Gynob- Ross

Question 1

What can cause bHCg to give a false neg?

Answer 1

Vit C, dilute urine and early pregnancy

Question 2

If a patient has a strong suspicion of pregnancy and bHCG qualatative says no, what should you do?

Answer 2

Quantatative bHCG to get the number value

Question 3

B-hCG normally ______- every two days and levels that do not increase by ____-% in two days imply an abnormal IUP or ectopic

Answer 3

double, 50%

Question 4

Someone in shock has these three things?

Answer 4

Hypotension, tachycardia, poor peripheral perfusion (cold, clammy extremities and diaphoretic)

Question 5

What are 4 RFs for ectopic pregnancy?

Answer 5

1. Hx PID
2. IUD
3. Infertility
4. Previous ectopic
5. Older age
6. Cigarette smoker
7. Previous pelvic surgery

Question 6

If you have a tubal ligation and pregnant with bleed… what should you consider?

Answer 6

ectopic

Question 7

What is the leading cause of death in the first trimester of pregnancy?

Answer 7

ectopic pregnancy

Question 8

What are the steps for vaginal bleeding/pain?

Answer 8

1. Pregnancy test
2. Rule in IUP with U/S
3. Quantitative b-HCg

Question 9

Seeing these two things on U/S should be reassuring?

Answer 9

-Fetal pole and double ring sign

Question 10

What is the discriminatory zone for b-hCG?

Answer 10

1500-2000 below which you may not see IUP on U/S

Question 11

What should we see at this b-hCG levels?

>1500

Answer 11

• should see gestational sac: 4.5 wks

- need a trans-vaginal U/S

Question 12

What should we see at this b-hCG levels?

>5000

Answer 12

-Should see a fetal pole: 6.5 wks

Question 13

What should we see at this b-hCG levels?

>15,000

Answer 13

-should see a heart beat

Question 14

What does a b-hCG of <1500 mean?

Answer 14

• normal early pregnancy
• ectopic
• miscarriage

Question 15

What should we see at this b-hCG levels?

2000

Answer 15

yolk sac

Question 16

If you do a bediside US and you see an IUP you can be confident not ectopic, however, if you don’t see an IUP what is the next step you should take?

Answer 16

official transvaginal u/s

Question 17

If a patient presents with + urine or quanlatative b-hCG, lower abd pain and vaginal bleeding and b-hCG is <1500 what should you do next?

Answer 17

You should re-check in 48 hours since it should double in 2 days

Question 18

b-Hcg of >1500 and U/S with no IUP is by default _______. What is the next step?

Answer 18

ectopic

Surgery

Question 19

The __________ dept is where patients go to die

Answer 19

radiology

Question 20

What pill can be used for an ectopic to terminate?

Answer 20

Methotrexate (helps dissolve the cells so you don’t have to do surgery)

Question 21

What are the criteria for a threatened abortion?

Answer 21

• Vaginal bleeding
• Closed os
• quant >1500
• U/s shows IUP

Question 22

Pregnancy w/ bleeding. If the os is open then what?

Answer 22

inevitable miscarriage

Question 23

Pregnancy w/ bleeding. If the os is closed then what?

Answer 23

discharge and restrict sexual and physical activity

-Have pt f/u needs bHCG

Question 24

If bleeding has caused the Hct to drop or there is hypotension what should you do?

Answer 24

obtain gyno consult

Question 25

What if there is a fetal heat beat and quant 60,000?

Answer 25

consult gyn (probs will offer d&c or misoprostol)

Question 26

What is an important thing to order in a patient with bleeding?

Answer 26

Rh type & screen

Question 27

What is the mc cause of 3rd trimester bleeding?

Answer 27

Abruptio placenta: rock hard uterus with painful vag bleeding; separation of placental from uterus

Question 28

You will usually see elevated BP, proteinuria and edema in what condition?

Answer 28

pre-eclampsia Diastolic >105 Proteinuria +2 Seizure

Question 29

htn, elevated LFT, low platelets are a sign of what?

Answer 29

HELLP | *need emergency GYN consult

Question 30

How to treat pre-eclampsia?

Answer 30

Labetalol or Nifidipine

Question 31

What meds should be avoided in pregnancy?

Answer 31

Thiazides

Question 32

This is extreme, persistent nausea and vomiting during pregnancy. It can lead to dehydration, weight loss, and electrolyte imbalances. Elevated specific gravity of urine, ketones and hemoconcentration.

Answer 32

Hyperemesis

Question 33

Lower abd pain ddx for non-pregnant and lower abd pain?

Answer 33

- Ectopic - Miscarriage - PID - Tubo-ovarian abscess - Ovarian torsion - Ovarian cyst (rupture)

Question 34

What is mittleschmerz?

Answer 34

one-sided, lower abdominal pain associated with ovulation

Question 35

Sudden onset of pelvic unilateral pain

Answer 35

Ruptured ovarian cyst

Question 36

These are findings of what? - Fever - Vag discharge - Elevated ESR or CRP - Lab evidence for infection

Answer 36

PID

Question 37

What is the tx for PID?

Answer 37

Ceftriaxone 250 mg IM plus doxy 100 mg PO BID for 14 days | *Metro added if evidence of vaginitis

Question 38

A patient who has unilateral pain with a fullness palpated on exam, sometimes sicker could be what?

Answer 38

tubo-ovarian abscess

Question 39

Treatment for tubo-ovarian abscess?

Answer 39

Ceftriaxone 1 g IV with azithromycin and flagyl