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Ob Gyn > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Normal range of hCG? Range of hCG that you can see intrauterine pregnancy by ultrasound?

A

Normal: 5-25. Can see intrauterine pregnancy by vaginal ultra sound at 1500 mlU

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2
Q

G and P of a woman with a single pregnancy that delivered twins.

A

G1P1

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3
Q

First Trimester Combined Test? What is used for?

A

PAPP, hCG, nuchal translucency.

Decrease in PAPP. Increase in nuchal translucency.

Trisomy 21: Increase in hCG
Trisomy 18: Decrease in hCG

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4
Q

MSAFP? When is it increased?

A

Maternal Serum Alpha Fetal Protein.

- inaccurate dates, multiple gestation, placental problems, neural tube defects.

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5
Q

What are the uses of oxytocin?

A

Induce labor. Control postpartum bleeding.

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6
Q

Contraindications of oxytocin?

A

Unfavorable fetal position, fetal distress, premature delivery

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7
Q

What indomethacin?

A

NSAID used as a common tocolytic.

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8
Q

What is early term, term, late term and post term?

A

Early - 37-39
Term - 39-41
Late - 41-42
Post term -> 42

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9
Q

How should PPROM be managed?

A

< 34 = expectant management, bed rest
34-36 = check maturity of lungs
> 36 = deliver

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10
Q

What is the definitive treatment for HELLP?

A

Deliver at 34 weeks.

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11
Q

What are the two most common sites of endometriosis?

A

Ovary. Cul de sac ( uterosacral ligament)

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12
Q

What is the most important consideration for abdominal trauma?

A

Placenta abruption

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13
Q

How can you distinguish between HELLP syndrome and Acute Fatty Liver?

A

Acute fatty liver presents with renal failure, hyperbilirubinemia, hypoglycemia and coagulopathy, while HELLP does not.

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14
Q

What is Acute Fatty Liver?

A

Deficiency of 3-hydroxyacyl dehydrogenase which results in microvesicular fatty changes in the liver. Presents with nausea, vomiting, abdominal pain, jaundice, elevated LFTs, preeclampsia, elevated ammonia, thrombocytopenia, may have DIC, and renal failure.

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15
Q

What are the main causes of DIC in pregnant patients?

A

Placenta abruption, saline-infusion therapy, and retained dead fetus.

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16
Q

Treatment for DIC?

A

PRBCs and fresh frozen plasma.

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17
Q

Prevalence and treatment of mastitis?

A

1-2% of breastfeeding women. Dicloxacillin is the treatment or erythromycin in those with penicillin allergies.

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18
Q

What is amniocentesis used for? What are the risk involved in amniocentesis?

A

Can karyotype and give a definitive diagnosis of Down Syndrome. Risk = 0.5% of fetal death. 1-2% of vaginal bleeding and amniotic fluid leakage and chorioamnionitis in <0.1% of cases.

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19
Q

Patient is at term (>37 weeks) with Oligohydramnios and IUGR. What is the next course of action?

A

Induction for labor.

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20
Q

When should a term or late preterm fetus with IUGR be delivered?

A

Typically the term or late preterm fetus that has intrauterine growth restriction is delivered if there is evidence of maternal hypertension, failure of apparent growth over a 2 to 4 week interval, there is a low biophysical profile score, and/or umbilical arterial Doppler velocimetry reveals absence or reversal of flow.

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21
Q

How does a patient with overflow incontinence (hypotonic bladder) present?

A

Diabetes. Patients complain of pelvic fullness and small amounts of urine loss during the day and night. Cystometric studies, such as a post-voiding ultrasound, may show increased residual volume.

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22
Q

How does a patient with urge incontinence (hypertonic bladder) present?

A

Urine loss occurs in large amounts during the day or night and is usually accompanied by urgency.

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23
Q

When should the hCG levels decrease to 0 postpartum? What is suspected if that doesn’t happen? What is the presentation?

A

After a normal pregnancy, the β-hCG levels should decrease to 0 within 2 to 4 weeks postpartum, therefore, if a quantitative hCG is grossly above the baseline, the diagnosis of either choriocarcinoma or PSTT (placental site trophoblastic tumor) is likely. Present with vaginal bleeding and physical examination will reveal an enlarged uterus and bilateral ovarian cysts (theca lutein cysts).

Age is older than age 35 or younger than age 20 years and previous GTD

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24
Q

Most common form of inherited mental retardation?

A

Fragile X syndrome.

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25
Q

When should an Rh- mother who is not alloimmunized receive RhoGAM (anti-D immune globulin)?

A

At 28 weeks. And within 72 hours of delivery of the birth of Rh+ baby, after spontaneous abortion, or after invasive procedures like amniocentesis. Should also strongly be considered given after abdominal trauma, external cephaloversion, antenatal bleeding, and threatened abortion. 300ug is given after Rh+ fetus is delivered, which covers 30mL of fetal-to-maternal hemorrhage. In a trauma situation, a Kleihauer-Betke test can determine the amount of hemorrhage to determine the dose of RhoGAM given.

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26
Q

How to test for urge incontinence?

A

Urodynamic studies. Particularly cystometry which looks at bladder capacity, detrusor stability, contractility, and voiding ability.

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27
Q

How to test for stress incontinence?

A

Pelvic exam. If cystocele (protrusion of the anterioinferior wall), it is a genuine stress incontinence. Q-tip test. (if>30 degrees, positive) provocation stress testing. Fluoroscopy.

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28
Q

How to test for overflow incontinence?

A

Oligoclonal band on CSF analysis can suggest multiple sclerosis. Postvoid residual volume.

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29
Q

How does hypothyroidism cause amenorrhea?

A

Anovulation.

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30
Q

What features would make preeclampsia severe?

A

> 160 SBP or 110 DBP
Renal failure (creatinine >1.1), Oliguria
Visual changes (scotoma)
Thrombocytopenia
New onset headache that doesn’t go away with conservative treatment
Pulmonary edema

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31
Q

What is the treatment (2) for bacterial vaginosis?

A

Metronidazole, or tinidazole (newer). Clindamycin can also be used.

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32
Q

Most frequent functional adenoma of the pituitary?

A

Prolactin adenoma

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33
Q

What are variable decelerations and do they impact clinical outcomes?

A

Decrease in FHR of at least 15/mins with onset to nadir < 30 secs. Mild to moderate variables (60/min) are non-reassuring and may indicate fetal acidosis.

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34
Q

Interventions for non-reassuring FHR.

A

Discontinue uterotonic drugs, change maternal position, IV fluids, oxygen. If fetal status is still non reassuring, a expeditious delivery is needed.

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35
Q

Which vaccines are contraindicated during pregnancy?

A

MMR, varicella

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36
Q

What does hypothyroidism increase the risk of during pregnancy?

A

Preeclampsia, preterm labor, placentae abruption, perinatal mortality, neuropsychological impairment.

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37
Q

What is the most common symptom of PMDD?

A 
Abdominal bloating (90%)
Breast tenderness (85%)
labile mood (80%)
Headache (60)
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38
Q

How is hyperthyroidism diagnosed in pregnancy? What is the drug of choice? How does it affect the fetus?

A

Low TSH (<=0.1) and a high free T4. Drug of choice is PTU or methimazole. About 1-5% of fetus will develop hyperthyroidism, advance bone age, craniosyntosis.

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39
Q

What are the types of breech presentation? Which is the only safe breech presentation to deliver vaginally?

A

Footling breech - foot presents first.
Frank breech - thighs flex, and legs extended. Only potentially safe vaginal deliver.
Complete breech and incomplete breech.

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40
Q

Most serious side effect of an endometrial biopsy

A

uterine perforation.

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41
Q

If fetal-maternal hemorrhage is suspected, what test should be used?

A

Rosette test. If negative, give 300 ug RhoGAM. If positive, perform the Kleihauer-Betke test to determine dosage of RhoGAM. For ever 15mL of fetal blood, a 300ug dose is given.

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42
Q

Less than what fetal kick count warrants further evaluation?

A

less than 10 kicks every 2 hrs. Should perform a non stress test. If not reassuring, should perform ultrasound, fetal biometry, and doppler blood flow for umbilical cord.

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43
Q

If the mother is positive for the Hep B surface antigen, what is given to the infant?

A

HBV, and HBIG

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44
Q

Why is estrogen contraindicated within 3 months of delivery?

A

It has an effect on breast feeding and the infant. It increases patient’s risk of thrombosis during a hypercoagulable period.

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45
Q

How is oligohydramnios defined based on AFI? What is the likely cause?

A

AFI < 5. Due to decrease in placental function.

46
Q

Definition of reassuring fetal tracing?

A

Beat-to-beat variability, gestational age-appropriate accelerations, no late/variable decelerations.

47
Q

What is the definition of anemia in pregnancy?

A

Hgb <10.5 in 2nd trimester

48
Q

Why is low-molecular weight heparin better to use than unfractionated heparin?

A

It is less likely to cause thrombocytopenia and hemorrhagic complications than unfractionated heparin. It has a longer half life, and has a more predictable dose-response relationship, which allows for once or twice dosing without laboratory monitoring of PT and PTT.

Both do not cross the placenta.

49
Q

What Is the most common presentation for multifetal? Vaginal birth possible?

A

most common presentation of twins is vertex/vertex, followed by vertex/breech and vertex/transverse. When the presenting fetus (twin A) is vertex and the second twin is the same size or smaller, successful vaginal delivery of both twins is likely.

50
Q

What is the proper management of a patient with a HGSIL on pap smear?

A

Colposcopy, biopsy. If CIN 1, 2, 3, then a LEEP procedure is warranted.

51
Q

What are the most common ovarian neoplasms?

A

Surface Epithelial tumors comprise 60% of all ovarian neoplasms, and 80-90% of all malignant ovarian neoplasms. Serous cystadenoma is the most common benign ovarian neoplasm, while serous cystadenocarcinoma is the most common malignant ovarian neoplasm. Mature teratoma is the most common benign ovarian germ cell tumor - it accounts for 10-20% of all ovarian neoplasms, and the most common ovarian neoplasms in women younger than 20.

52
Q

What is the most common complication of a cystic immature teratoma?

A

Torsion (up to 16% of cases)

53
Q

What is the risk of uterine rupture in a patient with a previous classical incision cesarian section?

A

7-10%. Should NOT TOLAC.

54
Q

What is the proper management of a pregnant patient with herpes?

A

Provide acyclovir (400 mg 3x/day) starting at 36 weeks. If outbreak are present during labor, cesarian delivery is needed.

55
Q

What conditions would warrant use of forceps during second stage of delivery?

A

Heart disease and valvular lesion (Mitral Stenosis). Increased risk of developing pulmonary hypertension, pulmonary edema, and arrhythmia.

56
Q 
When does cleavage occur in:
Dichorionic Diamniotic
Monochorionic Diamniotic
Monochorionic Monoamniotic
conjoined?
A

Dichorionic Diamniotic - up to 3 days
Monochorionic Diamniotic - 4-8 days
Monochorionic Monoamniotic - 9-12 days
conjoined - more than 12 days

57
Q

What percentage of threatened abortions proceed to spontaneous abortions?

A

50%

58
Q

If there is bleeding in the first trimester–with closed cervix– what kind of abortion is it most likely?

A

Threatened Abortion. You must assume the pregnancy is still viable unless told otherwise.

59
Q

Mullerian Agenesis

A

46XX. Absence of mullerian duct derivatives (i.e. uterus, fallopian tubes, cervix, upper vagina). They develop secondary sexual characteristics normally: breast development, axillary/pubic hair b/c estrogen is from ovaries not mullerian duct. Have primary amenorrhea.

60
Q

Androgen Insensitivity Syndrome

A

46 XY. Genetically male, phenotypically female. Female external genitalia develop: breast, little pubic/axillary hair. Does not have ovaries or uterus. Testes may be palpable in the labial and inguinal area. Testes must be surgically removed because increase risk of malignancy.

61
Q

Turner’s syndrome

A

45 XO. Develop streak ovaries and have primary amenorrhea, the presence of a uterus and absent breast. Have a high level of FSH because of the lack of estrogen feedback.

62
Q

Imperforate hymen

A

Hymen completely covers the vaginal orifice so menstrual fluids are unable to escape. Presents bulging membranes between the labia and hematocolpos. Requires minor surgery.

63
Q

Kallman Syndrome

A

The GnRH neurons fail to migrate from the olfactory embryonic epithelia to the hypothalamus during development. Presents as no breast development, uterus is present, and anosmia/hypoanosmia.

64
Q

What should be given for PPROM without evidence of fetal lung maturity?

A

2 doses of intramuscular betamethasone administered 24 hours apart will induce fetal lung maturity.

Or 4 doses of intramuscular dexamethasone administered 12 hours apart

65
Q

What is the proper management of PROM at term? How about PPROM?

A

PROM –> induction of labor.

PPROM –> may want to prophylaxis with antibiotics and assess lung function before induction of labor

66
Q

What are the risk factors for placenta previa?

A

Maternal age, minority race, previous cesarian section

67
Q

The risk of placenta accrete is increased substantially with what conditions? (2)

A

Previous cesarian sections. Placenta previa. Many will develop postpartum hemorrhage, and will need hysterectomies.

68
Q

Routine Pap smear guidelines

A

21-65: testing with cytology every 3 years

30-65: can combine cytology + HPV testing every 5 years

69
Q

Gestational diabetes increases the risk of what in the fetus?

A

Macrosomia (shoulder dystocia, fractured clavicle, c-section), polycythemia, hypoglycemia, hypocalcemia.

70
Q

Gestational diabetes increases the risk of what in the fetus?

A

Macrosomia (shoulder dystocia, fractured clavicle, c-section), polycythemia, hypoglycemia, hypocalcemia.

71
Q

Which two test are the gold standard for chromosomal evaluation?

A

CVS (10-12)

Amniocentesis (15-17)

72
Q

Treatment of choice for endometritis?

A

Coverage must include anaerobes, gram + and gram -

Clindamycin and gentamicin. Ampicillin can be added as well.

73
Q

Should uncomplicated, mild hypertension be treated?

A

No, since it doesn’t change outcomes. However hypertension (>160/>110) should be treated to protect mother from stroke, heart failure, renal failure.

74
Q

How is the diagnosis of PCOS made?

A

LH/FSH > 2 and ultrasound showing polycystic ovaries.

75
Q

At what level does Vit A supplementation become teratogenic?

A

> 10,000 IU. Prenatals containing <5000 IU is acceptable.

76
Q

How much folic acid is needed? Where can you find it?

A

0.4mg/day. Leafy greens, citrus fruits, beans, whole grains. For women who have had a NTD pregnancy in the past, they should receive 4mg/day beginning 1 month before conception. NTD occur 18-30 days into the pregnancy.

77
Q

How does a tuboovarian abscess present? What is the TX?

A

Elevated temperature, nausea, vomiting, abdominal pain, ultrasound shows an ovarian mass consistent with abscess. Due to an ascending infection from PID TX: hospitalization and IV clindamycin and gentamicin. Surgical drainage if refractory.

78
Q

What are considered high risk cardiac conditions at risk for bacterial endocarditis where IV antibiotic prophylaxis is required?

A

Previous endocarditis, prosthetic valve, complex cyanotic congenital disease, surgically corrected pulmonary shunts.

79
Q

Work-up for recurrent pregnancy loss

A

Saline-infused sonohysterogram (SIS) allows for characterization of the internal contours of the uterine cavity and as well as visualization of the outer surface and wall of the uterus.

anticardiolipin antibody (IgG and IgM), lupus anticoagulant, TSH, and thyroid peroxidase antibodies. Finally, parental karyotype and karyotype of the abortus can be undertaken if the above examinations are normal.

80
Q

Discriminatory zone threshold for transvaginal ultrasound.

A

Hcg > 1500

Visualize fetus at 5 weeks.

81
Q

Slow-growing and usually benign (90%) tumor that may reach very large and impressive sizes in premenopausal patients. The tumor is freely mobile, usually 4-5 cm, smooth, and well-circumscribed

A

Cystosarcoma phyllodes

82
Q

Women of reproductive age who complain of tender and lumpy breasts preceding the menstrual cycle. Large cysts can develop in this disease

A

Fibrocystic changes. Chronic cystic mastitis.

83
Q

What is polyostotic fibrous dysplasia (McCune Albright syndrome)

A

Autonomous stimulation of aromatase enzyme production of estrogen by the ovaries. Syndrome is characterized by precocious puberty, multiple cystic bone lesions, and cafe au lair spots.

84
Q

How is precocious puberty defined?

A

Development of secondary sexual characteristics and growth spurt before age 8 for girls and before age 9 for boys.

85
Q

OCPs decreases the risk of what cancers?

A

Endometrial cancer and ovarian cancer.

86
Q

How is the diagnosis of Hyperemesis Gravidarum made? What is the TX?

A

History and a loss of >5% of pre pregnancy weight.

Avoidance of triggers, ginger products, saltines with frequent small meals. Meds: Promethazine. If refractory, ondansetron.

87
Q

What is the most common cause of dysfunctional uterine bleeding?

TX?

A

Anovulation.

Check if pregnant first! Cyclic progestin on days 14-25 or oral combined pills. If hemoglobin <10 g/dL, hospitalization with IV fluids and hormone therapy is necessary.

88
Q

What bacteria is the cause of bacterial vaginosis?

A

Anaerobes.

89
Q

How is Fetal Scalp Sampling used?

A

If pH > 7.25, manage expectantly and observe.
if 7.20 < pH < 7.25, repeat the FSS in 15-30 mins.
if < 7.20, Deliver.

90
Q

How does primary syphilis present?

A

Chancre, a painless ulcer.

91
Q

How does secondary syphilis present?

A

Moth-eaten alopecia, rash on the palms and soles, white patches on the tongue, condyloma lata

92
Q

How does tertiary syphilis present?

A

Gumma formation, cardiac lesions, and CNS abnormalities

93
Q

When should cervix be examined if there is concern of cervical incompetence?

A

Regular examinations of the cervix, either digitally or with ultrasound, should begin at 16 weeks, because cervical incompetence becomes a concern during the second trimester.

94
Q

Imipramine

A

a tricyclic antidepressant with both alpha-agonist and anticholinergic activity and is occasionally used in patients who have mixed urge and stress incontinence.

95
Q

Oxybutynin

A

antimuscarinic and directly inhibits the action of acetylcholine on smooth muscle, making it ideal in the treatment of urge incontinence.

96
Q

Tamsulosin

A

an alpha-antagonist and is used to treat overflow incontinence from benign prostatic hyperplasia.

97
Q

What should a 66 y.o. woman’s health maintenance?

A

Mammogram, stool for occult blood, colonoscopy or barium enema/flexible sigmoidoscopy, pneumococcalvaccine, influenza vaccine, tetanus vaccine (if not within 10 years), choles-terol screening, fasting blood sugar, thyroid function tests, bone mineral
density screening, and urinalysis.

98
Q

When should osteoporosis screening start?

A

> 65 y.o.

99
Q

Screening for cholesterol, TSH, fasting glucose, vaccines.

A 
Tetanus: every 10 y
Age 50: annual influenza
vaccine
Age 60: varicella zoster 
vaccine
Age 65: pneumococcal vaccine
Cholesterol screening every 5 y at age 45
Fasting glucose every 3 yrs starting at 45
TSH ever 5 years starting at age 50 y.o.
100
Q

Aside from estrogen, what other agents are good for vasomotor symptoms during menopause?

A

the antihy-pertensive agent clonidine may help with the vasomotor symptoms.

101
Q

For a nulliparous woman, how long should the latent phase last? Multiparous?

A

≤18-20 h

≤14 h

102
Q

Oxytocin uses.

A

Strength and frequency. Does not help with dilation.

103
Q

What does 0 station mean?

A

The presenting part (bony part of the fetal head) is at the levels of the ischial spines.

104
Q

Engagement

A

Relationship between the widest part of the presenting part in relation to the pelvic inlet.

105
Q

Adequate contractions

A

greater than 200 Montevideo units with an internal uterine pres-sure catheter, or by uterine contractions every 2 to 3 minutes, firm on pal-pation, and lasting at least 40 to 60 seconds

106
Q

What are the effects of chlamydia and gonorrhea on the newborn?

A

Both chlamydial infection and gonorrhea may cause conjunctivi-tis and blindness in a newborn. Gonococcal infections usually presentbetween the second and fifth days of life, whereas chlamydial infec-tions present between the fifth and fourteenth day of life. Neisseriagonorrhea was once the most common cause of blindness in the new-born. Chlamydia trachomatis may also cause infantile pneumonia, gen-erally between 1 and 3 months of age.

107
Q

What should happen to the hCG levels after a complete abortion?

A

It should halve every 48-72 hours. If it doesn’t, there may be some retained tissue.

108
Q

Woman presents with painless cervical dilation without contractions. Dx?

A

Incompetent cervix.

109
Q

What is the Tx for an incomplete abortion?

A

D&C

110
Q

What is the management of a patient with a threatened abortion but a hCG <1500?

A

Serial hCG

Ob Gyn (5 decks)

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