OB Final Flashcards by Frankie Aguinot

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answer

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24 weeks pregnant woman with multifetal pregnancy manifested for signs of preterm labor. What is the treatment for the case?

A) Corticosteroids
B) Bed rest
C) Tocolytics
D) Pessary

C) Tocolytics

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Effects on pregnant patient of infection

A) Serologic
B) Gestational Age
C) Mode of Acquisition
D) Immunologic

B) Gestational Age

AOTA?

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Intrauterine fetal transfusion is management option for infection caused by:

A) Parvovirus
B) CMV
C) Influenza
D) Mumps

A) Parvovirus

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Most common anomaly in congenital rubella syndrome seen in 60-75%

Sensorineural deafness

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The most common anomaly associated with congenital hyperplasia in 60-75%?

A) Malformation
B) Cardiac Anomaly
C) Mental retardation

B) Cardiac Anomaly

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In contrast to congenital varicella, varicella-zoster immune globulin should be administered in neonatal varicella

A) 2 days before and a week after delivery
B) 7 days before and 7 days after delivery
C) 5 days before and 5 days after delivery
D) 5 days before and 2 days after delivery

D) 5 days before and 2 days after delivery

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Diagnosis of toxoplasmosis in the mother is best confirmed by serology. Serologic test suggestive of an acute infection includes the identification of

A) IgM antibody
B) Extensive high IgG Ab titer
C) IgG seroconversion from negative to positive
D) A and B
E) A, B, C

E) A, B, C

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The most valuable test for congenital toxoplasmosis is by detection through PCR. What specimen is obtained?

A) Maternal blood
B) Maternal tissue
C) Amniotic fluid
D) Fetal tissue

C) Amniotic fluid

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Confirmatory test for VZV

A) Antibody VZV IgM
B) Antibody VZV IgG
C) VZV IgM
D) VZV IgG

C) VZV IgM

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As opposed to congenital rubella, neonatal rubella happens when?

Congenital rubella – happens during pregnancy

Neonatal rubella – acquired after birth

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True about influenza vaccine?

A) All health worker should be vaccinated yearly
B) 70-90% efficacy and decrease the severity
C) All women planning to be pregnant should be vaccinated in flu season
D) A and C
E) All of the above

E) All of the above

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True on Influenza immunization

A) Getting pregnant at flu season
B) 70-90% efficacy and reduced severity
C) Healthworkers require immunization
D) All of the above

D) All of the above

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) In congenital toxoplasmosis infection, 40% neonates born to mothers with evidence of disease, most likely to occur when maternal infection develops during

A) 1st trimester
B) 2nd trimester
C) 3rd trimester
D) After delivery

C) 3rd trimester

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40% of neonates affected with toxoplasmosis infection given that the mother during pregnancy has the said disease

A) Maternal blood
B) Fetal blood
C) Amniotic fluid

A) Maternal blood

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Rubella crosses the placenta thru hematogenous dissemination, rate decreases with increasing gestational age. However, 50-80% develop infection as early as this gestation

A) 12 weeks
B) 14 weeks
C) 18 weeks
D) 20 weeks

B) 14 weeks

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The initial immune response of the fetus after delivery came from?

A) Cell-mediated immunity
B) Humoral
C) Both
D) Neither

C) Both

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What is the proper way of collection for screening of group B streptococcus?

A) From distal vagina and anorectal
B) Use speculum for proper visualization of vagina and rectum
C) Proximal vagina and anorectal
D) A and B
E) A and C

D) A and B

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Not true about Antileukotrienes effective in the management of acute asthma

Effective in the management of acute asthma

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Prophylacyive antibiotic

A) Group A streptococcus
B) Group B streptococcus
C) Streptococcus agalactiae (GBS)
D) All of the above

D) All of the above

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Classic sign of Sick Neonate, Except:

A) Poor suck
B) Vomiting
C) Lethargy
D) Hyperthermia

D) Hyperthermia

response to sepsis may be hypothermia

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Most common cause of Neonatal sepsis

A) Group A streptoccocus
B) Listeria monocytogenes
C) Streptococcus agalactiae
D) Mycobacterium leprae

C) Streptococcus agalactiae

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Acquired neonatal infection

A) 24 hours
B) 48 hours
C) 72 hours
D) 96 hours

C) 72 hours

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Sulfadoxine-pyrethamine is given to:

A) Toxoplasmosis
B) Malaria
C) Hansen’s Disease
D) Listeriosis

A) Toxoplasmosis

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In pregnancy, the predominant CD4 T-cell is/are? A) Th1 B) Th2 C) Th3 D) Th4

B) Th2

The primary fetal response in case of exposure to infectious agents is? A) IgG B) IgA C) IgM D) IgE

C) IgM

Entry of vertical transmission during pregnancy includes? A) Placenta B) Labor and Delivery C) Breast Feeding D) All of the Above

D) All of the Above

Not associate with fetal effects? A) Mumps B) Varicella Zoster C) Measles D)German measles

A) Mumps

After being given a mumps vaccine, it is recommended that women should not get pregnant for the next? A) 2 weeks B) 4 weeks C) 6 weeks D) 8 weeks

B) 4 weeks

Associated with placental trophoblast invasion? A) Group A streptococcus B) Group B streptococcus C) Salmonellosis D) Listeria Monocytogenes

D) Listeria Monocytogenes

Development of CMI and humoral immune response occurs by? a. 5-10 weeks b. 8-15 weeks c. 15-20 weeks d. 21-25 weeks

b. 8-15 weeks

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Best measures for assessment of asthma include the following: ``` A. Subjective assessment B. FEV and PEFR C. Arterial blood gas analysis D. Clinical assessment E. Aota ```

B. FEV and PEFR

Guidelines to management of labor and delivery in asthmatic | mother/woman includes the ff except:

ANS: PFA 2 AND ERGONOVINE for uterine atony.

Which of the following is the Most common cause of Pneumonia? A. Mycoplasma pneumonia B. Legionella Pneumonia C. Influenza A D. CA MRSA

C. Influenza A

The ff. describes the diagnostic procedures used for Pneumonia: A. Chest xray accurately predicts the etiology B. Chest radiography is essential for the diagnosis C. Sputum cultures is primarily indicated in all cases of pneumonia D. All of the above

B. Chest radiography is essential for the diagnosis

A 30 year old G3P2 on her 30 week AOG with history of mild upper respiratory tract infection, present with cough, dyspnea and fever. What is the effective initial monotherapy recommended: A. Levofloxacin B. Vancomycin C. Erythromycin D. Linezolid

C. Erythromycin

Exceptions to delay INH tx to pregnant tuberculin positive women. ``` A. Known skin test converter B. Positive PPD exposed to active dse. C. HIV women D. A and C E. AOTA ```

E. AOTA

Beta-agonist given to asthmatics in order to

abate bronchospasm

Severe asthma type not responding to 30-60 minutes intensive therapy

Status Asthmaticus

Positive for Tuberculin Skin Test (TST)/Purified Protein Derivative (PPD)

greater > 5mm wheal formation/induration after 48-72 hours

Continued treatment for TB a. Isoniazid and Rifampicin b. Ethambutol and Rifampicin c. Ethambutol and Pyrazinamide

a. Isoniazid and Rifampicin

Carbon monoxide, later in pregnancy a. Structural anomalies b. Growth restriction c. Anoxic encephalopathy d. No fetal effects

c. Anoxic encephalopathy

With no known risk factors for TB, aninduration or wheal of this size is indicative of a need for Anti-TB treatment: a. > 3mm b. > 5mm c. > 10mm d. > 15mm

d. > 15mm

Breastfeeding is NOT a contraindication during Anti-TB treatment a. True b. False

a. True

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answer

Cardiac output increases by approximately what percent?

Cardiac output increases approximately 40%

Increase in CO is due to

Stroke Volume

When is CO maximal?

28 weeks AOG

Normal (left/right) ventricular function is maintained during pregnancy

Normal left ventricular function is maintained during pregnancy

5 Symptoms of heart disease during pregnancy

``` . Progressive dyspnea or orthopnea . Nocturnal cough . Hemoptysis . Syncope . Chest pain ```

diagnostic studies for heart disease

electrocardiography, cxr, echocardiography

15° left axis deviation in ecg due to

due to an elevated diaphragm in | pregnancy

what are findings in heart disease in pregnancy

``` . 15° left axis deviation – due to an elevated diaphragm in pregnancy . Mild ST changes . Reduced PR interval . Inverted or flattened T waves . 1 wave in lead D1 ```

Which permits accurate diagnosis of most heart diseases during pregnancy? electrocardiography, cxr, echocardiography

echocardiography

slight limitation of physical activity Class I Class II Class III Class IV

Class II

comfortable at rest Class I Class II Class III Class IV

Class I, II, and III

ordinary physical activity is undertaken, discomfort in the form of excessive fatigue, palpitation,dyspnea, or anginal pain results Class I Class II Class III Class IV

Class II

marked limitation of physical activity Class I Class II Class III Class IV

Class III

less than ordinary activity causes excessive fatigue, palpitation, dyspnea, or anginal pain Class I Class II Class III Class IV

Class III

Which NYHA class is a predictor of cardiac complications?

Class III and IV

What singular clinical finding is a predictor of cardiac complication?

cyanosis

(Left/Right) sided heart obstruction is a predictor of cardiac complication

Left sided heart obstruction

# Define left sided heart obstruction . Mitral valve area of . Aortic valve are . peak left ventricular outflow tract gradient . Ejection fraction

. Mitral valve area of <2 cm2 . Aortic valve are below 1.5 cm2 . peak left ventricular outflow tract gradient >30mmHg by 2D Echo . Ejection fraction <40%

risk of congenital heart disease in offspring is?

risk of congenital heart disease in offspring is 3-4%

What cardiovascular changes in pregnancy occur that affect general management?

. Blood volume . CO . decline in systemic vascular resistance . hypercoagulability

Basilar rales, Dyspnea on exertion, Excessive coughing, Hemoptysis, Progressive edema, Tachycardia Are clinical symptoms of which NYHA Class?

Class I and II

What is the specific danger in illicit drug use on cardiac pathology?

raises the risk of infective endocarditis

Which anesthetic is preferred with CVD?

epidural

in CVD what is the preferred position during labor?

Semirecumbent position with lateral tilt

Findings suggestive of impending ventricular failure during labor Heart rate RR Associated with

Heart rate of > 100 beats/min RR >24/min Associated with dyspnea

Manifestation of Intrapartum Heart Failure (2)

Pulmonary edema with hypoxia, Hypotension

Pros and cons of porcine tissue valves

Pro: Safer for pregnancy, Anticoagulant not required Con: Needs another replacement in 10 to 15 years

What is management when there is mechanical valve replacement?

. Full coagulation throughout pregnancy . Use unfractionated heparin between 6-12 weeks and at 36 weeks . Starting at 35,000 U SQ, BID . Warfarin is used for the rest of the pregnancy . If delivery occurs before effect of anticoagulant fades, may give Protamine sulfate thru IV

Which type of contraception is contraindicated?

combination OCP

most common cause of mitral stenosis lesions

Rheumatic endocarditis

management of mitral stenosis

``` Physical activity limited Reduce salt intake Diuretic started B-blockers IV verapamil/electrocardioversion Digoxin Heparin ```

Mitral insufficiency is (well/poorly) tolerated during pregnancy. Prophylaxis against what is indicated?

Well tolerated during pregnancy Prophylaxis against bacterial endocarditis indicated

What Implies myxomatous degeneration?

mitral valve prolapse

mitral valve prolapse involves

Valve leaflets, Annulus, Chordae tendinae

Normal aortic valve area vs Severe stenosis. What is the pressure gradient in aortic stenosis?

Normal aortic valve area: 3-4 cm2 Severe stenosis: <1 cm2 Pressure gradient: <5mmHg

Management of aortic stenosis?

Limitation of activity Treat for infection Valve replacement Valvotomy

Aortic insufficiency is (well/poorly) tolerated during pregnancy.

Well tolerated during pregnancy

Pt has Systolic ejection murmur, pulmonary area louder during inspiration. What is Dx?

pulmonic stenosis

2nd most common congenital heart lesion in adults

atrical septal defect

When is ventricular septal defects well tolerated?

well tolerated for small to moderate, left to right shunts heart failure and pulmonary hypertension does not develop if defect is <1.25 cm2

This unrepaired defect may lead to Pulmonary hypertension

Pulmonary hypertension may occur in unrepaired Patent ductus arteriousus

What are characteristics of cyanotic heart disease?

Tetralogy of Fallot: Large Ventricular Septal Defect, Pulmonary Stenosis, RVH, Overriding aorta

What is Eisenmenget syndrome? What conditions is it common in? (3)

Pulmonary vascular resistance > systemic vascular resistance Common in: ASD, VSD, PDA

Normal resting Pulmonary | Pressure vs Pulmonary Hypertension

Normal resting Pulmonary Pressure: 12- 16 mmHg Pulmonary Hypertension: > 25mmHg

Pulmonary Hypertension is what NYHA class? Pregnancy is (well/poorly) tolerated.

GROUP II: most commonly encountered in pregnancy Pregnancy is CONTRAINDICATED

Treatment of Pulmonary Hypertension

Limitation of movement, Avoid supine position, O2, Vasodilators

Analgesia for pulmonary htn

subarachnoid, Avoid epidural analgesia

diagnositc criteria for peripartum cardiomyopathy

1. Cardiac Failure in the last month or within 5 months of pregnancy 2. No cause for the failure 3. No heart disease before pregnancy 4. Left ventricular systolic dysfunction

hallmark finding in idiopathic cardiomyopathy and treatment

Hallmark finding: cardiomegaly TREATMENT - NaCl is restricted - Diuretics - Hydralazine - Digoxin - Heparin

Diagnosis of peripartum heart failure

Chronic hypertension with superimposed Preeclampsia . Basilar rales w/ nocturnal cough . Sudden decline in activity . Increase dyspnea on exertion . Hemoptysis

management of peripartum heart failure

diuretics, antihypertensive, anticoagulant

What is the Duke criteria used for and what are the points?

diagnosis of infective endocarditis; positive blood cultures for typical organisms and evidence of endocardial involvement

What are the maneuvers to raise vagal tone ablock the AV node?

``` vagal maneuvers - raise vagal tone ablock the atrioventricular node -‐ Valsalva maneuver -‐ carotid sinus massage -‐ bearing down -‐ immersion of the face in ice water ```

pre-excitation of the ventricles of the heart due to an accessory pathway known as the bundle of kent A. Wolf-Parkinson-white syndrome B. Supraventricular Tachyarrythmia C. Ventricular Tachycardia D. Inc. QT interval

A. Wolf-Parkinson-white syndrome

Manged with Vagal maneuvers, Intravenous adenosine, Electrical cardioversion A. Wolf-Parkinson-white syndrome B. Supraventricular Tachyarrythmia C. Ventricular Tachycardia D. Inc. QT interval

B. Supraventricular Tachyarrythmia

Associated with fatal ventricular arrhythmias and w/ intake of: Azithromycin, Erythromycin, Clarithromycin A. Wolf-Parkinson-white syndrome B. Supraventricular Tachyarrythmia C. Ventricular Tachycardia D. Inc. QT interval

D. Inc. QT interval

When is CS recommned in marfan syndrom?

aortic root measures 4 to 5 cm or greater

A 23 year old primigravid. Diagnosed case of mitral valve prolapse. Complain of fatigue, palpitations, and dyspnea on ordinary activities. What is the patient’s classification? A. Class I B. Class II C. Class III D. Class IV

B. Class II

2.22 y/o G1P0 pregnancy uterine 10 weeks came in for prenatal check-up. She had valve replacement during childhood. What anticoagulant therapy is she most likely using now? A. Warfarin B. Coumarin C. Heparin D. She is not using any

C. Heparin

22 y/o G1P0 pregnancy uterine 10 weeks came in for prenatal check-up. She had valve replacement during childhood. If she undergoes vaginal delivery at term, and if she will need anticoagulant? A. Right after delivery B.6 hours after delivery C.24 hours after delivery D. 28 hours after delivery

B.6 hours after delivery

Prominent sign of ventricle failure A. Fever B. Dyspnea C. Chest pain D. Syncope

B. Dyspnea

A 21 y/o primigravid patient was diagnosed with aortic stenosis. What could have caused her condition? A. Most likely due to an infective process during her childhood days B. Most likely congenital in nature C. Most likely a connective tissue disease D. Most likely because of hypervolemia she is experiencing during pregnancy

B. Most likely congenital in nature

35 y/o G3P3 (3003), postpartum day 7, came in due to difficulty of breathing. Normal PE, chest x-ray, ECG: peripartum cardiomyopathy. Most likely condition: A. Valvular myocarditis B. Autoimmune response to pregnancy C. Chronic hypertension with superimposed preeclampsia D. Unknown

D. Unknown

A 28 y/o, multigravida complains of palpitation. ECG shows supraventricular tachycardia. The management consist of the following, EXCEPT: A. Carotid massage B. Immersion of the face in lukewarm water C. Valsalva maneuver D. Beta blocker

B. Immersion of the face in lukewarm water

Pregnant Woman was diagnosed with Aortic Stenosis. Asks how she could have had it. A. Infectious disease from childhood B. Congenital C. Connective tissue disease D. Acquired

B. Congenital

Cardio changes are evident in? A. Earl Pregnancy B. Mid pregnancy C. Late Pregnancy D. Not related

B. Mid pregnancy

Tubal ligation may only be done on a gravido-cardiac patient that is A. Afebrile B. Not anemic C. Not in respiratory distress D. All of the above

D. All of the above

The first warning sign that at would make the physician suspect that the pregnant woman is developing heart failure is A. Dyspnea on exertion B. Hemoptysis C. Tachycardia D. Basilar rales

D. Basilar rales

Best Prognosis for pregnancy outcome A. Aortic Stenosis B. Mitral Stenosis C. Eisenmenger syndrome D. Aortic Regurgitation

D. Aortic Regurgitation

Heart Disease not commonly seen in pregnant woman? A .Aortic Stenosis B .Mitral Stenosis C .Mitral Insufficiency D. Aortic Insufficiency

A .Aortic Stenosis

Obstetrical complication that is attributed to the development of peripartum heart failure? ``` A. GDM B. Gestational hypertension C. Pre-Eclampsia D. Chronic Hypertension E. Chronic hypertension with superimposed pre eclampsia ```

E. Chronic hypertension with superimposed pre eclampsia

Most common arryhtmia in reproductive age A. Wolf-Parkinson-white syndrome B. Supraventricular Tachyarrythmia C. Ventricular Tachycardia D. Inc. QT interval

B. Supraventricular Tachyarrythmia

What is the recommended anesthesia for gravido-cardiac patient? A.Pudendal Block B. General Anesthesia C.Subarachnoid block D.Epidural Block

D.Epidural Block

Cardiac output is higher in the ______ position: A. standing B. sitting C. left lateral decubitus D. supine

C. left lateral decubitus

____ out of 10 women with heart disease died during puerperium: A. 2 B. 4 C. 6 D. 8

D. 8

Because of hypervolemia and increased cardiac output, one can expect ___________ on physical examination: A. systolic murmur B. diastolic murmur C. orthopnea D. edema

A. systolic murmur

``` During normal pregnancy, there is an expected _____ degrees left axis deviation on ECG: A. 5 B. 10 C. 15 D. 20 ```

C. 15

50% of the increase in cardiac output for pregnant women occurs as early as 10 weeks AOG. A. True B. False

B. False; 28 weeks

The increase in stroke volume is due to the increase in the maternal blood volume during pregnancy. A. True B. False

A. True

The following are normal changes in the cardiovascular system of pregnant women: A. 20 degrees left axis deviation B. mild ST wave changes in the inferior leads C. increase in the cardio-thoracic ratio D. AOTA

B. mild ST wave changes in the inferior leads

Risk of congenital heart disease among children of mothers with such heart disease: A. 1-2% B. 2-3% C. 3-4% D. 4-5%

C. 3-4%

Factors that may affect the management of heart disease during pregnancy: A. blood volume changes B. fluctuation of blood volume after delivery C. increase in peripheral vascular resistance after delivery D. hypercoagulability of blood

D. hypercoagulability of blood

The best contraceptive for gravidocardiac patients would be: ``` A. OCPs B. progestin only pills C. IUD D. tubal sterilization E. vasectomy of the husband ```

D. tubal sterilization

A gravidocardiac woman is at risk of cardiac failure if her ejection fraction is less than: A. 10% B. 20% C. 40% D. 60%

C. 40%

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General categories of predisposing factors for ob hemorrhage

abnormal implantation, injuries to the birth canal, ob factors, vulnerable pt, uterine atony, coagulation defects

Expected blood loss after delivery

(blood loss of more than 500 cc after NSD and more than 1000 cc after CS delivery.)

According to the ACOG, postpartum hemorrhage is defined as

According to the ACOG, postpartum hemorrhage is defined as cumulative blood loss >1000 mL accompanied by signs and symptoms of hypovolemia

Normal Pregnancy Induced Hypervolemia

30-60% of the blood volume, 1500-2000 ml

blood loss can be estimated as the sum of the calculated pregnancy-added volume PLUS

PLUS 500 mL for each 3 volume percent decline of the hematocrit

Most important for activating hemostasis

contraction and retraction

hemostasis is achieved first by myometrial contraction

myometrial contraction

describe a Well Contracted Uterus

should be in the hypogastric area, slightly below the umbilicus, has to be stone hard, uterus has to be tetanically contracted or else the patient will suffer from hemorrhage

how does retained placental fragments cause postpartum hemorrhage

Adherent pieces of placenta or large blood clots prevent effective contraction and retraction of the myometrium, impairs hemostasis at the implantation site

signs of uterine atony

. Enlarged, boggy uterus: pathognomonic sign . above the umbilicus . not soft (just like water balloons)

risk factors of uterine atony

. Overdistended uterus . Macrosomia . High parity (more than 4)

central separation Duncan mechanism Shultze mechanism

Shultze mechanism

blood remains concealed behind the placenta and membranes until the placenta is delivered Duncan mechanism Shultze mechanism

Shultze mechanism

peripheral separation Duncan mechanism Shultze mechanism

Duncan mechanism

blood from the implantation site may escape into the vagina immediately Duncan mechanism Shultze mechanism

Duncan mechanism

Manual removal of placenta

One hand grasps the fundus. The other hand is inserted into the uterine cavity, and the fingers are swept from side to side as they are advanced When the placenta has become detached, it is grasped and removed.

2nd most common cause of post partum hemorrhage

retained placental fragments

Units of blood for Placenta Previa Placenta Accreta Placenta Percreta

Placenta Previa- 2 units of blood Placenta Accreta- 4 units of blood Placenta Percreta- 8 units of blood

management of percreta

Prompt hysterectomy

Mechanism of Placental Separation

1. Uterus becomes round and globular 2. Sudden gush of blood 3. Uterus goes back to the pelvic cavity 4. Lengthening of the cor

How long do you wait for placenta to separate?

Average is 5 mins. but as long as the patient is stable, wait for 5-15 mins.

What are the two surgical interventions for inverted uterus?

Huntington procedure - application of atraumatic clamps to each round ligament and upward traction or placing a deep traction suture in the inverted fundus or grasping it with tissue forceps. Haultain incision - sagittal surgical cut made posteriorly through the muscular ring to release constriction ring that prohibits repositioning.

application of atraumatic clamps to each round ligament and upward traction or placing a deep traction suture in the inverted fundus or grasping it with tissue forceps Haultain incision Huntington procedure

Huntington procedure

sagittal surgical cut made posteriorly through the muscular ring to release constriction ring that prohibits repositioning Haultain incision Huntington procedure

Haultain incision

Injury to the lower portion of the vagina and the perineal body Perineal Lacerations Vaginal lacerations Injuries to the cervix

Perineal Lacerations

Suturing Perineal Lacerations Vaginal lacerations Injuries to the cervix

Perineal Lacerations

Laceration involving the middle or upper third of the vagina Perineal Lacerations Vaginal lacerations Injuries to the cervix

Vaginal lacerations

Extensive repair of the laceration Perineal Lacerations Vaginal lacerations Injuries to the cervix

Vaginal lacerations

Difficult forceps rotation or deliveries performed incompletely Perineal Lacerations Vaginal lacerations Injuries to the cervix

Injuries to the cervix

Laparotomy; Intrauterine exploration; Surgical repair Perineal Lacerations Vaginal lacerations Injuries to the cervix

Injuries to the cervix

What is Colporrhexis?

Colporrhexis - cervix entirely or partially avulsed from the vagina in the anterior, posterior, or lateral fornices

Risk factors of puerperal hematomas

Risk factors: Nulliparity, episiotomy and forceps delivery

often involve branches of the pudendal artery, including posterior rectal, transverse perineal, or posterior labial artery vulvar hematoma vulvovaginal hematoma paravaginal hematoma retroperitoneal hematoma

vulvar hematoma

involve the descending branch of the uterine artery vulvar hematoma vulvovaginal hematoma paravaginal hematoma retroperitoneal hematoma

paravaginal hematoma

Most common symptom of puerperal hematoma

Most common symptom: Severe Perineal Pain

Complete vs incomplete uterine rupture

Incomplete Uterine Rupture (Uterine dehiscence) - uterine muscle separated but visceral peritoneum is intact

Diagnosis of Uterine Rupture

Hemoperitoneum from a ruptured uterus may result in irritation of the diaphragm with pain referred to the chest

First sign of uterine rupture is? Followed by?

First sign of uterine rupture is Abnormal fetal heart rate pattern then followed by pain, maternal hypovolemia – blood loss is strictly concealed

A case of a 38 yo, G5P3(3013) 37 weeks AOG, ongoing repeat CS for the fourth time with intraoperative findings: gravid uterus, uterine serosa infiltrated with placenta villi; term, cephalic live baby. What is the most likely diagnosis? A. Placental abruption B. Placenta accreta C. Placenta increta D. Placenta percreta

C. Placenta increta

A case of a 38 yo, G5P3(3013) 37 weeks AOG, ongoing repeat CS for the fourth time with intraoperative findings: gravid uterus, uterine serosa infiltrated with placenta villi; term, cephalic live baby. How must the case be managed? A. Hysterectomy with bilateral salpingooophorectomy B. Hysterectomy with bilateral salpingectomy C. Hysterectomy with bilateral salpingooophorectomy w/ methotrexate D. Repeat LTCS with bilateral tubal

C. Hysterectomy with bilateral salpingooophorectomy w/ methotrexate

40 year old G5P4 delivered a term 3.8 kg, immediately after delivering the placenta. BP was 70/50, PR 110 bpm. What step is not done to the patient? A. Immediate curettage for retained placenta. B. Uterine massage for atony. C. Check for vulvar laceration. D. Insert double line and hydrate.

A. Immediate curettage for retained placenta.

36 year old G5P5 delivered a baby weighing 2500g referred to ER due to hypotension and profuse vaginal bleeding. Upon inspection, (+) bleeding fleshy mass outside vagina with umbilical cord dangling from it. Placenta carefully detached. IE: Fundus palpable inside vagina. Palpation: intended fundus. Diagnosis? A. Uterine atony B. Uterine inversion C. Placenta previa D. Vulvar hematoma

B. Uterine inversion

A 21 year old G1P1 known diabetic, delivered a term live baby with birth weight of 4.2 kg uterus delivered completely. Uterus notes to be enlarged and boggy. A. Uterine atony B. Vulvar hematoma C. Uterine inversion D. Placenta previa

A. Uterine atony

2500g. referred to ER due to hypotension and profuse vaginal bleeding. Upon inspection, (+) bleeding fleshy mass outside vagina with umbilical cord dangling from it. Placenta carefully detached. IE: fundus palpable inside vagina. Palpation: indented fundus. Diagnosis: a. Uterine atony b. Uterine inversion c. Placenta previa d. Vulvar hematoma

b. Uterine inversion

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JNC 8 guidelines includes, except: ``` A. Recommends selection among: ACE-l,ARB, CCB, diuretics B. Diabetes: lowers pressure <140/90 C. HTN: defined as >140/90 D. CKD lowers pressure <140/90; adds ACE-l and ARB to improve outcomes ```

CKD lowers pressure <140/90; adds ACE-l and ARB to improve outcomes

Ideal time to counsel women with chronic hypertension and desirous in pregnancy A. Preconception B. 1st Trimester... C. 2nd Trimester... D. 3rd Trimester...

A. Preconception

Lifestyle modification for hypertensive patients Except: A. Moderation of alcohol B. Decrease Sodium intake not more than 2400mg per day; desirable is 1500 per day C. Increase intake of vegetables, poultry, fish, red meat and sweets D. Moderate to vigorous intensity of physical activity 3-4/week lasting an average of 40 mins per session

C. Increase intake of vegetables, poultry, fish, red meat and sweets

Which of the ff. Is an adverse effect of chronic hypertension in pregnancy? A. Post term B. Stillbirth C. Fetal macrosomia D. Placenta Previa

B. Stillbirth

How will you classify chronic hypertension in pregnancy? A. >140/90 prior to pregnancy or <20 wks AOG with new onset of proteinuria B. >190/140 prior to pregnancy or <20 wks AOG, persist 12 weeks after delivery C. >140/90 prior to pregnancy or <20 wks AOG, persist 12 weeks after delivery D. >160/200 prior to pregnancy or <20 wks AOG, with new onset of proteinuria

C. >140/90 prior to pregnancy or <20 wks AOG, persist 12 weeks after delivery

Which is NOT a component of HELLP Syndrome? A. Increased LDH B. Proteinuria 2+ on Urine dipstick C. Increased SGPT D. Platelet less than <100,000/μg

B. Proteinuria 2+ on Urine dipstick

36 weeks. Blurring of vision and headache. BP: 180/100 mmHg. Cervix long, firm, uneffaced. What is the management? A. MgSO4, Antihypertensive drugs, immediately do CS B. MgSO4, Antihypertensive drugs, Betamethasone, induce labor C. Observe, wait for 37 weeks for lung maturity

A. MgSO4, Antihypertensive drugs, immediately do CS

24 y/o, 30 weeks AOG, BP: 180/110, came in for her prenatal checkup. She complains of labor pains every hour, (+) bag of waters, albumin 3+, CBC and platelets, and SGPT within normal levels. A. Admit patient, give MgSO4, antihypertensive medication plus betamethasone and induction of labor B. Discharge patient and follow-up after 2 weeks C. Give MgSO4 plus hypertensive medication, then do CS D. Give MgSO4 plus antihypertensive agent then deliver

A. Admit patient, give MgSO4, antihypertensive medication plus betamethasone and induction of labor

What anti-hypertensive drug/s is/are proven to be safe and effective in pregnancy? ``` A. Diuretics (Furosemide) B. Centrally-acting β-adrenergic antagonists (Methyldopa) C. ACE inhibitors (Captopril) D. All of the Above ```

B. Centrally-acting β-adrenergic | antagonists (Methyldopa)

G2P1 30 weeks AOG, obese, admitted due to her BP: 180/110. Patient is asymptomatic. What treatment should be given? A. Clonidine B. Methyldopa

B. Methyldopa

In women with chronic hypertension and superimposed preeclampsia with severe features, what is the drug of choice for neuroprophylaxis? A. Diazepam B. Sodium Valproate C. Carbamazepine D. Magnesium Sulfate

D. Magnesium Sulfate

A 21 y/o G1P0 with chronic hypertension and superimposed preeclampsia. What will be the plan for management? A. BPS and NST B. Double dose of vitamins C. Frequent sonography D. None of the Above

C. Frequent sonography

Management of chronic mild to moderate hypertension: A. Treatment of persistent BP of <160/105mmHg B. Treatment of neuro, cardio, renal C. Treatment of healthy patients with persistent >150/100mmHg D. (+) end organ damage, treat DBP >90mmHg to avoid end organ failure

C. Treatment of healthy patients with persistent >150/100mmHg

37 y/o, G2P1, 27 weeks AOG, pre-gestational: 140/90, ER due to headache BP of 160/110, (-) proteinuria A. Gestational hypertension B. Chronic hypertension C. Chronic hypertension with superimposed preeclampsia D. Preeclampsia with severe features

D. Preeclampsia with severe features

30 y/o G2P1 (1001) with chronic HTN, which of the ff. is included in the “preemptive” management for the patient? A. High dose aspirin B. High dose antioxidant (vitamin C) C. Low dose aspirin D. Low dose calcium

C. Low dose aspirin

Adverse effects of Chronic Hypertension A. Fetal Death B. Stroke C. Neonatal Death D. AOTA

D. AOTA

Treatment for Chronic Hypertension in pregnant women except? A. Diuretics B. ACEi C. Beta D. CCB

B. ACEi

Adverse pregnancy outcome is increased in patients with A. Poorly controlled Hypertension B. Taking 2 anti-hypertensive drugs C. Both D. Neither

C. Both

Uncontrolled Chronic Hypertension in Pregnancy increases risk for? A. Placenta abruption B. CVA C. Heart Failure D. AOTA

D. AOTA

In chronic hypertension, the most affected organ is? A. CNS B. Heart C. Placenta D. Kidneys

D. Kidneys

Absolute contraindication of pregnancy with chronic hypertension A. CVA B. Pre-eclampsia C. Kidney disease D. AOTA

A. CVA

Chronic Hypertension in a 39 year old Primigravid patient is diagnosed as early as A. 10 weeks AOG B. 15 weeks AOG C. 20 weeks AOG D. 25 weeks AOG

C. 20 weeks AOG

Evidence of proteinuria in Preeclampsia A. 400mg/24 hour urine collection B. 0.3 protein:creatinine ratio C. Both

C. Both

Prevents cerebral hemorrhage A. Nifedipine B. Hydralazine C. Labetalol

B. Hydralazine

28 y/o, primi, 28 wks, 150/100, bipedal edema ``` . gestational hypertension . chronic hypertension . chronic hypertension superimposed with preeclampsia . Preeclampsia . Eclampsia ```

gestational hypertension new onset after 20 week AOG; no proteinuria

30 y/o, primi, 14-15 wks, 160/100, 2+ proteinuria ``` . gestational hypertension . chronic hypertension . chronic hypertension superimposed with preeclampsia . Preeclampsia . Eclampsia ```

. chronic hypertension superimposed with preeclampsia before 20 AOG

32 y/o, primi, 28 wks, 140/90, 3 g proteinuria ``` . gestational hypertension . chronic hypertension . chronic hypertension superimposed with preeclampsia . Preeclampsia . Eclampsia ```

. Preeclampsia proteinuria: . > 300mg/24 hr urine or . Protein/creatinine ratio > 0.3 or . Dipstick reading of 1+

``` . gestational hypertension . chronic hypertension . chronic hypertension superimposed with preeclampsia . Preeclampsia . Eclampsia ```

. Eclampsia

29 y/o G1P0 at 34 weeks AOG, diagnosed with preeclampsia with severe features. What is in her maternal history that will make her at risk for PIH? a. Primipara b. Nullipara c. AOG d. Age

b. Nullipara

What is PIH classification of a sudden rise in mean arterial pressure, but still in normal range, may also signify preeclampsia? BP < 140/90 a. Chronic hypertension b. Gestational hypertension c. Preeclampsia – non-severe d. Delta Hypertension

d. Delta Hypertension

25 y/o G1P0, 28 weeks AOG, BP 140/90 (pre), pregnant BP unknown, lab result – all normal, hypertensive – worried if transient or not. ``` a. Preeclampsia will lead to chronic hypertension b. Wait for 12 weeks, and if BP > 140/90 – chronic hypertension c. Wait for 6 hours. If BP >140/90 – CHRONIC HYPERTENSION d. Delta hypertension, therefore, only transient. ```

b. Wait for 12 weeks, and if BP > | 140/90 – chronic hypertension

question

answer

forceps for round multiparous infant Kielland Pipers Tucker-Mclane Simpson

Tucker-Mclane

forceps used for the breech delivery Kielland Pipers Tucker-Mclane Simpson

Pipers

used for deep transverse arrest Kielland Pipers Tucker-Mclane Simpson

Kielland

molded head in nulliparous Kielland Pipers Tucker-Mclane Simpson

Simpson

which of the ff. is not part of the criteria for outlet forceps delivery? a. sagittal suture is in the antero-posterior diameter b. fetal head is at the perineum c. scalp is visible at the introitus w/o separating the labia d. leading part of the fetal skull is at the station equal to or greater than +2

d.leading part of the fetal skull is at the station equal to or greater than +2

w/c of the ff. factors is associated with operative delivery failure? a. birth weight of 3500g b. direct occiput anterior position of fetal head c. absence of regional or general anesthesia d. right occiput position of fetal head

c. absence of regional or general anesthesia

the flexion point is the most important determinant of success in vaccum extraction. flexion point is along the sagittal suture a. 3cm from the anterior fontanel b. failure of extraction c. failure of forceps delivery

a.3cm from the anterior fontanel

anesthesia for outlet forceps extraction: a. Regional b. General c. IV sedation d. Pudendal

d. Pudendal

Blade solid shank is narrow Kielland Pipers Tucker-Mclane Simpson

Tucker-Mclane

MC forceps with Cephalic and Pelvic curves Kielland Pipers Tucker-Mclane Simpson

Simpson

Parallel Shanks Kielland Pipers Tucker-Mclane Simpson

Simpson

Fenestrated blade Kielland Pipers Tucker-Mclane Simpson

Simpson | Pipers

English Lock Kielland Pipers Tucker-Mclane Simpson

Tucker-Mclane | Simpson

sliding lock Kielland Pipers Tucker-Mclane Simpson

Kielland

Minimal pelvic curvature, light weight Kielland Pipers Tucker-Mclane Simpson

Kielland

long shank Kielland Pipers Tucker-Mclane Simpson

Pipers

double pelvic curve Kielland Pipers Tucker-Mclane Simpson

Pipers

In vacuum extraction, the flexion point is the most important determinant of its success. This is located along the sagittal suture A. 3 cm behind the posterior fontanel B. 3 cm in front of the posterior fontanel C. 3 cm behind the anterior fontanel D. 3 cm in front of the anterior fontanel

B. 3 cm in front of the posterior fontanel

In vacuum delivery additional prerequisite is/are : A. Fetus should be atleast 34 wks AOG B. Fetal scalp blood sampling should not have recently done C. None of the above D. A and B

D. A and B

To prevent perineal laceration in operative vaginal delivery the following may be used ``` A. Liberal median episiotomy B. Mediolateral episiotomy C. Rotate from POP to OA D. B&C E. A&C ```

B. Mediolateral episiotomy

Which of the following fetal injury in operative vaginal delivery is the function of the angle of traction applied? a. Shoulder dystocia from brachial plexus b. Facial nerve paralysis c. Scalp laceration d. Intracranial hemorrhage

Shoulder dystocia from brachial plexus

Which of the following fetal injury in operative vaginal delivery is the function of compression of the nerve against the facial bones? a. Shoulder dystocia from brachial plexus b. Facial nerve paralysis c. Scalp laceration d. Intracranial hemorrhage

b. Facial nerve paralysis

Flexion point except A. 3 cm from anterior B. Maximum traction C. Along the sagittal suture

A. 3 cm from anterior (ans 6cm)

Fetal head is engaged and at station >/= +2 A. Outlet forceps B. Low forceps C. Mid forceps D. High forceps

B. Low forceps

Fetal skull has reached the pelvic floor A. Outlet forceps B. Low forceps C. Mid forceps D. High forceps

A. Outlet forceps

Landing point of the fetal skull is at station above +2cm but engaged A. Outlet forceps B. Low forceps C. Mid forceps D. High forceps

C. Mid forceps

Fetal head is unengaged A. Outlet forceps B. Low forceps C. Mid forceps D. High forceps

D. High forceps

The most important function of both forceps and vacuum is for traction T or F

correct

For operative vaginal delivery, the 2 most important discriminator of risk for both mother and infant are traction and application t or f

incorrect station and rotation

Prerequisite for operative vaginal delivery a. Station – 1 b. Bispinous diameter 8.5 cm c. Ruptured bag of water

c. Ruptured bag of water

Causes of operative delivery failure

. Persistent occiput posterior . Absence of regional or general anesthesia . Birthweight >4000 grams

In forceps application, the fetal head is perfectly grasped when the long axis corresponds to the, a. Subfrontal diameter b. Occipotomento diameter c. SOB diameter d. NOTA

b. Occipotomento diameter

question

answer

Sarah, 26 y/o G1P0 at 16 weeks AOG,complains of frequent palpitations, nauseaand vomiting. On PE, she has thyromegalyand mild exophthalmos.What is yourworking diagnosis, based on herpresentation? a. Hyperthyroidism b. Hypothyroidism c. Gestational Trophoblastoid d. Hyperemesis gravidarum

a. Hyperthyroidism

Sarah, 26 y/o G1P0 at 16 weeks AOG,complains of frequent palpitations, nauseaand vomiting. On PE, she has thyromegalyand mild exophthalmos. What are the expected laboratory findingsfor your initial impression on Sarah? a. Decrease TSH, elevated T4 b. Increase TSH, low free T4 c. Decrease TSH, normal free T4 d. Increase TSH, normal free T4

a. Decrease TSH, elevated T4

Sarah, 26 y/o G1P0 at 16 weeks AOG,complains of frequent palpitations, nauseaand vomiting. On PE, she has thyromegalyand mild exophthalmos. What is the treatment?

Propylthiouracil (PTU) and or Methimazole

Choanal/esophageal atresia, atypia cutis,embryopathies. Associated drug? a. Methimazole b. Iodine c. Propylthiouracil

a. Methimazole | PTU has maternal effects

Fetus become thyrotoxic: a. Withdraw all medications b. Adjust maternal thionamides c. Shift to radioactive iodine therapy d. No therapy yet. Just start after delivery

b. Adjust maternal thionamides

(Hypothyroidism) What laboratory test will you request to confirm the diagnosis? a. TSH, T3, T4 b. TSH and TBG c. TSH, fT3, and fT4

c. TSH, fT3, and fT4

Drug of Choice for Hashimoto’s thyroiditis a. PTU b. Methimazole c. Levothyroxine d. Iodine

c. Levothyroxine

Patient was unable to breastfeed. Duringdelivery, patient had uterine atony, lost alot of blood. She was infused with 2 units of whole blood. What’s the probable diagnosis? a. Cushing’s syndrome b. Addisonian crisis c. Pheochromocytoma d. Sheehan’s syndrome

d. Sheehan’s syndrome

Hormone assay normally seen in a primigravid on her 10thweek of pregnancy A. Increase HCG and increase TSH; decrease TBG and T4 B. Increase T4 and TBG; decrease TSH and HCG C. Increase T3 and T4; decrease TBG D. Increase TBG and T4; decrease TSH

D. Increase TBG and T4; decrease TSH

G1P0 7wks AOG, palpitation, easy fatiguability. Thyroid studies reveal Thyroid peroxidase Ab. Treatment prevent this complication A. Preterm birth B. Hyperparathyroid C. Tetanic seizure D. Placenta previa

A. Preterm birth

S/Sx: Nausea, vomiting, weakness, high serum calcium A. Hyperthyroidism B. Hypothyroidism C. Hyperparathyroidism D. Hypoparathyroidism

C. Hyperparathyroidism

Tetany and seizure with neonatal fractures A. Hypothyroidism B. Hyperthyroidism C. Hypoparathyroidism D. Hyperparathyroidism

C. Hypoparathyroidism

10% tumor A. Congenital Adrenal Hyperplasia B. Pheochromocytoma C. Cushing Syndrome

B. Pheochromocytoma

Idiopathic adrenal hyperplasia A. Addison's Disease B. Cushing Syndrome C. Primary Aldosteronism

C. Primary Aldosteronism

Treatment for ASB A. Amoxicillin B. Nitrofurantoin C. Ampicillin D. Aminoglycoside

B. Nitrofurantoin

OB Final Flashcards

(256 cards)