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1
Q

3 signs of placental separation after delivery of baby

A

Gush of blood
Lengthening of cord
Uterine changes: hardening

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2
Q

Stages of labor

A
  1. Cervical dilation and effacement
    Ends when cervical is fully dilated (10 cm)
  2. Delivery of fetus
  3. Delivery of placenta
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3
Q

What is the role of hCG?

A

Maintenance of the corpus luteum in order to maintain progesterone secretion until the placenta is able to produce progesterone on its own

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4
Q

Premature rupture of membranes can cause what type of decelerations?

A

Variable – cord compression due to lack of amniotic fluid

Treat with amnioinfusion!

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5
Q

What does the progesterone challenge test look for?

A

Presence of estrogen

If there is withdrawal bleeding - pt has estrogen (PCOS)

If there is no withdrawal bleeding- pt does not have enough estrogen or has an anatomic condition (Ashermans syndrome)

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6
Q

When can you start to hear fetal heart tones?

A

12 weeks via Doppler

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7
Q

Erb palsy vs Klumpke

A

Erb: 5th and 6th cervical nerves

Klumpke: 8th cervical nerve and 1st thoracic nerve

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8
Q

Symmetric vs asymmetric IUGR

A

Symmetric IUGR
o Chromosomal abnormalities, congenital anomalies, fetal infections

Asymmetric IUGR
- Low abd circumference, normal biparietal diameter
o When fetal access to nutrients is compromised
o Maternal nutritional deficiency, HTN, uteroplacental insufficiency

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9
Q

What imaging should be done after a patient has an ultrasound-confirmed molar pregnancy?

A

CXR: most likely to metastasize to the lungs

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10
Q

Recommendation for seizure meds in pregnancy

A

High dose folic acid and stay on seizure meds

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11
Q

Treatment of dysmenorrhea

A
  1. NSAIDs

2. OCPs

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12
Q

Medical management of ectopic pregnancy

A

Methotrexate

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13
Q

Thyroid hormones changes in pregnancy

A

Free T3 and T4 levels = unchanged
TBG = increased
Total T4 = increased

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14
Q

Acid base status in pregnancy

A

Chronic respiratory alalosis with metabilic compensation

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15
Q

Why should asymptomatic UTIs be treated in all pregnant women?

A

Progsterone levels cause smooth muscle relaxation and ureteral dilation – increases risk of ascending infection (acute pyelonephritis)

Need to do a test of cure after antibiotic to make sure the infection has cleared

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16
Q

Twin twin tranfusion syndrome is seen in most in what type of twins

A

Monochorionic diamniotic

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17
Q

Most common cause of postpartum hemorrhage

A

Uterine Atony

Other causes:
Tone: atony
Tissue: retained placenta
Trauma: laceration
Thrombin: underlying coagulopathy
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18
Q

Protein level in 24 hours seen in severe preeclampsia

A

> 5000 mg (5 g)

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19
Q

The ovarian artery runs through which structure?

A

The suspensory ligament

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20
Q

Causes of fetal tachycardia

A

Maternal fever (chorio), maternal hyperthyroidism, medication use, placental abruption

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21
Q

Obesity is a risk factor for what type of cancer?

A

Endometrial: excess adipose tissue causes unopposed estrogen

Aromatase in adipose cells converts androgens into estrogens

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22
Q

What is the most effective screening test for Down Syndrome?

A

Cell free DNA

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23
Q

Treatment of early decels

A

Nothing. Related to head compression

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24
Q

What is the most accurate way of assessing gestational age?

A

First trimester US with crown-rump length

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25
Atypical glandular cells on Pap test may be due to?
Cervical or endometrial adenocarcinoma Colposcopy, endocervical curettage, endometrial biopsy
26
When, during pregnancy, are steroids no longer indicated?
After 34 weeks gestation
27
What antidepressant should not be used in pregnancy?
Paroxetine
28
Branches of the anterior division of the internal iliac artery
``` Obturator Inferior vesicle Internal pudendal Inferior gluteal Vaginal Uterine ```
29
What tests to order in secondary amenorrhea
#1 = pregnancy test! IF negative then order FSH, TSH , prolactin
30
Definitive diagnosis of endometriosis
Diagnostic laparoscopy
31
Most common congenital defect in maternal diabetes?
Cardiac defect
32
Treatment of lichen sclerosis and atrophic vaginitis
Lichen sclerosis: high dose topical steroids Atrophic vaginitis: topical estrogen
33
What size cystic adnexal mass should be explored surgically in the reproductive age perido
10 cm | 8cm if solid
34
Inc bhCG (in terms of cancer)
Choriocarcinoma
35
Cardinal movements of labor
Every Decent Family In Europe Eats Eggs ``` Engagement Descent Flexion Internal rotation Extension External rotation Expulsion ```
36
Oxytocin
Produced in hypothalamus and is secreted from the posterior pituitary gland Stimulates uterine contractions Pitocin is the synthetic form
37
Drugs used to control postpartum hemorrhage
Oxytocin Methergine (contraindicated in HTN) Hemabate (contraindicated in asthma) Misoprostol
38
Painless vaginal bleeding after 20 weeks gestation
Placenta previa: the presence of placental tissue overlying or proximate to the internal cervical os
39
SUdden onset of pelvic pain in a woman with a known ovarian cyst should make you suspect?
Ovarian torsion
40
Glucose screening prenatal care
24-28 weeks
41
Sheehan Syndrome
When a patient experiences a significant blood loss during delivery, this can result in anterior pituitary necrosis (loss of prolactin, TSH, ACTH, gonadotropin, LH) ``` Slow mental function Weight gain Fatigue Difficulty staying warm No milk production Hypotension Amenorrhea ```
42
``` Down syndrome quad screen MSAFP Estriol hCG Inhibin ```
MSAFP low Estriol low bhCG high Inhibin high
43
Treatment of late decels
Rotate mom | Give mom fluids, O2, tranfusion (if there is a hemorrhage)
44
OCPs post pregnancy
Non breastfeeding women Can initiate progestin only products (micronor) right away Initiate combined OCPs 3-4 weeks postpartum after hypercoagulability resolves Breastfeeding women Start progestin only pills 2-3 weeks postpartum Wait to start combined OCPs for at least 6 weeks when lactation is well established
45
treatment of variable decels
Amnioinfusion
46
Antihypertensives in pregnancy
Labetalol Hydralazine Nifedipine
47
Treatment of postpartum endometritis
Clindamycin and gentamicin
48
Corticosteroids have what benefits on premature infants?
Protects against NEC and intraventricular hemorrhage | Increases surfactant production (lung maturation)
49
What hormone suppresses lactation during pregnancy
Estrogen
50
Inc inhibin
Ovarian cancer: granulosa cell tumor
51
When is anti-D immune globulin given to an Rh negative mother?
28-32 weeks gestation
52
GBS prophylaxis
<37 weeks unknown GBS status = everyone gets antibiotics >37 weeks unknown GBS status, treat all of the following - GBS UTI during pregnancy - previous infant with GBS sepsis - maternal fever - prolonged rupture of membranes >18 hours
53
When is tocolysis indicated
Before 35 weeks gestation
54
Where is a baby if they are at zero station?
At the level of the ischial spines
55
What is the threshold bHCG level for visualizing pregnancy on transvaginal US?
2000
56
Pelvic inflammatory disease antibiotics
Ceftriaxone + doxycycline or Ceftriaxone + azithromycin
57
Where does the ovarian artery branch from
Aorta
58
Inc LDH
Ovarian cancer: dysgerminoma
59
Why is renal insufficiency a risk factor for magnesium toxicity? How do you treat magnesium toxicity
Magnesium is SOLELY excreted by the kidneys Treat toxicity with calcium gluconate
60
Hormone levels in primary ovarian insufficiency
Dec estrogen, inc GnRH, inc FSH Decreased ovarian function --> dec estrogen --> dec negative feeback on hypothalamus --> inc GnRH --> inc FSH --> infertility
61
How can you differentiate between hyperemesis gravidarum and typical nausea/vomiting of pregnancy?
Presence of ketones in urine | Hypokalemic hypochloremic metabolic alkalosis
62
PCOS increases risk of what cancer?
Endometrial (due to chronic unopposed estrogen)
63
1st trimester spontaneous abortions are seen in what chronic disease
DM
64
In utero exposure to DES can lead to what?
Clear cell adenocarcinoma of the vagina and cervix
65
Hydrops | Presentation and treatment
Abnormal fluid accumulation in 2+ sites: thorax, abdomen, skin Tx with fetal transfusion
66
what part of the colposcopy is not performed in pregnancy?
ECC (endocervical curettage)
67
How does pyelonephritis lead to ARDS in pregnancy? (Pulmonary edema)
Endotoxin release!
68
Phases of delivery
Phase 0: uterine quiescence Phase 1: preparation for labor Phase 2: labor Phase 3: post party
69
In someone who is less than 20 weeks pregnant and presents with signs of preeclampsia, what should you suspect?
Hydatidiform mole
70
What medical management can prevent preterm deliver
Weekly progesterone injections
71
Cervical diameter at active phase of labor
6 cm
72
Why should Bactrim be avoided in the third trimester of pregnancy? What other trimester(s) should it be avoided in?
It can cause kernicterus Should also be avoided in the 1st trimester as it interferes with folate metabolism
73
Paget disease is associated with what type of breast cancer?
Adenocarcinoma
74
Enlarged placenta and a fetus with abnormalities, suspect...
Congenital syphilis
75
Branches of the posterior division of the internal iliac artery
Iliolumbar Lateral sacral Superior gluteal
76
Anatomical difference between atrophic vaginitis and lichen sclerosis
In lichen sclerosis, the vagina is not involved
77
What should you suspect in a post partum patient who is being treated for endometritis but has a fever that is unresponsive to antibiotics? How should you proceed?
Septic pelvic thrombophlebitis Treat with anticoagulation and broad spectrum antibiotics
78
Inc AFP
Ovarian cancer: endodermal sinus tumor
79
Cerclage
Indicated in a patient with a history of >1 2nd trimester pregnancy loss related to cervical incompetence
80
Magnesium sulfate in preterm labor
Administered for fetal neuroprotection before 32 weeks
81
Medical treatment of uterine leiomyoma
GnRH agonist
82
When is rhogam given during prenatal care
24-28 weeks
83
Naegele's Rule
Estimated day of delivery Add seven to the date of the 1st day of the LMP and count back 3 months
84
Baby size in T1DM vs gestational diabetes
T1: small babies Gestation: large babies Babies can be hypoglycemic at birth
85
Drugs used to induce labor
Cervical ripening: Dinoprostone (cervidil) -- intravaginal, lasts 12 hours Misoprostol (cytotec) -- oral After cervical dilation: Oxytocin
86
Which choices of contraception have a <1% pregnancy rate?
Depo provera Sterilization LARCs (IUD or Nexplanon)
87
Adverse effects of oxytocin
Hyponatremia Hypotension Tachysystole (abnormally frequent uterine contractions)
88
When is Mg sulfate given in preterm labor? How about steroids?
Mg: less than 32 weeks Steroids: less than 34 weeks
89
First trimester bleeding differential
Physiologic Ectopic Miscarriage Structural pathology (cervical, vaginal, etc)
90
Minimum diagnostic criteria for PID
1. Pelvic or lower abdominal pain 2. Uterine tenderness or cervical motion tenderness or adnexal tenderness (Chandelier sign)
91
Kleihauer Beck test
Used to determine if there has been fetal to maternal hemorrhage
92
Genetic screening timing
15-20 weeks
93
What is the most common karyotype in a spontaneous abortion
Autosomal trisomy (trisomy 16)
94
When should you repeat bHCG if you suspect miscarriage?
After 48 hours
95
How can you tell if someone has chronic HTN vs Gestational HTN?
Chronic HTN = before 20 weeks gestation | Gestational HTN = after 20 weeks gestation
96
What is the most common cause of sepsis in pregnancy?
Pyelonephritis
97
Cervical mucus prior to ovulation is due to what hormone?
Due to the surge of LH
98
Postpartum hemorrhage
500 cc in vaginal delivery | 1000 cc in C section
99
What is a normal finding in urine in pregnancy that is abnormal otherwise?
Glucosuria
100
Magnesium mechanism as a tocolytic agent
Competes with Ca for entry into cells
101
Apt test
Used to dx vasa previa
102
Condyloma acuminata is caused by which strains of HPV
HPV 6/11
103
Fundal height
20 weeks = umbilicus Above 20 weeks, fundus will be gestational age in cm
104
Indomethacin is contraindicated in....
Oligohydramnios
105
Treatment of chorioamnionitis
Broad spectrum antibiotics (ampicillin and gentamicin)\ | Induction of delivery
106
Painful vaginal bleeding after 20 weeks gestation
Placenta abruptio: decidual hemorrhage leading to the premature separation of the placenta prior to delivery of the fetus
107
Managment of preeclampsia
W/o severe features: delivery after 37 weeks W/ severe features: delivery after 34 weeks Mg Sulfate Antihypertensives
108
How do OCPS help with hirsutism in PCOS?
Inc the amount of sex hormone binding globulin, which will lower circulating free testosterone

Shelf Exams (8 decks)

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