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OBGYN > OBGYN > Flashcards

OBGYN Flashcards

1
Q

treatment of chlamydia

A

1g azithromycin PO, or doxycycline 100mg BID x 7 days

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2
Q

counselling of patient with chlamydia re: sex

A

avoid sex for 7 days following completion of abx, inform partners within last 60 days

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3
Q

petechial or pustular rash acral rash on erythematous base, asymmetric arthralgia, tenosynovitis, or septic arthritis, fever, or general malaise

A

disseminated gonococcemia

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4
Q

test for GC/chlamydia

A

urine nucleic acid amplification test (NAAT)

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5
Q

treatment of gonorrhea

A

2g azithromycin PO + ceftriaxone 250mg IM

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6
Q

treatment of gonococcemia

A

admit to hospital for IV abx and workup for possible endocarditis and meningitis

ceftriaxone (1 gram IM or IV every 24 hours for 1 to 2 days) followed by cefixime 400 milligrams PO twice a day for a minimum of 1 week

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7
Q

symptoms of trichomonas

A
  • ranges asymptomatic carrier states to severe, inflammatory disease,
  • commonly has vulvar irritation and a malodorous, thin watery discharge with associated burning, pruritus, dysuria, urinary frequency, and dyspareunia, and occasionally low abdominal pain
  • symptoms can worsen during menstruation. -classic yellow-green, frothy discharge is infrequently found, and many women have minimal symptoms
  • O/E:irritated vulvar region with inflamed vaginal mucosa, and punctate cervical hemorrhages
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8
Q

microbiologic agent in syphilis

A

Treponema pallidum

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9
Q

painless chancre with indurated borders, lesion resolves spontaneously

A

primary syphillis

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10
Q

rash starts on trunk and spreads to flexor surface of extremeties, (dull red pink papular rash typically), lymphadenopathy (Firm, rubbery, discrete nodes), mucocutaneous lesions

A

secondary syphillis

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11
Q

involvement of the nervous and cardiovascular systems is characteristic, with widespread granulomatous lesions (gummata). Specific manifestations include meningitis, dementia, neuropathy (tabes dorsalis), and thoracic aneurysm.

A

tertiary syphilliis

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12
Q

initial test in suspected syphillis

A

VDRL or RPR

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13
Q

confirmatory test after positive VDRL or RPR

A

Positive results must be confirmed with an immunoassay specific for T. pallidum antibodies

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14
Q

most specific test for syphillis if positive

A

Direct visualization of the organism using darkfield microscopy is diagnostic of primary, secondary, or early congenital syphilis, no matter what the results on serology.

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15
Q

treatment of primary and secondary syphillis

A

penicillin G 2.4million units IM x 1

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16
Q

acute febrile reaction associated with headache and myalgias within the first 24 hours after treatment of syphillis

A

Jarisch-Herxheimer reaction

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17
Q

counselling re: partners in patient with syphillis

A

treat partners within past 90 days

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18
Q

treatment of tertiary syphilis

A

penicillin G 2.4million units IM weekly x 3 weeks min

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19
Q

prodrome lasting 2 to 24 hours that is characterized by localized or regional pain, tingling, and burning, then constitutional symptoms of headache, fever, painful inguinal lymphadenopathy, anorexia, or malaise are common, as the disease progresses, papules and vesicles on an erythematous base become evident.

A

HSV

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20
Q

clinical course of genital HSV

A

Complete healing usually occurs within 3 weeks, and viral shedding persists for 10 to 12 days after the onset of the rash

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21
Q

treatment of first episode genital HSV

A

valacyclovir 1g po BID x 7 days

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22
Q

diagnosis of genital HSV

A
  • clinical, Tzanck test can demonstrate large intranuclear inclusions
  • lab test: cell culture or polymerase chain reaction. When obtaining a specimen for analysis, puncture the vesicle and swab the fluid. Swab the base of the lesion vigorously, because the virus is cell associated
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23
Q

treat recurrent outbreak of genital HSV

A

valacyclovir 1g po bid x 5 days

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24
Q

when to use daily suppressive therapy in HSV

A

patients with more than 6 outbreaks per year

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25
Q

etiology of chancroid

A

Haemophilus ducreyi

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26
Q

Multiple painful, irregular, purulent ulcers with potential exudative base and painful suppurative inguinal nodes

A

chancroid

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27
Q

diagnostic test for chancroid

A

swab of a lesion or pus from a suppurative lymph node can be cultured, but a special medium is required that is not widely available, and culturing has a sensitivity of <80%. There is no current Food and Drug Administration–approved polymerase chain reaction test.

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28
Q

Small and shallow ulcer painless, associated proctocolitis with fistulas and strictures plus tender lymph nodes

A

lymphogranuloma venereum

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29
Q

etiology of lymphgranuloma venereum

A

Chlamydia trachomatis subtype L1, L2, L3

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30
Q

treatment of lymphogranuloma venereum

A

doxycycline PO 100mg BID x 3 weeks

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31
Q

begins as subcutaneous nodules on the penis or labial-vulvar area. The nodules then progress to the more classic painless, ulcerative lesions. These lesions are highly vascular, which explains both their appearance (beefy red) and their tendency to bleed easily on contact. Lymphadenopathy is not usually present.

A

granuloma inguinale (donovanosis)

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32
Q

etiology of granuloma inguinale (donovanosis)

A

Klebsiella granulomatis

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33
Q

treatment of trichomonas

A

metronidazole 2g PO x 1

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34
Q

treatment of granuloma inguinale (donovanosis)

A

doxycycline 100mg po BID x 3 week or until ulcer heals completely

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35
Q

flesh-colored papules or cauliflower-like projections that usually appear after an incubation period of 1 to 8 months and may coalesce to form condylomata acuminata

A

genital warts, HPV

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36
Q

diagnosis of genital warts

A

clinical

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37
Q

subtypes of HPV in Gardisil

A

HPV 6 and 11 - genital warts

HPV 16 and 18 - cervical cancer

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38
Q

risk factors for ectopic pregnancy

A 
PID, hx of STIs
IVF, assisted reproductive technologies
IUD
hx of tubal surgery
previous ectopic
smoking
prior pharmacologic abortion
maternal age 35-44
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39
Q

majority of ectopic pregnancies implant in the _____

A

ampulla of fallopian tube

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40
Q

classic triad in ectopic pregnancy

A

abdominal pain, amenorrhea, vaginal bleeding

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41
Q

at what level of beta HCG should you visualize an IUP with TVUS

A

1500mIU/L

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42
Q

US findings suggestive of ectopic pregnancy

A

any pelvic free fluid, hepatorenal free fluid, tubal ring, complex pelvic mass

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43
Q

treatment of ectopic pregnancy

A

surgical: laparoscopic salpingostomy or salpingectomy
medical: methotrexate

rhogam- 50mcg as appropriate in Rh neg

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44
Q

indications for medical management of ectopic pregnancy

A

unruptured ectopic pregnancy, hemodynamically stable, minimal abdo pain, normal baseline hepatic and renal function, reliable for follow up

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45
Q

absolute contraindications for medical management of ectopic pregnancy

A

IUP, evidence of immunodeficiency, moderate to severe anemia, leukopenia, or thrombocytopenia, sensitivity to methotrexate, active pulmonary disease, active PUD, clinically important hepatic or renal dysfunction, hemodynamic instability, breastfeeding

relative: ectopic > 4cm, cardiac activity, HCG >5000

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46
Q

patient with BHCG 2000mIU/L and no findings on TVUS

A

ECTOPIC PREGNANCY until proven otherwise

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47
Q

Ddx to first trimester vaginal bleeding

A

implantation bleeding
ectopic pregnancy
abortion
gestational trophoblastic disease

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48
Q

define spontaneous abortion

A

pregnancy loss before 20 weeks gestation or fetal weight under 500g

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49
Q

vaginal bleeding in early pregnancy, os closed

A

threatened abortion

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50
Q

vaginal bleeding in early pregnancy, os open

A

inevitable abortion

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51
Q

fetal death <20 weeks without any passage of tissue

A

missed abortion

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52
Q

vaginal bleeding/passage of tissue with products still present on US

A

incomplete abortion

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53
Q

passage of all fetal tissue prior to 20 weeks gestation

A

complete abortion

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54
Q

infection evident during abortion

A

septic abortion

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55
Q

management of incomplete abortion

A

1) watch and wait
2) misoprostol 600mcg
3) D&C

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56
Q

first trimester pregnancy with uterus large for date, higher BHCG levels, woman may have hyperemesis

A

gestational trophoblastic disease

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57
Q

management of gestational trophoblastic disease

A

suction curettage, send for path to assess for malignancy

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58
Q

diagnosis to consider if pregnancy induced hypertension seen before 24 weeks gestation

A

gestational trophoblastic disease

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59
Q

define hyperemesis gravidarum

A

intractable vomiting with weight loss, dehydration, hypokalemia or ketonemia

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60
Q

treatment of hyperemesis gravidarum

A

IV fluid repletion, 5% glucose in RL/NS
antiemetics, zofran, gravol
doxylamine with pyridoxine for maintenance

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61
Q

if pregnant patient has N/V and abdominal PAIN- DDx

A

cholecystitis, cholelithiasis, gastroenteritis, pancreatitis, appendicitis, hepatitis, fatty liver of pregnancy, pyelonephritis, PUD, HELLP syndrome

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62
Q

indications for admission in patient with hyperemesis gravidarum

A

uncertain diagnosis, intractable vomiting, persistent ketone or electrolyte abnormalities after volume repletion, and weight loss of >10% of prepregnancy weight

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63
Q

definitive method of diagnosis of endometriosis

A

laparoscopy

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64
Q

risk factors for ovarian torsion

A

pregnancy due to enlarged corpus luteum, presence of large ovarian cysts or tumors, chemical induction of ovulation (ovarian hyperstimulation syndrome), and tubal ligation

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65
Q

DDX of abnormal uterine bleeding

A

PALM COINE
polyps, adenomyosis, leiomyomas, malignancy,
coagulopathy, anovulation, endometriosis, iatrogenic, not yet specified

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66
Q

most common causes of AUB in adolescents

A 
anovulatory cycles (HPG immaturity)
infections
pregnancy
exogenous estrogen/OCP
coagulopathy
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67
Q

most common causes of AUB in reproductive age women

A 
pregnancy
anovulation (PCOS)
exogenous hormone use/OCP
leiomyomas
cervical, endometrial polyps
thyroid dysfunction
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68
Q

most common causes of AUB in perimenopausal women

A

anovulation
leiomyomas
cervical and endometrial polyps
thyroid dysfunciton

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69
Q

most common causes of AUB in postmenopausal women

A

atrophic vaginitis
exogenous estrogen use
endometrial lesions including cancer
other tumour- vulvar, vaginal, cervical

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70
Q

uterine fibroids which increase in size rapidly or after menopause are suspicious for

A

malignant transformation

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71
Q

management of hemodynamically unstable patient with vaginally bleeding

A

IV fluids, PRBCs, CBC/coags, For severe hemorrhage, conjugated estrogen (Premarin) 25 milligrams IV every 4 to 6 hours until bleeding stops
tranexamic acid 1g PO

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72
Q

management of hemodynamically stable patient with vaginal bleeding

A

conjugated equine estrogen 25mg IV q4-6h x 24 hours
combined OCPs TID x 7 days
medroxyprogesterone acetate 20mg po TID x 7 days

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73
Q

risk factors for endometrial cancer

A

obesity, nulliparity, history of anovulation, tamoxifen use, infertility, and a family history of endometrial or colon cancer

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74
Q

Pap test screening guidelines - initiation of screening

A

age 21 + sexual activity, can begin later if there has never been any digital/oral activity

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75
Q

Pap test guidelines- interval

A

q 3 years if normal results

annually if immunocompromised /HIV+

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76
Q

what to do if normal Pap smear, but visible abnormality on cervix

A

refer for colposcopy !

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77
Q

when to D/C screening with Pap

A

if age 70 and has had 10 years of normal cytology

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78
Q

Pap cytology results which require immediate colposcopy

A

HSIL (high grade squamous cell intraepithelial lesion)
AGUS (atypical glandular cells of unknown significance), this includes abnormal endometrial or endocervical cells, this finding needs colposcopy + endometrial biopsy
ASCUS-H (atypical squamous cells, cannot rule out high grade lesion)

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79
Q

what to do with Pap result of ASCUS (abnormal squamous cells of uncertain significance)

A

women under 30 - repeat cytology in 6 months

women over 30- HPV testing for oncogenic strains, if negative return to regular q 3 years, if positive - colposcopy

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80
Q

what to do if Pap result of ASCUS on repeat cytology 6 months later after initial ASCUS

A

colposcopy

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81
Q

what to do if Pap result of normal on the repeat Pap 6 months after ASCUS

A

repeat cytology again in 6 months, if normal go back to normal q 3 years, if ASCUS again colposcopy

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82
Q

what to do with Pap result of LSIL

A

repeat cytology in 6 months OR refer for colposcopy

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83
Q

what to do if Pap smear unsatisfactory for interpretation

A

repeat Pap in 3 months

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84
Q

what to do if benign endometrial cells on Pap smear

A

pre-menopausal - nothing
post-menopausal - endometrial biopsy/investigations

if symptomatic AUB then investigate as appropriate

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85
Q

what to do with AGUS on Pap smear results

A

colposcopy + endometrial biopsy

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86
Q

mammogram screening for breast cancer in average risk women (ages and interval)

A

50-74 q 2 years

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87
Q

define populations at high risk for breast cancer

A
  • known BRCA1 or BRCA2 mutation
  • has first degree relative with BRCA1/2, has underwent genetic COUNSELING and DECLINED genetic TESTING
  • previously assessed by genetic clinic and told 25% chance or greater lifetime risk of breast cancer based on FamHx.
  • received previous chest radiation before age 30, at least 8 years previously
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88
Q

breast cancer screening offered to high risk women

A

annual mammogram and breast MRI for women age 30-69

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89
Q

risk factors for breast cancer

A 
BRCA1/2 genes
breast cancer in mom/sister
young menarche, under 12
last menopause, over 55
use of oral contraceptives / HRT
EtOH - 2-5 drinks per day
dense breasts
high bone density
history of benign breast biopsy
history of atypical hyperplasia on biopsy
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90
Q

factors protective against breast cancer

A

breast feeding > 16 months , parity > 5, recreational exercise, BMI under 22.9, oophorectomy before age 35, aspirin use 1x/week for 6 months

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91
Q

workup of patients presenting with palpable breast mass based on age

A

women under 20= no imaging or biopsy needed
women under 30 = breast US
women 30-70 = breast US + mammogram
women over 70 = mammogram

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92
Q

most common breast lump in women under 30, firm and mobile

A

fibroadenoma

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93
Q

breast US finding of simple cyst –> next step in mgmt

A

aspirate cyst, repeat clinical breast exam in 4-6 weeks

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94
Q

breast US finding of complex cyst or solid mass –> next step in mgmt

A

mammogram + FNA or core needle biopsy

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95
Q

breast US does not visualize palpable breast mass –> next step in mgmt

A

mammogram + FNA or core needle biopsy

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96
Q

breast cyst has been aspirated and shows bloody fluid or residual mass –> next step in mgmt

A

mammogram or core needle biopsy if over 40

US or core needle biopsy if under 40

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97
Q

solid breast mass on FNA shows malignant cells

A

definitive treatment - ie. surgery

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98
Q

solid breast mass on FNA shows atypical or suspicious cells

A

core needle biopsy or excisional biopsy or refer

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99
Q

solid breast mass on FNA shows benign cells

A

get mammogram, if positive US or core needle biopsy,

if mammogram negative repeat clinical exam in 4-6 weeks

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100
Q

solid breast mass on FNA is nondiagnostic

A

if women under 40 US or core needle biopsy

if women over 40 mammogram or core needle biopsy

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101
Q

benign breast mass which typically occurs after trauma

A

fat necrosis

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102
Q

breast tissue changes in premenopausal women which are diffuse and tender, often change cyclically

A

fibrocystic changes

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103
Q

breast lump common in breastfeeding

A

milk retention cyst / galactocele

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104
Q

raw, scaly, vesicular, or ulcerated lesion that begins on the nipple and spreads to the areola

A

Paget disease of breast

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105
Q

uncommon fibroepithelial breast tumors that can behave in variable fashion, and are classified as benign, borderline, or malignant based on histologic criteria (cellular atypia, mitotic activity, margins, and stromal overgrowth)

A

Phyllodes tumour of breast

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106
Q

rare, histologically homogenous tumors that arise from the connective tissue within the breast; associated with previous ionizing radiation, and lymphedema of arm etc. from previous surgery.

A

breast sarcoma

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107
Q

heterogeneous group of precancerous lesions confined to the breast ducts and lobules, and is potentially a precursor lesion to invasive breast cancer

A

DCIS (ductal carcinoma in situ)

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108
Q

noninvasive lesion that arises from the lobules and terminal ducts of the breast.

A

LCIS (lobular carcinoma in situ)

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109
Q

LCIS effect on risk of breast cancer

A

not a precursor lesion but associated with increased risk of invasive breast cancer

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110
Q

management of LCIS

A

surgical excision

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111
Q

management of atypical hyperplasia on breast biopsy

A

a wire localization excisional breast biopsy is typically performed to exclude the possibility of an associated worse lesion

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112
Q

medical management of LCIS or atypical hyperplasia

A

SERMs or aromatase inhibitors to decrease risk of breast cancer; tamoxifen, raloxifene or anastrozole

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113
Q

management of DCIS

A

lumpectomy + radiation or mastectomy

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114
Q

indication for endocrine therapy following excision of DCIS

A

ER or PR positive DCIS

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115
Q

management of fibroadenoma

A

core needle biopsy or excisional biopsy - US and FNA alone canNOT differentiate fibroadenoma from Phyllodes tumour

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116
Q

management of intraductal papilloma

A

excision of involved duct to rule out atypia

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117
Q

most common cause of spontaneous, bloody, unilateral nipple discharge

A

intraductal papilloma

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118
Q

obstruction of a subareolar duct leading to duct dilation, infammation, and fibrosis, may present with nipple discharge, bluish mass under nipple, local pain

A

mammary duct ectasia

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119
Q

management of mammary duct ectasia

A

should regress spontaneously, risk of secondary infection

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120
Q

indication for sentinel lymph node biopsy

A

invasive breast ca at time of lumpectomy

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121
Q

indication for axillary node dissection in breast cancer

A

positive sentinel node

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122
Q

where does breast cancer metastasize

A

bone, lungs, pleura, liver, brain

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123
Q

risk factors for postpartum endometritis

A

chorioamnionitis
prolonged labor, prolonged rupture of membranes
multiple cervical examinations
internal fetal or uterine monitoring
large amount of meconium in amniotic fluid
manual removal of the placenta
low socioeconomic status
maternal diabetes mellitus or severe anemia
preterm birth
operative vaginal delivery
postterm pregnancy
HIV infection
colonization with group B streptococcus
nasal carriage of Staphylococcus aureus
heavy vaginal colonization by Streptococcus agalactiae or Escherichia coli

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124
Q

signs in postpartum endometritis

A

postpartum fever, tachycardia that parallels the rise in temperature, midline lower abdominal pain, and uterine tenderness

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125
Q

treatment of postpartum endometritis

A

clindamycin IV 900mg q8h + gentamicin

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126
Q

most common micro-organism in postpartum endometritis

A

polymicrobial (anaerobic and aerobic mix)

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127
Q

most likely cause of postpartum fever after C-section

A

endometritis

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128
Q

most important risk factor in development of endometritis

A

C-section (15-30% develop endometritis), vaginal delivery (3%)

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129
Q

factors associated with decreased success of VBAC

A 
BMI > 40
2 or more C-sections in past
maternal age over 35
previous C section for failure to descend in 2nd stage of labour
requirement of induction of labour
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130
Q

VBAC success rate

A

60-80%

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131
Q

% increased risk of uterine rupture after previous low transverse C-section

A

0.5-1%

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132
Q

most common abx. prophylaxis given at C-section to prevent endometritis

A

cefazolin

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133
Q

increased risk of thromboembolic complications in C-section associated with

A

obesity BMI > 30

emergent. vs planned C-section

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134
Q

complication of C-section, and cause of postpartum pyrexia on 2 days on day2-10 postpartum, no infectious source noted/pt not responding to abx.

A

septic pelvic vein thrombophlebitis

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135
Q

presentation of ovarian vein vs. deep septic pelvic thrombophlebitis

A

ovarian: fever, chills, flank or back pain, N/V, pelvic tenderness
DSPT: fever/chills only

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136
Q

reversible causes for urinary incontinence

A

DIAPPERS

  • delirium or acute confusion
  • infection (symptomatic UTI)
  • atrophic vaginitis or urethritis
  • pharmaceutical agents
  • psychological disorders (depression, behavioural disturbances)
  • excess urine output (due to excess fluid intake, alcoholic or caffeinated, etc.)
  • restricted mobility
  • stool impaction
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137
Q

risk factors for spontaneous abortion

A 
maternal age over 40
previous spontaneous abortion
smoking
cocaine use
NSAID use around time of conception
high caffeine intake
prolonged ovulation to implantation interval
prolonged time to achieve pregnancy
maternal weight BMI less than 18.5 or above 25
untreated celiac disease
feeling stressed
advanced paternal age
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138
Q

contraindications to IUD use

A 
uterine cancer or fibroids
uterine malformations
current PID
presence of pregnancy
undiagnosed uterine bleeding
acute liver disease or liver tumors
breast carcinoma
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139
Q

risks of IUD insertion

A

uterine perforation
PID post insertion

risk less than 1%

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140
Q

what are the chances that pregnancy is ectopic if conceived with IUD in place

A

50% !! therefore need investigations IMMEDIATELY if positive pregnancy test in patient with IUD, ie. get ultrasound

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141
Q

what to do if pregnant patient with IUD

A

remove IUD ASAP, small risk of spontaneous abortion

142
Q

what is the most significant risk of leaving an IUD in place during a pregnancy

A

septic abortion

143
Q

what is gold standard to diagnose PID

A

laparoscopy

144
Q

complications of untreated PID

A 
ectopic pregnancy
infertility
tuba-ovarian abscess
pyosalpinx
chronic pelvic pain
bacteremia
peritonitis
adhesions
septic arthritis
fitz-hugh-curtis
endocarditis
145
Q

how to stage cervical cancer

A

CT or MRI of abdomen pelvis

146
Q

which viruses are causative factor in cervical cancer

A

HPV and rarely HSV

147
Q

management of CIN-I on cervical biopsy

A

observe, repeat cytology in 12 months

if finding of CIN-1 after cytology of of HSIL or AGUS, then review cytology and biopsy, if discrepancy remains may be appropriate for excisional biopsy

148
Q

management of CIN-II on cervical biopsy

A

if women over 25: excisional biopsy

if women under 25: observed with colposcopy q6mo, for 24 months until treatment considered

149
Q

management of CIN-III on cervical biopsy

A

excisional biopsy

150
Q

how to manage CIN-II or III found during pregnancy

A

repeat colposcopy, delay treatment until 8-12 weeks post delivery

151
Q

management of stage 1A1 cervical cancer

A

trachelectomy - cervix removal only if future fertility desired
hysterectomy if not desired fertility

152
Q

management of stage 1A2 and 2B1 cervical cancer

A

radical hysterectomy and pelvic lymphadenectomy
ovaries can be spared if premenopausal
if fertility preservation wanted: radical trachelectomy and nodes
concurrent chemorad if high risk features, positive pelvic nodes etc.

153
Q

management of stage 2B2, 3, 4 cervical cancer

A

primary chemo and radiation

hysterectomy not recommended following primary treatment with curative intent

154
Q

define premature ovarian failure

A

hypergonadotropic hypogonadism before age 40

155
Q

presentation of premature ovarian failure

A

oligomenorrhea or amenorrhea, hot flashes, vaginal dryness

156
Q

physical exam findings to look for in premature ovarian failure

A

hyperpigmentation or vitiligo related to autoimmune primary adrenal insufficiency
goiter related to Hashimoto’s thyroiditis or Graves
signs of atrophic vaginitis
ovarian enlargement related to autoimmune lymphocytic oophoritis or steroidogenesis defect
ptosis, associated with a rare familial form of spontaneous POI (blepharophimosis/ptosis/epicanthus inversus syndrome [BPES])

157
Q

Symptoms of anorexia, weight loss, vague abdominal pain, weakness, fatigue, salt craving, or increased skin pigmentation WITH premature ovarian failure associated with

A

primary adrenal insufficiency

158
Q

work up for patient with premature ovarian failure

A

TSH
anti-adrenal antibodies and anti-21 hydroxylase antibodies
bone mineral density with DXA
genetic testing for FMR1 (Fragile X gene) because familial POI, approximately 14 percent will be found to have a premutation in the FMR1 gene; 2% of sporadic cases
ovarian biopsy NOT recommended anymore

159
Q

symptoms of estrogen deficiency

A

vasomotor flushes, vaginal dryness, night sweats, fatigue, and mood changes

160
Q

patients with premature ovarian failure are at higher risk of

A

CAD
osteoporosis/fractures
memory loss
diminished sexual wellbeing

161
Q

treatment of premature ovarian failure

A

estrogen until age 50-51, transdermal patch or vaginal ring of 17B-estradiol is best option
need medroxyprogesterone acetate for first 10 days of cycle to prevent endometrial hyperplasia

162
Q

can women with premature ovarian failure still get pregnant?

A

yes, spontaneous ovulation can occur, so need barrier contraception

163
Q

can you give Hep B vaccine during pregnancy

A

if series started prior to pregnancy, follow 0,1,6 scheduel

164
Q

vaccines to consider during pregnancy

A

hepatitis A vaccine for woman who is close contact of person with hepA, or if traveling
tetanus toxoid and reduced diphtheria toxoid containing vaccine if indicated
meningococcal vaccine in outbreak or post-exposure
pneumococcal polysaccharide if high risk group due to underlying disease
acellular pertussis if risk outweigh benefits during 2nd half of pregnancy ie. during pertussis outbreak

165
Q

define cervical insufficiency

A

inability of cervix to retain pregnancy in second trimester in absence of contractions

166
Q

biochemical changes of cervix which induce premature cervical shortening

A

decreased collagen concentration, increased collagen solubility, increased IL8, increased glycosaminoglycans, increased tissue hydration

167
Q

when is cervical cerclage performed ?

A
  • between 12 and 14 weeks gestation in women with previous history of preterm loss
  • US-indicated cerclage between 16-23 weeks if cervix length less than 25mm, singleton pregnancy and previous loss
  • physical exam -indicated cerclage between 16-23 weeks if dilated cervix noted on exam
168
Q

what cervical length is considered short ?

A

less than 25mm

169
Q

what medication can be given to women with previous spontaneous preterm pregnancy loss ?

A

17-alpha-hydroxyprogesterone weekly starting at 16-24 weeks until week 36; inferior to cerclage and no benefit to combining both has be shown

170
Q

complications of cervical cerclage

A

increase puerperal pyrexia, sepsis, cervical dystocia, PROM, cervical laceration at delivery, and hemorrhage
NO INCREASED RISK OF CHORIO

171
Q

risk factors for cervical insufficiency

A

cervical trauma during labor or delivery (spontaneous, forceps- or vacuum-assisted, cesarean)
rapid mechanical cervical dilation before a gynecologic procedure (eg, uterine evacuation)
treatment of cervical intraepithelial neoplasia
congenital abnormalities include genetic disorders affecting collagen (eg, Ehlers-Danlos syndrome), uterine anomalies, in utero diethylstilbestrol (DES) exposure, and biologic variation

172
Q

when to initiate screening for cervical length

A

initiate cervical length screening in women with suspected cervical insufficiency at about 14 weeks, but may screen as early as 12 weeks in women with early second-trimester losses, recurrent second-trimester losses, or a prior large cold-knife conization

173
Q

contraindications to cerclage

A

fetal anomaly incompatible with life
intrauterine infection
active bleeding
active preterm labor
preterm premature rupture of membranes (PPROM)
fetal demise
relative: presence of fetal membranes prolapsing through the external cervical os - over 50% risk of ROM

NB: previa is NOT absolute contraindication

174
Q

when is cerclage removed ?

A

37 weeks or at onset of preterm labor

175
Q

how long to wait after miscarriage for subsequent pregnancy

A

3 months

176
Q

comparison of efficacy of expectant vs. medical vs. surgical management for incomplete, inevitable or missed abortion

A

similar efficacy for all 3 treatment options

177
Q

indication for surgical management of miscarriage

A

septic abortion, hemodynamically unstable

178
Q

when is medical/surgical mgmt of abortion preferred to expectant management

A

embryonic demise or anembryonic pregnancy

179
Q

painful vulvar/vaginal ulcerations with or without vesicles + painful lymphadenopathy, can cause dysuria, systemic symptoms like fever, malaise

A

HSV

180
Q

painless ulcer usually single + painless lymphadenopathy

A

syphillis

181
Q

painful non-indurated ulcer with irregular border and ring of erythema + painful lymphadenopathy, no systemic symptoms

A

chancroid

182
Q

painless herpetiform ulcers + tender inguinal lymphadenopathy

A

lymphogranuloma venereum

183
Q

large painless beefy red ulcers with NO lymphadenopathy

A

granuloma inguinale (donovaniasis)

184
Q

management of ectopic pregnancy with 400mL blood in the pelvis

A

it’s ruptured, therefore salpingectomy is required, this patient is no longer a candidate for salpingotomy and mass removal

185
Q

preferred screening method for gestational diabetes

A

2 step approach: glucose challenge test followed by formal OGTT

screening 50g OGTT, no fasting prior:
1 hour post < 7.8 is normal, over 11.1 is GDM, if between 7.8-11.1 then do a 2 test

75g OGTT: fasting 5.3, 1 hour post 10.6, 2 hours post >9, GDM if any of these +’ve

186
Q

risk factors for gestatational diabetes

A 
obesity, BMI > 30 prepregnancy
previous gestational diabetes
previous LGA baby > 4000g
heavy glycosuria
PCOS
FamHx of T2DM
187
Q

gestational diabetes associated with increase risks of

A 
preeclampsia
hypoglycaemia, DKA or HHS
polyhydramnios
stillbirth
neonatal morbidity: hypoglycemia, hyperbilirubinemia, hypocalcemia, hypomagnesemia, polycythemia, respiratory distress, and/or cardiomyopathy
188
Q

when to test for gestational diabetes

A

initial prenatal visit to identify overt diabetes, can use A1c
screen for GDM between 24-28 weeks

189
Q

first line treatment for GDM

A

nutritional therapy + exercise + self monitoring of blood glucose

190
Q

treatment of GDM when blood glucose not controlled by diet & exercise

A

insulin therapy

191
Q

stages of endometrial cancer (IA, IB, II, III, IIII, IV)

A

IA: less than 50% invasion of myometrium
IB: more than 50% invasion of myometrium
II: involves cervix
III: regional spread (vagina, pelvic or para-aortic lymph nodes)
IV: invasion of surrounding bladder, rectum, etc.

192
Q

treatment of endometrial cancer stage II or greater

A

total abdominal hyst + BSO + chemo + radiation

193
Q

Ddx of amenorrhea

A

ovarian insufficiency: premature ovarian failure, congenital/Turner’s, autoimmune, Swyer’s (46XY)- androgen receptor insensitivity
pituitary: hyperprolactinemia, Sheehan, prolactinoma, meds, autoimmune
outflow tract: Asherman syndrome, cervical stenosis, congenital/mullerian abnormalities
hypothalamic: anorexia, stress, gonadotropin deficiency (Kallman syndrome)
endocrine: thyroid dz, adrenal dz, androgen-secreting tumor, PCOS
physiologic: breastfeeding, contraceptives, pregnancy, menopause

194
Q

diagnostic approach to amenorrhea

A

pregnancy test
check TSH, prolactin
progesterone challenge, if no withdrawal bleed then estrogen/progesterone challenge
if withdrawal bleed after estrogen/progesterone check LH, FSH
if at that point, LH/FSH normal OR high prolactin, get MRI

195
Q

gold standard to diagnose Asherman’s syndrome

A

hysteroscopy

196
Q

treatment of Asherman sydnrome

A

hysteroscopy and lysis of adhesions, then use hyaluronic gel to prevent reformation

197
Q

risk factors for uterine inversion

A 
twin pregnancy
Crede maneuver (fundal pressure)
magnesium sulfate
repeated cord traction
placenta accreta
uterine atony
uterine abnormality
connective tissue disorder
short umbilical cord
198
Q

first line management of uterine inversion

A

Johnson maneuver: fundal pressure and push fist through vagina, leave hand in place until strong contraction around it

199
Q

2nd line management of uterine inversion after failed manual repositioning

A

O’Sullivan maneuver: use hydrostatic pressure to reverse uterus, install warm saline into vagina
add relaxing agent like sublingual glyceril trinitrate or subcut terbutaline to increase success

200
Q

3rd line management of uterine inversion after failed manual and hydrostatic attempts

A

Haultaim procedure: longitudinal incision in posterior uterus through the ring for replacement

201
Q

most common cause of postpartum hemorrhage

A

uterine atony

202
Q

risk factors for uterine atony

A 
prolonged labor
polyhydramnios
previous uterine atony
multiple gestation
use of magnesium sulfate
LGA fetus
203
Q

how long after pregnancy to resume sex

A

6 weeks

204
Q

contraception for postpartum women who want a future pregnancy and will be breastfeeding

A

progestin only pill

205
Q

most common cause of lactational mastitis

A

Staph aureus

206
Q

treatment of lactational mastitis

A

oral cloxacillin or cephalexin, continue breastfeeding

207
Q

Pap smear in pregnancy

A

not safe to cytobrush

screen as normal schedule

208
Q

risk factors for placental abruption

A 
trauma
previous abruption
cocaine use
smoking
maternal htn
multiple gestation
premature ROM
hydramnios
thrombophilia
209
Q

classes of placental abruption: mild, moderate, severe correspond with

A

mild: no fetal compromise
moderate: signs of fetal compromise
severe: fetal demise

210
Q

management of mild placental abruption and preterm fetus

A

conservative, monitor in hospital until bleeding has stopped x 48 hours, give corticosteroids for lung maturity, nifedipine for tocolysis if in preterm labor x 48 hours, weekly NST after goes home, plan to deliver at 37 weeks

211
Q

management of mild placental abruption and term fetus

A

attempt vaginal delivery- can use induction and augmentation to speed up

212
Q

management of moderate placental abruption

A

emergency delivery, regardless of gestational age

C-section unless vaginal delivery is imminent

213
Q

management of severe placental abruption

A

delivery required but not as emergency because fetal demise already occurred

214
Q

complications of placental abruption

A

maternal hypovolemia, DIC, renal failure, ARDS, MODS, death

fetal asphyxia, preterm birth, death

215
Q

initial approach to 28 week pregnant women presentation with vaginal bleeding and cramping after falling down the stairs

A

ABCs, vitals, large bore IV placed

CBC, type and cross, coags

216
Q

US finding of placental abruption

A

retroplacental hematoma

217
Q

at what level does a placental abruption usually occur?

A

maternal vessels shear at the decidua basalis

218
Q

vaginal discharge showing pseudohyphae and spores on wet mount

A

Candidiasis

219
Q

vaginal discharge showing clue cells on wet mount, positive Whiff test, vaginal pH > 4.5

A

bacterial vaginosis, Gardnerella

clue cells are fragments of coccobacilli on squamous cells

220
Q

vaginal discharge- shows intracellular gram negative diplococci

A

Gonorrhea

221
Q

vaginal discharge showing motile flagellated organisms on microscopy

A

Trichomonas

222
Q

gold standard to diagnose urinary incontinence

A

urodynamics

223
Q

first line management for overflow incontinence

A

intermittent catheterization

224
Q

first line management for stress incontinence

A

Kegel exercises

weight loss, timed regular voiding, topical vaginal estrogen

225
Q

first line management for urge incontinence

A

anticholinergics

226
Q

Grading of stress incontinence

A

grade 1: loss of urine with stress ie. cough, laugh
grade 2: loss with less, ie. standing or walking
grade 3: loss without position change, ie. laying down

227
Q

classic triad of endometriosis

A

dysmenorrhea, dyspareunia, dyschezia

228
Q

differentiating factor of subserous uterine leiomyomas

A

calcification

229
Q

treatment of uterine leiomyomas

A

treatment with GnRH agonists, causes downregulation and therefore stops endogenous pulsatile secretion and therefore less FSH/LH and less estrogen which feeds the fibroids, i.e. they cause hypogonadism
and shrink the leiomyomas

230
Q

treatment of choice for DVT/PE in pregnancy

A

LMWH, may initiative UFH first then switch

heparins do not cross placenta

231
Q

warfarin effects during pregnancy

A

crosses placenta, teratogenic during 6-12 weeks gestation and increases fetal/neonatal bleeding if used in 2nd-3rd trimesters

232
Q

anticoagulation used in breastfeeding

A

both heparins and warfarin are safe

233
Q

define retained placenta

A

placenta has not been delivered 30 mins after fetus delivered

234
Q

define postpartum hemorrhage

A

more than 500cc blood loss after vaginal delivery, more than 1L after C-section

235
Q

management of retained placenta

A

if blood loss minimal, can consider giving more oxytocin and watchful waiting for another 15 mins
if significant blood loss, carboprost and manual removal of placenta (in OR)

236
Q

define gestational hypertension

A

2 BP measured over 140/90 at least 4 hours apart

237
Q

questions to ask on history when pregnant patient has gestational hypertension

A

headache, vision change, RUQ/epigastric pain, oliguria, edema (peripheral & pulmonary), seizure, vaginal bleeding (possible abruption), and stroke sx.

238
Q

define pre-eclampsia

A

2 BP measured over 140/90 at least 4 hours apart WITH end organ dysfunction =more than 0.3g proteinuria/ greater than 1+ on dipstick, OR platelets below 100, Cr above 97.2, liver transaminases 2x ULN, pulmonary edema, cerebral or visual symptoms

239
Q

define HELLP syndrome

A

pre-eclampsia with hemolysis, elevated liver enzymes, low platelets

240
Q

risk factors for pre-eclampsia

A 
first pregnancy
multiple gestation
past history of pre-eclampsia
family history of pre-eclampsia
advanced maternal age
pregestational diabetes, hypertension
antiphospholipid antibodies
BMI > 26.1
CKD
241
Q

lab tests to order in women with suspected pre-eclampsia

A 
CBC
lytes, urea, Cr
liver transaminases
liver function: glucose, INR, bilirubin, albumin
urinalysis  - protein
NST and BPP
242
Q

initial hypertensive therapy used in gestational htn or preeclampsia

A

labetalol
nifedipine
hydralazine

243
Q

when to use magnesium sulphate in gestational hypertensive disorders

A

treatment of seizures in eclampsia

prophylaxis of seizures in severe preeclampsia or non-severe with end organ symptom

244
Q

ultrasound findings of adenomyosis

A

symmetrical enlarged uterus, areas of decreased echogenicity in the myometrium, cystic spaces in myometrium and eccentric endometrial cavity

245
Q

definitive treatment of adenomyosis

A

hysterectomy

246
Q

which breech presentation can be delivered vaginally

A

frank breech

247
Q

indications for C-section

A

HIV positive mother not on antiretrovirals
HSV lesions at time of delivery (offer suppressive therapy at 36 weeks to decrease chance)
failure to progress during labor
fetal distress
fetal malpresentation

248
Q

bacteria which commonly accompany Gardenerella vaginalis in bacterial vaginosis

A

Mycoplasma hominis
Mobiluncus
Prevotella

249
Q

define infertility

A

1 year of trying to conceive under age 35

6 months of trying to conceive over age 35

250
Q

1st stage of labor - latent phase

A

irregular contractions + dilatation 0-3cm

251
Q

1st stage of labor -active phase

A

regular contractions + dilating 4-10cm

252
Q

2nd stage of labor

A

full dilated to delivery of fetus

253
Q

3rd stage of labor

A

from delivery of fetus to delivery of placenta

254
Q

4th stage of labor

A

uterus contracts back down to normal size

255
Q

failure to progress

A

less than 1.2cm/hr dilation in nullip

less than 1.5cm/hr in multip

256
Q

menopausal symptoms

A

vasomotor: hot flushes, night sweats
neuromusc: headaches, joint pains
mood: low mood, insomnia, irritability, fatigue
urogenital: urinary frequency/incontinence, vaginal dryness, low libido

257
Q

top 3 most common cancer in women

A
  1. breast, 2. lung, 3. colon
258
Q

contraindications to combined oral contraceptives

A 
cirrhosis, hepatic adenoma
migraine with aura
age over 35 and smoking
hypertension
breast cancer
multiple CV risk factors, known ischemic heart disease
previous DVT/PE
hx of stroke
lupus
259
Q

define labour

A

contractions + uterine dilatation

260
Q

pre conceptual folate

A

0.4-1mg if normal

5mg if risk factors FamHx,

261
Q

when should have first prenatal visit

A

before 12 weeks

262
Q

preconceptual testing

A

HBV, HIV, syphillis, parvovirus B19, rubella, varicella, GC/chlamydia

263
Q

Naegele’s rules

A

LMP + 7 days - minus 3 months

264
Q

when to give Rhogham

A

give when any bleeding, at 28 weeks, within 72 hours of delivery based Kleihauer-Betke dose or 300ug

265
Q

how often prenatal visits

A

q 4 weeks until 28
q 2 weeks until 36
then q 1 week until delivery

266
Q

Ddx for small for dates

A

date miscalculation
IUGR
fetal demise
oligohydramnios

267
Q

Ddx for large for dates

A 
date miscalculation
multiple gestation
polyhydramnios
LGA (familial, DM)
fibroids
268
Q

when to do dating U/S

A

8-12 weeks

269
Q

when to do IPS screening

A

part 1: 11-14 - PAPPA, B-HCg

part 2: 15-20: MSAFP, β-hCg, Unconjugated estrogen (estriol or μE3), Inhibin A

270
Q

Ddx of increased MSAFP

A 
incorrect GA
> 1 fetus, twins
fetal demise
neural tube defects
abdo wall defects - omphacelen
271
Q

Ddx of decreased MSAFP

A 
increased GA
GTN
missed abortion
chromosomal anomalies
maternal DM
272
Q

when to look for gestation diabetes

A

50g OGCT

273
Q

what to do at 28 weeks in pregnant women

A

repeat CBC

Rhogham

274
Q

when to screen for GBS

A

36 weeks

275
Q

causes of polyhydramnios

A

maternal: T1DM
maternal-fetal: chorioangiomas, multiple gestation, fetal hydrops
fetal: chromosomal anomaly, cystic adenomatoid malformed lung, anencephaly, hydrocephalus, meningocele, TEF, duodenal atreaia, facial clefts

276
Q

causes of oligohydramnios

A

maternal: uteroplacental insufficiency (pre-eclampsia, nephropathy), meds (ACEIs)
fetal: congenital urinary tract anomalies (renal agonies, obstruciton, posterior urethral valves), demise/chronic hypoxemia (blood shunt away from kidney shunt away from kidneys to perfuse brain), IUGR, ruptured membranes, amniotic fluid normally decreases after 35 week

277
Q

uncomplicated UTI in pregnancy treated with

A

first line: amoxicillin 500mg q8h x 7 days

second line: nitrofurantoin 100mg BID x 7 days

278
Q

differential for postpartum pyrexia

A

breast-5W

breast: engorgement, mastitis
wind: atelectasis, pneumonia
water: UTI
wound: episiotomy, C/S site infection
walking: DVT/thrombophlebitis
womb: endometritis

279
Q

stages of puberty

A

boobs, pubes, grow, flow

280
Q

diagnostic test for granuloma inguinale

A

punch biopsy

281
Q

DDX of decreased fetal movements

A 
DASH
death of fetus
amniotic fluid decreased 
sleep cycle of fetus
hunger/thirst
282
Q

get mom to sit in quiet room drink juice and count fetal movements should have

A

more than 6 movements in 2 hours

283
Q

what defines a normal NST

A

baseline: 110-160
variability: 6-25bpm
access: 2 accelerations lasting 15 secondas, 15bpm above baseline, in 20 min strip (only 10bpm change if under 32 weeks)

284
Q

what to do if there is not 2 accels in first 20 mins of NST

A 
stimulate fetus (fundal pressure, acoustic/vibratory stimulation) and continue monitoring for 30min
if NST abnormal, then perform BPP
285
Q

NST shows
baseline: 170 for 15 mins, rising baseline
variability: 5
variable decals: 30-60s duration
2 accels of 15bpm lasting 15s in 40-80 mins

A

atypical NST, which requires further assessment - BPP

286
Q

NST shows:

baseline: 90 for 40 mins, erratic baseline
variability: <5 for 80 mins, sinusoidal, or 25bpm > 10 min
decels: variable > 60s, or late decels
accels: less than 2 in 80 mins

A

abnormal NST

urgent action required; U/S or BPP required, some siutations will require delivery

287
Q

normal AFI (amniotic fluid index)

A

> 5cm and <24cm

288
Q

normal single deepest pocket of amniotic fluid measure

A

2x2 to 8x8

289
Q

oligohydramnios numners

A

AFI < 5

depth locker <2cm

290
Q

polyhydramnios numbers

A

AFI > 24

depth pocket > 8

291
Q

population at risk for thalassemia

A

mediterranean, SE asian, western pacific

292
Q

screening test for thalassemia

A

CBC (MCV and MCH), Hb electrophoresis, or HPLC

293
Q

population at risk for sickle cell

A

African, Caribbean

294
Q

population at risk for Tay Sachs

A

Ashkenazi Jewish, French Canadians, Cajun

295
Q

screen test for Tay Sachs

A

enzyme assay EXA or DNA analysis HEXA gene

296
Q

components of BPP

A 
LAMB
limb extension + flexion
AFV 2x2
movement - 3 discrete
breathing ((one episode x 30s)
297
Q

dating ultrasound done

A

8-12 weeks by crown rump length

298
Q

US at 18-22 weeks helps determine

A

number of fetusses
GA
location of placenta
fetal anomalies

299
Q

severe symptomatic polyhydramnios between 32 and 34 weeks of gestation

A

amnioreduction

300
Q

severe symptomatic polyhydramnios after 34 weeks GA

A

amniocentesis

301
Q

severe symptomatic polyhydramnios under 32 weeks GA

A

amnioreduction followed by indomethacin

302
Q

complications of pregnancy increased with bicornuate uterus

A

pregnancy loss, preterm labor, or malpresentations

303
Q

complications of pregnancy increased with unicornuate uterus

A

higher risk for infertility, endometriosis, premature labor, and breech presentations

304
Q

goals of GDM therapy

A

fasting sugar < 5.3
one hour post prandial < 7.8
2hr post < 6.7

305
Q

prenatal screening done at first visit

A 
dating U/S 
possible Pap smear
CBC, blood group and screen
VDRL, HIV, HepBSAg, GC/chlamydia
rubella IgG
varicella IgG if no hx of disease/immunization
parvovirus IgM or IgG if high risk
306
Q

when is part 1 of IPS done

A

11-14 weeks

307
Q

what is in IPS part 1

A

U/S for NT
BHCG
PAPPA

308
Q

when is part 2 of IPS done

A

15-20 weeks

309
Q

what is in IPS Part 2 (same as MSS)

A

MSAFP
B-HCG
unconjugated estroenen
inhibin A

310
Q

when do pregnant women notice fetal movements

A

18-20 weeks

311
Q

when to screen for GDM

A

24-28 weeks

312
Q

whats done at 28 weeks GA

A

repeat CBC to look for anemia

Rhogham for all Rh negative women

313
Q

what screening done 35-37 weeks

A

GBS screen

314
Q

what screening done at 18-20 weeks GA

A

anatomical survey ultrasound

315
Q

what is non invasive prenatal testing

A

analyses maternal blood for circulating cell free fetal DNA at 10 weeks

high sensitivity for Trisomy 21

316
Q

when to do amniocentesisi

A

15-16 weeks

317
Q

when to do CVS

A

10-12 weeks

318
Q

difference between CVS and amnio

A

amniocentesis has higher accuracy and lower risk of spontaneous abortion (0.5% vs. 1-2%)

319
Q

risk factors for neural tube defects

A

GRIMM
genetics: fame of NTD, consanguinity, chromosomal
race: european caucasians > african americans, nisuffieicny vitamins: zinc and foalte
maternal chronic disease eg. DM
maternal use of antiepeileptic drugs

320
Q

investigations for isoimmnzaiton

A

screen with indirect Coombs test at first visit for blood group, Rh status and antibdoies

Kleihauer-Betke test used to determine extent of fetmomaternal hemorrhage by estimating volume of fetal blood volume that entered maternal cirucaltion
detailed US for hydrous fetalis

321
Q

when to give Rhogham

A

routinesy at 28 weeks GA
within 72 hours of birth of Rh positiv efetus
with positive Kleihauer Betke test
with any invasive procedure in pregnancy (CVS, amnio)
in ecptopci pregnancy
with miscarriage or TA
with antepartum hemorrhage

322
Q

what to do if Rh negative and Ab screen positive

A

follow mother with seiral monthly Ab titres throughout pregnancy +/- serial amnio as needed

323
Q

how to investiate for fetal anemia

A

MCA dopplers

324
Q

expected weight gain in pregnancy in BMI <19

A

12.7-18.2kg

325
Q

expected weight gain with BMI 19-25

A

11.3-15.9 kg

326
Q

expected weight gain when BMI over 25

A

6.8-11.3kg

327
Q

adverse effect of ACEI in pregnancy

A

fetal renal defects, IUGR, oligohydramnios

328
Q

adverse effect of tetracycline in pregnancy

A

staisn infant teeth, may affect long bone development

329
Q

adverse effect of retinoids (ie. accutane) in pregnancy

A

CNS, raniofacial, cardic, thyme anomalies

330
Q

adverse effect of misoprostol in pregnancy

A

mobs syndrome (congenital facial paralysis with or without limb defects, SA, preterm labour

331
Q

advser effect of phenytoin in pregnancy

A

fetal hydrantoin syndrome in 5-10% (IUGR, MR, facial dysmorphogenesis, congenital anomalies)

332
Q

adverse effect of valproate, carbamazepine on pregnancy

A

open neural tube defects in 1-2%

333
Q

adverse effect of lithium on pregnancy

A

ebstein’scardiac anomaly, goitre, hyponatremia

334
Q

adverse effect of warfarin on pregnancy

A

increased incidence of SA, stillbirth, pre, IUGR, fetal warfarin syndrome (hypoplasia, epiphyseal stippling, optic atrophy, MR< ICH)

335
Q

adverse effect of erythromycin in pregnancy

A

maternal liver damage (Acute fatty liver)

336
Q

adverse effect of sulpha drug in pregnancy

A

anti-folate properties, therefore theoretical risk in T1, risk of kernicterus in T3

337
Q

adverse effect of chloramphenicol in pregnancy

A

grey baby syndrome (fetal circulatory collapse secondary to toxic accumulation)

338
Q

DDX for bleeding in pregnancy 20 weeks to term

A

bloody show (shedding of cervical mucous plug)
placenta previa
abruptio placenta
vas previa
cerical lesion (cervicitis, polyp, ectropion, cervical cacner)
uterine rupture
other: bleeding from bowel of bladder, palcenta accreta, abnormal coagulation

339
Q

work up for fetal death in utero over 2- weeks

A

maternal: HbA1c, fasting glucose, TSH, Kleihauer, Betke, VDRL, ANA, CBC, anticardiolipins, antibody screens, INR/PTT, serumurine tox, cercical and vagina cultures, TORCH screen
feta: karyotpye, cord blood, skin biopsy, genetics evaluation, autopsy, amniotic fluid culture for CMV, paravovorius B19, herpes
placetena: pathology, bacterial cultures

340
Q

define IUGR

A

infant weight <10th percentile for GA, or <2500g

341
Q

approach to abnormal FHR

A 
POSION ER
position (LLDP)
O2 100% by ask
fetal scalp stimlation
fetal scalp electrode
fetal scalp pH
stop Oxytocin
Notify MD
vag exam to rule out cord prolapse
rule out fever, dehydration, drug effects , prematurity
342
Q

what to do if fetalscalp pH < 7.2

A

delivery indicated

343
Q

Ddx for fetal tachycardia

A

maternal: fever, hyperthroidism, aneamia, dehydration
fetal: arrythmia, anemia, chornic hypoxemia, congential anomalies
drugs: sympathomimiteics
uteropalcental: early hypoxia (abruption, htn), chorioamnionitis

344
Q

Ddx for fetal bradycarda

A

maternal: hypothermia, hypotension, hypoglycemia, position, umbilical cord occlusion
fetal: rapid descent, dysrthymia, heart block, hypoxia, vagal stimulation (head compression), hypothermia, acidososi
drugs: B-blockers, anestehtics
uteroplacetnal: late hypoxia (abruption, stn), acute cord prolapse, hypercontractiliy

345
Q

DDx for decreased variabilty

A

maternal: infection, dehydration, fetal: cNS anomalies, dysrhythmia, inactivity/sleep cycle, preterm fetus
drugs: narcotics, sedatives, MgSO4, B-blcokers
uteroplacetnal: hypoxia

346
Q

Bishop score

A 
position
consitency
effacemnet
dialtation
station
347
Q

4 Ps of labour dystocia

A

power
passenger
passage
psych

348
Q

define labour dystocia

A

during active phase > 4h of <0.5cm/hr
therefore ex: 9:00 4cm dilated, 13:00 only 5cm dilated

OR
>1h with no descent durign active pushing

349
Q

complications of shoulder dystocia

A

fetal
-HIE chest compression by vagina or cord compression by head can lead to hypoxia
brachial plexus injury- Erbs C5-7, or Klumpke’s C8-T`
fracture
death
metarnal: perineal injury, PPH, uterine rupture

350
Q

approrach to shoulder dystocia

A

ALARMER
apply suprapubic pressure and ask for help
Legs in full flexion (McRobrt’s manuever
anterior shoulder disimpaction (suprapubic pressure)Release posterior shoulder by rotating it anteriorly with ahnd in vagina under adequate analgeasia
Manual corkscrew, e. rotatie fetus by posterior shoulder until anterio shoulder emerges from behind maternal symphysis
Episiotyom
Rollowver (on hands and knees)

351
Q

grading of vaginal lacerations in delivery

A

1st: skin and vaginal mucosa only - not underlying fascination or muscle
2nd: fascia nd muscles fo pernieal body, but not anal sphincter
3rd: analsphincter but not extenindg through it
4th: extends through anal sphincter into rectal mucosa

352
Q

drugs contraindciated in breastfeedign

A 
BREAST
bromocriptin/benzos
radioactive isotopes/rizatriptan
ergotamine/ethosuxoimide
amiodarone/amphetamines
stimulate laxatives/sex hormones
tetracyscline/tretinoin

OBGYN (1 decks)

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