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USMLE STEP 3 Top 1% > OBGYN > Flashcards

OBGYN Flashcards

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1
Q

Normal BP meds for preeclampsia… and which one we don’t give if emergency HTN

A

Can’t give can’t give methylpdopa as it takes a while to work. Methyldopa, hydralazine, labetalol, nifedipine

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2
Q

Eclampsia mx rules

A

Deliver is only cure
HTN control
Mg for seizure (diazepam step up)
General monitoring and fluids

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3
Q

Mg tox Tx

A

Calcium gluconate

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4
Q

Tx for preeclampsia without severe features

A

Daily aspirin

BP meds

Deliver at 37

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5
Q

Tx for preeclampsia with severe features

A

Same as without severe features. Deliver at 34 weeks though. Aim for BP less than 160… Mg for prophlx seizures. Best to c sec when it comes to it. Just more cautious than without severe features

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6
Q

Assymptomatic bacteruria Tx in pregnancy

A

3-7 days nitroF. OR Amoxiclav, ceph. No quinolone or TMPSMX. Follow up in 1 week (test to cure)

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7
Q

Tx for intrahepatic cholestasis in pregnancy

A

URSO and delivery around 37 weeks

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8
Q

Severe features in preelacmpsia?

A

Vision change, headache not caused by other things, RUQ pain, 160 or more SBP, Cr elevation, pulm edema, TCP etc.

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9
Q

RF for preeclampsia

A

Nullparity, extremes of age, twins, molar, renal issues, HTN, fam Hx

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10
Q

HbA1c above 8 in preg….. significance?

A

Invx issues wit the fetus. 8 = investigate

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11
Q

Delivery in a preg lady with DM. Considerations

A

In labour, keep normal glucose (IV insulin and glucose). Try to deliver after 32 weeks of course, but be careful of fetal demise, macrosomia etc. Poor control, fetal lung mature, macrosomia = deliver. If EFW >4500, do c sec

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12
Q

Complications to the mother…. Of gestational diabetes

A

DKA/HHS, eclampsia syndrome, macrosomia, preterm, polyhydramnios, infx, post partum hem.

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13
Q

Complications to the fetus, of gest DM

A

Small LFT side colon, macrosomia, renal and cariac issues, NTD, low calcium, PCT, high biliR, low glucose form high insulin, NRDS, birth injury

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14
Q

MX overview for gestational DM mother…. Deep breath!

A

Diet, excersize, and monitor strictly.

Regular US and surveillance.

Insulin best Tx. When deliver, give IV insulin and dextrose.

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15
Q

When to do the glucose challenge test?

A

At 24-28 weeks

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16
Q

Tx of hyperemesis Gravidarum

A

Doxylamine pyridoxine. Step up is metoclopromide, or anti H. Ondansetron is the final step…. Obvs IV fluid and correct cause

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17
Q

Elective abortions

  1. If less than 10 weeks
  2. If 10-13 weeks
  3. If second trimester
A
  1. Mi mi (mifepristone and misoprostol)
  2. Uterine aspiration or D&C
  3. Induce labour or same Sx as above
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18
Q

What is stillbirth… vs spont abortion

A

Stillbirth is after 20 weeks. Abortions are before 20 weeks.

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19
Q

Tx of:
1. Threatened abortion
2. Inevitable abortion
3. Incomplete
4. Complete

A
  1. US follow up
  2. Help deliver
  3. Manual aspiration or D and C if second trim (above 13 weeks)
  4. None
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20
Q

Still birth (dead fetus above 20 weeks). Tx above and below 24 weeks

A

D and C and induce labour respectivly

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21
Q

Spont abortion causes…. Divide based on early (first trim) and later

A

Earlier = chromosomal issues

Later - hypercoag patients, APLS, SLE, Cervicle insuff, LOOP procedure, uterine abnormalities, DM, thyroid issues, osteogenesis imperfecta type II

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22
Q

Cong INfx with perventricular calcifications

A

CMV

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23
Q

HIV in preg woman…. Rules?

A

AZT (for my pregnant ladYYY). And elective c sec if viral load above 1000. Then tx the infant with it too! No breastfeeding

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24
Q

Macrolide teratogen issue?

A

Hearing loss due to cn8 tox

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25
Cocaine does what to the uterus
Bowel atresia, heart, limb and face and GU issues. Micro ceph. Infarctions
26
When to do CVS or amnio
CVS 10-12 weeks and amnio 15-20 weeks Do if the A scan and quad screen show sus fidnings
27
My A scan??? In pregnancy
First screen for trisomy and stuff. PAPP A, HCG and nuchal trans
28
AFP high in which issues in preg
Open diseases (NTD, gastroschisis, omphalocele). Twins, wrong gest date, detail death, placenta breaks off
29
AFP low in which issues in preg
Incorrect gest date and 21/18 trisomy
30
Most accurate way to date preg
CRL as early as possible. Into second trim need to do our BPD, FL, AC instead
31
What happens to sodium in pregnant woman?
Lowers due to duration and ADH elevation
32
Resp alk or ac in pregnancy
Alk, since TV increases
33
Folic acid in preg, two rules and doses
400 micrograms…. Or 4000 micrograms (4mg) if prior NTD, on a folate depleting drug,
34
When do we swab for GBS in preg woman? And when do we give IV penicillin
We do the test at 36-38 weeks (entering birth time). If the swab is +, if any UTI + for GBS, prior child with GBS sepsis, or we do not know the status because of emergency delivery prior to testing
35
First visit of a preg woman…. What do we check
CBC, Rh status, infx check (HBV, HCV, RPR, GON, CHLAM, PPS, HIV, PAP). SCD, THAL, genetic issues if needed
36
When to start our A scan and aneuploidy screening
Around 10-22 weeks…. But near 1st-2nd trim junction
37
When do we give Rh Ig (RHOGAM)
28-30 weeks (2nd-3rd trim junction)
38
Recall we check gonorreha and chlamydia in the first visit. If there’s a high risk patient (that a lot of time to get the infx since the inital test), what do we do
TEST AGAIN! Around 34-40 weeks
39
Measures female takes. If she wants to suppress lactation
Supportive bra, avoid nipple stimulation, ice packs, NSAID. Don’t breast bind
40
Breast engorgement vs Mastitis Tx
Breast engorg: bilateral, and Managment with frequent breast feeding, compresses. NSAID if needed. Suppress lactation if needed Mastitis: usually unilateral and higher WBC.
41
Two causes of suprapubic pain after partum
Postpartum urine retention (atony of bladder). Catheterise if needed. Spont resolves usually. Can also be form pubic symphysis diathesis. Supportive Tx mainly
42
Post partum Hem: three main causes
Uterine atony, genital tract trauma, retained placenta
43
Uterine atony risk factors
Tired uterus: Long labour, oxytocin used a lot, macrosomia or polyhydramnios, twins, infx in uterus, myomas
44
45
After septic abortion or endometritis, patients gets up and downs fevers of 40 C. Patient also report abdomen/back pain in the lower area. DX Dx and Tx
Septic pelvic thrombophlebitis. Do broad spec ABX and heparin for a week.
46
Patient just given birth and now had fevers of 39, uterine tenderness and foul smelling lochia.
Post partum endometritis. Tx with empiric abx (clinda genta for eg.). Wait until fever goes down for at least 2 days
47
Sheehans patient. Even if multiple endocrine hormones are effected, which replacement, alone, may be enough for the patient
Cortisol
48
Post partum fever DDX
Endometritis, pneuma, atelectasis, UTI, DVT/PE, incision or Sx infx, breast engorgement, mastitis, drug based fever
49
Ectopic pregnancy flow chart: HCG 3600, US non Dx
Repeat HCG and US in two days
50
Ectopic pregnancy flow chart: HCG 3000, US non Dx
Repeat HCG test only….. essentially, do serial HCG until above 3500, because this is when an ectopic pregnancy can be seen
51
You have you confirmed ectopic pregnancy on US. Tx overview
MTX only, if small and unruptured. Can do salpingostomy or ectomy. If unstable, we would have gone straight for lap no matter the HCG or US ambiguity
52
Choriocarcinoma mets main location?
Lung and CNS
53
Risk factors for gest trophoblastic disease
Folate def and extremes of age
54
What ovarian issues do we see in Choriocarcinoma
Bilateral; Theca luteal cysts
55
MX overview for gest trophoblastic illness (similar for the different types, but consider Choriocarcinoma extras)
D and C Weekly hcg after, until negative Then monthly for half a year Choriocarcinoma needs methotrexate or other chemo If residueal disease: hysterectomy
56
MX overview for placatal abruption 1. Mild and preterm 2. Not mild/at term and mother stable 3. Not mild/at term and mother unstable
Mild abruption and premature: expectant managing At term or moderate to severe abruption: immediate delivery (Mother’s stale do vaginal delivery, mother in distress do C-section)
57
Mx overview for placatal previa (at birth and bleeding)
Give tocolysis and schedule c section
58
Mx of placatal previa before labour…. US finding. What is CI?
Serial US to see resolution…. If not resolving, schedule date for C sec. Give CS early(around 30 weeks) to mature lungs in case.
59
Mx of vasa previa (dx before bleeding)
Schedule c sec. Hospitalise and CS around 30 weeks, and monitor carefully until ok to deliver, or have to
60
Difference in causes of symmetrical vs asymmetrical FGR
Sym: aneuploidy, Infx, etc… more first trim issues Asym: placental insuff (head ok, rest of the body not). More second/third trim issue
61
Mx overview for FGR
US is the Dx…. Look for causes. For weekly biophysical profile, umbilical Doppler (see if placental insuff). If near to term, give CS and try to deliver. Non reassuring status on profile, deliver
62
Fetal macrosomia…. Main mx is to find cause and correct it. But the next main thing, is to know when to deliver or do c sec. What do we need to know for this?
EFW. If > 5000g, then c sec. Or >4500g if DM mother.
63
AFI (amniotic fluid index). What is concerned poly and oligo?
>24 and <8 cm resp
64
Kleihauer betke test
Done if the mum is Rh negative and we confirmed the baby is Rh positive. This test is done to see how much rhogam we need to give to the mum (how many abs is she producing)
65
Procedures and issues which constitute the woman getting a dose of rhogam (if she Rh negative or unknown)
Amnio, abruption or previa, any vag bleeding, ectopic. Recall…. They all get it at 28 weeks anyway. And at birth if they confirm the baby is Rh positive.
66
Tx of haemolytic disease of the newborn (Rh issues, but its the hemolysis occurring)
If severe, do preterm delivery. Otherwise, do placental artery blood tests to get FBC/HTc etc. And transfuse as much as possible.
67
Who needs anti partum surveillance? And what do we do?
When fetal demise is high…. Occurs at 32-34 weeks…. At the ages we start to consider delivering in severe cases. Do fetal movement assessment (ask mum first, expect around 5 movement in 1 hour). Then NST or stress tests if this is abnormal
68
What is the NST and contraction stress tests
NST: measure FHR and uterine contractions CST: the same, but with oxytocin given… dont do if PPROM, previa, uterine surgery etc.
69
Reactive NST? What do we see Non reactive NST? What do we see, and what could it mean? What next?
Reactive: good, 2 accel in 20 min period. Non reactive: not good, insuff accel over 40 min period (not the above). Maybe fetal sleeping (wake up using acoustic vibration). Maybe less than 32 weeks. Maybe CNS issue, mum maybe on narcotics. Need biophysical profile and CST!
70
Positive CST Negative CST Equivocal
Positive: late decel, after 50% or more contractions. Deliver! Negative: no late or variable decel in 10 mins. Good Equivocal: inbetween
71
What does the biophysical profile look at?
NST, AFI, fetal movements, fetal tone, fetal breathing
72
Biophysical profile… done when? And interpret these scores: 0-4 8-10 Inetween
Done if the NST is dodgy and we not assured in the anti partum surveillance. Done usually with a CST. 0-4… worrying for asphyxia and many issues. Deliver 8-10 is reassuring Invetween in equivocal. Deliver if 37 weeks and older… or do again in 24 hours.
73
When is umbilical artery Doppler done…. What is a bad finding on it?
If FGR is suspected… its the only times we need it. To see if FGR is due to placental insufficiency or other stuff Look out for: decreased, absent or reversed NR diastolic flow. (Normal is high velocity diastolic flow)
74
What can fetal HR monitoring tell us
Rate and variability, decel/accel
75
FHR monitoring, what’s normal and what is not: Rate: Variability: Accel/decel;
Rate (110-160) Variability is Normal… absent, minimal, marked or sinusoidal is abnormal Accel os normal, decel is not
76
77
Causes of increase FHR
Anemia, hypoxia, infection
78
Causes of decrease FHR
Uterine hyper slim, cord prolapse, rapid fetal decent
79
Absent variability on FHR monitoring… causes
Fetal acidemia
80
Minimal variability on FHR monitoring… causes
Hypoxia, opioid, Mg, sleeping
81
Increase variability on FHR monitoring… causes
Hypoxia
82
VEAL CHOPS for decel in FHR monitoring
Variable = cord compression Early = head compression Accel = ok Late - placental insufficiency or
83
Types of obs analgesia for birth….
Pudendal block: used in second stage, and gives perineal anaesthesia Epidural: for either c sec or vaginal delivery
84
SE of analgesia given in labour
Slight drop in BP. Headache, post partum urine retention.
85
When not to give epidural or spinal block for labour
Maternal low BP, coag, on heparin, untreated maternal bac, skin infx, ICP due to mass. All makes sense, risk of bleeding or CNS infection or hernation
86
Is cerivle carcinoma a reason to C sec
Yes
87
ROM, PROM, PPROM, prolonged ROM
Rupture of membranes after labour PROM (premature), occur before labour by 1 or more hour. Normal, but increase risk of infx. PPROM (preterm premat), same as above but preterm baby. (36 or less) Prolonged is just for more than 18 hours… in young, smokers, sti
88
How to Dx and confirm ROM/PROM/PPROM
Sterile speculum to see the amniotic fluid in the vault. Fern test or nitrazine test. US to check AFI. If al the above are equivocal, then do the us guided indigo carmine dye leakage test. Then check FHR
89
Breech position fetus…. Mx overview.
Just leave it until 38 weeks…. Attempt external cephalic version (be prepared for c sec since abruptio and cord compression are risks). Can trial breech delivery if imminent. Elective c sec is best
90
Umbilical cord prolapse. Presentation? Is this serious? Mx?
The cord presents before fetus. Can see it on exam. Occurs in prolonged labour, PROM, malpresentation, polyhydramnios. Very serious and causes decel. Manually elevate the presenting part and prep for delivery

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