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Gynecology > Exam Qs Oral > Flashcards

Exam Qs Oral Flashcards

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1
Q

Who to screen for gestational diabetes

A

Part of screening program = check all pregnant

  • At 24-28 gw
  • At time 0 min (lower than 5,6), 120 min (lower than 7,8) «5,6,7,8»
  • 75 gram glucose
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2
Q

Define preeclampsia

A
  • Original version: after 20 gw, hypertensive disorder (over 140/90) + proteinuria (300mg/24 hrs)
  • Need hypertension + something else (not necessary with proteinuria in new definition)
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3
Q

Postpartum hemorrhage

A

4 T´s

  • Tone: uterine atony is an exclusion diagnosis (after excluding the other T´s)
  • Tissue
  • Trauma
  • Thrombin
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4
Q

Pregnant to emergency 30th gw and bleeding - DDx and what to do

A
  • First: good morning (no anamnesis) + CTG (fast)
  • Placenta previa or placental abruption
  • How to check: First palpate uterus - outer examination/abdomen (if hard - abruption - surgery) (if normal - previa)
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5
Q

Presumptive, probable, definite signs of pregnancy

A
  • Presumptive: signs we can have in pregnant, non-pregnant and men (nausea, vomiting)
  • Probable: in pregnant and non-pregnant (physical changes, pregnancy tests - can be tumor)
  • Definite sign: detecting fetus (US, CTG)
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6
Q

US screenings

A

5 screenings:

  • Type 0: detect pregnancy
  • Type 1: 11 gw +0 days - 13 gw+6 days, screen downs, malformations, detect pregnancy, size
  • Type 2: genetic
  • Type 3: IUGR
  • Type 4: 38 gw, position, size, estimated weight etc
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7
Q

Stages of delivery

A
  • First stage: dilation cervix (9 or 11 hrs, multiparous: half)
  • Second: delivery of fetus (50-60 min, multi: half)
  • Third: delivery placenta (5-15 min, should not be longer than 30 min)
  • Fourth: artificial, 2 hrs observation
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8
Q

Delivery starts - signs

A
  • Regular contractions (every 10 min or more often)

- Rupture of membranes

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9
Q

Folliculogenesis

A

Sperm & egg are both produced in 60-90 days - so the egg that is ovulated is produced 3 cycles before (after spontaneous abortion the whole system is at time zero, so therapy will give pregnancy earliest after 3 months)

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10
Q

Ovulation time

A

24 hrs after LH surge

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11
Q

Hormonogenesis

A

The hormones are produced by the follicles in the ovaries, so a person with ovaries, but no follicles in them, does not produce sexual hormones (e.g Turner syndrome)

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12
Q

Ovulation - chance of getting pregnant

A
  • Sperm lives 48 hrs
  • Egg should be fertilized within ~12 hrs after ovulation (max 24 hrs)
  • So approximately a 3 days window of when intercourse leads to pregnancy
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13
Q

hCG (human chorionic gonadotropin) - pregnancy test

A
  • Urine (yes/no)
  • Serum to know when pregnancy happened - important in ectopic pregnancy, but still do urine tests in emergencies because faster results
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14
Q

Spontaneous abortion %

A
  • 60-70 % of all pregnancies end in spontaneous abortions - many not recognized
  • Clinically detected pregnancies - 10-15 % end in spontaneous abortion
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15
Q

Folic acid

A
  • Daily requirement: 300-500 microgram

- To avoid neural tube defects

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16
Q

Dilution anemia in pregnany

A

Dilution anemia (lower Hgb, Htc) - normal during pregnancy («she´s not anemic»), true anemia is Hgb below 12 g/dl

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17
Q

Leukocytosis in pregnancy

A

Leukocytosis is normal 10000-16000

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18
Q

Proteins in pregnancy

A

Eat and drink as much proteins as possible - at least 65 g/day (for normal growth, development of fetus)

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19
Q

AFP (alphafetoprotein) in pregnancy

A
  • Peak at week 13

- Screening at 16th week for NTD

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20
Q

Arterial blood pressure in pregnancy

A

Does not increase in normal pregnancy! (OBS preeclampsia)

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21
Q

Chadwick´s sign

A

Bluish discoloration of cervix, vagina and labia resulting from increased blood flow. Can be observed spprox 6-8 weeks after congestion as an early sign of pregnancy.

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22
Q

«Mask of pregnancy»

A

Chloasma

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23
Q

Hormone responsible for bone and joint changes during pregnancy

A

Relaxin (source: corpus luteum, ovary, breast etc)

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24
Q

Normal weight gain during pregnancy

A

10-12 kg

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25
Average length of labor
Nulliparous: 12-18 hours Multiparous: 6-8 hours
26
Ruptured membranes without regular contractions first
Increased risk of infection
27
Stages of partuition
- Phase 0: uterine quiescence - Phase 1: preparation for labour - Phase 2: process of labor (1st, 2nd, 3rd) - Phase 3: recovery
28
Principles of management of labor
1. Diagnosis of labour 2. Monitoring the process of labour 3. Ensuring maternal well-being 4. Ensuring fetal well-being (CTG)
29
Criteria for normal labour (8)
1. Spontaneous expulsion 2. Of a single (twins/triplets «not normal» labour) 3. Mature fetus (gw 37 - 42) 4. Presented by vertex 5. Through the birth canal 6. Within reasonable time (more than 3, less than 18 hours) 7. Without complications to the mother 8. Without complications to the fetus
30
3 P´s in progress of labour
- Power: uterus (myometrium) - Passenger: fetus (head mostly) - Passage: pelvis of the mother
31
Stages of delivery
- First stage: cervical dilation and effacement - Second stage: birth - Third stage: placental stage - Fourth stage: postplacental stage
32
First stage of delivery
Cervical dilation and effacement - Contractions (regular, stronger, more frequent, longer) - Cervical dilation: latent phase (3 cm), active phase (3-10 cm)
33
Second stage of delivery
Birth, 2 phases: - Propulsive phase (ful dilation and presenting part in pelvic floor) - Expulsive phase (delivery of fetus)
34
Third phase of delivery
Placental stage (5-20min) - 2 phases: Separation and expulsion - Check if missing parts of placenta or if hemorrhage (150-250 ml is normal)
35
Considerations regarding fetal position in labor (4)
1. Lie (longitudinal, transverse, oblique) 2. Presentation (vertex, breech, transverse, face, brow, shoulder etc) 3. Attitude or posture (ovoid mass) 4. Position (left vs right)
36
Fetal lie
Relation of long axis of fetus to that of the mother - Longitudinal (99 %) - Transverse - Oblique (unstable - always become longitudinal or transverse during labor)
37
Smallest diameter fetal posture
Suboccipitobregmatic diameter
38
Leopold maneuvers
1. First maneuver Palms at uterine fundus - should feel soft (butt of baby) If hard: can be the head due to baby lying in breech presentation 2. Second maneuver Palms on each side on belly 3. Third maneuver Thumb and fingers at lower abdomen Movable mass- the presenting part is not engaged Differentiation between head and breech 4. Fourth maneuver Examiner faces mothers feet - tips of fingers each hand exerts deep pressure in direction of the axis of the pelvic inlet Feel if passes through pelvis(?)
39
Amniotomy
No spontaneous rupture of membranes, so we have to artificially rupture it - more rapid labour
40
Amnioscopy
- Check colour (urine like, brown, green, red) and amount of amniotic fluid - Meconic amniotic fluid: can be due to hypoxic fetal state
41
True labour
- Regular contractions - Intervals shorten - Intensity increase - Discomfort back/abdomen (?)
42
False labour
- Irregular contractions - Intervals remain long - Intensity remains unchanged - Discomfort is chiefly in lower abdomen - Cervix does not dilate - Discomfort usually relieved by sedation
43
Heart beat fetus
6 weeks
44
Naegele rule
Estimate expected delivery | - First day of last menstrual period + 7 days - 3 months
45
Crown-rump length
Best to estimate due date | - US first trimester
46
Hegar sign
- Softening in consistency of the uterus | - Uterus and cervix seem to be two separate
47
Piskacek sign
Softened prominence of uterus
48
Fetal surveillance
- HR: week 16-19 - US: from week 5-6 - Amniotic fluid - Fetal movement: week 18-20
49
Fifth Leopold maneuver
Zangemeister maneuver
50
Obstetrical hemorrhage groups
1. Early 2. Late - Antepartum - Intrapartum - Postpartum
51
Causes of early hemorrhage
- Molar pregnancy | - Ectopic pregnancy
52
Causes of late hemorrhage
- Abruptio placentae - Placenta previa - Postpartum hemorrhage (4 T´s - uterine atony most common)
53
Postpartum hemorrhage definition
- Losing over 500 ml after vaginal delivery | - Losing over 1000 ml after c-section
54
Indication induced abortion
- Non-medical: until 12th gw (18th if crime, misdiagnosis) | - Medical: until 20th gw (24th if laboratory delay)
55
Induced abortion techniques
Until gw 6 - Menstrual aspiration - Medical abortion Until gw 12 - Cervical dilatation - Evacuating pregnancy Second trimester - Medical induction - Oxytocin infusion - Curettage
56
C-section vs forceps/vaccum
First stage of labor: c-section Second stage of labor: forceps, vacuum - c-section is no longer an option
57
Cephalopelvic disproportion
Estimated fetal weight (4500 gr) | Height of mother (under 150 cm)
58
Prerequesite and contraindications of c-section
No absolute prerequesite - except that fetal head is not engaged (aka 1st stage labor) No absolute contraindication
59
Anesthesia in labor
- Vaginal=epidural - C-section=spinal - Emergency c-section =intratracheal
60
Abdominal incision
- Vertical incision: lower median | - Suprapubic transverse incision: Pfannenstiel
61
Uterine incision
- Classical incision (corporal longitudinal): easier, but seldom used today because all forecoming pregnancies must be delivered by c-section due to rupture risk - Transperitoneal cervical transverse (tct incision): mostly used today, least likely place to rupture in later pregnancy
62
HCG levels in different pregnancies
- hCG doubles every 2nd day in normal pregnancy - Decreased hCG can be spontaneous abortion - Steady slowly increasing hCG indicates extrauterine pregnancy
63
US ectopic tubal pregnancy
US ectopic pregnancy: tubal ring (donut) with flow around it
64
Polyhidromnia
Over 25 cm
65
Oligohydromnia
Less than 5 cm
66
Anhydromnia
Less than 3 cm
67
Size of fetus gw 12
Man fist
68
Size of fetus gw 26
At level of navel
69
Size of fetus gw 34
Between navel and xiphoid
70
Big belly causes
- Twins - Big baby - Polyhydramnios
71
Normal heart beat CTG
120-160 bpm
72
Decellerations CTG
Over 15 bpm for over 15 seconds = bad prognosis
73
Pearl index different contraceptives
- Oral contraceptive pill: 0.1 – 2.5 - Emergency contraceptive pill (postcoital): 0.5 – 2.5 - Intrauterine device: 0.5 - 5.0 - Operative methods (sterilisation): 0.3 – 6.0 - Condom: 3 - 28
74
Uterine fundal height
- 20: 2 fingers under umbilicus - 24: Umbilicus - 28: 2 f above umbilicus - 32: 4 f above umbilicus - 35: between xyphoid and umbilicus - 36: 4 f below xy - 37: 3 f below xy - 38: 2 f below xy - 39: 3 f below xy (descend) - 40: 4 f below xy (decend/engage)
75
Normal weight newborn
2500-4290 gr
76
Normal length newborn
44-54 cm
77
Normal head circumference
32-38 cm
78
Normal abdominal circumference
17-24 cm
79
Average umbilical cord (length, diameter, helices)
- Length: 55 cm - Diameter: 1-2 cm - 11 helices
80
Abortion definition
Loss of fetus younger than 20 gw
81
Stillbirth definition
Delivery of dead fetus over 20 gw (or 350 gr if gw not known)
82
Neonate definition
0-28 days - Early: first 7 days - Late: 8-28 days
83
Infant definition
0-365 days
84
Early preterm
20-33+6
85
Late preterm
34-36+6
86
Postterm
Over 42 gw
87
6 fetal movements in labor
1) Descent 2) Flexion 3) Internal rotation 4) Extension 5) External rotation 6) Expulsion
88
Station: Floating
-5
89
Station: engaged
0
90
Station: crowning
+5
91
Smallest diameter fetal head (name)
Suboccipitobregmatic

Gynecology (4 decks)

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