OB/gyn Flashcards by Molly Thayer

how do you manage GBS in pregnant women with history of previous GBS+ pregnancy?

prophylactic IV penacillin

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when do you give anti-D Ig?

screen at 24-28 weeks –> if negative, give at 28 weeks and within 72 hours of delivery of Rh+ baby

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rubella in pregnancy

rash the spreads face down, spares palms and soles
postauricular LAD
arthralgias

**sx tx after 18 weeks

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risks for endometritis? treatment?

prolonged labor and/or C section after onset of labor

tx with IV clinda/gent (polymicrobial infx)

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t/f: active maternal HSV infx is an indication for csection?

yes

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approach to meconium ileus?

gastrograffin enema= diagnostic and therapuetic

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signs/sx of chorio?

maternal tachy
WBC >15k
uterine tenderness
malodorous discharge
fetal tach >150

***give IV amp/gent and deliver!

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c section or NSVD in chorio?

csection if hemodynamically unstable or other pathology

add CLINDA to amp/gent

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nerve injury moms at risk for (especially from prolonged labor)

common peroneal –> footdrop

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hepatic adenoma vs focal nodular hyperplasia on imaging

FNH has stella scar (central area of fibrosis)
-FNH is less risk of bleeding than Hepatic adenoma

-If on OCPs and hepatic adenoma found, you should dc OCP

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cut off ages for HPV vax?

girls <26

boys <21

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character of variable decels?

differ in amplitude, duration and form

**indication of cord compression –> reposition and administer O2 —> amnioinfusoin if previous attemps are unsuccessful

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hyperkeratotic exophytic papules that turn white with acetic acid?

HPV

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vaginismus

severe pain/ anticipatroy anxiety on insertion of anything into the vagina

if complaints are due to pain: pelvic floor PT
if complaints are due to anxiety and stress: sex psychotherapy

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preterm infants exclusively breast fed are at greater risk for….

Fe deficiency anemia

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how does clomiphene induce ovulation?

SERM –>blocks hypothalamic endogenous estrogen receptors therefore blocking negative feedback inhibition –> this increases pulsatory GnRH –> inc FSH/LH –> ovulation

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tx for ectopic (After its out)// contraindications

methotrexate –> check after 7 days, expect to see >15% drop in Hcg

CI:

immunodeficiency
non compliant patients
hepatotoxicity
ectopic > 3.5 cm (high failure rate)
fetal heart beat (high failure rate)

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HPO immaturity

cycles in girl with recent menarche that are heavy and occur >45 days apart

*lack progesterone signal

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non stress test

20 minutes on the montior looking for >2 accels for at least 15 seconds

-indicated after 32 weeks in high risk pregnancies or when mom stops feeling movement

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3 D’s of entrometriosis

dsymennorrhea
dysperuenia
dyschezia (painful poops)

*rectovaginal nodularity in the posterior cul-de-sac

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management of stable PPROM < 35 weeks

steroids
antibiotics
mag if <32 weeks
delivery

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BP lowering meds for preE

IV hydral
IV labetalol –> look at HR
PO nifedipine –> is patient able to take PO?

*methyldopa is for chronic HTN

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treating syphillis in pregnancy with reported hx of allergy?

there are no alternatives. Do a skin test. Do a sensitization if you need to.

(if someone is not pregnant, you can use IV ceftriaxone)

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how to treat vulvovaginal candadiasis

pregnant= intravaginal clomitrazole

not pregnant= oral fluconazole

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- clue cells = epithelial cells covered in coccobacili (gram indeterminate) - alkali pH - treat with oral metro

when to use FNA vs core needle in breast mass?

FNA is not definitive, jsut shows abnormal cells. Use this to evaluate non suspicious cystic lesions in women under 30 Core needle used in suspicious mass in older women

up until what age do you screen for GC/CT?

physiologic nipple discharge

BILATERAL, can be milky or greenish, in young women with normal endo fx is physiological. Avoid nipple stimulation

large, rapidly growing breast mass, that appears sharply demarcated from normal tissue on imaging?

phyllodes --> benign! however, treat like a cancer because they can rarely become malignant

distinguish pagets of the breast from inflammatory breast CA?

paget's generally involves/ is limited to the areola

how to treat breast cancer in pregnancy

chemo can be given after the first tri?

trich

pH> 4.5 burning with urination strawberry cervix

5a-reductase deficiency

X,Y but maintain female external genitalia because they lack testosterone to convert from default -increasing levels of T at puberty cause adrenarche and virilization but no secondary sex characteristics

aromatase deficiency

``` ambiguous genitalia at birth -decrease est, increased T ---> virilization of mom during pregnancy as androgens cross placenta tall stature osteoporosis ```

function of aromatase

converst androgens to estrogens

endometrial tissue within the uterine wall. associated with pelvic pain in a woman closer to menopause

adenmyosis **uniformly enlarged uterus but assymetrical thickening, wahtever that means

what factor, generally, has greatest impact on prognosis of breast cancer

nodal status

endometrial thickness >5mm, with no atypia, in postmenopausal woman?

endometrial hyperplasia - risk: estrogen replacement without P, obesity, PCOS * ***at risk for malignant transformation - tx= progestin

endmetrial hyperplasia with atypia, tx?

hyst +bso

confirmation of fat necrosis of the breast?

oil cysts | multinucleated giant cells

approach to primary dysmennorrhea

nsaids | OCPs

mastitis

caused by over production of milk or insufficient drainage --> staph infection - occurs 2-4 weeks after birth - tx with a pcn of sorts and continue breast feeding

linchen sclerosis

- vaginal pruritis in post menopausal women - figure 8 pattern - do punch to r/o SCC - treat with high dose steroids

GnRH ago 3 months before definitive surgery for leiyomyomas

decreases size, decreases surgical time/ complications | -decreases dysmennorrhea/mennorhagia in the mean time

first line tx for PMDD

SSRIs | should also advise to stop smoking

pharmacological tx of acute AUB in hemodynamically stable patient

high dose conjugated estrogen therapy --> triggers rapid growth of endometrium, stops bleeding from endometrial surface

age of endometrial cancer

>45 | >35 with risk factors (ie obesity, nulliparity)

t/f: isolated precocious adrenarche in an obese (probably african america feamle) can be caused by insulin resistance?

true. It's a complicated mechanism that bascially leads to increased free T

most common vaginal forein body in a young girl and easy office procedure to get it out?

TP --> warm saline irrigation

how to manage delivery in HIV positive mom

cART during pregnancy, C/S, zidovudine for baby at birth for prophylaxis PEP brings vert transmission risk down to ~2%

contraindication to breast feeding:

MOM - maternal HIV - active TB - drug abuse (MARIJUANA!) - meds: tetracyclines, chemo, chloramphenicol BABY -active galactosemia

quickie on physiologic change in pregnancy: - acid base? - hgb? - renal fx?

acid base= chronic compensated respiratory alkalosis (bicarb will be up) hgb= dec by 2mg/dL due to increase in plasma volume by 40-50% renal= 50% decrease in GFR due to inc blood flow= increase filtration --> dec Cr, BUN, uric acid

oral glucose challnege should occur when?

24 weeks (24-28)

risk factors for intrauterine hypoxia? sequelae of this in baby?

- maternal smoking, MGD, SGA, LGA | - polycythemia

safe managment of preE with severe features

if stable, >34 weeks, induce labor. Vaginal > CS if stable <34 weeks, give IV mag, steroids and BP meds

you admin IV Mag to prevent progression of pre-E, and then patient looses DTRs. What do you do?

d/c Mag and start Ca-gluc. loss of reflexes is earliest sign of Mg toxicity

what is the CONFIRMATORY test for Downs?

chorionic villous sampling, between 10-15 weeks. amnio at 15-17 weeks

whats a way to distinguish abruption from rupture when presentation is looking very similar?

abruption = rigid uterus with hypertonic contractions rupture= cessation of previously adequate contractions (they'll give you a hx of a previously scarred uterus)

GBS test timing?

35-37

Rh antibody testing

28-29 weeks

"chronic" hypertension in pregnancy

before 20 weeks, or persisting after 42 weeks

ruptured vasa previa

presents with antepartum hemorrhage and signs of FETAL distress/ blood loss. There will be no signs of maternal blood loss.

management of threatened abortion:

reassurance --> f/u ultra sounds --> limit physical activity/ sex ***intact IUP + closed os + intrauterine bleeding

management of APLA in pregnancy

ASA + heparin **d/c ASA in third trimester to prevent premature closure of ductus

anti epileptics in pregnancy

they are all bad, so choose one that best controls moms seizures at lowest dose possible

placental thrombosis causing abortion in first/second tri?

think APLS/ SLE --> look for prolonged PTT!

rosette test

tests for fetal/maternal hem

gestational hypertension causes:

IUGR.

hypotension and increased HR after spinal epidural?

sympathetic blockadge

incomplete abortion? management?

retained products, dilated os d/c! give abx for retained products

genetic contraindication to copper IUD?

wilson's

breast imaging modality in pt under 30?

US!

whats a good lab to check in someone presenting with menopause like sx?

TSH!!!!!!!

OB/gyn Flashcards

(73 cards)