agenesis?
Myer-Roktansky-Kuster-Hauser syndrome
222
What is the prevalance of Mullerian Agenesis?
1 in 5k
223
What percent of women with Mullerian agenesis have skeletal abnormalities?
90%
224
What percent of women with Mullerian agenesis have renal abnormalities?
30%
225
What is metabolic syndrome?
3 of the 5:
1) abd obesity (waist >88cm or 35 inches)
2) Triglycerides >150
3) HDL <50
4) BP > 130/85
5) Fasting glucose >100
226
Who would qualify for an MRI for breast cancer screening?
```
those at high risk:
1st degree relative with mutation
20% lifetime chance
radiation to chest at ages 10-30 yo
25-29yo with BRCA, li-frameni, Cowden, or Peutz-Jegher
```
227
What is a therapeutic level of mag?
4-7 mEq/L
228
What levels do mag toxicity occur?
loss of DTR 7-10 mEq/L
Respiratory depression >12
Cardiac arrest >15
229
What is the treatment for mag toxicity?
1 g IV Ca gluconate
230
What is a didelphys uterus? How does it occur? Pregnancy outcomes?
2 uteri, 2 cervixes
failed fusion of ducts
best pregnancy outcomes
231
What is a septate uterus? How does it occur? Pregnancy outcomes?
fundal notch < 1 cm
failed medial regression
causes repeat preg loss and PTL
232
What is a bicornuate uterus? How does it occur? Pregnancy outcomes?
fundal notch > 1 cm
incomplete fusion of ducts
causes repeat preg loss and PTL
233
What is the primary procedure for a neovagina?
vaginal dilators (80% effective)
234
What is the McIndoe neovagina procedure?
skin graft tube
235
What is the Davydov neovagina procedure?
made of bowel wall/peritoneum
236
What is the Vecchietti neovagina procedure?
traction to anterior abdominal wall
237
What is the Williams neovagina procedure?
Skin flap from labia majora
238
What measurement is an abnormal nuchal translucency?
>3 mm
239
When do you measure nuchal translucency?
10-13w (best at 13w)
240
What fetal anomalies is an thickened nuchal translucency associated with?
```
cardiac defects (septal)
abdominal wall defects
diaphragmatic hernias
```
241
If a fetus has a thickened nuchal translucency, how much does this elevate its risk for aneuploidy?
increase by 50%
242
What percentage of normal, healthy fetuses will have a thickened nuchal translucency?
<20%
243
NIPT down syndrome detection rates?
Quad: 81%
Nuchal translucency + PAPP-A: 82%
cffDNA: 99% (10w to term)
244
What is the first tri screen?
Nuchal translucency
Beta hcg
PAPP-A
245
Work-up for patient with nipple discharge (uni) if >30yo
US and mammogram then possible bx
246
Characteristics of nipple discharge concerning for cancer?
unilateral, uniductal
spontaneous (no manipulation required)
with mass or skin change
bloody
247
Cut off T and Z scores for osteoporosis
T-score < -2.5
| Z-score < -2.0
248
When to use Z-score instead of T-score
Z-score in patients < 35yo
249
When to treat for osteoporosis?
if 10yr major fracture risk >20%
| or hip fracture risk > 3%
250
When to start screening for osteoporosis and how often?
65yo
| q15 y
251
What is an omphalocele? Where is is located? What is it associated with?
MIDLINE abdominal wall defect at >12 w
with intestines outside of body, but COVERED by peritoneum
associated with aneuploidy and males
252
What is gastroschisis? Where is is located? What is it associated with?
abdominal wall defect at >12w, uncovered. to the RIGHT of the umbilicus
bad outcomes, can still deliver VD
no association with aneuploidy
253
How does obesity change the rates of gastroschisis?
decreases rates
254
How does ovarian cancer spread?
"exfoliation" or transcoelomic (clockwise in peritoneal cavity)
255
How does rupture of ovarian cancer intra-op change management?
Up-stage to 1C, needs chemo
256
Stage that majority of ovarian cancer presents at?
3C (peritoneal implants >2 cm)
257
Where do the majority of ovarian torsions happen?
right side (64%)
258
What is the "whirl-pool" sign?
along with an enlarged ovary, this is ovarian torsion
259
What percentage of ovarian torsions will have normal blood flow on doppler?
60%
260
What percentage of Americans are obese?
40%
261
BMI cut-offs for classes of obeseity
Class I: BMI 30-35
Class 2: 35-40
Class 3: >40
262
What class of obesity qualifies for bariatric surgery?
Class 3 (BMI >40)
263
Cell marker for choriocarcinoma
hcg
264
Cell marker for dysgerminoma?
LDH
265
Cell marker for Yolk sac (endodermal sinus)
AFP
266
Cell marker for Epithelial ovarian cancer?
ca-125
267
Cell marker for granulosa cell tumor?
inhibin
268
Cell marker for mucinous adenoma?
CEA
269
Cell associated with clear cell
Hob nail
270
Cell associated with yolk sac (endodermal sinus)
Schiller-Duval
271
Cell associated with granulosa cell
call-exner bodies
272
What type of study is odds ratio used in
case-control (retrospective)
273
When does odds ratio estimate relative risk?
when prevalence is < 5%
274
How to calculate odds ratio?
AD/BC
275
At what gestational age is vaccuum assisted delivery contra-indicated?
<34w (vacuum okay)
276
What type of virus is Parvo?
single stranded DNA
277
What is Parvo virus associated with in-utero?
SAB, hydrops (from aplastic anemia)
| most have NO poor fetal outcomes
278
How does Parvo present in women?
flu-like symptoms
279
How to test mom for parvo? what to do if she tests positive?
IgM and IgG for diagnosis
if positive: serial US to look for hydrops + MCA dopplers for anemia
q 1-2 weeks for 8-12 weeks after exposure
280
What percentage of weight loss is needed to decrease androgens in a patient with PCOS?
5%
281
How do OCP's help with hirsutism in PCOS?
(not FDA approved)
| increase sex-hormone-binding-globulin which binds androgens, decreased hirsuitism
282
What is "string of pearls" on TVUS?
+12 follicles per ovary (on periphery)
| can be sign of PCOS
283
When does perinatal depression occur? How long does it last?
within 1 year of delivery, lasts >2w
284
What percentage of women get perinatal depression?
15% (1 in 7)
285
Wat percentage of women get PP blues? What is it (timeline)?
40-80%
| feeling down within 1 week of delivery, resolves in 2 weeks
286
What is a normal acid-base status of pregnancy?
Respiratory alkalosis
287
How much does plasma volume expand at term?
45% (1.5-2L)
288
How much do RBC increase by at term?
25% (450cc)
289
How much does SVR decrease by? And how early in pregnancy?
decreased by 35-40% in 1T
290
How do cardiac output, stroke volume, and HR change in pregnancy?
Cardiac output increases by 20% (in 1T)
Stroke volume increases by 15% (in 1T)
HR increases
291
How much blood flow does the uterus get a term? in a non-gravid state?
at term: 17% (450-650 cc)
| non-gravid: 2%
292
How much does renal blood flow increase in pregnancy?
increase by 50%
293
What causes physiologic dyspnea in pregnancy?
increase in tidal volume causes decrease in pCO2 which increases "awareness to breathe"
294
When does PP cardiomyopathy occur?
last month of pregnancy to 5 months PP
295
When is anticoagulation needed in PPCM?
when EF <35%
296
What medication reduces mortality in PPCM?
beta blockers
297
If unknown etiology of pelvic pain, what percentage of women will have persistent pain after hyst?
40%
298
How long does pelvic pain have to be there to be considered chronic?
> 6 mo
299
What percentage of women with chronic pelvic pain have depression?
33%
300
What percentage of women have chronic pelvic pain?
6-25%
301
What does the pudendal nerve innervate?
sensory and motor of the perineum
302
What nerve roots does the pudendal nerve originate from?
S2- S4
303
What are the branches of the pudendal nerve?
clitoral
perineal
inferior hemorrhoidal
304
Rate of preterm delivery in US
12%
305
What percentage of women suffer from PP thyroiditis/
7-8%
306
What causes postpartum thyroiditis? (timeline)
destructive antibodies within 1y of delivery or abortion releases thyroid hormone
(can be hyper or hypo)
307
Why doesn't PTU or methimazole work in PP thyroiditis?
Because it is due to antibodies causing thyroid hormone release, not overproduction
308
Course and treatment of PP thyroiditis?
self-limited
| beta-blockers can be used to relieve symptoms
309
Pelvis type associated with transverse arrest
platypelloid
310
Pelvis type associated with vaginal delivery (most common)
gynecoid
311
Pelvis type associated with male pelvis, least favorable for vaginal delivery
android
312
Pelvis type associated with OP position
anthropoid
313
When is a presacral neurectomy indicated?
patient with chronic midline pelvic pain
| after failure of OCP's, NSAIDs, IUD and lupron)
314
What are the most common complications with pre-sacral neurectomy and how long do these complications last?
urinary retention lasts 1-2w
| constipation lasts 6w
315
What is the dose of rhogam?
300 mcg
316
How much whole fetal blood dose a regular dose of rhogam cover? How much fetal RBC's?
Rhogam covers 30 cc of fetal whole blood
| 15 cc of fetal RBC's
317
When should you give PP rhogam?
within 72h of delivery (up to 4w)
318
How much fetal blood can cause alloimmunization?
0.1 cc
319
At what gestational age does fetal blood form?
7w3d
320
How is sickle cell inheritied?
autosomal recessive
321
Where is the sickle cell mutation?
beta globulin gene
| thymine instead of adenine
322
What is the risk of regret after sterilization?
7%
323
Which type of sterilization has the highest risk of ectopic pregnancy?
bipolar coagulation (3cm of isthmus)
324
What are benefits to permanent sterilization apart from contraception?
Decreases ovarian cancer risk
| Decreases rates of PID
325
When does a small bowel obstruction normally present?
4-6w post abdominal surgery
326
What is the ideal imaging if you suspect SBO?
KUB
| or CT with IV and PO contrast
327
What will show on imaging of an SBO?
dilated loops of bowel with air-fluid levels.
| Proximal dilation with distal collapse
328
What physical exam finding differentiates SBO from ileus?
bowel sounds
hyperactive (high pitched) in SBO
absent in ileus
329
What is the primary management of SBO?
NG tube and IVF hydration
330
What is the definition of 2nd stage arrest of labor?
Primip without CLE >3h
Primip with CLE >4h
Multip without CLE >2h
Multip with CLE >3h
331
When is a steroid taper required?
taking steroids for 3+ weeks or 5+ mg/day
332
What is a typical steroid burst and taper at delivery?
hydrocortisone 25mg IV q6h.
Bolus at delivery of 100mg IV
then taper to baseline over 3d
333
What does warfarin do to a fetus and when is it most susceptible?
nasal/midline facial hypoplasia
stippling vertebrae
worst around 8w
334
What does lithium do to a pregnancy?
ebstein's anomaly: downward displacement of tricuspid valve
335
What does valproic acid due to a pregnancy?
NTD
336
What does meth do to a pregnancy?
FGR
337
What do Thalidomides do to a pregnancy?
limb abnormalities
338
What does lisinopril do to a pregnancy and when?
renal agenesis
| 2 and 3T
339
When it comes to teratogens, what are the GA cut-offs for when things are occurring that you should keep in mind?
0-4 w: "all or nothing"
4-11 w: organogenesis
12-15 w: CNS
340
How should you adjust synthroid in a pt with hypothyroidism upon confirmation of pregnancy and why?
increase dose by 25% because hcg in T1 will decrease TSH (T4 stays unchanged)
341
How often do you follow TSH in pregnancy in a woman with hypothyroidism?
q-4-6w
342
What pregnancy outcomes can hypothyroidism have on a pregnancy? on a fetus?
SAB
PTD
abruption
PIH
demise
LBW
neurodevelopmental delays
343
What is the most common TORCH infection?
CMV
344
What pregnancy outcomes can toxo cause?
microcephaly
| Intracranial calcifications
345
What pregnancy outcomes can varicella cause?
FGR
limb hypoplasia
microcephaly
346
What pregnancy outcomes can rubella cause?
FGR
cardiac defects
hepatosplenomegaly
347
What pregnancy outcomes can CMV cause?
```
FGR
venticulomegaly
hydrops
retinitis
intracranial calcifications
```
348
What pregnancy outcomes can HSV cause?
FGR
microcephaly
hepatosplenomegaly
349
What percentage of pregnant women with CMV are asymptomatic?
90%
350
When is the risk of congenital CMV infection the highest? When is CMV infection the most common?
Highest risk in 1T
| Most common in 3T
351
What is the transplacental transmission rate of CMV?
30-40%
352
If a pregnant woman gets chicken pox (varicella) at term, what is the treatment?
PO acyclovir within 24h of rash
353
How much do multifetal gestations increase the risk of PTD?
twins: 6x
triplets: 10x
354
What is considered discordant growth?
20%
355
How to calculate growth discordance?
smaller - larger / larger
356
Which type of zygosity is more common?
dizygotic twins (paternal) are more common than monozygotic twins
357
If one twin demises >14w, what is the chance of the 2nd twin dying? What is the chance of neurologic deficit? In both mono and di twins?
mono:
chance of death: 15%
chance of neuro deficit: 18%
di:
chance of death: 3%
chance of neuro deficit: 1%
358
When should you check chronicity in twins?
around 13w
359
If you have mono twins, when should you start screening for TTTS and how often?
16w, q 2w
360
Sign for di-di twins? For mo-di twins? Mo-Mo's?
Di-Di: lamba (Twin peak)
Mo-Di: T sign (thinner)
Mo-Mo: no sign, same sac
361
When is delivery indicated for mo-mo twins?
32-34w
362
When is delivery indicated for mo-di twins?
34-37w6
363
When is delivery indicated for di-di twins?
38w
364
When do the fetuses separate for each type of twin? (days and cell stage)
Di-di: 1-3 days (morula)
Mo-di: 4-8 days (blastocyst0
Mo-mo: 8-13 days (implanted blastocyst)
conjoined: 13-15 days (embryonic disk)
365
Definition of thrombocytopenia
PLT < 150
366
Typical PLT level for ITP?
PLT <100
367
What percentage of patient with ITP will have severe PPH?
1%
368
What is the most common type of thrombocytopenia?
gestational
369
How does gestational thrombocytopenia present?
PLT <150, but greater than 85
| incidental finding on routine CBC
370
What percentages of thrombocytopenias in pregnancy are gestational?
80%
371
What is 2nd most common cause of thrombocytopenia in pregnancy?
Pre-eclampsia
372
How often should you repeat labs in a pregnant woman with thrombocytopenia?
q3-4 w
373
What is the most common acquired thrombophilia?
APAS
374
What is the most thrombophilic thrombophilia?
Antithrombin deficiency
375
Which factor in the clotting cascade is decreased in pregnancy (cannot test for this)?
Protein S
376
Which thrombophilias can you not test if a patient is on anticoagulation?
Factor V leiden
protein C or S deficiency
anti-thrombin deficiency
377
What percentage of mo-di twins have TTTS?
15%
378
What are the stages of TTTS
```
1 = poly-oly
2= absent bladder in donor twin
3= doppler abnormalities
4= hydrops
5= death
```
379
What is the treatment for a TOA?
Cefoxitin 2g IV q6h +
| Doxy 100 mg PO or OV q6h
380
If no improvement of TOA after 72h of ABX, what is the next step?
IR drainage
381
Who needs anticoagulation in pregnancy?
Women with a personal h/o VTE AND anti-thrombin deficiency will need lovenox during preg and 6w PP
Women with a personal h/o VTE AND all other def will need it PP for sure, intra-partum is per case
382
Most common presenting signs of urethral diverticulum?
dribbling
dyspareunia
dysuria
383
What percent of women will have recurrent UTI's?
3-5%
384
What is the definition of recurrent UTI's?
> 2 UTI's in 6 mo
or
>3 UTI's in 1 year
385
What is the most effective treatment to prevent recurrent UTI's?
1) macrobid 50-100mg PO daily (or postcoital)
| 2) bactrim 40/200 daily
386
After ABX PPX, what other evidence based methods exist for preventing recurrent UTI's?
```
drink >1.5 L per day
vaginal estrogen (if postmenopausal)
```
387
What is the Cr level of urine?
>17
388
What is the gold standard to diagnose ureterovaginal fistula?
IV Pyelogram
389
What is the gold standard to diagnose urethrovaginal fistula?
cysto
390
What dose of Vit D is in PNV?
400 IU (but need 600 IU daily)
391
What dose of iodine is needed daily in pregnancy?
220 mcg
392
What is the most important prognostic factor in sqCC of the vulva?
lymph node invasion!
| inguino-femoral
393
What is the most important prognostic factor in melanoma of the vulva?
depth of invasion
394
How does vaginal cancer spread?
direct
lymphatically
and hemotogenously
395
Which lymph nodes do the lower 1/3 of the vagina drain into? The upper 2/3?
lower 1/3: inguinal nodes > femoral nodes
| upper 2/3: external/internal iliac nodes
396
What risk factors of vulvar abscess necessitate I&D + IV ABX?
DM, immunosuppression of patient
>5 cm
involving other compartments
recurrent
**cover for MRSA
397
Recommended weight gain in pregnancy
Under weight BMI <18.5: 28-40#
Normal BMI 19-25: 25-35#
Overweight BMI 25-30: 15-25#
Obese: BMI >30: 11-20#
398
5 W's and timeline of post-op fever
```
Wind (PNA, atelectasis): POD#1-2
Water (UTI): POD#2-5
Wound (SSI): POD#5-7
Walking (DVT) : POD#5+
Wonder drugs: anytime
```
399
What antigen is associated with Kell alloimmunization? Where does it come from?
K1 antigen, comes from blood transfusions
400
If a pregnant woman tests + for Kell ab, what next?
Test dad.
If negative, no work-up.
If positive, MCA doppler's q2w (from 18w-35w)
401
What abnormal MCA doppler level necessitates a fetal transfusion?
MoM > 1.5
