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Ob/gyn Flashcards

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1
Q

Guide for abnormal fetal heart tracings. VEAL CHOP

A

Variable decels, early decels, accelerations, late decels

(Cord compression/prolapse; oligohydroamnios), head compression, Ok/normal, placental insufficiency

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2
Q

In what phase of menstrual cycle in the mucus, abundant, basic pH, clear, and stretchy?

A

In the ovulatory phase. Think evolutionarily, this allows for a friendly environment for sperm.
In all other phases, the mucus is acidic (

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3
Q

little vulva inflammatio. thin, off-white malodorous (fishy) vaginal discharge. pH>4.5

A

bacterial vaginiosis. Caused by Gardenerella vaginialis. You see clue cells. treat with metronidazole

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4
Q

yellow-green, malodours, thin, frothy and purulent vaginal discharge. Severe vulva inflammation
pH >4.5

A

Trichomonas vaginitis. You see highly motile pear shaped organisms. treat with metronidazole

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5
Q

Cottage cheesy vaginal discharge. Significant vulva inflammation. Normal pH

A

Candida vulvovaginitis

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6
Q

Hyperemesis gravida definition and treatment

A

Persistent vomiting, acute starvation (large ketouria and weight loss of at least 5%). Must first rule out molar pregnancy with US + b hCg. Treat by Vit B6, doxylamine (antihistamine for mild) or promethazine or dimenhydrinate. Support with IV if dehydrated and unable to PO.

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7
Q

7 Ws of post partum fever

A

Same as other 5 + weaning (mastitis, engorgement) and womb

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8
Q

Treatment for postpartum endometritis

A

Broad coverage. Clindamycin and gentamicin. Due to polymicrobial.
Chorioamniotis is amp gent.

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9
Q

Pseudocyesis

A

Seen in women with a strong desire for pregnancy. Present with amenorrhea, breast enlargement, abdominal enlargement but empty uterus on US and neg office pregnancy test

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10
Q

21 hydroxylase deficiency

A

Most severe classic form of CAH. Presents as new born femal with ambitious genitalia and life threatening salt wasting.
17 hydroxyprogesterone will be elevated

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11
Q

11 b-hydroxylase deficency

A

Less common cause of CAH

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12
Q

Elevated DHEAS

A

Suggests adrenal source

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13
Q

Normal female phenotype, normal ovaries, abnormal vagina and absent uterus precluding menstruation is consistent with.

A

Mullerian agenesis

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14
Q

Contraindication to Raloxifene

A

Venous thromboembolism
Raloxifene is a selective estrogen receptor modulator (SERM) that increases bone mineral density and is used to prevent osteoporosis

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15
Q

Amber one cause of postpartum hemorrhage

A

Uterine atony

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16
Q

At what beta hCG level and gestational age should a one see an interuterine growth on ultrasound

A

Five weeks gestational age or better hCG 1500

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17
Q

Treatment for urinary retention after epidural anesthesia with a post void residual greater than 500

A

Indwelling catheter allow decompression and recovery

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18
Q

Acceptable antihypertensives in pregnancy

A

Preferred: hydralazine, labetalol (Particularly in hypertensive crisis or preeclampsia)
First line:Methyldopa, hydralazine, beta blockers (labetalol), calcium channel blocker’s (Amlodipine)
Second line: clonidine, thiazides .

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19
Q

Contraindicated antihypertensives in pregnancy

A

ACEi/ARB, Lasix, Aldosterone blockers, direct renin inhibitor

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20
Q

Vasa previa versus placenta previa

A

Bleeding after rupture of membrane can be seen both however the baby does not experienced rapid deterioration after placenta previa.

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21
Q

kleihauer betke test or apt test

A

Differentiates Fetalfrom maternal blood

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22
Q

Early decelerations signify

A

Head compression. Can be normal

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23
Q

Late decelerations signify

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A

Uteroplacetal insufficiency, Fetal hypoxia, fetal acidosis

24
Q

Variable decelerations signify

Study These Flashcards
A

Cord compression
Oligohydroamnios
Cord prolapse

25
Amsel criteria for diagnosis of bacterial vaginosis
Whitish grey discharge pH >4.5 Positive whiff test with addition of amine to discharge Clue cells
26
Severe postpartum hemorrhage and inability to lactate several days after delivery
Sheenan syndrome | Pituitary hypoperfusion leading to anterior pituitary infarction
27
Women taking metronidazole should avoid
alcohol because it is a disulfiram like reaction
28
How do you edit levothyroxin in pregnancy
You must increase the dose | Total T3 and T4 are elevated in pregnancy because of an increase in thyroid binding globulin levels
29
Small teardrop like growths the results with trichloroacetic acid
HPV associated genital warts
30
What form of birth control is associated with weight gain
MeDoxyprogesterone is associated with increased body fat and reduce lean muscle which can lead to weight gain
31
Cause of symmetric growth restriction
Growth lag begins at the first or second trimester (before at 28 weeks gestation) do to fetal factors. These include chromosomal abnormalities congenital infections (toxoplasmosis, cytomegalovirus, rubella, malaria) and congenital anomalies (cardiac Abnormalities, Gastroschisis)
32
Causes of asymmetric growth restriction
Usually due to sub optimal maternal factors such as vascular insults from things such as hypertension, diabetes mellitus, preeclampsia, cigarette smoking, drug use
33
What stage of the menstrual cycle is the cervical mucus clear profuse and thin
Ovulatory phase. This is in contrast to the mucus of pre-and post ovulatory phase which are scant, opaque and thick
34
Folate supplementation in pregnancy
0.4 mg/day | Or 4 mg/day in people with a history of neural tube defects
35
Screening at 9-14 weeks
PAPP-a + Michael transparency + free b-hCG +/- CVS | (PAPP-A can be done before CVS and can be good for the diagnosis of
36
15-22 weeks screening
Maternal serum a-fetoprotein MSAFP or quad screen (AFP, estriol, b-hCG, and Inhibin A) +/- amniocentesis
37
Trisomy 18 vs trisomy 21
All 4 are reduced in trisomy 18 | Trisomy : Inhibin A and b-hcg are increased ; MSAFP and estriol are decreased
38
How to assess lung maturity
Lecithin:sphingomyelin > 2.5 | Or presence of phosphatidylglycerol in the 3rd trimester
39
Intracranial calcifications, chorioretinitis, hydrocephalus, ring enhancing lesions on MRI
Congenital toxoplasmosis Avoid cat feces during pregnancy Treat with pyrite thiamine +sulfadiazine
40
Blueberry muffin rash, cataracts, hearing loss, patent ductus arteriosus
Congenital rubella | Immunize prior to pregnancy. Cannot be nice during pregnancy because it's a live vaccine
41
Peri ventricular calcifications, petechia rash
Congenital CMV. | Treat with postpartum ganciclovir
42
Maculopapular skin rash, hepatomegaly, sniffles ( mucho purulent Rhinitis), saber shins, saddle nose
Congenital syphilis | Treated with penicillin
43
Elective termination of pregnancy in the first trimester
49 days : oral mifepristone + oral/vaginal misoprostol; IM/oral methotrexate +oral/vaginal misoprostol 59 days: vaginal or sublingual or buccal misoprostol Surgical management up to 13 weeks
44
Elective termination of pregnancy in second trimester
13-24 wks : induction of labor or D&E
45
Timing of first stage of labor
Latent: onset to 3-4 cm dilation Active: 4cm to complete cervical dilation: four hours with adequate contractions or six hours without adequate contractions
46
Second stage of labor
Complete cervical dilation to delivery of infant | .5 to 3 hours
47
Third stage of labor
Delivery of the infants to delivery of placenta | 0-0.5 hrs
48
What should you not do if you expect rupture of membranes
Do not do a digital exam instead do a sterile speculum exam
49
What nerve is responsible for pain during childbirth
Uterine contractions and cervical dilation result in visceral pain T 10 to L1 Descent of the fetal head and pressure on the vagina and Perineum result in somatic pain (pudendal nerve, S2 to S4)
50
Contra indications to regional anesthesia during childbirth
Hypotension, maternal coagulatopathy, use of low molecular weight heparin, maternal bacteremia, skin infection over site of needle placement, increased intracranial pressure
51
Clothes of hyperemesis gravidarum
If morning sickness persists after the first trimester. Persistent vomiting, acute starvation (usually large ketouria), weight loss (at least 5% decrease in body weight) The first step is to rule out molar pregnancy with ultrasound
52
Treatment for hyperemesis gravidrum
Vit B6, antiemetics
53
Work up for pelvic mass in post menopausal woman
Pelvic ultrasound and CA125 (only marker that is useful)
54
What constitutes severe features of preeclampsia
``` Blood pressure above 160 thrombocytopenia less than 100,000 renal dysfunction: creatinine greater than 1.1 Elevated transaminases Pulmonary edema Neurological signs ```
55
Relationship between thyroid hormone and prolactin
TRH stimulate prolactin
56
OCPs and hypertension
OCPs can sometimes worsen and hypertension
57
Testing for CIN 1 by age
21-24 : usually regresses; repeat in one year 25-29: should have colpo and biopsy >30: should be tested for HPV (16 and 18). If negative then cytology plus HPv testing in a year is preferred; if positive or hpv status unknown then perform colpo and biopsy

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