OB/Gyn Flashcards by alias last name

tx of ectopic >3.5cm?

> 3.5cm: laproscopic

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mc tocolytic

MgSO4 (not just used for preeclampsia)

tocolytics slow progression of cervical dilation and contraction

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first sign of pregnancy

Goodell sign

cervical softening, around 4 wks

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Virchow’s triad elements occur in pregnancy. What are they?

Venous stasis
endothelial injury
hypercoaguability

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Term lengths

Preterm: 25-37 weeks
Term: 38-42
Postterm: after 42weeks

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Nagele rule for estimated day of delivery

LMP - 3mo + 7 days = estimated delivery day

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mc site for ectopic pregnancy specifically?

ampulla of the fallopian tube

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methotrexate MOA?

it is a folate receptor antagonist

can be used on ectopic preg

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how do you know methotrexate is knocking out that ectopic preg?

Want to see a 15% decrease in bHCG in 4-7d

follow every week until bHCG levels are 0

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granulosa cell tumor

ovarian solid tumor, malignant
produced excess estrogen
see: precocious puberty, or postmeno bleeding (bimodal age distribution)

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missed vs threatened abortion

missed: nonviable fetus
threatened: viable fetus

do: fetal heart tones, pelvic exam (asses cervix, fluids), then US
(i picked bHCG over US; wrong)

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HELLP syndrome

Hemolysis (schistocytes, etc)
Elevated Liver enzymes
Low platelets

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elevated alk phos in pregnant woman

normal

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preg pt with HELLP syndrome has pitting LE edema, rales , and oliguria. What is happening?

pulmonary edema (a rare complication of preeclampsia) (HELLP is a variant of preeclampsia)

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tx for magnesium toxicity?

obvi stop mag

then give calcium gluconate

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gestational HTN is when?

only after 20wk gestation!

After diet and excercise, what 3 treatments are safe for gestational DM?

insulin
metformin
glyburide

placenta previa vs vasa previa antepartum hemorrhage

both cause painless vaginal bleeding upon ROM; however, vasa previa you see rapid fetal distress

What are the 5 elements of the Biophysical Profile?

Nonstress test
Fetal chest expansions (1+ in 30min)
Fetal movement (3+ in 30min)
Fetal muscle tone (1 flex)
Amniotic fluid

Fetal tachycardia

> 160bpm

What is the nonstress tests?

external fetal HR monitoring for ~30 min
good results: > or = 2 accelerations
bad: multiple variable or late decels

External cephalic version

can be done between 37weeks - labor
to turn breech baby around
CI: placental abnormalities, oligohydramnios, multiple gestation

Meconium aspiration syndrome looks like? assc with? at risk for?

see low APGARs, resp distress, and CXR with patchy b/l infiltrates

associated with advanced gestational age

at risk for persistent pulm HTN

Testing at first prenatal visit? (8 things)

CBC
ABO &amp; Rh status
Hep B 
Syphilis
Rubella 
HIV
UA 
Gonorrhea
Chlamydia

itchy white plaques in the anogenital region

(vulvular) lichen sclerosis tx: topical steroids, or tacrolimus (calcineurin inhib) if steroids aren't enough dx: biopsy at risk for developing squamous cell CA biopsy to tell this from Paget's disease. tx for Pagets is b/l vulvectomy

post partum hemorrhage

needs to be >500mL of blood (can be up to 6 wk later) do: 1. examine the uterus for rupture, retained stuff 2. compression and massage 3. administer uterotonic agents (oxytocin, methylergonovine, caraboprost tromethamine(this is a PGF2a analog))

Avoid these drugs in pregnancy

ACEi valproic acid, carbamazepine, Li warfarin aminoglycosides, tetracyclines, fluoroquinolones, TMP-SMX

Non-cancerous condition where the endometrium invades the myometrium

Adenomyosis uterus feels boggy on exam dx&tx: hysterectomy

Drugs to tx prolactinoma

1.Bromocriptine 2. Cabergoline these are dopamine receptor agonists. Dopamine inhibits prolactin release (note: in order to treat with drugs, needs to not be causing visual disturbances)

intraurterine adhesions

Asherman's syndrome | secondary to D&C

mc site for ureteral injury after a hysterectomy?

cardinal ligament it attaches the cervix to the pelvic wall and houses the uterine arteries The ureter run just lateral and below the uterine arteries "water under the bridge"

assessment of amenorrhea:

1. bHCG preg test 2. TFT 3. prolactin levels 4. progestin challenge test

What is a cerclage?

Stitches to hold in place an incompetent cervix | ex: a patient who had several abortions in their youth is now ready for a serious pregnancy

Third trimester testing (5)

1. 27wk CBC (did this at visit 1, Hg less than 11, give PO Fe) 2. 24-28 do glucose load 3/4. 36wk: Chlamydia, gonorrhea testing 5. Group B strep rectovaginal swab

motile flagellates on saline wet mount is? tx?

trichomonas | tx pt AND partner with metronidazole

mild vs. severe preeclampsia?

mild: BP more than 140/90, 24H protein of more than 300mg severe: more than 160/110, 24H protein of more than 5g