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Flashcards in Ob/Gyn APGO Deck (138)
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1

abnormal pap test results... whats the best next step in management?

colposcopy
-also do reflex HPV testing for high-risk HPV types
-if negative then do repeat testing in one year

2

whens the earliest indication to give a pt a pap smear?

21 years old regardless of coitarche

3

cervical cancer screening for women ages 30-65
-whats special about pts ages 21-24

cytology and HPV cotesting every 5 years (preferred)
or
cytology alone every 3 years (acceptable)
-no need to HPV test alone

*pts 21-24 --> considered a special population are ususally positive for HPV and end up clearing it anyways so its not worth it to test them for HPV
-do expectant management and repeat cytology alone in 12 months if a pt does test positive for HPV

4

pt with lower abdominal pain, adenexal pain/tenderness, fever, cervical motion tenderness, and vaginal discharge

pelvic inflammatory disease (usually caused by chlamydia and gonorrhea)

5

gold standard to diagnose herpes

culture: highly specific not super sensitive (false negative 10-20% of the time)
best to culture very early in course

6

how often do you screen for colon cancer in a pt with average risk

start screening at age 45-50
1. yearly hemoccult testing
2. flexible sigmoidoscopy every 5 years
3. colonoscopy every 10 years

if pt has a first degree relative with colon cancer before age 60 then screen at age 40 or 10 years before dx of their relative and repeat every 5 years

7

DEXA test

used to test for bone mineral density... specifically in women who show signs of osteoporosis prior to age 65

8

what age should annual mammograms start for women?

40

9

how much folate should you give a woman of reproductive age

daily 400 microgram supplement

note: non-high risk pts get at least 0.4mg/day
high risk pts (pts with neural tube defect in previous pregnancy) get 4mg/day

10

what are the normal physiologic changes to lung capacities during pregnancy

increases: inspiratory capacity (due to increases in tidal volume and inspiratory reserve volume)... minute ventilation also increases --> responsible for respiratory alkalosis in pregnancy

respiratory rate does not change

decreases: functional residual capacity

11

why are pregnant pts more likely to get pulmonary edema

decreased plasma osmolality

12

sickle cell anemia prevalence in black pts and how to test for it in a pregnant pt

1/500 (autosomal recessive)

carrier state is found in 1/10 blacks

*test for this and all other hemoglobinopathies via electrophoresis

13

mediterranean populations are most at risk for what

beta-thalassemia

14

ashkenazi jews are at risk for what

fanconi anemia, tay-sachs, neimen pick, cystic fibrosis (all are autosomal recessive)

15

what is the best test for trisomy 21 and 18

cell free DNA screening with a detection rate of over 99% at 0.2% false-positive rate

16

most common form of inherited mental retardation

fragile x

17

most reliable method for confirming gestational age

dating ultrasound (specifically during the first trimester)

18

what do you expect to see in a pt with pre-existing diabetes vs gestational diabetes

pre-existing --> intrauterine growth restriction

gestational diabetes --> shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios, and fetal macrosomia

19

short in duration and less intense contractions associated with pain in the lower abdomen/groin

braxton-hicks contractions

20

how will a pregnant pt with dehydration present

maternal tachycardia and ketonuria

21

why would you do a nitrazine test

confirm rupture of membranes of if a pt is unsure about leakage of fluid

22

what do you do if the pt has an umbilical cord prolapse?

immediate c-section (even if the mom and baby both seem totally fine)

23

what is the single greatest risk factor for 3rd and 4th degree lacerations

median episiotomy

24

insufficient power of contractions

< 240 Montevideo units
give ptosin if this occurs

25

type 1 diabetic... what do you expect to see with the baby

small and hypoglycemic baby

26

fetal tachycardia and minimal variability

septic infant

27

treatment for sheehan syndrome?

estrogen and progesterone replacement and supplementation with thyroid and adrenal hormones

28

what is the best positioning for breast feeding

mom and baby being belly to belly

29

how does candida of the nipple present

-sore nipples and burning thats worse with breastfeeding
-tips of nipples are pink and shiny with peeling at the periphery
-make sure to check the babies mouth for candida and treat both mom and baby

30

what are the signs that the baby is getting enough breast milk

3-4 stools in 24hrs
6 wet diapers in 24hrs
weight gain
sounds of swallowing