OB/GYN Flashcards
(47 cards)
Initial prenatal visit tests
Rh(D) type, Ab screen, Hgb/Hct, MCV, HIV, VRDL/RPR, HBsAg, reubella and varicella immunity, pap, chlamydia, urine culture, dipstick for urine protein
- influenza vaccine
Active phase arrest
no cervical change in 4 or more hours with adequate contractions (>200) or 6 or more hours with inadequate contractions
- tx with c section
secondary amenorrhea with increased FSH in a pt <40
Primary ovarian insufficiency
- accelerate ovarian follicle depletion
- leads to decreased estrogen with thin endometrium and vaginal atrophy
Fetal sinusoidal heart rate tracing is associated with
fetal anemia (ruptured vasa previa)
Risk factors for hyperemesis gravidarum
Hydatidiform mole
multifetal gestation
hx of previous hyperemesis
Post menopausal woman with endometrial cells on pap smear
Requires endometrial biopsy
increased AFP during pregnancy most commonly related to
open neural tube defects
ventral wall defects
multiple gestations
Target blood glucose levels and tx options in gestational diabetes
fasting glucose: <95
1 hour PP: <140
2 hour PP: 120
Tx: dietary modifications (first line), insulin and metformin (second line)
Management of shoulder dystocia
BE CALM
B: Breath; do not push
E: Elevate the legs and flex hips (McRoberts)
C: Call for help
A: Apply suprapubic pressure
L: enLarge vaginal opening with episiotomy
M: Maneuvers: deliver posterior arm, rotate posterior shoulder (Wood’s screw), adduct posterior shoulder (Rubin), mother on hands and knees (Gaskin), replace fetal head into pelvis for cesarean (Zavanelli)
Lady at 28 weeks gestation has high grade squamous intraepithelial lesion on pap smear. Next best step?
Immediate colposcopy
tx for preterm labor
<32 weeks: betamethasone, tocolytics (indomethacin), mag sulf, penecillin if GBS + or unknown
32-33 6/7: betamethasone, tocolytics, penecillin if GBS + or unknow
34-36 6/7: betamethasone, penecillin
Management of pregnant patient with past HSV infection
Antiviral suppression beginning at 36 weeks
- Lesions at time of delivery: C-section
- no lesions: vaginal
When is an endometrial biopsy necessary
On TVUS if endometrium in >4 mm
Next best step in management of patient with mullerian agenesis?
Renal ultrasound
- uterus comes from paramesonephric ducts
- primitive kidneys come from mesonephric ducts
When to progress to c-section during arrest of labor
if no cervical change in 4 or more hours with adequate contractions
if no cervical change in 6 or more hours with inadequate contractions
*if cervix is not progressing as fast as it should (1.2cm/hr or 1.5cm/hr) give oxytocin
58 year old female presents with glazed, brightly erythematous vulvar erosions with a border of serpentine-appearing white striae. She also has serosanguinous vaginal discharge and lace like reticular erosions on the gingiva and palate
vulvar lichen planus
Side effect of OCPs on liver
hepatic adenoma
- well demarcated hyperechoic lesion
pregnant women with bilateral dilation of renal pelvis and proximal ureters
physiologic hydronephrosis of pregnancy
- no additional management
Young male with persistent cough and dull back pain. CXR shows retroperitoneal LAD and multiple pulmonary nodules
Metastatic testicular cancer
28 year old male with left testicular mass that has increased in size. Ultrasounds shows hypoechoic, 5 cm left testicular mass
Testicular cancer
- requires radical inguinal orchiectomy for confirmation of dx and tx
- will also have elevated tumor markers: Bhcg, afp, and LDH
Second stage labor arrest
10 cm and pushing for 4 or more hours in primigravid or 3 in multiple with lack of fetal descent
- move to operative vaginal delivery
Pt is 10 days post partum and still having low back pain. She had a c-section due to failure to progress. She now has fever, weakness, and decreased sensation in her leg
epidural abscess
- needs urgent MRI
Next step if atypical glandular cells are found on pap smear
colposcopy, endocervical curettage, and endometrial biopsy
Follow up for a 29 year old after draining simple cyst
repeat breast exam in 2 months
