OBGYN Flashcards
(72 cards)
1
Q
What are the indications for use of forceps and a vacuum?
A
- Maternal exhaustion
- Prolonged 2nd stage of labor
- Fetal distress
- Inadequate maternal expulsion
- Need to avoid maternal expuslive efforts (cardiac or CNS disease)
2
Q
What are contraindications to the use of forceps or a vacuum during labor?
A
- Fetal prematuritin
- Osteogenesis imperfecta
- Fetal bleeding disease (e.g., hemophilia)
- Unengaged head
- Unknown fetal position
3
Q
Early decelerations are assoc. w/?
A
Uterine contractions (“mirror images”)
4
Q
{{BLANK}} decelerations are a result of fetal head compression
A
Early decelerations
5
Q
{{BLANK}} decelerations follow maternal contractions
A
Late decelerations
6
Q
Late decelerations are assoc. w/
A
uteroplacental insufficiency
7
Q
Early onset neonatal encephalopathy after 34 weeks of gestational age and fetal metabolic acidosis are assoc. w/?
A
Cerebral palsy
8
Q
Preterm labor versus incompetent cervix
A
- Preterm labor: regular contractions; revival effacement before 37 wks gestation
- Incompetent cervix: cervix begins to dilate & efface before pregnancy has reached term; absence of contractions
9
Q
Placental abruption versus placental previa
Both cause bleeding but which one causes pain?
A
- Placental abruption: Abnormal premature separation of normal placenta in 3rd trimester; painful
- Placental previa: Placental location close to internal cervical os in 3rd trimester; w/o pain
10
Q
What are risk factors for placental abruption?
A
- Chronic HTN
- Preeclampsia
- Multiple gestation
- Advanced maternal age
- Multiparity
- Smoking
- Choroamniotis
- Trauma
11
Q
{{BLANK}} placental tissue extends into superficial layer of myometrium
A
Placental accreta
12
Q
{{BLANK}} placental tissue extends into myometrium
A
Placental increta
13
Q
{{BLANK}} placental tissue extends completely from myometrium to serosa of uterus
A
Placental percreta
14
Q
What are you going to see if a patient in labor has uterine rupture?
A
- Vaginal bleeding, sudden pain between contractions, recession of baby in birth canal, loss of station, slowing of contractions
- Turtling
15
Q
What are the laboratory charts show in fetal demise?
A
- AFP will increase
- DHEA-S & 16-OH-DS will decline
- hCG will decline
- Urinary estriol E3 will decline within 24-48 hours
16
Q
How do you calculate an APGAR score?
A
- HR: absent/< 100/>100
- Tone: limp/mild/active
- Respiration: absent/slow/good cry
- Reflex: absent/grimace/crying or coughing
- Color: blue/blue extremities/pink
0/1/2; 7-10 good; 4-7 mild; < 4 rescucitate
17
Q
What hormones come from the posterior pituitary?
A
- Oxytocin
- ADH
18
Q
What hormones come from the anterior pituitary?
A
- GH
- TSH
- ACTH
- LH
- FSH
- Prolactin
19
Q
{{BLANK}} is poor contraction of the uterus (myometrium) following delivery of baby
A
Uterine atony
20
Q
{{BLANK}} are first line treatments of uterine atony
A
- Oxytocin
- Massaging the uterus
21
Q
If you have a patient with septic pelvic thrombophlebitis, how do you treat?
A
Heparin
22
Q
If you have a post-op patient that has unrelenting fever no mattery what is wrong with them, what do you think they have?
A
Septic pelvic thrombophlebitis
* Sequela of pelvic infection w/ residual fever & tachycardia
23
Q
What are the stages of grieving?
A
- Shock: disbelief, detachment
- Searching: guilt, hostility, empty
- Disorientation: depression
- Reorganization: gradual adjustment of loss; return to normal activity
24
Q
How do molar pregnancies present on ultrasound?
A
- cluster of grapes
- Snowstrom
- Honeycombed uterus
25
If you have a couple trying to have a baby but fail to do so, what do you check?
* Woman, if she is fertile
* Then check male
26
What is supposed to be normal on hysterosplaningography?
* Smooth symmetrical endometrial cavity
* Slender proximal tubes w/ dilation at the ends
* Constrast media easily spilling out of fimbriae
27
What are ABSOLUTE contraindications to hormonal birth control?
* Thrombophlebitis/Thromboembolic disease
* Cerebral vascular disease
* Coronary artery occlusion
* Impaired liver function or hepatic necrosis
* Known or suspected breast cancer or pregnancy
* Undiagnosed abnormal vaginal bleeding
* Smokers over 35 yo
28
What are the (2) best treatments for PCOS?
* Weight loss
* Hormonal birth control
29
What medications are given for preterm labor?
* Atobsian
* Magnesium sulfate
* Nifedipine
30
What medications induce labor?
Oxytocin analogs
31
Autonomic dysreflexia is an uncoordinated response to demands of heart and vascular tone due to a lesion below T6. This can induce **labor**. What is the treatment?
Epidural to T10
32
When is MTX repeated in the case of ectopic pregnancy?
* To ensure fetus has been aborted
* Measure hCG on day 4, if not below > 15%, continue w/ more MTX
| MTX is initiated IM x 2 doses (1 in ea. cheek)
33
What are the most common places for ectopic pregnancy?
* Fallopian tubes (esp. ampulla)
34
Absence of menses is not an issue unless?
* Pt ≥ 15 yo w/ 2° sex characteristics
* Pt is 13 ≥ w/o 2° sex characteristics
35
Why/how do you perform percutaneous umbilical cord blood sampling?
* Transabdominal needle w/ aspiration of umbilical cord
* > 20 wks
| Looking for abnormality
36
Why/How do you perform chorionic villus sampling?
* Reserved for pts w/ > 0.5% chance of abnormality
* Women > 35 yo or w/ probable genetic predisposition
* Can be done earlier (versus percutaneous umbilical cord sampling)
37
What are causes of primary amenorrhea?
* Turner syndrome 45,X (most common)
* Pregnancy
* Alterations in genital outflow tract
* Premature ovarian failure
* Hypogonadotrophic hypogonadism
* Kallman's syndrome
* Marijuana use
38
{{BLANK}} is the most common cause of primary amenorrhea
| Hint: 45, X
Turner syndrome
39
{{BLANK}} syndrome is assoc. w/ primary amenorrhea, absence of GnRH and hypoplasia of olfactory tracts
Kallman syndrome
40
Marijuana use blocks the release of {{BLANK}} so it can cause primary amenorrhea
Blocks release of GnRH
41
Why do you treat early menarche?
* Early closure of bone epiphysis
* Short stature
42
When do you give Rhogam to a pregnant patient?
* Exposure of RBCs --> anti-RBC Abs
* Rh- mother can develop Rh antibodies
* therefore, in f/u pregnancy, give rhogam
| Specifically, if < 1:8
43
{{BLANK}} can cross the placenta and cause hydrops fetalis. To prevent this, you give Rhogam
IgG
44
Macrocytic versus microcytic anemia
* **Macrocytic**: MCV > 100
* **Microcytic**: MCV < 80
45
How is hypothyroidism treated in pregnancy?
Increase the dose of levothyroxine
46
How is hyperthyroidism treated in pregnancy?
* 1st trimester: PTU
* 2nd/3rd: MMI
47
HbS trait is assoc. w/ increased {{BLANK}} during pregnancy
UTI
48
Explain the difference regarding dichorionic/diamniotic, monochorionic/diamniotic, and monochorionic/monamniotic.
* **Dichorionic/Diamniotic**: 2 distinct amniotic cavities w/ their own placenta & chorionic sac
* **Monochorionic/Diamniotic**: Identical twins who each share a placenta but not chorionic sac
* **Monochorionic/Monamniotic**: Identical twins who share placenta & amniotic sacs (separate umbilical cords)
49
What measurements do you suspect in a fetus with IUGR?
* Fundal height ≤ 4 cm
* Fetus est. weight < 10th percentile for age
* Fetus abdominal circumference < 2.5 percentile for age
* Birth weight for IUGR is < 2.5 kg
50
What qualifies as macrosomnia?
* Fetus > 90% percentile at gestational age
* Weights > 4 kg
51
How long does Rhogam last? When do you give it?
* T1/2 ~16 days
* within 72-hours post-delivery
52
Symmetric IUGR versus Asymmetric
* **Symmetric**: early onset, decreased cell #; irreversible diminution of organ size & function; BPD/HC small & HC/AC normal (
* **Asymmetric**: late onset; decrease cell size; amenable to adequate nutrition; BPD/HC normal & HC/AC increased
53
1st & 2nd line Tx fr post-partum hemorrhage?
* 1st: massage
* 2nd: oxytocin analog
54
If a patient comes in Hx of fetal demise & O- blood type. What do you give?
Rhogam
55
If a patient comes in full-term after MVC and have a port-wine vaginal bleeding. Both her & the baby are O-. Do you need to use Rhogam?
No
56
If a patient comes in w/ low fundal height, what in her hx would cause IUGR?
HTN
57
What are the maternal factors that increase IUGR?
* Preeclampsia
* Eclampsia
* Smoking
* Malnurishment
* Connective tissue dx
| Fibroids are NOT a risk factor
58
What do you do for a patient who is 34 weeks gestation and her water broke?
Induce labor
59
Which trocolytic medicine has data that it can prevent preterm labor?
Atobisan
60
When does the splitting of monozygotic twins occur?
Within 0-3 days
61
What are the complications of increased risk w/ twins/triplets?
* High incidence of congenital malformations
* Higher risk of miscarriage
* Increased risk of IUGR
* Higher risk of pre-eclampsia
* Higher risk of placental or umbilical cord issues
62
{{BLANK}} is the removal of the uterus
Hysterectomy
63
{{BLANK}} placement of occlusive device in tubal ostia bilaterally
Hysteroscopy
64
{{BLANK}} is the surgical cutting of vas deferens
Vasectomy
65
What is the best choice for teenagers who have never had a baby and may not remember to take pill everyday?
* Implant in arm
* Nuvaring
* Dep-provera
66
What is the MOA of clomiphene?
Binds to ERs in hypothalamus & increases FSH production
67
Why do you perform a semen analysis?
40% of infertility cases are due to defects in spermatogenesis
68
What are cardiac problems that it is okay for them to get pregnant?
* Septal defect
* PDA
* mild mitral & aortic valve disorders
* Grades 1/2 CHF
69
What are the cardiac problems that it is NOT okay to get pregnant?
* Primary PHTN
* Tetralogy of Fallot
* Eisenmenger syndrome
* Marfan syndrome w/ aortic root dilation
* Grades 3/4 CHF
70
If a pregnant patient comes in w/ flank pain, what do you worry about?
Pyelonephritis or kidney stone
71
{{BLANK}} deficiency is more common in people w/ multiple gestations & people taking phenytoin.
| Def. = increased risk of neural tube defects
Folate deficiencies
72
