Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ob Gyn > Obstetrics 2 > Flashcards

Obstetrics 2 Flashcards

1
Q

What is the management in shoulder’s dystocia?

A

Suprapubic pressure
McRobert’s maneuver (hyperflexion of mother’s hips onto abdomen)

(Others: Wood’s corkscrew, delivery of the posterior arm, Zavernelli’s maneuver)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Erb’s palsy involves damage to which nerves?

A

C5-C6 nerve roots.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does the McRobert’s maneuver work?

A

Straightens the sacrum relative to the lumbar spine and rotates the symphysis pubic anteriorly toward the maternal head.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is macrosomia defined?

A

> 5000g

> 4500g in diabetics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is the most common location for ureteral injury?

A

At the cardinal ligament, where the ureter is only 2 to 3 cm lateral to the cervix internal os. It is just under the uterine artery, and can be injured when clamping the uterine arteries.

Other injury locations include pelvic brim when the ovarian arteries are being ligated. And where the ureter enter the bladder, anterior to the vagina, which can be injured when vaginal cuff is ligated at the end of a hysterectomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the most common causes of postmenopausal bleeding?

A

Most common cause: Atrophic endometrium (friable endometrium or vagina due to low estrogen)

Endometrial polyps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is considered abnormal thickness on an endometrial stripe?

A

> 5mm in postmenopausal woman

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the risk factors for placenta previa?

A 
Grand multiparity
Previous C-sections
Curretage
multiple gestation
previous placenta previa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Rupture of membranes should only be attempted when the fetal head is in what position

A

Engaged with the pelvic inlet. Otherwise, umbilical cord prolapse is very possible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What position should patient be placed in umbilical cord prolased?

A

Trendelenburg position - Patient has head down, to elevate the presenting part and keep pressure off the cord.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does hyperstimulation with oxytocin cause fetal bradycardia?

TX?

A

Uterus becomes tetanic or the uterus contractions become frequent (every minute)

B-agonist such as Terbutaline will help relax the uterine musculature.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When does the fundal height correlate well with wga?

A

18-34 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common finding in uterine rupture?

A

Fetal heart rate abnormality which includes bradycardia, severe variable decelerations, or late decelerations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is uterine overstimulation defined?

Causes?

A

More than 5 contractions over a 10 minute window

Causes: Misoprostol, which can cause prolonged fetal decelerations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How to clearly differentiate the maternal pulse from fetal bradycardia?

A

Ultrasound.

Fetal scalp electrode.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How dilated does the cervix have to be to obtain a fetal scalp pH?

A

At least 4 cm dilated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the steps in managing fetal bradycardia after rupture of membranes?

A
  1. Differentiate fetal bradycardia from maternal pulse.
  2. Initiate maneuvers to improve maternal oxygenation (placement of mom on left side, oxygen, stop uterotonics, start terbutaline, IV fluid bolus)
  3. Vaginal exam for cord prolapse
  4. Emergent C-Section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the causes of galactorrhea?

A

Pituitary adenoma, pregnancy, breast stimulation, chest wall trauma, or hypothyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does hypothyroidism cause hyperprolactinemia?

TX?

A

Increases in TRH also stimulates the release of prolactin.

Thyroxine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Is bromocriptine safe during pregnancy?

A

Yes, bromocriptine is safe for pregnant women who have a microadenoma with headaches and visual disturbances.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the most sensitive imaging test for pituitary adenoma?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the DDx for generalized pruritus?

A

(1) Cholestasis of pregnancy - bile salts are incompletely cleared by the liver. No skin rashes. W/ or W/O jaundice. Begins in the third trimester. Increases incidence of prematurity, fetal distress, and fetal loss.
(2) Pruritus urticarial papules and plaques of pregnancy (PUPPP) - erythematous papules and hives beginning in the abdomen and spreading to the buttocks.
(3) Herpes gestationis - intense itching with erythematous blisters (vesicles and bullae) on abdomen and extremities. 2nd trimester.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

TX for cholestasis of pregnancy?

A

1st line: antihistamines and cornstarch baths

2nd line: Ursodeoxycholic acid, Cholestyramine, bile salt binders.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Nulliparous woman with abdominal pain, cervical motion tenderness and adnexal tenderness.

A

Salpingitis = PID. Long term complications: ectopic pregnancy, infertility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is PID diagnosed? Confirmed?

A

Diagnosis via clinical findings: abdominal tenderness, cervical motion tenderness, and adnexal tenderness.

Confirm: Positive Neisseria/Chlamydia culture, ultrasound suggestive of TOA. Further evaluation: laparoscopy. Purulent discharge from fimbria of the tubes –> PID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Other DDx similar to PID?

A

Ovarian torsion: colicky pain, U/S with ovarian cyst
Acute appendicitis
Pyelonephritis/nephrolithiasis

If RUQ pain as well when perihepatic adhesions are present: Fitz-Hugh and Curtis Syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Culture of purulent drainage in PID would show which organism(s)?

A

Multiple organisms: N. Gonorrhea, Chlamydia, anaerobes, and gram - organisms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the most accurate (gold standard) for diagnosing PID, and differentiating it from appendicitis?

A

Laparoscopy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Risk factors for PID?

Protective against PID?

A

Nulliparity
IUDs

OCPs such as depot progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Pregnant with acute onset of pleuritic chest pain and severe dysnea. Significant hypoxia with decreased oxygen hypoxia.

Dx? Test?

Tx?

A

Pulmonary embolus (clot in pulmonary artery circulation)

Test: Spiral computed tomography. Magnetic resonance angiography of lungs.

Tx: anticoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Other DDx with pulmonary embolus?

A

Pulmonary edema
Reactive airway disease
Pneumonia

Clear lungs on X-ray rule out all three.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are normal arterial blood gas changes in pregnancy?

A

pH 7.45 (respiratory alkalosis with partial metabolic compensation)
PO2 - 95-105 (increase tidal volume)
PCO2 - 28
HCO3 - 19 - renal excretion of bicarbonate to partially compensate for respiratory alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Most common cause of maternal mortality during pregnancy?

A

Thomboembolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What percentage of transmission of herpes is transplacental?

A

5-10%.

Most are obtained from the secretions in the genital tract.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the rational of oral acyclovir therapy at the primary outbreak of herpes?

A

Decrease viral shedding and the duration of lesions. Acyclovir does not affect the likelihood of future recurrence and does not change the patient’s immune response.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Most common reason for a hysterectomy?

A

Symptomatic uterine fibroids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are treatments for uterine leiomyomata?

A 
Medroxyprogesterone acetate (Provera)
GnRH agonist

If severe symptoms, hysterectomy.
Myomectomy if pregnancy is still desired.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Carneous Degeneration

A

Changes of the leiomyomata due to rapid growth; center of the fibroid becomes red, causing pain. Red degeneration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Physical presentation of a uterine fibroid?

A

Irregular, midline, firm, non-tender mass that moves contiguously with the cervix. Lateral, fixed, fluctuant masses are not typical for fibroid – ovarian mass, tuboovarian masses, pelvic kidney, and endometrioma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Patient with severe preeclampsia, epigastric pain, markedly elevated liver function test, delivers and develops sudden severe abdominal pain, abdominal dissension, syncope, hypotension and tachycardia. Dx? Tx?

A

Hepatic rupture. This is a serious sequelae of preeclampsia.

Laparoscopy and massive blood product replacement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the side effects of magnesium sulfate

A

Pulmonary edema. Hyporeflexia (decrease deep tendon reflexes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Hypertensive medications during pregnancy

A

Labetalol and hydralazine

43
Q

Algorithm for preeclamptic pregnancies?

A

> 37 weeks - magnesium sulfate + deliver
< 37 weeks with severe features - magnesium sulfate + deliver
< 37 weeks without severe features - expectant management

44
Q

What are severe features of preeclampsia? Management?

A
  • Systolic blood pressure of 160 mm Hg or higher, or diastolic blood pressure of 110 mm Hg or higher on two occasions at least 4 hours apart while the patient is on bed rest (unless antihypertensive therapy is initiated before this time)
  • Thrombocytopenia (platelet count less than 100,000/microliter)
  • Impaired liver function as indicated by abnormally elevated blood concentrations of liver enzymes (to twice normal concentration), severe persistent right upper quadrant or epigastric pain unrespon- sive to medication and not accounted for by alternative diagnoses, or both
  • Progressive renal insufficiency (serum creatinine concentration greater than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease)
  • Pulmonary edema
  • New-onset cerebral or visual disturbances

For women with severe preeclampsia at or beyond 34 0/7 weeks of gestation, and in those with unsta- ble maternal–fetal conditions irrespective of gesta- tional age, delivery soon after maternal stabilization is recommended.

45
Q

Most common cause of maternal death due to eclampsia?

A

Intracerebral hemorrhage.

46
Q

Chronic hypertension

A

If hypertension (>140/110) occurs before 20 weeks gestation or lasts beyond 12 weeks postpartum.

47
Q

Tx for fibrocystic changes

A

decrease caffeine, adding NSAID, tight fitting bra, OCP, oral progestin therapy.

If severe symptoms, danazol (anti-estrogen, androgenic compound) and masectomy is considered.

48
Q

Most common cause of dominant breast mass in adolescent years - 20’s

A

fibroadenoma

49
Q

What are the 5 factors that can lead to infertility?

A
  1. ovulatory (30-40%)
  2. uterine
  3. tubal
  4. male factor
  5. peritoneal factor (endometriosis)
50
Q

What is a normal semen analysis?

A

volume (nl > 2.0 mL), sperm concentration (nl > 20 million/mL), motility (nl > 50%), and morphology (nl > 30% normal forms).

51
Q

Most common causes of abdominal pain in pregnant women

A 
Appendicitis
Cholecystitis
Ectopic pregnancy
Placenta Abruption
ovarian torsion
52
Q

What is the leading cause of mortality in women in the first and second trimester?

A

Ectopic pregnancy

53
Q

How can we treat degenerating fibroids?

A

prostaglandin synthetase inhibitors

54
Q

How can progesterone levels help assess normal/abnormal pregnancies?

A 
>25ng/mL = normal 
<5ng/mL = abnormal
55
Q

treatment of ectopic pregnancy

A

Methotrexate, but 10% will require surgical intervention

Salpingectomy (removal of affected tube) for those where gestation too large, rupture has occurred, fertility no longer desired.

Salpingostomy if fertility is still desired.

56
Q

Gold standard for detecting ectopic pregnancy

A

Laparoscopy

57
Q

What type of testing would show thalassemia?

Should iron be given?

A

Elevated A2 hemoglobin on hemoglobin electrophoresis

Iron should not be given since these patient are prone to iron overload.

58
Q

What is anemia in pregnant ladies?

A

hemoglobin <10.5 g/dL

59
Q

Patients with sickle cell disease HbSS present with what symptoms during pregnancy?

A

intense anemia, and more frequent bouts of sickle cell crisis, and more frequent infections and pulmonary complications.

60
Q

Patient with pyelonephritis is given amp/gent. She now has symptoms of dysnea and tachypnea. What is the most likely etiology?

A

ARDS due to endotoxin release from lysed bacteria

Tx: oxygen supplementation, carefully monitor fluids, and supportive measures.

61
Q

Most common cause of septic shock in pregnancy?

A

Pyelonephritis

62
Q

Leading causes of pyelonephritis

A 
Aerobes: 
Ecoli
Proteus
Klebsiella
S. Aureus
63
Q

What tests are used to determine preterm labor will lead to preterm delivery?

A

Fetal Fibronectin Assay:
If FFN positive, high risk for preterm delivery
If FFN negative, no deliver within a week.

Cervical Length Assessment:
If <25mm, increase risk of preterm delivery
Impinging amniotic cavity into cervix (funneling) also increases risk of preterm delivery.

64
Q

Dx of Preterm Labor

A

Uterine contractions with >=2cm dilation and >=80% effacement.

65
Q

Which tocolytic agents can cause pulmonary edema

A

B-agonist - terbutaline, ritodrine

Magnesium sulfate

66
Q

What are the side effects of indomethacin?

A

Closure of fetal ductus arteriosus –> pulmonary hypertension

Oligohydramnios

67
Q

What type of infection if strongly associated with preterm delivery?

A

gonococcal cervicitis

68
Q

What can be used for emergency contraception

A

Yuzpe’s regimen: Combination OC emergency contraception

Plan B - 0.75 mg Levonorgestrel 12 hours apart

IUD - Levonorgestrel release or copper IUD

69
Q

Management of deep venous thrombosis

A

Anticoagulation, bed rest with leg elevation. aPTT should be 1.5-2.5 times control for 3 months after the acute event

70
Q

Why does venous stasis occur in pregnancy?

A

Uterus compresses the vena cava

71
Q

Long term complications of heparin use?

A

Osteoporosis and thrombocytopenia.

72
Q

Most common sites for DVT after gynecological surgeries

A

lower extremities, and pelvic veins.

73
Q

A 3-D dominant breast mass is present. Management?

A

Excisional biopsy - removes the entire mass

since mammography has a 10% false negative rate

74
Q

What is the 2 leading causes of cancer deaths in women

A
  1. Lung cancer 2. Breast cancer
75
Q

What is the most important risk factor for breast cancer?

A

Increase in age.

76
Q

Who are candidates for genetic testing for BRCA1/BRCA2?

A

Patients with 2 first-degree relatives with breast cancer.

BRCA1 is associated with 50-70% risk of breast cancer and 30% risk of ovarian cancer.

BRCA2 has a lower risk

77
Q

Management if aspiration of breast tissue is straw color? Bloody?

A

Straw color - fluid discarded, no therapy needed

Bloody - sent to cytology

78
Q

How are adnexal masses managed during the reproductive age?

A

8cm likely to be a tumor

5<8 sonographic features helps to differentiate
Septation, solid components, excrescences are associated with neoplasms.

79
Q

How are adnexal masses managed during prepubertal years and menopausal years?

A

> 2cm operate

>4-5cm operate

80
Q

What are granulosa cell tumors and sertoli-leydig cell tumors?

A

Solid tumors that secrete respectively, estrogen and androgens.

81
Q

If ascites is present with an adnexal mass, what does that signify?

A

Common sign of ovarian malignancy

82
Q

Ovarian cancer staging

A

Total abdominal hysterectomy, bilateral-salpino-oophorectomy, omentectomy, peritoneal biopsies, peritoneal washes, sampling of ascitic fluid, lymphadenectomy.

83
Q

What are the risk factors for surgical site infection due to fascial disruption?

A

Obesity, diabetes, cancer, chronic cough and a probable vertical incision. Occurs 7-10 days post-surgery.

84
Q

When does fascial disruption and evisceration likely occur?

A

5-14 days after surgery. Needs to be repaired immediately.

85
Q

If some passed tissue floats in a “frond” pattern in saline, what does that mean?

A

Product of conception (chorionic villi) in 95% of the time.

86
Q

Progesterone comes from the corpus luteum until what week of gestation?

A

10 wk

87
Q

What are the earliest indicators of hypovolemia

A
  1. Decrease urine output
  2. Positive tilt test
  3. tachycardia
  4. hypotension (by the time hypotension is noted in a young healthy person, 30-40% of blood is lost)
88
Q

Most common cause of hemoperitoneum in early pregnancy

A

ectopic pregnancy

89
Q

Itchiness of vagina, external genitalia that is white, thin, excoriated with retraction of the clitoris and constriction of the introitus. Dx? Manage? Tx?

A

Dx: Lichen Sclerosis
A figure 8 around the vulva and anus, with a cigarette paper like texture (crinkled and fragile)

Manage: biopsy
Tx: corticosteroid ointment

90
Q

Lichen planus can present similarly to Lichen Sclerosis, but what is the difference?

A

LP involves the vagina whereas the LS does not.

91
Q

Crampy pain from retrograde menstruation is caused by?

A

cervical stenosis after a conization.

92
Q

What are the 2 most common cause of primary amenorrhea when there is normal breast development? How can one differentiate?

A

Mullerian Agenesis or Androgen Insensitivity (both have absent uterus and blind vagina)

Test for testosterone and karyotype

93
Q

Amenorrhea with no breast development

A

Most likely Turner’s syndrome (gonadal dysgenesis)

94
Q

20 yo F presents with Tanner stage 1 breast development, and told her gonads will turn malignant. The most common cause of delayed puberty.

A

Gonadal dysgenesis (can be 46 XY, 45X, or 46XX)

The most common karyotype of gonadal dysgenesis is Turner’s syndrome.

95
Q

causes of early PPH

causes of late PPH

A

Early PPH:
Uterine Atony (risk: MgS, oxytocin during delivery, rapid labor or delivery, over distended uterus, intraamnionitic infection, prolonged labor, high parity)
genital laceration
retained placenta

Late PPH:
sub involution of the placental site,

96
Q

Ligation of which branches can help in PPH

A

Ascending branches of uterine arteries or internal iliac (hypogastric artery)

97
Q

What vitamin is not in breast milk that needs to be supplemented when the infant is 2 months?

A

Vit D

98
Q

What is the best management of a thyroid storm in pregnancy

A

B-blocker (propranolol), corticosteroids, PTU

99
Q

How does pregnancy affect thyroid binding globulin and total T4 levels? How about free T4 and TSH?

A

Increases TBG and total T4 levels

Not change free T4 and TSH

100
Q

How can hyperthyroidism affect the fetus?

A

fetal thyrotoxicosis –> non-immune hydrous and fetal demise

101
Q

What is the most common cause of hyperthyroidism in postpartum?

A

Destructive lymphocytic thyroiditis

102
Q

Result of Parvo 19 in pregnancy

A

Severe fetal anemia may result, leading to fetal hydrops. One of the earliest signs of fetal hydrops is hydramnios, or excess amniotic fluid.

103
Q

Causes of fetal hydramnios

A

isoimmunization, gestational diabetes, syphilis, fetal arrythmias, fetal intestinal atresia, parvo19

Ob Gyn (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions