Mehl. OBGYN bullet point in general nr 1 Flashcards
(31 cards)
28F + African American + 7 weeks’ gestation + microcytic anemia + Hb electrophoresis shows 95% HbA1; Dx?
Iron deficiency anemia; thalassemia would show HbA2.
Diabetic mom giving birth + shoulder dystocia + McRoberts maneuver implemented + postpartum bleeding + uterus is firm on palpation; most likely cause of bleeding?
vaginal laceration, not uterine atony.
In atony = boogy uterus, not firm
Episiotomy performed posterior in the midline; what does the obstetrician cut into if he cuts too far?
external anal sphincter.
What are tachysystole and uterine hypertonus?
tachysystole is >5 contractions every ten minutes; uterine hypertonus is a sustained contraction >2 minutes.
33F + postpartum bleeding despite uterine massage and oxytocin; next best step?
ergonovine therapy (do not give in HTN).
24F + immune thrombocytopenic purpura (ITP); Q asks the potential effect on the fetus?
“fetal platelet destruction”; maternal IgG against her own platelet GpIIb/IIIa can cross placenta, attacking the fetal platelets. This is on new Obgyn form.
What do we order to evaluate thyroid function in pregnancy?
always choose free T4 if you are asked.
TSH - for non-pregnant. IF they ask most definitive marker for thyroid function in non-pregnant = Free T4
Postpartum thyroiditis. Can be both or alone disturbance.
When hyper? When hypo onset?
Hyper 1-4 week postpartum
Hypo 4-8 months postpartum
Logiska, nes is pradziu plysta lasteles - issilieja hormonai. Veliau eina hipotiroze
Postpartum thyroiditis. How to Dx? Tx?
w/ Hx + ordering serum TSH;
Tx w/ short course of propranolol if hyperthyroid; give short course of levothyroxine if hypothyroid.
Postpartum thyroiditis. risk for progression to what?
increased risk of progression to Hashimoto;
When to give methotrexate to Tx ectopic?
all must be fulfilled:
beta-hCG <6,000; < 3 cm in size;
fetal HR not detectable; no evidence of fluid leakage in the cul de sac; mom stable vitals.
PID + fever does not improve after several days on Abx; next best step?
adnexal USS to look for
tubo-ovarian abscess -> must drain if present.
13F + Tanner stage 2 + never had menstruation + brought in by mom concerned about lack of menstruation; answer?
follow-up in 6 months (Tanner stage 2 so menarche is not yet imminent).
Tx for HG?
admit to hospital and give parenteral anti-emetic therapy.
23F + 10 weeks’ gestation + nausea and vomiting for 4 weeks + lost 1.8kg; what is the most likely adverse effect on the fetus?
“no significant adverse effect.”
32F + G1P0 + third trimester + itchy hives-like eruptions within abdominal striae; Dx + Tx?
pruritic urticarial papules and plaques of pregnancy (PUPPP); occurs in ~1/200 pregnancies (usually primigravid); cause is unknown, presents as pruritic hives-like eruption within striae;
Tx is with topical emollients; for severe cases, topical steroids can be given; resolves spontaneously within a week of delivery.
25F + G1P0 + third trimester + itchy palms + soles; Dx + Tx?
usually occurs third trimester; pruritis, particularly of palms + soles;
diagnosis is achieved by ordering serum bile acids (elevated);
Tx = ursodeoxycholic acid (ursodiol);
important to note that ICP is associated with increased risk of third-trimester spontaneous abortion – i.e., it is not benign; delivery at 35-37 weeks may be considered; if bile acid levels normal, new literature suggests waiting until 39 weeks is acceptable.
32F + 30 weeks’ gestation + 10-day Hx of nausea and generalized itching + bilirubin 2.1 mg/dL + ALT/AST/ALP all normal; Dx?
intrahepatic cholestasis of pregnancy;
no mention of palms + soles itching in vignette.
36F + G1P0 + 36 weeks’ gestation + nausea/vomiting + jaundice + high bilirubin + high ALT and AST + no mention of pruritis of palms/soles; Dx?
acute fatty liver of pregnancy; caused by deficiency of long-chain 3-hydroxyacyl-CoA dehydrogenase (sounds absurdly pedantic but asked on Obgyn shelf); often fatal;
Tx is IV hydration + hepatology/high-risk obgyn consults + delivery.
Tx of intrahepatic cholestasis of pregnancy (ICP)?
Tx = ursodeoxycholic acid (ursodiol);
acute fatty liver of pregnancy Tx?
Tx is IV hydration + hepatology/high-risk obgyn consults + delivery.
23F + extremely painful periods + needs to miss grad school classes sometimes because of the pain + examination shows nodularity of the uterosacral ligaments; Dx?
How to Dx this condition?
endometriosis
Dx = diagnostic laparoscopy.
if examination normal = primary dysmenorrhoe
Hx of many pregnancies + downward movement of vesicourethral junction => urinary?
stress incontinence
“decreased external urethral tone.”
stress incontinence Tx first -> second?
Pelvic floor exercises (Kegel); if insufficient -> mid-urethral sling.
