Gyge

Question 1

Definition of Preeclampsia/Eclampsia

Answer 1

After the 20th gestational week
Preeclampsia : BP > 140/90mmHg, Proteinuria > 300mg/d
Eclampsia : Preeclampsia + Tonic Clonic Seizures

Question 2

Indications for C-Section

Answer 2

M/F - Cephalopelvic disproportion, Failed Induction of Labor
Maternal - Eclampsia, Cervical cancer, Fibroid, Herpes
Fetal - Fetal abnormality(Hydrocephalus), Multiple Gestations, Malpresentaton, Cord Prolapse, Nonreassuring fetal HR(Bradycardia)
Placental - Previa, Abruptio

Question 3

US in Pregnancy

Answer 3

0(6~7wks) = Confirm(Gestational sac, HR), Location Intrauterine or Extrauterine, Twins
1(11~13wks) = Congenital Malformations, Nuchal translucency(Down’s)
Neural tube defects, Biometrics
2(18~20wks) = Congenital Malformations, Genetics
3(30~31wks) = IUGR, Late Congenital Malformations
4(36~38wks) = Fetal Presentation, Fetal Weight, Info for delivery

Question 4

Placenta abruptio / Placenta Previa Check

Answer 4

Use hands to Palpate the Uterus
Abruptio → Painful, Hard uterus → C-Section
Previa → Painless, Cardiotocograph normal → C-Section

Question 5

PostPartum Hemorrhage

Answer 5

Retained Placenta, Vaginal Laceration, Coagulopathy(DIC), Uterine Atony(Exclude other causes)

Question 6

Stages of Birth

Answer 6

Onset of Labor → Longest stage, Latent(3cm) / Active(3~10cm)
Baby → 30~90min, Propulsive phase(Full dilation, descend to pelvic floor), Expulsion Phase(Ends with delivery of baby)
Placenta → 5~30min, separation, Expulsion of Placenta → membrane
Recovery → 2h, after expulsion of placenta
Increased risk of bleeding, Repair laceration, RhoGAM

Question 7

Techniques of C-section

Answer 7

Abdominal Wall : Transverse(Pfannenstiel), Vertical(Midline)
Uterus : Transverse(Lower segment incision), Vertical(Classical)

Question 8

Pearl Index

Answer 8

Number of Pregnancies in 100 females/year with chosen contraceptive
Oral Contraceptives(0.1~2.5), PostCoital Pill(0.5~2.5)
IUD(0.5~5.5), Condom(3~28), Sterilization(0.3~6.0)

Question 9

Routine Exam

Answer 9

Colposcopy, Cytology(pap smear), Bimanual exam, Breast exam

Question 10

Longterm Oral Contraceptive use Advantage and disadvantage

Answer 10

Advantages - Decreased risk of Ovarian, Endometrial, Colorectal cancer
Lowers risk of Bone loss, Dysmenorrhea, Acne
Decreases risk of Trisomy in Older maternal age
Disadvantages - Increased risk of VTE(DVT, PE) due to low estrogen
Increased risk of Breast, Cervical, Liver cancer
Increased Body weight
Depression due to Low level of serotonin(Progestin)
Hypertension due to Progesterone(Cannot breakdown
bradykinin)

Question 11

Endometriosis definition, diagnosis, Treatment

Answer 11

Definition - Endometrial like tissue outside the uterine cavity
Diagnosis - Gold standard is Laparoscopic Visualization
Treatment - Oral Contraceptives, Surgery(Ablation or excision, Segmental excision), Hysterectomy
Progesterone(Counteract estrogen and inhibit growth of endometrium)
GnRH Agonist, Aromatase inhibitor, Progesterone receptor modulator

Question 12

Urinary Incontinence types

Answer 12

Irritative - Urinalysis → Cystitis, tumor, foreign body
Stress - Loss of Bladder support → Cough
Urge - Hypertonic → Increased Detrusor muscle → Anticholinergics
Overflow/Neurogenic - Hypotonic with dribbles → Cholinergics
Bypass/Fistula

Question 13

Main Vaginal Infection

Answer 13

Bacterial Vaginosis, Trichomonas, Mycosis(Candida), Condyloma
pH Paper!!!!! Mycotic infection pH < 4.5

Question 14

Spontaneous Abortion

Answer 14

Pain + Bleeding → Diagnosis by Cervix, US, hCG

Question 15

Contraindications to Tocolysis

Answer 15

Obstetric(Severe Abruption, Ruptured membrane, Chorioamnionitis)
Fetal(Lethal Anomaly, Already dead fetus, Fetal jeopardy)
Maternal(Eclampsia, Advanced Dilation)

Question 16

Leopold Maneuvers

Answer 16

1. Fungal grip = Palpate upper abdomen with both hands
2. Umbilical grip = Palpate to localize fetal back
   One palm to fix, while the other explores one side then change
3. Pelvic grip = 1st Pelvic grip, Determine what fetal part is lying above the inlet, grasp lower portion of abdomen just above the pubic symphysis with thumb and fingers of the right hand
4. Pawlick grip = 2nd Pelvic grip, Face woman’s feet, attempt to locate fetus brow. Fingers of both hands moved gently down the sides of the uterus to pubis. The side where there is resistance to the descent of the fingers is greatest where the brow is located.

Question 17

Stopping Uterine bleeding

Answer 17

Young = progesterone → Preserve fertility
Old = Dilation and Curettage

Question 18

Mayer-Rokitansky-Kuster-Hauser Syndrome

Answer 18

Fancy word for Mullerian agenesis
- Congenital malformation, Failure of Mullerian duct to develop
- Missing uterus, Cervix, vagina, Variable degree of Upper vaginal hypoplasia(Shortened)
Causes 15% of Primary amenorrhea
Ovaries intact, ovulation usually occurs
Will enter Puberty and have secondary sexual characteristics

Question 19

Pap Smear

Answer 19

p0 - Improper samble
p1 - Negative, Superficial cells on slide
p2 - Superficial cells and WBCs
p3 - Unsure
p4 - Atypical cells → Suspect Malignancy
p5 - True malignancy

Question 20

Bethesda

Answer 20

Reporting Cervical or Vaginal Cytological Pap smear result
Important steps
1. Quality of the slide
2. Whether the result is positive or negative
3. Details of the slide(types of cells, LSIL/HSIL)
4. Physician recommendation of how to proceed

Question 21

Prenatal Care

Answer 21

Starts before conception

Question 22

Puerperium

Answer 22

Period beginning immediately after the birth of child extending for ~ 6w

Question 23

Statistics

Answer 23

Neonatal Mortality Rate - Number of Neonatal deaths during the 1st months/1000 live births
Early NMR in 1st week, Late NMR in 2~4th weeks
Perinatal Mortality Rate - Number of Perinatal deaths(Stillbirths + neonatal deaths from 22nd gestational week to 7th week postpartum) / 1000 total births

Question 24

To exclude ectopic pregnancy

Answer 24

Measure B-hCG
1000U/L Gestational sac, 7000U/L Yolk sac, 10000U/L Embryo
Brown spotting and abdominal pain indicates ectopic pregnancy
→ Check fallopian tubes
B-hCG doubles every 2nd day, if high but not doubled → Ectopic pregnancy

Question 25

Vitamin Supplements

Answer 25

Preconception : Folic acid up to 6 weeks before 400mcg/day 2nd trimester : Low dose Iron and Iodine 250mg/day

Question 26

History taking

Answer 26

Previous Operation Allergy to medication Obstetric anamnesis Illness, drugs First day of last menstrual period - Naegele's Rule : Can only be applied if menses are regular and cycle is 28days - If 1st day = 20th September, +7days is 27th, -3months → June 27th delivery date

Question 27

Signs of Pregnancy

Answer 27

Presumptive sign : Chadwick's sign → Bluish discoloration of the cervix and vagina due to pelvic vasculature engorgement(6th week) Probable sign : Positive home urine pregnancy test, uterine enlargment, Breast engorgement - Piskacek sign(Soft prominence over the site of implantation) - Goodell's sign(Softening of the cervix) - Hegar's sign(Softening of the cervical Isthmus) Positive sign : Detection of a fetal Hemoglobin, recognition of fetal movement

Question 28

Location of Bartholin's Cyst

Answer 28

Lower 1/3 of Labia Majora

Question 29

Marsupialization of Bartholin's Cyst

Answer 29

Cyst opened at the edges + Sutured, forming an open pocket

Question 30

Asherman's Syndrome

Answer 30

Adhesions/Fibrosis of the uterine cavity, usually from D&C, Reversible infertility

Question 31

Types of anesthetics used in C-Section

Answer 31

Spinal, Epidural(Vaginal delivery), Intratracheal Narcosis(Emergency C-Section)

Question 32

Appendicitis in Pregnancy, difficult to diagnose why?

Answer 32

Leukocytosis may occur in pregnancy

Question 33

Physiologic changes in pregnancy, renal system, hormonal changes

Answer 33

Increased RBF and GFR → Decreased Serum Creatinine Increased Total Thyroid hormone, increased BMR

Question 34

Multiple gestation : How to differentiate dizygotic from monozygotic twins

Answer 34

If the twins are of different sex - Boy and girl = Dizygotics

Question 35

What does HELLP stands for

Answer 35

Hemolysis, Elevated liver enzymes, Low platelet count

Question 36

Toxoplasma how can you get it?

Answer 36

Household pets(Cats)

Question 37

Classification of C-section indications

Answer 37

SLIDE

Question 38

How to differentiate placenta Previa from placental abruptio

Answer 38

Put the hands on the mother's belly and if it is firm = Abruptio

Question 39

Obstetric Emergencies

Answer 39

Massive Obstetric hemorrhage Nonhemorrhagic shock(Amniotic fluid embolism, Acute uterine inversion) Shoulder dystocia Eclampsia Cord prolapse(Cord compression) Trauma

Question 40

Most common emergency obstetrical diseases

Answer 40

Infection, Endometritis, Pelvic Inflammatory Disease

Question 41

How to check if a fetus is infected with Toxoplasma

Answer 41

Do amniocentesis and check the viral DNA, PCR of Amniotic fluid

Question 42

Treatment of Toxoplasmosis

Answer 42

Affected women during pregnancy → Spiramycin Infected Fetus → Pyrimethamine and Sulfadiazine

Question 43

Licit and Ilicit drug use

Answer 43

Mention the BP drugs you can give in pregnancy - Labetalol, Nifedipine, A-Methyldopa

Question 44

Preterm labor - What drugs do you give?

Answer 44

Betamethasone(Antenatal corticosteroid) + Tocolytics for 48h birth dealy for lung maturation GBS prophylaxis(IV Ampicillin) Mg-Sulfate for neuroprotection

Question 45

Uterine rupture how to diagnose on Physical

Answer 45

Loss of fetal station, Nature of patients pain changes to diffuse abdominal pain as opposed to contractions Before rupture(Severe abdominal pain, Increased contraction followed by hyperactive labor, Bandl ring) After Uterine rupture(Severe abdominal pain, Sudden pause in contraction, fetal distress - Deteriorating fetal HR, Vaginal Bleeding, Hypovolemia, Loss of fetal station, palpable fetal parts through the rupture)

Question 46

How to diagnose placental abruption / What examination would you do first?

Answer 46

Physical exam, Hypertonic Uterus

Question 47

Polyhydramnios/Oligohydramnios - How to measure (AFI), what are the cutoff values

Answer 47

<5 Oligo, >23 Poly

Question 48

Which patients would you send for genetic testing?

Answer 48

Older patient, Diabetic patient(Specifically mentioned Hba1c level) Patient with previous pregnancy with aneuploidy or other abnormalities

Question 49

Physiological changes in Pregnancy CV changes

Answer 49

HR, CO, CV increase and Plasma volume increase