OB Flashcards
(162 cards)
1
Q
How does pregnancy affect thyroid
A
1T hcg increases which stimulates TSH rec, increase T4
Fetal Thyroid works at 12w
Increase in Thyroid volume
2
Q
Management of subclinical Thyroid disease in pregnancy
A
Don’t treat or follow
3
Q
What if someone tests positive for hyperthyroidism in pregnancy
A
Test for anti-TPO ab
4
Q
Daily recommended iodine
A
Pregnant 220 micrograms a day
Lactating 290 micrograms a day
5
Q
When to screen a pregnant woman for thyroid
A
Family or personal hx
T1dm
Clinical signs
6
Q
Treatment for hyperthyroidism in pregnancy
A
1t: PTU
2T: Ptu vs methimazole
7
Q
Side effect of ptu
A
Hepatotoxicity
8
Q
Fetal effects of methimazole
A
Esophageal atresia
Aphasia cutis
9
Q
How to trend treatment of hyperthyroidism
A
Trend t4 levels
10
Q
What level to start levothyroxine
A
1-2 micrograms per kg per day
11
Q
When to establish chorionicity of twins
A
Around 10-12 weeks (less that 14w)
12
Q
Growth discordant definition and formula
A
> 20%
Large-small /large
13
Q
Management for di-di twins
A
20 w Anatomy scan
Growth scans at 28-32w
Surveillance at 36w
Delivery at 38-39 w
14
Q
Which twins need echos and when
A
Mono-chorionic at 20 w
15
Q
What percentage of monochorionic twins develop TTTS
A
10-15%
16
Q
When to screen for TTTS
A
Start at 16w every 2 weeks
17
Q
Management of mo-di twins
A
Start surveillance at 32w
Delivery at 34-37w
18
Q
Management of mo-mo twins
A
In-patient at viability
Daily surveillance
Delivery at 32-34w by CS
19
Q
Types of Vasa previa
A
Type 1: velamentous cord, free vessel over os
Type 2: succenturiate placenta, free vessel connecting 2 over os
20
Q
Risk factors for Vasa previa
A
Previa
IVF
Multiples
21
Q
When do you diagnose Vasa previa
A
Dx at 20 weeks
Rescan at 32 weeks
22
Q
When to deliver a Vasa previa
A
At 34-35w by CS
NO DELAYED CORD CLAMPING
23
Q
How does PAS occur?
A
Abnormal trophoblastic invasion
24
Q
Risk of PAS by # of CS
(With previa!)
A
0= 3%
1= 11%
2= 40%
3= 67%
25
Ultrasound findings of PAS
Multiple vascular lacuna
Loss of hypoechoic zone
Decreased retro placental myometrium
26
When to deliver PAS
Around 34w by CS (never passed 36w)
27
Additional study to get if PAS suspected?
MRI
28
What level do you want you fibrinogen above in pregnancy?
>200 mg/dL
29
Accelerations on NST
Before 32w= 10 seconds x 10 BPM
After 32w= 15x15
30
Recurrence rate of shoulder dystocia
10%
31
Erb's palsy
C5-c6
Waiters tip
32
Klumke palsy
C8-t1
Claw
33
Weights to consider primary cs
Non-diabetic 5000
Diabetes 4500 g
34
Recurrence rate of FGR
20%
35
FGR which makes you think generic
Early <32w
Or +poly
36
Management of Fgr
Growth scan q3-4w
Dippers weekly
3-10%= 38-39w
<3%= 37w
37
When to deliver accreta
34w
38
When to deliver history of rupture
36w
39
When to deliver chtn without meds
38w
40
When to deliver Vasa previa
34w
41
When to deliver myomectomy
37w
42
When to deliver oligo
36-37w
43
When to deliver history of classical
36w
44
When to deliver allo-immunization
37w
45
When to deliver icp
Bile acids <100 36-39w
>100= 36w
46
When to deliver poly
39w
47
When to deliver twins
Di-di 38w
Mo-di 34w
Mo-mo 32w
48
Hct/hgb levels of Anemia in pregnancy
1 and 3t= 11/33
2t= 10.5/32
49
ferritin level for fe deficiency
<30 micrograms/L
50
Recommend daily intake of iron
Which iron do you use to supplement
27 MG
Ferrous sulfate 325 MG tablet
51
Risk factors if fe deficiency Anemia in pregnancy
Black, Mexican
Teen
Increases by trimester
Parity >2
Poor diet
Gi disease
Heavy menses
Short interval pregnancy
52
Ob complications from APAS
PreE <34w
Iugr (15% risk)
Placenta insufficiency
Ptd
53
Tests for apas
Lupus anticoagulant
Anti-cardiolipin
Anti-beta 2 glycoprotein
54
Vte recurrence risk with apas
25%
55
Risk of vte in pregnancy with apas
25%
56
Clinical criteria for apas
Vascular thrombosis or one of the following:
Loss >10w with normal fetus
3+ losses at <10w with normal chromosomes
Delivery <34w due to preE
57
How to treat apas in a patient with ho rpl?
Heparin + Asa
Decreases loss by 50%
58
How to treat person with apas and how vte while pregnant?
Anti-coagulayion during pregnancy and PP
59
Treatments of gusm
Vaginal estrogen
Ospemiphene
60
Components of female sexual dysfunction
Desire
Arousal
Orgasm
Pain
61
Medication for decreased sexual desire
Flibaserin (addyi)
For pre-menopausal women without depression
Do not take with alcohol
Can add buproprion to SSRI
62
Treatment for persistent vulvar pain
Anesthetic ointment
Estrogen cream
Topicsl Tca
Po amytriptyline
Po gabapentin
Pfpt
63
Proportion of white people carrying cf mutation
1/2500
64
Number of repeats in fragile x
Pre-mutation 55-200
Mutation >200
65
Proportion of blacks carrying Sickle cell
1/10
66
Nipt detection rates
Cff DNA= 99%
Integrated=96%
1t= 87%
2t=85%
67
Proportion aloft live births with downs
1 in 700
68
Proportion al live births with edwards
Trisomy 18
1 in 3000
69
Most common sex vhromosomal abnormality
Kleinfelter 47 xxy
70
Proportion of t21 by age
25= 1:1000
30= 1:700
35=1:300
40=1:80
71
Ppv of cff DNA by age
20= 80%
35=95%
40=99%
72
What DNA is cff DNA measuring?
Placental trophoblasts
73
Fetal fraction in cff dna
3-13% minimum 4%
74
Rate and causes of cff DNA false positive
Mosaics
Vanishing twin
Malignancy
0.1%
75
Timing and components of 1t screen
10-14w
Nuchal transluceny (normal <3 cm)
Beta hcg, papp-a, afp
76
Timing and components of 2t screen
15-22w
Hcg, afp, inhibin, estriol
77
Soft markers for downs
Absent nasal bone
Thickened nt
Cystic hygroma
Pyelectasis
Echogenic bowel
Short humerus and femur
Ventriculomegaly
78
What does valproate cause in pregnancy?
Spina bifida
FGR
Fascia/limb abnormalities
Cardiac defects
79
Edps scores
Mild= 10-14
Moderate= 15-20
Severe= >20
80
What can lithium cause in pregnancy?
Ebsteins anomaly- get echo at 20w
81
What are newborns risks of mom taking SSRI?
Persistent pulmonary htn
Neonatal adaptation syndrome
82
What is the safest mod stabilizer in pregnancy
Lamotrigine
83
How to treat psychosis
Haldol
Ativan
Benadryl
84
When to give pneumococcal vaccine
65yo
85
When to screen for lung cancer?
50-80yo with 20 pack years or <10y since quit
86
When to start colon cancer screening?
45yo or 10 years before 1st degree family member
87
4 major parts of well woman visit?
Screening
Evaluation
Counseling
Immunizatio
88
Dose of calcium
<50yo= 1000 mg/day
>50yo= 1200 mg/day
89
Dose of vitamin d
<70yo = 600 iu/day
>70yo= 800 iu/day
90
Folic acid dose
Normal risk= 0.4 MG daily
High risk 4 MG daily
91
When to give zoster vaccine?
50yo
92
What percentage of couples suffer from infertility?
15%
93
What is the hymen?
Squamous tissue where urogenital sinus and mullein duct meet
94
Where does deca scan measure? What is osteoporosis?
Bone density of hip and lumbar spine
T score <-2.5
Start at age 65, q2y
95
Normal ovarian reserve tests?
Amh > 1ng/ml
Afc >5-7
Fah <10 (e2 <70 pg/mL)
96
What percentage of infertility is unexplained?
30%
97
What percentage of infertility is due to male factor?
40-50%
98
Who needs immediate evaluation for infertility?
40+ yo
Oligo/amenorrhea
Known pelvic dz
Stage 3 or 4 endo
Suspected male infertility
99
What percentage of regular cycles will be anovulatory?
1/3
100
Luteal phase progesterone
Day 21= >3 ng/ml
101
Luteal phase progesterone
Day 21= >3 ng/ml
102
What structures should you see when measuring BPD and HC?
Level of thalami and cacun septum palladium
103
Crown rump length
Use when <14w
Mean of 3
Plane of genital tubercle and fetal spine longitudinally
104
What is considered sub-optimal dating?
>22w
105
When to do GS instead of CRL?
>14w
106
When to change EDD?
<9w= 5 days
9-16w= 7 days
16-22w = 10 days
22-28w = 14 days
>28w = 21 days
107
What structures should you see when measuring the AC?
Symmetric transverse, stomach, umbilical vein, portal sinus
108
Dose for medical management of epl?
800 micrograms of misoprostol, 24h after 200mg mife
If rh negative give 50 mcg rhD immune globulin
109
Diagnosis of EPL?
CRL >7 mm with no Cardiac activity
Mean gs >25mm with no embryo with Cardiac activity
No embryo with ca 11 days after gs with ys or 14 days without
110
Contraindications to medical management of EPL?
Infection
Hemorrhage
Severe Anemia
Bleeding disorder
111
Outcomes of exp man for EPL?
80% will pass spontaneously after 8 w
112
What percentage of EPL is due to chromosomes?
50%
113
Contraction stress test
Positive= Presence of late decelerations with at least 50% of the contractions
Negative= No late or significant variable decelerations,[with at least 3 uterine contractions (lasting 40 seconds) in 10 minute period.
Equivocal—Suspicious= Presence of late decelerations with fewer than 50% of contractions or significant variable decelerations.
Equivocal—Tachysystole= Presence of contractions that occur more frequently than every 2 minutes or last longer than 90 seconds in the presence of late decelerations.
]Equivocal—Unsatisfactory= Fewer than three contractions occur within 10 minutes, or a tracing quality that cannot be interpreted.
114
What does Gestational trophoblastic tissue originate from?
Placental villous trophoblasts
115
Risk factors for gtd?
Extremes of age <21, >35
H/o molar
H/o sab
Ovulation induction
116
Where does invasive mole metastasize to?
Lungs 15% of time
117
Chromosomes of compete mole
46xx
Empty ovum, duplication of haploid sperm
118
Chromosomes of incomplete mole
69xxy
Normal egg, 2 sperms
119
How does invasive mole relate to hcg?
That's how it is diagnosed
Hcg correlation with burden of disease
120
How does invasive mole present and what tests should you order?
Bleeding after d&c
Type and cross
Hcg level
LFTs
Tsh
Cxr
121
How to trend hcg after d&c showing mole?
Q 1w until 3 consecutive negatives then q3mo x2.
Contraception x6 months
122
Most common postmenopausal adnexal mass
Cystadenoma
123
% of ovarian cancer with genetic syndromes
Brca 1= 40-45%
Brca 2= 10-30%
Lynch= 5-10%
124
Us consistent with benign ovarian cyst
Simple
Thin walled
No solid
No internal blood flow
No ascites
125
Ca 125 levels of concern
Pre-menopausal >200 u/ml
Postmenopausal >35 u/ml
126
Germ cell tumors and markers
Dysgerminoma LDH
Embryonic hcg, AFP
Endometrial sinus AFP
Choriocarcinoma hcg
Immature teratoma AFP, LDH
127
Where do androgenic come from in a woman's body?
Ovary makes testosterone
Adrenals make DHEA
128
Rotterdam criteria
Hyperandrogenism
Ovulatory dysfunction
Polycystic ovaries
129
What is metabolic syndrome
BP >130/85
Waist >35 inches
Fasting glucose >100
TG> 150
HDL < 50
130
Labs for pcos
Free testosterone
TSH
PRL
17-OHP
2H GTT
Fasting lipids
+/- TVUS (12+ Follicles)
131
Ovulation induction with PCOS
Letrozole > Clomid
2.5 ng start day 3 x 5 days
132
Treatment of hirsutism
OCPs
Spironolactone
Flutamide (teratogen)
Finasteride
Topical eflorithine
133
What are fibroid made of?
Smooth muscle cells and fibroblasts
134
Figo staging of fibroids
0 = pedunculated
1= submucosal, <50% intramural
2= submicosal >50% intramural
3= intramural but torches endometrium
4= totally intramural
5= subserosal, >50% intramural
6= subserosal, <50% intramural
7= pedunculated
135
Treatment options for fibroids
52-LNG-IUD
OCPs
TXA
GnRH agonist (lupron)- bridge to surgery
- decrease fibroid size in 3-9 months
GnRH antagonist- elagolix- up to 2y with add back
136
Benefits of add back therapy
Prevents hot flashes
Decreases bone mineral density loss
Helps with lipid levels
137
Reintervention rate after UAE
20% in 2-5y
138
What is post-embilization syndrome?
Pain
Nausea
Fever
Vaginal discharge
139
Recurrence rate after myomectomy
25%
140
When to give abx after HSG and which ABX?
If tubes are dilated or if h/o PID
Give docycycline 100mg BID x5d
141
How to treat surgical patient with known mesa carrier?
Give vancomycin pre-op 15 mg/kg
142
What did WHI show about HRT regarding VTE?
Estrogen + progesterone increases vte risk x2
143
Cabrini scores
1-2 low risk, SCDs
3-4 moderate risk, ppx/scd
5+ high extended ppx (x28d if cancer)
144
Epidural with ppx anti-coagulation timing
Heparin: 4-6h before, immediately after
Lovenox: 12h before, 4h after
145
Add back therapy dose
Transdermal estradiol 25 micrograms/day
Medroxy progesterone acetate 2.5 mg
146
Risk of recurrence of ectopic pregnancy
1= 10%
2= 25%
147
Normal rate of rise of hcg
<1500=50%
1500-3000=40%
>3000=33%
148
SAB vs ectopic uterine aspiration follow up
Check hcg 24 hours later
SAB= 50% drop
Ectopic= rise of <10% drop
149
Contraindications and relative contraindications to MTX
Contraindications: IUP, immunodeficiency, severe Anemia, peptic ulcer disease, hepatic or renal dysfunction, breast feeding, hemodynamically unstable, no follow-up
Relative contra-indications: Cardiac activity in annexation, >4cm in annexation, hcg high, refuses blood transfusions
150
Mtx dosing
50 mg/m2 check for drop day 4 and 7
Single dose= 2 doses max
Double dose= 4 dose max
Fixed multi-dose
1 mg/kg
Day 1,3,5,7
Folinic acid 0.1 mg/kg
days 2,4,6,8
151
When to give aspirin to prevent preE?
Major: H/O preE, multiples, cHTN, t2dm, kidney dz, SLE, Apas
Minor (need 2): AMA, Obesity, fam h/o preE, black, low income, personal low body weight, IVF
152
Breast cancer risk with brca
Brca 1 and 2 45-85% by 70yo
153
When to start breast cancer screening in brca patient?
25yo with mammo and MRI Q6 months
154
Baseline lifetime breast cancer risk
13%
155
Endometrial cancer screening in lynch syndrom
Start at30-35yo q1y
156
Treatment for syphilis? Late latent?
Penicillin g 2.4 million units
3 doses if late latent
157
List of thrombophilias
FVL
ApAs
Anti-thrombin 3 deficiency
Protein c or s deficiency
158
Which strains of Hpv does the vaccine cover?
6, 11, 16, 18, 31, 33, 45, 52, 58
159
Hpv Vax ages
Original: 15-25 yo
Now: up to 45 yop
160
Dose of vitamin e supplements for mastalgua
200 iu BID X2 months
161
Treatment for herpes
Valacyclovir 1g bid x7d
Suppression: 500 mg daily
162
Follow up for LEEP with negative margins vs positive margins
Negative margins: pap in 6 mo
Positive margins: pap with colpo in 6 mo
