OB 2 Flashcards
(110 cards)
1
Q
3 things that cause elevated AFP in pregnancy
A
open NT defects, ventral well defects, multiple gestation
2
Q
Is AFP up or down in aneuploidies
A
down
3
Q
You get lab results with elevated AFP, what next?
A
fetal anatomy US
4
Q
deltaF508 mutation
A
CF
5
Q
Quad screen profile for Down Syndrome
A
low MSAFP and estradiol, elevated BHCG and inhibin A levels
6
Q
sudden-onset, severe, unilateral lower abdominal pain with N/V
A
ovarian torsion
7
Q
after sx pt develops fever, tachycardia and tachypnea, muscle rigidity
A
malignant hyperthermia, stop anesthesia and give DANTROLENE
8
Q
difference between NMS and MH
A
NMS = neuroleptic agents (haloperidol, promethazine) and develops over course of DAYS
9
Q
you suspect a gynecological tumor, what imaging to do first?
A
US
10
Q
why do endometrial biopsy?
A
when suspect hyperplasia or carcinoma
11
Q
with what gynecological problems do we use diagnostic laparoscopy?
A
endometriosis or pelvic adhesions
12
Q
what is pseudocyesis
A
cond’n in which a nonpsychotic woman presents with signs and symptoms of early pregnancy and the belief that she is pregnant but evaluation excludes prenancy
13
Q
N/V, uterine size larger than dates, markedly elevated BhCG, uterus filled with a heterogeneous cystic mass
A
hydatidiform mole
14
Q
irregular menses, unable to get pregnant and low FSH and low Estradiol
A
hypogonadotropic hypogonadism - loss of pulsatile GnRH secretion previptated by weight loss, stress, chronic illnes
15
Q
GDM target blood glucose levels
A
Fasting < 95
1 hr post-prandia < 140
2 hr post-prandial < 120
16
Q
Woman presents in labor at 34 weeks, do you do tocolysis or proceed?
A
proceed when > 34 wks
17
Q
Who gets external cephalic version?
A
> 37 weeks, breech, no CI to vaginal delivery
18
Q
unilateral pelivc pain precipitated by strenuous activity or sex, free fluid in pelvis
A
ruptured ovarian cyst
19
Q
complex multilocular adnexal mass, fever, leukocytosis,
A
tubo-ovarian abscess
20
Q
bright, glazed, red-purple plaques and papules with an overlying white, lacy pattern, pruritus, pain, dyspareunia, other mucosal lesions (mouth)
A
lichen planus
21
Q
hypopigmented skin, thin wrinkled appearance, pruritus, vaginal introitus stenosis
A
vulvar lichen sclerosus (post menopausal and young girls)
22
Q
painless vaginal bleeding > 20 weeks
A
placenta previa - FHR tracing will look good, blood is maternal
23
Q
risk factors for placenta previa
A
prior PP or c-section, multiple gestation
24
Q
this causes second trimester pregnancy loss
A
cervical insufficiency (look for previous conization)
25
bleeding, abdominal pain, fetal decelerations, smokers
placental abruption - stabilize mom with aggressive fluid resuscitation and have mom on left lateral decubitas for uterine displacement
26
dx and tx or lichen planus
vulvar punch biopsy, high-potency corticosteroids
27
postcoital bleeding, mucopurulent d/c friable cervix
acute cervicitis
28
thin, grey d/c, fishey odor
BV
29
indications for vacuum/forceps
protracted second stage of labor, fetal HR abnormalities, maternal CI to pushing
30
Signs for Sertoli-Leydig tumor
frank virilization - voice deepening, male-pattern baldness, increased mucle bulk, clitoromegaly; and estrogen deficiency (breast atropy, vulvovaginal atrophy)
31
mgmt of labor < 32 wks
mag sulfate and indomethacin
32
when is indomethacin CI
> 32 wkns due to risk of premature fetal ductus arterosus closure
33
what can be prescribed to adolescents with irregular heavy menstrual bleeding
progesterone - stabilizes unregulated endometrial proliferation
34
post-partum hemorrhage, lactation failure, hypotension, anorexia
sheehan - piturity ischemic necrosis
35
endometrial glands within the myometrium bulky, tender uterus that is UNIFORMLY enlarged
adenomyosis
36
proliferation of smooth muscle cells within the myometrium, heavy menstural bleeding, IRREGULARLY enlarged uterus
leiomyomata uteri (fibroids)
37
When do you give Rhogam to Rh - mom
28-32 weeks and after delivery of baby is Rh + (do a test to determine amount of dose; inadeqate dose = alloimmunization)
38
mgmt of IUFD 20-23 wks
Dilation and evacuation or vaginal delivery
39
mgmt of IUFG >24 wks
vaginal delivery
40
critical elements of IUFD evluation
fetal autopsy, karyotype, placental examination, maternal lab testing for fetomaternal hemorrhage and APS
41
at what hBCG level should pregnancy be visible by US
1500-2000
42
raloxifene
antagonist in breast and uterus, agonist in bone; CI in pt with hx of thromboembolism
(tamoxifene = antag of breast and agonist of uterus, risk of endometrial proliferation)
43
what are SAB tx options
expectant mgmt, medical induction (misoprostol), suction curretage if infxn or hemodynamic instability
44
tamsulosin
a-blocker used for tx of overflow inctoninence by BPH
45
deafness, cardiac defects, hepatosplenomegaly, micocephaly, cataracts
congenital rubella syndrome
46
> 60 with new vaginal bleeding, malodorous discharge, irregular vaginal lesions
r/o vaginal cancer with biopsy
47
5 complications of shoulder dystocia
```
fractured clavicle
fracture humerus
erb-duchenne palsy
klumpke palsy
asphyxia
```
48
shoulder dystocia, decreased moro and biceps reflex on right side, righ arm with extended elbow, pronated forearm, flexed wrist and fingers, intact grap reflex
erb duchenne palsy
49
describe presentation of klumpke palsy
claw hand with extended wrist, hyperextended MCP, flexed interphalangeal, absent grasp, horner syndrome, intact moro and biceps
50
which nerves are injured in klumpke palsy
C8 and T1
51
waiters tip, 5th and 6th cervical nerves
erb-duchenne palsy
52
lab findings consistent with POI
elevated FSH
53
secondary amenorrhea, elevated FSH, vaginal atrophy, thin endometrium
POI
54
absolute CI to combined hormone contraceptives
```
migraine with aura
> 15 cigarettes/day + age > 35
HTN
heart disease
DM with end-organ damage
hx of TE disease or stroke
APS
Breast CA
Cirrhosis and liver CA
Major sx with prolonged immobilization
use < 3 wks post partum
```
55
GnRH, FSH and Estrogen for POI
GnRH high, FSH high, Estrogen low
56
GnRH, FSH, and Estrogen for Hypothalamic hypogonadism
GnRH low, FSH low, Estrogen low
57
who gets hypothalamic hypogonadism
eating disorders or strenuous exercise (GnRH is low, and so is FSH and estrogen)
58
When start pregnant lady of acyclovir ppx for delivery
> 36 weeks
59
pH > 4.5, clue cells, positive whiff test, metronidazole or clindamycin
BV
60
pH > 4.5 in both of these causes of vaginal symptoms
BV and trichomoniasis
61
thin, yellow-green, malodorous, motile trichomonad, tx pt and sexual partner with metronidazole
trichomoniasis
62
pH < 4.5 (normal)
candid vaginitis
63
eclampsia tx
mag sulfate for seizure recurrence prevention, BP control, expedient delivery
64
normal cervical length?
> 2.5 cm
65
mgmt of pregnant lady with hx of preterm delivery
progesterone supplementation + serial cervical length measurements
66
impaired virilization during embryogenesis and testosterone to DHT conversion
5 alpha reductase deficiency
67
intrahepatic cholestasis of pregnancy
third trimester pruritus, elevated total bile acids, manage with ursodeoxycholic acid and delivery at 37 weeks
68
empiric tx of acute cervicitis
ceftriaxone + azithromycin
69
PID tx
cefoxitin + doxycycline
70
when to use progesterone withdrawal test
evalute secondary amenorrhea
71
most common cause of second stage arrest
cephalopelvic disproportion
72
what is adequate contractions?
> 200 mV unites average over 10 minutes
73
unilateral bloody nipple d/c without co-existing breast mass
intraductal papilloma
74
redness, ulceration, scaling and flaking of nipple
mammary paget disease
75
active phase arrest
no cervical change for > 4 hrs with adquate contractions OR > 6 hrs with inadequate contractions --> c-section
76
risk with short interpregnancy intervals
preterm labor, preterm prelabor ROM, low birth weight
77
epithelial cells coated with bacteria
clue cells of BV - tx = metronidazole or clindamycin
78
is labor and vaginal delivery CI after classical c-section (vertical incision) and myomectomy with uterine cavity entry?
YES due to significant risk of uterine rupture
79
placenta accreta risk factors
prio c-section, dilation and curretage, advaced maternal age
80
pt with secondary amenorrhea, elevated FSH levels, low estrogen (lack of withdawal bleeding after a progesterone stimulation challenge)
POI
81
can choriocarcinoma occur after hydatidiform mole, normal gestation and spontaneous abortion?
yes
82
where does choriocarcinoma metastasize?
the lungs; check bHCG
83
intrauterine synechiae
Asherman syndrome ; complication of intrauterine surgeries (myomectomy, curettage)
84
undercooked meat, cat feces, unwashed produce + bilateral ventriculomegaly, diffuse intracranial calcifications, fetal growth restriction + chorioretinitis, hearing loss, seizures
congenital toxoplasmosis
85
struma ovarii
teratoma composed of mature thyroid tissue
86
QUAD screen results for Trisomy 21
elevated BHCG and Inhibin A, low AFP
87
BhCG and Inhibin A are elevated in what abnormality?
Trisomy 21
88
These 3 values are decreased in Trisomy 18
MSAFP, BhCG, Estriol (afp is low in aneuploidy)
89
This value is increased in neural tube or abdominal wall defects and multiple gestation
MSAFP
90
Combined OCPs can be used in patients > X week pp while breastfeeding
6 weeks
91
vaginal bleeding, abdominal/pelvic pain that is excrutiating, uterine tenderness/rigidity
abruptio placenta (contrast to placental previa which is painless bleeding)
92
HSP tx
doxycycline
93
RUQ pain, leukocytosis, mildly elevated LFTs, hypoglyemcia, hyperbilirubinemai, thrombocytopenia
AFLP
94
> 40, dysmenorrhea, heavy bleeding, progressive chronic pelvic pain, boggy, tender and symmetrically enlarged uterus
adenomyosis
95
genotypically male pt that appears phenotypically female with primary amenorrhea, normal breast and female external genitalia development, and minimal or no axillary and pubic hair
androgen insensitivy syndrome (contrast to 5 alpha reductase deficiency where external genitalia is ambiguous)
96
how to differentiate AIS from mullerian agenesis
AIS = elevated testosterone and no hair
| Mullerian agenesis = normal testosterone, normal female development with pubic and axillary hair
97
condyloma acuminata
HPV 6 and 11, nontender, verrucous genital lesions, tx = tricholoacetic acid or surgical excision
98
condyloma acuminata vs lata
```
acuminata = HPV, cauliflower shaped and raised
lata = secondary syphillis, broad smooth base
```
99
first line HTN tx in pregnancy
labetaolol and methyldopa
100
what does early rupture of membranes put a pt at risk of
placental abruption, intraamniotic infection, umbilical cord prolapse, preterm labor
101
female pt with normal internal genitalia but ambiguous external genitalia
congenital aromatase deficiency; blocks conversion of androgens to estrogens
102
severe microcephaly, thin cerebral cortices, multiple intracranial calcification, craniosynostosis, multiple contractures, hypertonicitiy
zika
103
intracranial calcifications, hydrocephalus, chorioretinitis
toxo
104
what do these ovarian US findings suggest: solid mass with thick septations and the presence of ascites
malignancy - epithelial ovarian carcinoma
105
dysmenorrhea, deep dyspareunia, dyschezia
endometriosis, start on OCP
106
Describe thyroid function in pregnancy
T hormone prodxn + during pregnancy to cope with metabolic demands; estrogen causes + TBG, leading to increased total (but not free) T levels; hCG directly stimulates TSH receptors, causing + T prodxn
107
how to differentiate hyperemesis gravidarum from typical nausea and vomiting of pregnancy?
urinary ketones
108
presentation of vWD in pregnancy
PPH and prolonged bleeding - a PTT may be normal or prolonged
109
severe unilateral pain + abdominal mass
ovarian torsion
110
uterine tachysystole
> 5 contractions in 10 minutes
