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Flashcards in Hinjke Deck (126):
1

What is a tier 1 contraceptives?

Progestin implants and IUD
Implanon
Copper IUD
Mirena

2

What are tier 2 contraceptives?

DMPA, rings, patches, OCP

3

What is a tier 3?

Condoms, diaphragms, caps, shield, spermicides, withdrawal, fertility awareness, natural family planning

4

What is the mechanism of action of implanon?

Negative feedback on hypothalamus decreasing GnRH
Thickens cervical mucus
Thins endometrium

5

What is a contraindication to using implanon?

Breast cancer

6

What drugs may decrease the efficacy of implanon?

Phenobarbital
Dilantin
St. John's Wort

7

What are the emergency contraceptions?

Combo OCPs with 100 mcg of ethinyl estradiol and .5 mcg levonorgestrel twice 12 hours apart
Copper IUD
Plan B

8

How does a copper IUD work?

Immobilizes and kills sperm
Prevents implantation if fertilization

9

How long does a copper IUD last?

10-20 years

10

What is a contraindication in copper IUD?

Wilson's disease and PID

11

How is a copper IUD used for contraception?

Can use for up to 5 days after

12

What do you worry about when your perforate laterally?

Bleeding through uterine artery
If patient feels pain immediately afterward - think perforation

13

How does levonorgestrel work?

Thickens cervical mucous
Thins endometrium
Does NOT prevent ovulation

14

How long does levonorgestrel work?

5 years

15

What are the contraindications to levonorgestrel?

Breast cancer
PID

16

How do tier 2 contraceptives work?

Thicken cervical mucous
Preventing ovulation by suppressing LH surge

17

What is a contraindication to OCPs?

Aura or hx of migraines
Hx of uncontrolled HTN
Hx of TE, stroke, MI, breast cancer
Advanced DM
Unexplained dysfunctional uterine bleeding - could have cancer

18

If someone on OCPs comes in with RUQ pain, what should you be thinking?

Cholelithiasis or benign hepatic tumor

19

What is the downside to ortho evra patch?

Skin irritation
Must be under 198 pounds
Higher risk of DVT!

20

What do you give to milking mothers for contraception?

The progesterone only pill - micronor

21

How does progestin only work as a contraceptive?

Thickens cervical mucous
Inhibits ovulation

22

Who cannot use progestin only?

Women who have had breast cancer in the last 5 years

23

What do progesterone and estrogen do to triglycerides?

They make them go up so don't use for someone with hyperlipidemia

24

What is DMPA?

An IM injection every 3 months

25

What is the biggest problem with the DMPA?

Weight gain
Return to fertility may be prolonged

26

What is a contraindication for using DMPA?

If the patient has asthma

27

What is the Yuzpe method?

Using OCPs for emergency contraception

28

What is plan B?

Progestin only
.75 mg of levonorgestrel
Can take up to 5 days after
89% effective

29

What female sterilization method is good for patients who aren't good with anesthesia?

Hysteroscopic - can be done in office.
Put little stainless steel coils in the Fallopian tubes --- inflammatory reaction causes closure of the tubes.
Do a hysterosalpingogram afterward to make sure the tubes closed

30

What is the Texas law in abortion?

Legal up to 20 weeks
After 16 - must happen in a hospital
Under 18 must have parental consent
Info on alternatives must be provided 24 hours before
Descriptions of US findings must be given
Must offer to view US

31

What can be used for abortions before 7 weeks?

Mifepristone - anti progesterone
Misopristol - prostaglandin that causes uterine contractions

32

What is placental abruption?

Premature separation of normally implanted placenta

33

What are the risk factors for placental abruption?

HTN, hx of abruption, trauma, short umbilical cord (less than 30 cm), tobacco use, PROM

34

What is a succenturiate placenta?

An accessory placenta
Associated with postpartum hemorrhage or infection

35

What is velamentous cord insertion?

Vessels only surrounded by fetal membranes, no Wharton's jelly

36

What is vasa previa?

When vessels course over the cervical os.
Associated with perinatal mortality

37

What is a complication of velamentous cord insertion?

Fetal exsanguination

38

What is the Apt test?

When you are trying to figure out who is bleeding - mom or baby.

Take blood from vag, put in water and add KOH. RBCS will lyse. Mom's Hb will be brown and baby's will be red

39

What is the greatest risk factor for velamentous cord insertion?

Multiples

40

What is the management for velamentous cord insertion?

Immediat abdominal delivery

41

Woman comes in at 30 weeks with painless vaginal bleeding and no contractions. Her vital signs are stable and is afebrile. What is the dx?

Placenta previa

42

A girl comes in with light vaginal bleeding after intercourse. Everything else is good. Cervix is friable. What is the dx?

Ectropion of pregnancy

43

What is cervical ectropion?

When the endocervical columnar epithelium is exposed to the vaginal milieu by eversion.

44

Preggers Patient comes in with heavy bleeding, ab pain, firm uterus. What is the dx?

Placental abruption

45

What does a normal placenta look like?

Diameter = 22 cm
Thickness = 2-2.5 cm
Cord length = 55-60 cm
Gray wrinkled shiny and translucent

46

Pregger patient comes in with bright vag bleeding and no pain or contractions. How do you dx placenta previa?

Pelvic US

47

What is placenta accreta?

Deep attachment of the placenta through the endometrium and myometrium of the uterus due to defective desidual formation.
Lots of hemorrhage and often leads to a hysterectomy
Accreta - superior
Increta - invades partially into the myometrium
Percreta - extends to the serosa of uterus

48

What are the risk factors for placenta accreta?

Prior c-section!!!!!
Scar tissue - asherman's

49

What is a good method for determining the cause of third semester bleeding?

Pelvic US

50

What is a low lying placenta?

When the placenta is with 2 cm of the cervical os

51

What are the signs for placental abruption?

Painful vaginal bleeding
Increased uterine tone and activity
Uterine tenderness
If fibrinogen is down

52

What are the risk factors for a ruptured placenta?

Maternal HTN
Trauma
Prior abruption
PROM
Short umbilical cord
Tobacco use
Folate deficiency

53

What is the most common cause of DIC in pregnancy?

Placental abruption

54

What is the best way to manage a placental abruption?

A vaginal delivery

55

What are the consequences of placental abruption?

Fetal demise
Hypovolemic shock
Acute renal failure
Sheehan's syndrome

56

What are the signs of uterine rupture?

Sudden onset of intense abdominal pain and some vaginal bleeding
No longer feel fetal parts
Mother has hx of C-section

57

What is the most consistent clinical finding with a uterine rupture?

Abnormal fetal heart rate

58

What is the treatment for uterine rupture?

If you can't fix it - hysterectomy

59

What does uterine inversion cause?

HTN and postpartum hemorrhage

60

What is postpartum hemorrhage?

Blood loss of over 500 ml in vag delivery
Over 1000 ml in c-section

61

Patient with multiple different delivery attempts with fever and ok bp - had a c-section. what is dx?

Endometritis

62

What is uterine atony?

Loss of uterine muscle tone

63

What are the risk factors for uterine atony?

Multiples
Macrosomia
Prolonged labor
Over distention

64

How does trichomonas present?

Itchy
Odor
White, greenish discharge that pools in the fornix and has bubbles in it.
Strawberry cervix
Will see WBCs

65

How do BV present?

Odorous discharge
Milky white
Fishy
Usually just see in the walls
Presence of clue cells = Gardernella
No WBCs

66

How does Candida present?

Itching
No odor
Clumpy white
Will see WBCs

67

What is the treatment for trich?

Metronidazole - 2 g

68

What is the treatment for candida?

Oral fluconazole
Vaginal miconazole
Boric acid suppositories

69

How do you diagnose a tuboovarian abscess?

US or CT

70

When do you hospitalize a patient when they have PID?

Pregnant
Unsure about the dx
Tuboovarian abscess
Sepsis

71

What is the protocol for PID?

Test for all STDs
Broad spectrum antibiotics because PID is a polymicrobial infection

72

What is Fitzhugh-Curtis syndrome?

Perihepatic adhesions presenting with RUQ pain

73

What are the clinical pearls for herpes?

Do not biopsy - too painful
Start tx immediately
Start suppressive tx at 36 weeks and consider c-section

74

What do you do for condyloma acuminatum?

Tx with TCA - chemical burn
Surgical removal
Antiviral - cidofovir
Anti proliferation - podophyllotoxin
Immunomodulatory - imiquimod

75

Is condyloma an indication for a c-section?

No, infection rate is low

76

What happens in lichen sclerosis?

You lose anatomical distinction between the labia minora and majora. Introitus is small

77

How does lichen sclerosis present?

Usually older woman with severe itching, especially at night who is not sexually active with husband because it is too painful

78

What is the tx for lichen sclerosis?

High dose steroids

79

When do you biopsy condyloma acuminatum?

If the lesions haven't gotten better

80

What do you do to confirm diagnosis of lichen sclerosis?

Office punch biopsy

81

How does lichen planus present?

Older woman with vulvar itching, not having sex, burning

82

What is lichen sclerosis a risk factor for?

Vulvar SCC

83

What is the most common form of mental retardation?

Down's syndrome

84

What are the sex-linked disorders mentioned?

Fragile X - triple repeat expansion on long arm of X
Duchenne's muscular dystrophy

85

What are some multifactorial disorders?

Cleft palate
Spina bifida
Anencephaly
Pyloric stenosis

86

What is the recommendation is the patient has a history of babies with NT defects?

4mg of frolic acid daily

87

What is a triple marker screen?

Offered at 16-18 weeks
Tracks alpha fetoprotein, hCG, unconjugated estriol

88

What does an elevated MSAFP mean?

You need to do a sonogram because there are higher rates of NT defects associated with this
Can also do amniocentesis

89

What problem is associated with low MSAFP, UE3, and hCG?

Trisomy 18

90

What problem is associated with low MSAFP, UE3, and high hCG?

Down's

91

When do you do a cordocentesis?

When there is rh factor problems to see how anemic the baby is and figure out when it's time to get the baby out

92

What are the screening tests in the first trimester?

Serum hCG
Sono + Pregnancy associated plasma protein a
Thickened nuchal translucency
Chorionic villus sampling

93

What is the screening in the second trimester?

Quad screen: AFP, HCG UE3, inhibit a

94

When is the fetus most susceptible to teratogens?

3-8weeks

95

What does an FAH baby look like?

Low nasal bridge
Thin upper lip
Small chin
Flat midface
Short nose

96

What are the anxiolytics that can be teratogens?

Meprobamate and chlordiazepoxide

97

What are the anti neoplasticism agents?

MTX, amionopterin
Busulfan, chlorambucil, cyclophosphamide, nitrogen mustard

98

What is warfarin syndrome?

Stipples epiphysis
Nasal hypoplasia

Use heparin instead because it doesn't cross the placenta as readily

99

What are the anticonvulsants?

Dilantin
Trimethadione
Valproic acid - NT defects
Carbamazepine - spina bifida

100

What is the problem with phenobarbital in pregnancy?

Low teratogenicity but baby goes through withdrawal

101

What do retinoids cause?

Ear defects, blindness,

102

What is preterm labor?

Contractions with cervical change prior to 37 weeks

103

What are the risk factors for preterm labor?

Infection
Vascular problems (SLE)
Placental problems
Stress/strain
Uterine stretch
Hx of preterm
Multiples

104

What are the two leading factors for preterm?

Multiples and hx

105

What is the most concerning diagnostic finding for preterm labor?

Cervical length less than 2.5 cm

106

What does the fetal fibronectin tell you?

If positive - you have a 50% chance of going into labor within the next 2 weeks

107

How do you treat preterm labor?

Give antibiotics
Give steroids prior to 34 weeks
Recommend hydration, bed rest

108

When do we use magnesium sulfate?

When they are having contractions - tocolytic

109

How does magnesium sulfate work?

It competes with calcium so it decreases contractions.
Makes you feel crummy

110

What else is mgso4 used for?

Neuroprotection

111

What is nifedipine?

It is a calcium channel blocker
Tocolytic and anti hypertensive

112

What is indomethacin?

Prostaglandin synthetics inhibitor - tocolytic

113

What is atosiban?

Oxytocin receptor antagonist
Tocolytic

114

What is PROM?

Rupture of membranes without other signs of labor.
Don't induce until after 34 weeks

115

How do you diagnose PROM?

Pooling - fluid in the vault
Ferning - take liquid and dry it - if amniotic fluid, will see crystals
Nitrazine - paper that turns blue
Amnisure- detects alpha microtglobulin

116

What are the markers for fetal lung maturity?

Lecithin/sphingomyelin ratio is 2/1
Presence of phosphatidylglycerol with the ratio = great sign
Lamellar body density count

117

What is IUGR?

When fetus is below 10th percentile

118

What is symmetrical IUGR?

When head to abdominal ratio is normal. The whole fetus is small

119

What is symmetrical IUGR due to?

Infection

120

What is asymmetrical IUGR?

When the head is larger than the rest of the body

121

What is asymmetrical IUGR due to?

Vascular problems - HTN, SLE, DM

122

What is the screening test for gestational growth?

Fundal height

123

What is used to diagnose fetal IUGR?

US

124

What is fetal post aridity syndrome?

When the placenta functions poorly, SC fat loss, long fingernails and dry peeling skin on baby

125

What do you worry about in a mother who has been carrying a dead fetus for several weeks?

DIC - check fibrinogen

126

What is IUFD?

Death of the fetus past 20 weeks and before th onset of labor