Do you pap smear pts w/history of hysterectomy?
why or why not?
Pap smear screening is not indicated in patients who have had a hysterectomy, unless it was done for cervical cancer or a high-grade cervical dyspalsia.
women age 30-65.
-how often should they be cotested cytology/HPV?
Should be screened with cytology and HPV testing (‘‘cotesting’’) every five years.
Initial triage of finding atypical squamous cells of undetermined significance (ASCUS) on a Pap smear?
HPV typing is an option in the initial triage of the finding of atypical squamous cells of undetermined significance (ASCUS) on a Pap smear
women age 21-29
-how often should they have pap smear?
Every three years.
When is a DEXA scan indicated?
DEXA scan is only recommended in patients with risk factors for osteoporosis prior to age 65.
Women 40+ how often do they get mammograms?
ACOG recommends that women aged 40 years and older be offered screening mammography annually.
When do you begin colonoscopies and how often do you get them?
For patients with average risk for colon cancer, the recommended screening is to begin colonoscopy at age 50 and then every 10 years, if normal
Physiologic dyspnea of pregnancy is present in up to ___% of women by the ____ trimester.
Physiologic dyspnea of pregnancy is present in up to 75% of women by the third trimester.
respiratory alkalosis/acidosis in pregnancy is normal
-which?
alkalosis
Why are pregnant pts at risk for pulmonary edema?
Plasma osmolality is decreased during pregnancy which increases the susceptibility to pulmonary edema.
Name 2 tocolytics:
terbutaline, nifedipine.
What happens to cardiac output during pregnancy?
-What happens to systemic vascular resistance in pregnancy?
The cardiac output increases up to 33% due to increases in both the heart rate and stroke volume.
-The SVR falls during pregnancy
The quadruple test
maternal serum alpha fetoprotein, unconjugated estriol, human chorionic gonadotropin, and inhibin A.
What is 1st trimester screen for Downs?
Nuchal translucency measurement with maternal serum PAPP-A and free Beta-hCG (known as the combined test) is a first trimester screen for Down syndrome
Folic acid:
- dose for normal pts?
- dose for high risk pts?
- non-high risk patients is 0.4mg/day
- 4 mg of folic acid daily before conception and through the first trimester.
How can dehydration lead to braxton hicks contractions?
ADH can mimic oxytocin effects & cause contractions.
1st trimester abortion: think what first?
chromosomal abnormalities
3 signs of placenta separation:
cord lengthening, gush of blood, uterine fundal rebound as placenta detaches from wall.
4th degree laceration: what needs to happen?
anal mucosa is entered
Spinal vs epidural: which more common in C/S?
C/S: spinal.
Vaginal: epidural.
Complication of spinal/epidural:
Mat. hypotension due to dec. SVR. Can lead to dec. placental perfusion & fetal brady.
Is general anesthesia used in OB?
Only for emergent C/S.
Stage 1 of labor:
Extends until complete cervical dilation.
Stage 2 of labor:
Extends until delivery of infant.
Stage 3 of labor:
Extends until placental delivery.
previa vs abruption:
- which one is painful?
- which one has bright red blood?
- abruption = painful
- bright red blood = previa (dark = abruption).
placental abruption:
-main risk factor?
HTN
placental abruption:
-Tx?
Only need rapid delivery if severe. If small, give bethamethasone and tocolytics to prolong til 34 wks.
ritodrine
-what is it?
tocolytic
-beta2 agonist (causes smooth muscle relaxation).
Best way to rule out MgSO4 tox?
Test DTRs.
-
How do prostaglandins cause contractions?
inc. intracellular calcium.
Most common concern in PROM?
chorioamnionitis
-give mom broad-spectrum ABxs
cause of variable decels?
cord compression
desired vertex presentation?
occiput anterior
Prolonged decel = how many min?
Bradycardia = how many min?
- PD = >2 min
- brady = >10 min
*if brady dont resolve in 4-5 min: Code Green/deliver vaginally ASAP.
AFI
-oligo vs poly, what cutoff values?
20 = poly
MCC of oligohydramnios?
ROM
How much is standard dose of Rhogam?
-how much fetal blood will it eradicate?
- .3mg
- 15 mL of fetal RBCs = 30 mL of fetal blood w/hct of 50.
ACOG definition of post term
-greater than how many weeks?
> 42 wks
Mortality rate of mono-mono twins?
50% secondary to cord entanglements.
dizygotic twins
- how many amnions?
- how many chorions?
always di-di.
Twin-twin transfusion syndrome
-only happens when?
monochorionic twins.
-must share placenta for this to occur. Duh!
vertex-breech twins
-how do you deliver?
vaginally
How much protein in urine to Dx severe pre-eclampsia?
5g protein/24 hrs
How do pts usually present w/HELLP syndrome?
RUQ pain.
Pre-eclampsia ruled out if urine protein less than what?
Tx for MgSO4 tox:
calcium chloride or calcium gluconate
Criteria for superimposed pre-eclampsia on chronic HTN?
rise in BP 30/10
+ 1hr GTT = ?
> 130 mg/dL
-then do a 3 hr GTT
DM-A1
gestational DM, diet controlled
DM-A2
gestational DM, insulin controlled
IV PCN G given when?
- GBS +
- ROM > 18 hrs til delivery
Most sensitive screening test for chorioamnionitis?
IL-6 in amniotic fluid
Congenital rubella:
-Sxs:
Classic triad: PDA (or pulmonary artery hypoplasia),
cataracts, and deafness & “blueberry muffin” rash.
congenital CMV
-Sxs:
Hearing loss, seizures, petechial rash, “blueberry muffin” rash.
Can you breastfeed your child if you’re HIV +?
No.
Chlamydia
-Tx during pregnancy?
azithro, amox, erythro
-doxy & tetracycline = C/I in pregnancy
congenital toxoplasmosis
- Tx for mother?
- Tx for infant?
- mom = spiramycin
- baby = pyrimethamine & sulfadiazine w/folic acid.
Hyperemesis gravidum
-what causes the N/V?
high levels of bHCG.
-seen frequently in molar pregnancies.
Is hepatic P450 system inc or dec during pregnancy?
Inc. due to estrogen.
1st line Tx for pregnant woman w/pulm art HTN or eisenmenger?
abort pregnancy
pregnant pt w/hypothyroidism
-management?
inc dose of levothyroxine by 25-30% bc inc. Vd & inc. binding proteins.
benzos v barbs
-which ones teratogenic?
benzos = teratogenic
How long should you wait after vaginal delivery before having sex again?
6 weeks
Uterine atony
-Tx if pitocin & uterine massage fail?
methergine aka metherergonovine (C/I in HTN).
-next step is hemabate aka PGF2 alpha (C/I asthmatics).
Tx for mastitis
dicloxacillin PO
-bc usually due to s. aureus.
- colpos
- meaning?
vagina
lichen sclerosis
- pre-malignant?
- Tx:
- no
- clobetasol ointment.
bartholin gland cyst
-can it be cancerous?
yes
-take biopsy.
