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OB OME Flashcards

(60 cards)

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1
Q

Define and treat chronic htn in pregnancy

A

^140/^90 before 20 wks gestation

Tx alphamethyldopa
Can consider hydralazine and labetalol

((Avoid typical thiazide diuretics, acei’s, arb’s, ccb’s - teratogenic))

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2
Q

Define and manage mild preeclampsia

A

^140/^90 after 20 wks gestation
^300mg/dL proteinuria

Mag and deliver if ^36 wks
Wait and allow dev/growth if v36 wks

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3
Q

Define and manage severe preeclampsia

A

^140/^90 after 20 wks gestation
^5Gg/dL proteinuria
With sx (abdominal pain, headache, visual changes, ankle edema)

Mag and deliver emergently

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4
Q

Treat eclampsia

A

Stabilize seizure with mag

Emergent delivery

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5
Q

Treat HELLP

A

Emergent delivery

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6
Q

Epigastric pain in pregnancy

Think

A

Gerd (common)

Eclampsia HELLP Preeclampsia (Life-threatening)

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7
Q

tf

14 wk preggy htn to 145/95 first time recognized in office, treat?

A

F
To dx and tx htn, need 2 separate readings from 2 separste locations at least 2 weeks apart

So f/u 2 weeks for remeasurement
Can consider alphamethyldopa then

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8
Q

Most common cause of bilateral ankle edema in pregnancy

A

Vena cava compression

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9
Q

Signs of magnesium toxicity (eg to look for in mag check in preeclamptic preggy)

Mag mechanism
Treat toxicity

A

Hyporreflexia first
Respiratory depression next
Death

Mag blocks nmda channels, countering calcium flux
So give calcium carbonate to reverse toxicity

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10
Q

Route of mag administration for eclampsia

A

IV

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11
Q

Severe features of preeclampsia

A 
BP ^160/110
Thrombocytopenia v100
AST and ALT elevated x2 uln
Cr ^1.1 renal insufficiency
Pulmonary edema
New onset cerebral or visual disturbances
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12
Q

tf

Eclampsia always requires c-section

A

F

Not always – can induce labor as long as mom amd baby are stable

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13
Q

Quad screen for downs

A

HCG and Inhibin A UP

msAFP and Estriol DOWN

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14
Q

Quad screen for edwards

A

HCG and Inhibin A DOWN
msAFP and Estriol DOWN

Edward is down for everything

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15
Q

Inhibin A in triple screen

A

Inhibin A

Up in downs
Down in edwards
Variable in patau

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16
Q

Most common cause of elevated maternal serum AFP

Other causes

A

Mis-estimated gestational age

Neural tube defects
Abdominal wall defects
Multiple gestation

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17
Q

Elevated msAFP on prenatal screen

Next steps

A

Ultrasound to rule out mis-estimated geststional age

Chorionic villus sampling
Or Amniocentesis
To assess for chromosomal abnorm or ntd

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18
Q

Amniocentesis vs chorionic villus sampling

A

Both can be done after triple/quadruple screen and nuchal translucency ultrasound suggest a trisomy

Chorionic villus sampling can be done after 12wks to inform a 1st trimester abortion, higher risk to fetus

Amniocentesis can be done after 16wks to inform an early 2nd trimester abortion, lower risk than chorionic villus sampling

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19
Q

Percutaneus umbilical blood sampling

A

Done after fetal transcranial ultrasound to assess anemia and transfuse baby

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20
Q

Follow up a decreased nuchal translucency ultrasound

A

Chorionic villus sampling if ^12wks

Amniocentesis if ^16 wks

If clinical use eg elective termination or risk planning

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21
Q

cfDNA screens for

A

Downs
Rh mismatch
Sex determination maybe

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22
Q

Sheehan’s syndrome
Pres
Pathophys
Etiology

A

Vague symptoms of lethargy, weight gain, fatigue
Orthostasis, thinning hair, delayed dtr’s… weeks-months after giving birth

Panhypopituitarism
no ACTH driving Cortisol
no TSH driving T4
Lack of LH FSH and GH not as symptomatic with contributions to fatigue and amenorrhea

Ischemic necrosis of pituitary with INTRAPARTUM BLEED or POST-PARTUM HEMORRHAGE

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23
Q

Symptoms of panhypopituitarism

A

Vague symptoms of lethargy, weight gain, fatigue
Orthostasis, thinning hair, delayed dtr’s, amenorrhea

no ACTH driving Cortisol
no TSH driving T4
Lack of LH FSH and GH not as symptomatic with contributions to fatigue and amenorrhea

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24
Q 
No-Drugs teratogenic list in pregnancy
CV drugs
Psyche drugs
Abx
Neuro drugs
Acne drugs
Antineoplastic/immunosuppressives
A 
CV - ACEI's and ARBs
Psyche - Lithium
Abx - Tetracyclines eg Doxy
Neuro - antiepilepticS espec phenytoin
Acne drugs - Isoretinoin Vit A
Antineo/immunosup - Thalidomide, MTX
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25
Why do levothyroxine levels need to be increased for hypothyroid pt who gets pregnant?
Prenancy increases thyroglobin... which binds T4 keeping it reserved but inactive And probably need increases... that is why the increase in thyroglobin? Helps the euthyroid mama keep up with demand?
26
Major side effect of Valproate Lithium Escitalopram
Valproate - liver tox and blood disorders Lithium - renal tox Escitalopram - serotonin syndrome (ssri)
27
How does Quetiapine cause amenorrhea and galactorrhea
Atypical antipsychotic Can cause promactinemia Has antidopaminergic action Block dopamine, release prolactin
28
TF | Gentamycin amd ciprofloxacin are contraindicated in pregnancy
T
29
What happens to TSH Total T4 and free T4 in a normalpregnancy
TSH and free T4 normal High Total T4 because estrogen induced increased thyroglobulin
30
Treat UTI in preggy with ___ not ___
Nitrofurantoin (Macrobid) Not TMP-SMX (Bactrim) -- contraindicated in pregnancy
31
TF RPR and VDRL are specific for treponemes How to follow up a positive
F Can be positive with inflammation of other sorts eg lupus So if screen positive with one of these, usually follow-up with a treponeme specific test like fta-abs, microhemagglutination, enzyme immunoassay, chemiluminescence assay, darkfield microscopu
32
How to act on fetal bradycardia after paracervical block with lidocaine
Watch and wait -- brady will be temporary...
33
When to do c-section vs vacuum/forceps for arrest of active labor with adequate contractions
C-section if stuck at 0 station Vac/forceps if stuck at +1 or +2
34
How does accidental subdural anesthetic present
Like shock -- subdural can travel up and down spine, causing sympathetic block and diaphragmatic block -- hypotension, compensatory tachycardia, tachypnea but shallow with accessory muscles from diaphragmatic block, sob, tingling in distal extremities
35
IUD vs BTL for contraception?
Prefer IUD... non-invasive, 5 year protection but reversible of desired, less risk of regret, surgical scarring, ectopic
36
OCPs increase risk of Decrease risk of
Increase vasculopathy -DVT most significantly, also HTN, DM, hypertriglyceridemia Decrease Ovarian cancer (less cyst eruption) Endometrial cancer (less inflammation) Benign breast disease
37
Emergency contraception can be used within how long of unprotected sex
120hrs 5 days
38
Plan B generic Mechanism Not effective if
Levonorgestrel (progestin) Prevent ovulation and implantation (negative feedback on LH FSH, thickens cervical mucus, alters endometrium) Not effective if implantation had already occured
39
Breast feeding mom who is married wants temporary contraception
``` Mini pill (progestin) Breast feeding - does not impact milk production Married - does not need sti protection Wants more kids - temporary ``` IUD (progestin) could also be a reasonable amswer for 5 years contraception, can be placed before discharge or at first post-partum visit
40
Which female hormone negatively impacts breast milk production
Estrogen
41
p only vs ep pill timing strictness
p only needs strict on the hour daily timing ep is more forgiving/lax
42
TF | Femal condom/diaphragm protects against STI's
T | Barrier and Sperimicidal agent coating
43
Tests to work up secondary amenorrhea, in order
UPT TSH PRL FSH
44
How does prolactin cause amenorrhea
Inhibits GnRH release
45
Savage syndrome aka pathophys presentation
aka resistant ovary syndrome ovaries good to go with follicles intact but do not respond to FSH and LH which are elevated for this reason Woman too young for menopausal symptoms abated with estrogen/OCP
46
resistant ovary syndrome aka pathophys presentation
Savage syndrome ovaries good to go with follicles intact but do not respond to FSH and LH which are elevated for this reason Woman too young for menopausal symptoms abated with estrogen/OCP
47
why does PCOS bleed with progestin challenge
because anovulation and constant estrogen leave endometrium constantly growing... finally sloughed with exogenous progestin
48
TF | can see ovarian follicles on US in premature ovarian failure
F | no follicles
49
how does premature ovarian failure present differently from savage/resistant ovary syndrome
same early menopausal symptoms but follicles not present on ultrasound in premature ovarian failure
50
TF | side effects of oral contraception include premature ovarian failure
F | think more DVT or weight gain
51
LH:FSH level in PCOS LH:FSH level in menopause
PCOS 3:1 | menopause 1:3
52
what does clomiphene do
induces ovulation eg in PCOS
53
scant vaginal fluid that is acidic and easily fractrures, classic for what phase of menstruation
early follicular
54
vaginal fluid descriptions early follicular ovulatory mid luteal late luteal
early follicular - scant, acidic, easily fractrures ovulatory - thin, stretches to 6cm, ferns, higher pH mid luteal - thickened with less stretch late luteal - thickened with less stretch (built to keep foreign bodies out unless ovulating
55
TF | in vitro fertilization or artificial insemination can be used when "uterus is inhospitible to sperm+
T just need to bypass inhospitable cervical secretions in vitro or artificial insem can work as long as axis is working...
56
Suspect PCOS, next test to dx
LH:FSH ratio ^3:1 Hint ultrasound is not a necessary or sufficient part of the diagnosis
57
PCOS at risk for what cancer
Endometrial (No ovulation, no luteal/progesterone phase, unregulated estrogen (turned to testosterone peripherally) and unregulated endometrial growth
58
When to get dexa for menopause
Age 65 Or earlier if risk factors for osteoporosid
59
``` Role of venlafaxine in menopause Drug class Mechanism in menopause ```
Treat hot flashes snri No one knows mechanism for this use
60
What is AMH anti-mullerian hormone a sign of
Marker for primordial ovarian follicles / ovarian reserve

OB/GYN (5 decks)

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