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clin med > OB > Flashcards

OB Flashcards

1
Q

What is the treatment for morning sickness?

A

Vit B6
Can add Doxylamine

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2
Q

What is hyperemesis gravidarum and how do you treatment?

A

Intractable vomiting during pregnancy
Tx: IV fluids, electrolyte replacement, Zofran/Promethazine, ginger, steroids

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3
Q

What is characterized by an increase in hCG despite the absence of fetal heart tones?

A

Gestational Trophoblastic Disease

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4
Q

What is the treatment for gestational trophoblastic disease?

A

Refer to OB for D&C

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5
Q

What is considered a threatened abortion?

A

Any bleeding before 20 weeks

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6
Q

What can occur if a fetus is Rh+ and a mother is Rh-, and how does this happen?

A

Rh Incompatibility
The Rh+ pos fetus’ blood can mix with the Rh- mother’s blood
The mother’s immune system makes antibodies against the antigens of the Rh+ fetus
The antibodies attack the fetal RBCs and cause hemolytic disease of the newborn (HDN)

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7
Q

What is the treatment for Rh incompatibility?

A

Give RhoGAM to Rh- mother at 28 weeks and after delivery

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8
Q

What is preterm labor and what are the signs/symptoms?

A

Labor that occurs before 37 weeks
> 6 contractions in 1 hour, maybe premature rupture of membranes and cervical dilation

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9
Q

What is the treatment for preterm labor?

A

IV hydration
Tocolysis (terbutaline, nifedipine, prostaglandin inhibitors, mag sulfate)
Steroids (2 doses of betamethasone if < 34 weeks)
Fetal fibronectin

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10
Q

What is the treatment if there is premature rupture of membranes?

A

Ampicillin
Expectant management if > 34 weeks
Steroids & tocolysis if < 34 weeks

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11
Q

When is a mother tested for Group B strep?

A

35-37 weeks

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12
Q

What is the treatment if a mother tests positive for Group B strep?

A

IV abx (penicillin) at the beginning & throughout labor

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13
Q

When would you treat empirically for Group B strep?

A

If mother goes into labor at < 37 weeks
If membranes rupture > 18 hrs before delivery
If mother has a fever during labor

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14
Q

What is the difference between placenta previa and abruptio placenta?

A

Placenta previa: painless bleeding
Abruptio placenta: painful bleeding

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15
Q

What is vasa previa?

A

The umbilical cord covers the internal cervical os

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16
Q

What are the different positions a fetus/baby can be in?

A

Occiput posterior: back of baby’s head is toward mom’s spine
Breech: baby’s bottom is presenting
Transverse lie: baby is sideway
Face presentation: hyperextension of the head w/occiput to the back
Compound & brow presentation: hand or foot (compound) or forehead (brow)

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17
Q

How does shoulder dystocia occur?

A

The anterior shoulder gets impacted against the symphysis pubis after delivery of the head

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18
Q

How do you treat shoulder dystocia?

A

McRoberts maneuver
Suprapubic presser
Woods’ screw maneuver
Zavanelli maneuver (push baby back in and do c-section)

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19
Q

What kind of heart decelerations may be seen on a fetal cardiac monitor?

A

Variable decel: from cord compression, brady <100
Late decel: decrease HR after onset of contraction
Decreased variability: < 3-5 beat change

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20
Q

What HR indicates that there is fetal distress?

A

> 160 or < 110

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21
Q

What is the 3rd leading cause of maternal death?

A

Postpartum hemorrhage

22
Q

What are the signs/symptoms of postpartum hemorrhage?

A

Blood loss > 500mL in 24 hrs
Hypotension
Tachycardia

23
Q

What is the treatment for postpartum hemorrhage?

A

Large-bore IV
Pitocin
Check placenta
Fundal massage
Explore uterus
Check for cervical/vaginal lacs

24
Q

When is a glucose tolerance test performed?

A

24 weeks

25
Q

What is the process for diagnosing gestational diabetes?

A

1 hr glucose tolerance test: abnormal if > or = 140
If 1 hr test abnormal, perform 3 hr test
3 hr glucose tolerance test: abnormal if > 180 at 1 hr, > 155 at 2 hrs, > 140 at 3 hrs

26
Q

What establishes the diagnosis of gestational diabetes?

A

2 or more abnormal results during the glucose tolerance test

27
Q

What is the non-pharm treatment for gestational diabetes?

A

Tight glucose control (fasting BG < 95, 1 hr < 140, 2 hr <120)
Refer to dietician
Encourage exercise

28
Q

If non-pharm treatment of gestational diabetes fails, what is the 1st line medication treatment?

A

Insulin (metformin or glyburide)

29
Q

What is considered hypertension in pregnancy?

A

SBP > 140 and/or DBP > 90

30
Q

What is the treatment for hypertension during pregnancy?

A

Prevention: 81mg aspirin at 12-28 weeks until delivery if mod-high risk factors
1st line: labetalol (BID up to 2400mg/day) or nifedipine (up to 120mg/day)

31
Q

What are some medications that are contraindicated in pregnancy?

A

ACE inhibitors
Angiotensin receptor blockers
Mineralocorticoid receptor antagonists
Nitroprusside

32
Q

What is the diagnostic criteria for pre-eclampsia?

A

Meets criteria for HTN with:
> or = 300mg protein in the urine in 24 hr period
Urine protein/creatinine ratio is > or = 0.3
Proteinuria 1+ on dipstick
Meets criteria for HTN w/o proteinuria with:
Thrombocytopenia
Renal insufficiency
Pulmonary edema
Impaired liver function
New onset HA unresponsive to meds

33
Q

What is HELLP syndrome?

A

Hemolysis
Elevated liver enzymes
Low platelet count

34
Q

What is the diagnostic criteria of HELLP syndrome?

A

Hemolysis: LDH > 600IU/L
AST/ALT: > 2x ULN
Thrombocytopenia: < 100,000 x 10*9/L

35
Q

What is the treatment for HELLP syndrome?

A

Blood transfusion (for anemia)
Bedrest
Continuous monitoring mom & baby
Mag sulfate (prevent seizure)
BP meds
Corticosteroids (for fetal lung development)

36
Q

What is eclampsia?

A

Progression of the pre-eclamptic patient to the development of generalized tonic-clonic seizures

37
Q

What are signs/symptoms of iron deficiency anemia?

A

Lightheadedness
Fatigue
Dyspnea
Palpitations
Skin pallor, pale palpebral conjunctiva on PE

38
Q

When/how do you screen for iron deficiency anemia in pregnancy?

A

At 1st prenatal visit and at 28 weeks
Iron studies, B12, folate labs

39
Q

How do you treat iron deficiency anemia in pregnancy?

A

Prevention w/good diet & prenatal vitamins
Mild: prenatal vitamin w/iron, B12, folate
Mod (clinically stable with Hgb > 7): oral iron
Hgb < 7 and/or hemodynamically unstable: blood transfusion

40
Q

What are the signs/symptoms of folate deficiency?

A

Sore lips/tongue
Nausea
Diarrhea
Anorexia/weight loss
Cognitive dysfunction/dementia
Depression

41
Q

What treatment is provided to pregnant pts with HIV?

A

CD4 count < 100: bactrim
CD4 count < 50: azithromycin
Viral load > 1000 or unknown: scheduled c-section at 38 weeks

42
Q

What is the 2nd most common endocrine disorder in pregnancy?

A

Thyroid disease

43
Q

What is the treatment for thyroid disease in pregnant pts?

A

Prevent w/150mcg of iodine/day
Hypo: levothyroxine; TSH goals by trimester
Hyper: maintain mild maternal hyperthyroid to avoid fetal hypothyroid; PTU (1st trimester), methimazole (2nd trimester)

44
Q

What is an ectopic pregnancy?

A

Gestation that implants outside of the endometrial cavity (most commonly ampullary)

45
Q

What are signs/symptoms of an ectopic pregnancy?

A

Amenorrhea
Vaginal bleeding
Lower abdominal pain

46
Q

What is the treatment for an ectopic pregnancy?

A

Methotrexate OR
Surgery

47
Q

When can a pt be given methotrexate for an ectopic pregnancy?

A

Must be hemodynamically stable
Must not have any renal, hepatic, or hematologic disorders
Must attend post-treatment appointments
Serum hCG < 5000
No fetal heart activity

48
Q

How is methotrexate given for ectopic pregnancy?

A

1 dose 50mg per square meter of body surface
Return to check hCG in 4 days
Check hCG on day 7
Repeat hCG test every 7 days until reaches 0

49
Q

What medications/procedures are used to induce abortion?

A

Mifepristone, Misoprostol, Methotrexate (up to 10 weeks)
Dilation & curettage (12 weeks or less)
Dilation & evacuation (13+ weeks)

50
Q

What is the definition of infertility?

A

> 1 year of unprotected intercourse without conception

clin med (15 decks)

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