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MTB STEP 2 (R) > MTB 2 CK - Obstetrics > Flashcards

MTB 2 CK - Obstetrics Flashcards

(157 cards)

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1
Q

Definition of embryo

A

Fertilization - 8 weeks

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2
Q

Definition of fetus

A

8 weeks - birth

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3
Q

Definition of infant

A

Birth to 1 yo

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4
Q

Developmental age

A

Number of days since fertilization

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5
Q

Gestational age

A

Number of days since LMP

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6
Q

Nagele rule

A

Est day of delivery by taking LMP - 3 mo + 7 d

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7
Q

First trimester def

A

Fert - 14 w GA

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8
Q

Second trimester def

A

14 w GA - 26 w GA

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9
Q

Third trimester def

A

26 w GA - delivery

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10
Q

Previable

A

Born before 24 w

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11
Q

Preterm

A

25-37 weeks

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12
Q

Early term

A

37 - 38.6

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13
Q

Full term

A

39 - 40.6

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14
Q

Late term

A

41 - 41.6

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15
Q

Postterm

A

42 w +

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16
Q

First sign of pregnancy on PE

A

Goodell sign (softening of cervix at 4 w)

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17
Q

Ladin sign

A

Softening of midline uterus at 6 w

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18
Q

Chadwick sign

A

Blue discoloration of vagina and cervix at 6-8 w

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19
Q

Chlosama

A

Mask of pregnancy on forehead, nose, and cheeks at 16 w

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20
Q

What makes B HCG

A

Placenta

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21
Q

When does BHCG peak

A

10 weeks

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22
Q

When should gestational sac be evident

A

5 w or BHCG of 1000-1500

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23
Q

Cardiology changes in pregnancy

A

Increased CO

Lower BP

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24
Q

What are GI changes in pregnancy

A

Morning sickness
GERD
Constipation

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25
What are renal changes in pregnancy
Pyelo from ureter compression Increased GFR Decreased BUN/Cr
26
What are heme changes in pregnancy
Anemia | Hypercoagulability
27
What to do in first trimester
``` q4-6 week checks US at 11-14 w (GA, nuchal trans) FHR at end of first tri Blood tests, Pap, GC First tri noninvasive screen ```
28
How to confirm GA in first tri
US
29
What to do in second trimester
Triple or quad at 15-20 FHR Quickening US for fetal malformation
30
What is a triple screen
MSAFP BHCG Estriol
31
What is a quad screen
MSAFP BHCG Estriol Inhibin A
32
High MSAFP
Dating error Neural tube defect Abdominal wall defect
33
What to do in third trimester
``` q2-3 w visits until 36 w, qweekly >36 At 37 w, examine cervix qvisit 27 w CBC 24-28 w glucose load 36 week repeat GC, do GBS ```
34
What is glucose load test
Give 50 g glucose and check after 1 hr
35
What is glucose tolerance test
Get fasting glucose Give 100 g glucose Check at 1, 2, 3 hours (Elevation at any 2 is GDM)
36
How to interpret 3rd tri CBC
If hgb
37
When to get glucose tolerance test
If load >140 at 1 h
38
What is chorionic villus sampling
10-13 week for fetal karyotype
39
What is amnio
11-14 week for fetal karyotype
40
What is fetal blood sampling
Perc umb blood sample for Rh isoimm
41
Most common site of ectopic pregnancy
Ampulla
42
Risk factors for ectopic pregnancy
PID IUD Previous ectopic
43
Pres ectopic pregnancy
Unilateral pelvic pain Vaginal bleeding Hypotx if ruptured
44
How to dx ectopic
BHCG US Laparoscopy
45
Tx ectopic preg
If HDUS, IVF and immediate surgery | If stable, CBC, type and screen, LFTs, BHCG then methotrexate
46
How to follow medical treatment of ectopic pregnancy
Follow BHCG for 15% decrease in 4-7 d If none, second dose methotrexate If not decreasing after second dose, surgery
47
Who shouldn't get methotrexate
``` Immunodeficiency Noncompliant Liver dz >3,5 cm ectopic Fetal heartbeat can be heard ```
48
Sfx methotrexate
Hepatotox
49
Surgery in ectopic
Salpinostomy (preserves tube) | Salpingectomy (no preservation)
50
Definition of abortion
Pregnancy that ends before 20 weeks
51
Cause of abortions
``` Csomal abnormalities >>> Anatomic abnormalities STDs Immunological factors (APL) Endocrine factors Malnutrition Trauma Rh isoimm ```
52
Pres abortion
Crampy pain | Vaginal bleeding
53
How to dx abortion
CBC Blood type and Rh screen US
54
Complete abortion
No products of conception | Office f/u
55
Incomplete abortion
Some products of conception | D&C, medical
56
Inevitable abortion
Products of conception intact but IU bleeding and cervical diln D&C, medical
57
Threatened abortion
Products of conception intact but IU bleeding | Bed rest
58
Missed abortion
Death of fetus with products in uterus | D&C, medical
59
Septic abortion
Infection of uterus and surrounding area | D&C and IV Abx
60
Medical treatment of abortion
Misoprostol
61
Who should receive Rhogam
Rh negative moms that have trauma
62
First clue for multiple gestations
High BHCG and MSAFP
63
Complications of multiple gestations
Spontaneous abortion of one Premature L&D Placenta previa Anemia
64
Risk factors for premature labor
``` PROM Multiple gestations Previous preterm labor Placental abruption Uterine abnls Infx PreE Intrabdominal surgery ```
65
When should premature labor not be stopped with tocolysis
``` Severe HTN Cardiac dz Diln >4 cm Maternal hemorrhage Fetal death Chorio ```
66
What are some tocolytics
Mag sulfate CCB Terbutaline
67
Sfx mag
Flushing HA Diplopia Fatigue
68
Sfx CCB
HA Flushing Dizzy
69
Sfx terb
Palps | Hypotx
70
Monitor mag
DTRs frequently
71
How to confirm amniotic fluid
Pool Nitrazine paper = blue Fern
72
WHat is PPROM
Early and >24 h
73
Complications of PROM
Preterm labor Cord prolapse Abruption Chorio
74
Manage PROM
Chorio = deliver No chorio, at term = wait 6-12 h for spont delivery, then induce Preterm = steroids, tocolytics, ampicillin and azithro x 1 (cefazolin or clinda if allergic)
75
What increases the risk of placenta previa
Previous C sections Previous uterine surgery Multiple gest Previous previa
76
First step in third tri bleeding
TRANSABDOMINAL US (DO NOT DO DIGITAL VAGINAL EXAM OR TRANSVAGINAL US)
77
Pres of placenta previa
Painless vaginal bldg
78
When to tx previa
Large volume bldg | Drop hct
79
How to tx previa
Strict pelvic rest
80
When to deliver in previa
>4 cm diln Severe hemorrhage Fetal distress
81
Risk factors for abruption
``` HTN Prior abruption Cocaine External trauma Smoking ```
82
Pres of abruption
Third tri bleeding Severe pain Ctx Possible fetal distress
83
Complications of concealed abruption
DIC Uterine tetany Fetal hypoxia, death Sheehan
84
Do C section in abruption with
Uncontrolled hemorrhage Rapidly expanding concealed hem Fetal distress Rapid separation
85
Do vaginal delivery in abruption with
Limited separation Reassuring FHR Extensive separation with dead fetus
86
Risk factors for uterine rupture
``` C section Trauma Myomectomy Polyhydramnios Multiple gestations Placenta percreta ```
87
Pres of uterine rupture
Extreme abdominal pain Abnl bump in abdomen No ctx Regression of fetus (moving away from vagina)
88
Tx uterine rupture
Immediate LAPAROTOMY
89
Cause of Rh incompatibility
Rh negative mom with Rh positive baby
90
How to screen for Rh incompatibility
If Rh negative, check antibody titer for sensitization
91
What does Rh incompatibility cause
Hemolytic dz of newborn
92
What is hemolytic dz of newborn
Fetal anemia Extramedullary prodn of RBCs (HSM) High hgb and bilirubin Erythroblastosis fetalis (CHF)
93
How to manage Rh incomp
If unsensitized, give Rhogam at 28 weeks and at delivery if baby is positive If sensitized, get titer, if >1:16, serial amnio for bili If high bili, do IU transfusion
94
Chronic HTN in preg
>140/90 before 20 week GA
95
How to tx chronic HTN in preg
Methyldopa Labetalol Nifedipine
96
Gest HTN in preg
>140/90 after 20 week GA with no proteinuria or edema
97
Risk factors for preE
Chronic HTN | Renal dz
98
Difference btwn mild and severe preE
``` 140/90 vs 160/110 1-2+ (300mg) vs 3-4+ (5g) Facial, hand, feet edema vs generalized Normal mental status vs changes No vision changes vs yes No LFT changes vs yes ```
99
What is eclampsia
TC seizure in preE
100
Manage mild preE
Deliver if at term | BMZ and Mag if preterm
101
Manage severe preE
Deliver if at term | Mag and hydralazine if preterm to stabilize, BMZ and mag if can't stabilize
102
What is HELLP
Hemolysis Elevated liver enzymes Low platelets
103
Comps of pregestational DM
``` PreE Spont abt Increased infx Increased postpartum hem More congenital problems Macrosomia/dystocia Preterm labor ```
104
Addl tests to do in pregest DM
EKG 24 h Cr A1C Optho exam
105
Fetal testing needed in pregest DM
32-36 w: Weekly NST and US >36 w: Weekly NST, BPP 37 w: L/S ratio
106
What is the definition of IUGR
Weight in the bottom 10%
107
What does symmetric IUGR baby look like
Brain in proportion with rest of body
108
When does symmetric IUGR occur
Before 20 w
109
What does asymmetric IUGR baby look like
Brain weight is not decreased (big head)
110
When does asymmetric IUGR occur
After 20 w
111
What are causes of IUGR
``` Chromosomal abnormalities Neural tube Infx Multiple gestation Renal dz ```
112
Complications of IUGR
``` Premature labor Stillbirth Fetal hypoxia Low IQ Seizures MR ```
113
What is the definition of macrosomia
4500 g
114
Risk factors for macrosomia
Maternal DM Maternal obesity Postterm pregnancy
115
When to do an US for larger than expected fundal height
>3 cm
116
Complications of macrosomia
Dystocia Birth injuries Low Apgars Hypoglycemia
117
How to manage macrosomia
If lungs are mature, IOL before 4500g | If >4500g, C section
118
What is a reactive NST
2 fetal movements | Acceleration >15 bpm lasting 15-20 seconds within 20 mins
119
What to do if NST is nonreactive
VIbroacoustic stimulation
120
What is BPP
``` NS Fetal chest expansion (1x in 30 min) Fetal movement (>3 in 30 mins) Flexion of an extremity AFI ```
121
What is normal BPP
>8
122
What is normal fetal HR
110-160
123
What is fetal bradycardia
124
What is fetal tachycardia
>160
125
Cause of early decels
Head compressions
126
Cause of variables
Cord compression
127
Cause of late decels
Hypoxia
128
What is lightening
Fetal descent to pelvic brim
129
What is bloody show
Bloody mucus released with cervical effacement
130
How long should phase 1 last
Primip: 6-18 Multip: 2-10
131
How long should latent phase last
6-7, 4-5
132
How long should active phase last
1 cm/h | 1.2 cm/h
133
How long should stage 2 last
30 min - 3 h | 5-30 min
134
How long should stage 3 last
30 min
135
Signs of placenta separation
Fresh vaginal bleeding Umb cord lengthening Uterine fundus rising Uterus becoming firm
136
Meds for IOL
Prostaglandin E2 for cervical ripening | Oxytocin
137
Who to avoid prostaglandin E2 in
Asthma
138
What defines arrest of cervical dilation
No dilation for >2 h
139
What defines a prolonged latent stage
>20 h for primip | >14 h for multip
140
What causes prolonged latent stage
Sedn Unfavorable cervix Uterine dysfx with irreg/weak ctx
141
Tx prolonged latent stage
Rest and hydration
142
What defines protracted cervical dilation
143
Causes of protracted cervical diln
Power Passenger Passage
144
Tx protracted cervical diln
C section or oxytocin
145
What is arrest of fetal descent
No descent for 1 h
146
What causes arrest disorders
Cephalopelvic disproportion Malpresentation Excessive sedn/anesthesia
147
First step in presumed breech
US
148
What are Leopold manuevers
Estimate fetal wt and presenting parts
149
What is frank breech
Hips are flexed with extended kneew
150
What is complete breech
Hips and knees are flexed
151
What is footling breech
Feet first
152
When can you perform cephalic version
After 36 weeks
153
Steps of tx shoulder dystocia
McRoberts (flexion of knees, suprapubic pressure) Rubin (push posterior shoulder toward fetal head) Woods (push posterior shoulder toward fetal back) Deliver posterior arm Fracture clavicle Zavanelli (push head back in)
154
What defines PPH
>500 ml
155
What defines early vs late PPH
24 h
156
Risk factors for atony
``` Anesthesia Uterine overdistension Prolonged labor Lac Retained placenta Coagulopathy ```
157
Tx PPH
Bimanual exam for rupture, retained placental If normal, bimanual compression and massage Oxytocin

MTB STEP 2 (R) (12 decks)

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