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WOLFPACC > OBGYN > Flashcards

OBGYN Flashcards

(48 cards)

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1
Q

CVS (when?)
Amniocentesis (when)
PUBS

A

CVS
12-14wks (late 1st early 2nd)

Amniocentesis
15-20wks (2nd/3rd trimester)
@24wks Rh isoimmunization check
@34wks Lecithin:Sphingomyelin (>2:1)

PUBS
>20wks
Last resort (highest risk pregn. loss)
Blood gasses, blood typing, intrauterine blood transfusion

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2
Q

Long philthrum
Midfacial hypoplasia
Short palpebral fissure

A

Fetal Alcohol Syndrome

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3
Q

Causes Phocomelia (limb defects)
Pyloric and duodenal stenosis

A

Thalidomide
used in MS and Leprosy

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4
Q

Isotreitinoin during pregnancy

A

Congenital deafness
Congenital heart defects

*2 forms of birth control req

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5
Q

Lithium in Pregnancy

A

Mom
Diabetes Insipidus (AVP-D)

Fetus
Epsteins anomaly- “Atrialization (compressed RV) of R-side of heart
Compressed RV–> Decreased Pulm. Blood flow–> Hypoxemia

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6
Q

Streptomycin in Pregnancy

A

CN8 (Vestibulocochlear n.) dmg–> hearing impairment

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7
Q

Tetracycline

A

Competes with Ca2+
Teeth Discoloration
Muscle Contraction impairment
Bone Matrix

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8
Q

Phenytoin

A

Fetal Hydantoin Syndrome
P- cleft Palate/lip
H- small Head, Hirsutism, Hypoplastic face, Hypoplastic nails, Heart defects
E- Embryompathy
N- Neuro deficit

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9
Q

Valproate in Pregnancy

A

NTD
GU defects
Dev. delay
Limb defects

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10
Q

1st Trimester events and complications

A

<13wks
N/V
Spotting/Bleeding
5-8lb weight gain

Complications:
Ectopic
Spontaneous abortion

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11
Q

2nd Trimester events and complications

A

13-26 wks
Braxton Hicks Contractions
Round Ligament pain
Quickening (first kick)
1Ib/wk

Complication:
Incompetent cervix

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12
Q

3rd Trimester events and complications

A

Decreased libido, back pain, urinary freq.
Lightening (mom feels baby coming)
Bloody show (Mucus plug release when cervix begins to ripen)
1Ib/wk

Complication
PROM

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13
Q

HBcAb
HBsAb
HBsAg
HBeAg
HBeAb

A

HBcAb- Lifetime exposure?
HBsAb- Vaccinated?
HBsAg- Currently infected
HBeAg- Severe infectivity/ transmission
HBeAb- No more transmission

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14
Q

HIV+ Mothers

A

Mom: 3 ART starting @ 14wks until delivery
1 must be ZIDOVUDINE
No Breast Feeding
C-section @38wks unless viral load <1000

Infant: 6wks of Zidovudine

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15
Q

Triple/Quad screen results
Trisomy 21
Trisomy 18

A

Trisomy 21:
Increased: Inhibin A, B-hCG
Decreased- Estriol, AFP

Trisomy 18:
Decreased- AFP, Inhibin A, Estriol, B-hCG

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16
Q

GDM screen

A

24-28wks (2nd Tri screen)

1hr OGTT (50g)…..
IF <140 (WNL)–> STOP

IF > 140–> home for 12hr fast and repeat….

IF>125= GDM

IF<125 do 3hr OGTT (100g)…..
-1hr <180
-2hr<155
-3hr<140
If 2 values out of range = GDM

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17
Q

NST

A

Done when mom cant feel fetus moving
Reactive (movement) = Reassuring

No movement check FHR monitor ( VEAL CHOP)

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18
Q

BPP scoring

A

Done when NST nonreactive
8-10= Reassuring (Weekly BPP)

3-7= worrisome….
>36wks–> Deliver
<36wks–> BPP q 12-24hrs

0-2= Fetal Hypoxia–> Deliver ASAP

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19
Q

UTI in Pregnancy

A

Tx even if asx
1st line: Nitrofurantoin
Alt. (2nd line) : Cephalexin or Amoxicillin

UTI
1. E. Coli
2. Proteus
3. Klebsiella
4. Enterobacter
5. S. Saprophyticus

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20
Q

Tx:
Bacterial vaginosis
Trichmonas
Vaginal Candidiasis

Study These Flashcards
A

BV- Metro or Clinda
Trichomonas- Metro + tx sexual partner
Candida- Fluconazole

21
Q

GBBS Management

Study These Flashcards
A

IV PCN
If PCN allergy–> Clinda or erythro -mycin

Any of the following is an indication
+Urine Cx GBBS
Previous baby had GBBS infxn
Unk GBS status PLUS any of the following
- >18 ROM
- <37wks gestation
- Intrapartum fever (regardless of cx)

PPx: IV PCN

22
Q

Painful Genital Lesions (2)

Study These Flashcards
A

HSV (Bilateral, Tender LAD)
Chancroid (Unilateral, Tender LAD)

23
Q

Painless Genital Lesions

Study These Flashcards
A

Syphilis (Bilateral, Nontender LAD)

Lymphogranuloma venereum (Unilateral, Tender LAD)

Granulaoma Inguinale aka Donovanosis due to klebsiella… NO LAD, Beefy red ulcer, usually travel to India/ Guayana

24
Q

Abruptio Placenta Mgmt

Study These Flashcards
A

PAINFUL BLEEDING
If mom or fetus unstable–> EMERGENCY C-section
Vaginal delivery if STABLE + >36wks

25
Placenta Previa Mgmt
Painless Bleed Unstable--> C-section May attempt vaginal delivery if lower placental edge >2cm from edge (Marginal)
26
Vasa Previa
Triad: Painless Bleed, AROM (ROM due to Amniotomy), Fetal Bradycardia Mother and Fetus bleed but Fetus more than mom IMMEDIATE C-section
27
Complete Mole
= Completely paternal empty ovum +1/2 sperm 46XX or XY No maternal contribution= no fetal parts "Snow storming" Cluster of grapes Tx: Dil. and Evac.
28
Partial mole
Partial mom partial dad ovum+ 2 sperm 69XXX or XXY (triploidy) +fetal parts Tx: Dil. and Evac.
29
Abortion Types
Prior to 20 wks= Abortion: 1) Threatened= OS(c), FHR(+), POC (-) -May return to viable 2) Missed= OS (c), FHR (-), POC (-) 3) Inevitable= OS (o), FHR(-), POC (-) 4) Incomplete= OS (o), FHR(-), POC (+) 5) Complete= OS (c), FHR (-), POC (-)
30
PCOS Mgmt
Best= weight loss OCP Metformin Clomiphene (block (-)feedback on estradiol) Letrozole (Block conversion Testosterone to estradiol aka inhibts aromatase) Spironolactone (Block Testosterone)
31
PID Mgmt and Complications
Outpt.--> Ceftriaxone + Doxycycline Inpt.--> IV Cefoxitin OR If prior tx fail or medication non adherance can give: IV Cefotetan + Doxycycline Complications: Perihepatitis (Fitz Hugh Curtis) Pelviv peritonitis Tubo-Ovarian abcess
32
Dx Chorioamnionitis
Triad (must have all 3): Maternal Fever Firm Uterus Confirmed PROM Tx: IV Abx + DELIVER fetus
33
PE findings for Endometriosis and Definitive Dx
Fixed Retroverted Uterus Tender Nodules Adnexal Mass May see chocolate cyst ( Endometrioma) on ovary Laparascopy w/ biopsy: powderburn/gunpowder lesion
34
PROM Mgmt
Avoid Tocolytics (Allow for Uterine contractions) If chorioamnionitis IV abx and deliver fetus No chorioamnionitis <24wks dismal outcome >24wks Bed rest, IM Betamethasone, 7d PPx of Ampicillin + Erythromycin
35
Tocolytic agents
Used in Preterm labor to allow time for fetal lungs to mature Indications: Preterm labor (20-37wks), uterine contractions (1q10min), Cervical dilation> 2cm Prolong Pregnancy up to 72 hrs MgSO4--> Blocks Ca2+ (Looks like a pilot aka Ca but cant fly) -Monitor DTR -IV Ca2+ gluconate = Antidote Contraindic: Renal Insuff.; MG Terbutaline (Beta agonist) Indomethacin (PG inhib) Nifedipine (DHP-CCB)
36
Prolonged Latent phase
CERVICAL Problem Cervical dilation <3cm for..... >20hrs if primipara >14hrs if multipara MCC= Too much anesthesia--> Let it wear off (Therapeutic Rest)
37
Prolonged Active Phase
Cervical dilation >3cm... Prolonged= <1.2cm dilation for >2hr Passenger Problem: size/orientation OR Power Problem: Inadequate uterine contraction Tx: Power problem--> IV oxytocin Contraction normal( aka passenger problem) --> Go to C-section
38
Prolonged 3rd stage
Placenta does not deliver w/in 30 min If does not remove with IV oxytocin think accreta/increta/percreta
39
Vulvar Ca in Postmeno female (2 most likely causes)
#1 Lichen sclerosus #2 HPV
40
HPV Vaccine age recc.
B/w 8-48yo
41
PAP Test
Offer at age 21 regardless of sexual activity IF <30yo and avg risk q3yr w/ cytology only IF >30yo and average risk q3yr w/ cytology only OR q5yr w/ HPV co-testing (HPV and cytology) D/C if >70yo w/ 3 negative paps
42
ASCUS-LSIL Mgmt
**<30yo** Repeat PAP in 6mo until 2 negative paps IF a repeat shows ASCUS-LSIL: Colposcopy/ ENDOcervical curettage (nonpregnant) Colposcopy/ ECTOcervical curettage (Pregnant) **>30yo** HPV Testing.... Negative--> PAP/HPV 3yr Positive--> Colposcopy Colposcopy/ENDOcervical(nonpregnant) Colposcopy/ECTOcervical (Pregnant)
43
HSIL Mgmt
Age>25yo Colposcopy/ ENDO or ECTO cervical curretage (Straight to colposcopy)
44
CIN2/3 Mgmt
NO Colposcopy (passed HSIL already know its Cancer) TAH/BSO Conization OR LEEP ( may cause cervical insufficiency) - Prevent with Progesterone/ cervical cerclage)
45
HIV Dx and PAP indications
Dx with HIV--> Screen w/ PAP at same visit 6mo repeat PAP--> Normal.... Check CD4..... IF >200 Repeat PAP q1yr IF <200 Repeat PAP q6mo
46
Medical Abortion
#1 MIFEPRISTONE Blocks Progesterone--> Uterine lining breaks down--> Pregnancy stops (Note may also block cortisol) 2nd MISOPROSTOL 2nd medication taken either right away or up to 48 hrs after causes uterus to contact and empty and cervical dilation/ripening
47
EMERGENCY CONTRACEPETION
PLAN A: Copper IUD Progestin IUD PLAN B: Levongestrel, Ulipristal Remember emergency contraception does not protect against STD/HIV
48
OCP Contraindications
Age >35 + Smoker (can use progestin only or hormonal) H/o DVT (progestin only or IUD Migraine w/aura (progestin only/ IUD) Uncontrolled HTN or CAD (progestin only or IUD) BMI> 30 Breast feeding (use progestin only pill) Liver dz/ Breast Ca (copper IUD/ Barrier methods) NOTE: Progestin only pills more important to take AT SAME TIME EVERYDAY; Progestin only is easily discontinued NOTE for HeavyMB--> COCP or LNG-IUD pref.

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