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*****ObGYN > Kaplan Q's > Flashcards

Kaplan Q's Flashcards

1
Q

What is the benefit of using LMWH compared to unfractionated heparin in a pregnant pt w/ DVT?

A

longer half life
more predictable dose-response relationship
less likely to cause thrombocytopenia and hem. complications* (most important)
(NEITHER cross placenta or cause teratogenesis)

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2
Q

Warfarin embryopathy sx?

A

nasal hypoplasia

stippled vertebral/femoral epiphyses

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3
Q

2nd and 3rd T exposure to warfarin can cause what sxs?

A

hydrocephaly, microcephaly, ophtho abnormalities, IUGR, developmental delay

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4
Q

What are the complications of overt hypothyroidism in pregnancy?

A

inc risk of pre-eclampsia, LBW, preterm labor, placental abruption, MR

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5
Q

dx of primary amenhorrhea?

A

absence of menses at age 14 without secondary sex characteristics; or at 16 w/ secondary sex char.

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6
Q

another name for Mullerian agenesis?

A

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome

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7
Q

What is absent w/ Mullerian agenesis?

A
  • fallopian tubes, uterus, cervix, upper vagina
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8
Q

What is present w/ Mullerian agenesis?

A

normal external genitalia/sex characteristics (tanner stage IV: breasts/pubic hair because ovaries do NOT originate from Mullerian duct)
- lower vagina (comes from urogenital sinus) ends in blind pouch

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9
Q

primary amenorrhea w/ bulging membranes b/w labia and hematocolpos. dx?

A

imperforate hymen. usually requires sx

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10
Q

inability to produce GnRH?

A

Kallman syndrome

(neurons fail to migrate) -> anosmia; no breast development. DO have uterus

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11
Q

Criteria for discharge of a post-op pt?

A
  • alert
  • ambulatory
  • tolerate PO
  • VSS
  • adequate bowel/urinary tract fxn
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12
Q

Indications for neurosurgery for prolactinoma?

A
  • failure of medical managment after 1-3 months
  • persistent vf defects despite tx
  • large cystic or hem tumors
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13
Q

Contraindications for tolterodine use for urge incontinence?

A
  • it is antichol

- CI in urinary retention, gastric retention, narrow angle glaucoma or allergy

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14
Q

Contrast PID with TOA

A

both have ascending infxn from upper gential tract

  • PID: infxn of epithelial cells lining tubes
  • TOA: adnexal abscess
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15
Q

TOA tx

A

IV clindamycin and gentamycin

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16
Q

other indications for inpt IV clinda/gent

A

indications for inpatient:

  • preg
  • T >39 (102)
  • IUD
  • pelvic abscess
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17
Q

DOC for acute PID without TOA?

A

oral ofloxacin for 14 days

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18
Q

what is pseudocyesis and how do you dx it?

A

woman convinced she is pregnant when she is not

  • negligible BhCG
  • no IUP on TV/US
  • may have symptoms of preg
  • can last for a few weeks up to 9 months
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19
Q

When to give Rhogam?

A
  • to ALL Rh negative moms: at 28 weeks, with bleeding, at delivery (300 mcg standard ppx dose)
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20
Q

How to determine Rhogam dose w/ fetomaternal hemorrhage?

A
  1. Rosette test to screen
    (if neg -> 300 mcg dose)
  2. If positive, do Kelihauer-Betke stain
  3. for every 15mL fetal blood in maternal serum, give 300 mcg dose IM to a max of 5 doses
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21
Q

What should be given before an epidural is placed?

A

antacid to increase the stomach pH (help prevent aspiration pneumonitis should aspiration occur w. general anesthesia)

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22
Q

persistent scaling, eczematous, ulcerated lesion of nipple/areolar complex. dx?

A

paget disease of the breast;

often coexists w/ DCIS

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23
Q

what is expected microscopically w/ pagets of breast?

A

individual adenocarcinoma cells of the epidermis

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24
Q

Causes of face presentation (instead of normal occiput pres)

A
  • anencephaly
  • pelvic contraction
  • high parity

can continue w/ normal vaginal delivery

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25
Q

when to deliver term or later preterm IUGR fetus?

A
  • maternal HTN
  • growth failure of 2-4 wks
  • low BPP
  • absence/reversed flow on umbilical arterial doppler velocimetry
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26
Q

when would you do SIS (saline-infused sonohysterogram)

A

work up of RPL to assess uterine cavity

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27
Q

other tests to work up RPL?

A

IgG and IgM anticardiolipin antibody, lupus anticoag, TSH, thyroid peroxidase; parental/abortus karyotype (if all else normal)

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28
Q

when is oral fluconazole contraindicated for vulvovaginal candidiasis?

A 
first trimester (due to potential for embryopathies)
-> use miconazole cream instead
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29
Q

Who should undergo yearly mammography screening?

A

women age 50-70

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30
Q

Safe abx for UTI in preg?

A

nitrofurantoin, keflex

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31
Q

what is the max safe radiation dose in preg?

A

5 RAD

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32
Q

malodorous (fish)
greenish-gray “frothy discharge”
erythematous/edematous vulva/vaginal epithelium
petechial cervical lesions

A

“strawberry cervix” “motile flagellated protozoa”

dx = trichomonas vaginalis

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33
Q

how to interpret ph of fetal scalp sampling?

A

pH > 7.25 -> expectant management

pH 7.20-7.25 - repeat in 15-30 min

pH <7.2 take steps to bring about delivery (damage if pH <7.0)
(choose b/w forceps, vacuum, C-section depending on station, dliation etc)

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34
Q

When do you see physiologic leukorrhea?

A
  • female neonate shortly after birth (maternal estrogens stim newborn endocervical glands & vag epithelium -> gray/gelatinous d/c)
  • months preceding menarche (inc. estrogen levels -> whitish d/c_
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35
Q

tx for heme stable pts w known hxDUB?

A

Ocp w high dose E+P qidx7 days

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36
Q

when do you give IV estrogen for vaginal bleeding?

A

profuse and pt is unresp to ivf

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37
Q

when do you give progestins alone?

A

anovulatory dub when dx is clear

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38
Q

tx of endometrial cancer?

A

TAH, bilateral adnexectomy, possilbe LN sampling

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39
Q

def and cause of early decels?

A

gradual dec in FHR directly correlated w/ uterine contractions;
cause: fetal head compression and vagal nerve stim

40
Q

pattern seen w umbilical cord compression?

A 
variable decels (abrupt, not related to ctx)
if >60/min, may indicate fetal jeopardy
41
Q

magnesium sulfate:

  • excretion method
  • contraindications
  • SE
  • signs of toxicity
  • antidote
A
  • excreted by kidneys (adjust dose)
  • CI in MG
  • SE: flushing, diaphoresis
  • toxicity: loss of DTR, resp paralysis, cardiac arrest
  • antidote: calcium gluconate
42
Q

how do you define variable decelerations?

A

abrupt FHR decrease of at least 15 below baseline with no relationship to uterine contractions

43
Q

what causes variable decelerations?

A

umbilical cord compression

44
Q

how do you define accelerations?

A

increases in FHR above baseline

if >32 wks: >15 increase in FHR lasting >15s

45
Q

what do late decelerations indicate?

A

uteroplacental insufficiency - most concerning!

-> transient hypoxemia or myocardial depression

46
Q

criteria for dx of precocious puberty

A

development of secondary sex char and accelerated growth in age:
<8 if girl (usually thelarche -> adrenarche ->growth)
<9 if boy (usually testicular->penile-> adrenarche -> growth spurt)

47
Q

enlarged, symmetric, tender uterus. not pregnant.

dx?

A

adenomyosis (presence of endometrial glands/stroma in myometrium)

48
Q

enlarged, asymmetric, nontender uterus. not pregnant.

A

leiomyoma (benign smooth muscle growth of myometrium aka fibroids)

49
Q

what is the only breech presentation that can be delivered potentially safely vaginally?

A

frank breech (thighs flexed, legs extended)

50
Q

what is compound presentation?

A

presentation of more than one anatomic part (e.g. both fetal head and an arm)

51
Q

in evaluation of fertility, what is next step if sperm is abnormal?

A
  • repeat semen analysis in days to weeks b/c of sig. variability; THEN investigated FSH, LH, testosterone
52
Q

what is the most common symptom of PMDD?

A

abdominal bloating

53
Q

tx for granuloma inguinale?

A

bactrim or doxy for 3 weeks

54
Q

how do you characterize placental abruption?

A

mild - minimal vag bleed w/ normal FHT and localized pain/tenderness

moderate - mod bleed/pain w/ fetal tachy with decreased variability and/or mild late decels

severe - continuous “knife-like” uterine pain w/ fetal brady, severe late decels, or fetal death. +/- DIC

55
Q

when should you test for GDM?

A

week 24-28

56
Q

when should you test for GBS?

A

week 35-37

57
Q

what to use for GBS if PCN allergy and no time to desensitize?

A

cefazolin, clindamycin, or vanc

58
Q

germ cell tumor assoc w/ increased LDH, normal-increased BhCG?

A

dysgerminoma

59
Q

GCT assoc w/ increased LDH and AFP?

A

yolk sac tumor (endodermal sinus(

60
Q

GCT assoc w/ increase of all 3 markers (AFP, BhCG, LDH)

A

mixed germ cell

61
Q

GCT assoc w/ increased B-hCG and LDH?

A

choriocarcinoma

62
Q

tx of choice for endometritis following a C section?

A

clindmycin and gentamicin (add ampicillin if patient still spiking a fever; flagyl if pcn allergy)

63
Q

what kind of IUGR does chronic maternal dz cause?

A

Asymmetric (normal head, small abdominal circumference)

64
Q

what can cause symmetric IUGR?

A

aneuploidy, early infxn, gross anatomic anomaly

65
Q

what is another common cause of anovulation besides PCOS?

A

hypothyroidism

66
Q

what is incomplete isosexual precocious puberty?

A

change in only ONE of thelarche, adrenarche, or menarche

67
Q

what cancer does OCPs decrease your risk for?

A

endometrial

68
Q

what is a pt at risk for with placenta previa and a hx of prior C-sections?

A

placenta accreta

69
Q

why are ocps contraindicated immediately after delivery?

A

ESTROGEN- bad for baby if breastfeeding; bad for mom for up to 3 months due to hypercoag state

70
Q

classic triad of vasa previa

A
  1. fetal brady
  2. ruptured membranes
  3. painless vaginal bleed
71
Q

what is lochia?

A

normal discharge after pregnancy; due to normal shedding of endometrium after delivery of placenta

72
Q

normal lochia progression?

A

mean 4 weeks

bright red blood -> pinkish brown -> yellowish white

73
Q

definition of arrest of labor?

A

no change in cervical dilation for >4 hrs if adequate contractions (>6hrs if inadequate)

74
Q

how is the active phase of labor definied?

A

after 3 cm dilation

75
Q

latent phase of labor?

A

onset of contractions up until rapid cervical dilation

76
Q

what sonographic findings are consistent with retained products of conception?

A

endometrial thickness >10mm, intrauterine mass

77
Q

AFI - definition of oligohydramnios

A

AFI <5cm

78
Q

rate of HIV vertical xmission WITHOUT haart?

A

25%

79
Q

What is an indication for forceps delivery?

A

mitral stenosis

80
Q

what are the levels of SHBG like in PCOS?

A

decreased! (due to increased androgens)

81
Q

what is the LH;FSH ratio like?

A

greater than 1:1; more LH -> stim theca cells -> more androgens -> decreased SHBG by liver

82
Q

What are signs of infection that would cause you to be concerned for chorioamnionitis?

A

uterine tenderness, maternal fever, fetal tachy

83
Q

when is beta unnecessary in prom/pprom?

A

if fetus if 34 weeks or greater

84
Q

What does bleeding gums while pregnant indicate?

A

NORMAL physiologic change caused by hypervascularity and increased circ blood volume

85
Q

what is the next step in evaluation of a pregnant woman with low TSH?

A

look at free T4 - if high, indicates hyperthyroidism - give (propanolol) or PTU if moderated/severe

86
Q

tx of lichen sclerosis?

A

clobetasol or halobetasol topical corticosteroid

87
Q

when do you treat persistent chronic HTN in pregnancy?

A

systolic >= 160, diastolic >= 105

88
Q

what should you do after a pregnant woman gets her 2nd uti during pregnancy?

A

put her on abx ppx for the remainder of the pregnancy

89
Q

triad of dysuria, dyspareunia, and postvoid dribbling. dx?

A

urethral diverticulum

90
Q

mild pre-eclampsia criteria

A

bp >= 140/90 after 20 wks gestation, proteinuria >300 mg/24 hr or 1+

91
Q

severe pre-eclampsia findings

A

bp >=160/110, proteinura >5g/24 hrs, HA, vision changes, upper abdominal pain, oliguria, inc. creatinine, increased LFTs, thrombocytopenia, IUGR, pulmonary edema

92
Q

IUD absolute contraindications

A

current/suspected pregnancy, gross uterine abnormalities, abnormal uterine bleeding of unknown cause, acute pelvic infxn, current breast cancer
(copper IUD also contraindicated in wilsons’ dz and in those w/ copper allergy)

93
Q

dx criteria for hyperemesis gravidarum?

A

hx of vomiting, plus loss of 5% pre-preg wt

94
Q

tx for HG?

A
  1. pyridoxine-doxylamine
  2. promethazine
  3. IVF if signs of dehydration, lyte abnormalities, ketonuria/acid base
95
Q

components of BPP?

A
  1. NST
  2. AFI
  3. gross fetal movements
  4. extremity tone of fetus
  5. fetal breathing

**important to obtain if NST equivocal or non-reassuring

96
Q

cancer treatment differences in pregnant women

A
  1. no chemo in T1

2. no radiation during preg

97
Q

management of PID in pregnancy?

A

admit and IV abx: clinda, gent

*****ObGYN (3 decks)

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