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OB/GYN > OBSTETRICS > Flashcards

OBSTETRICS Flashcards

1
Q

In what context is use of prostaglandins for cervical ripening contraindicated?

A

History of prior C-seciton –> risk of uterine rupture

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2
Q

What antibiotics are use for pPROM and why?

A

Ampicillin/erythromycin –> shown to prolong latency period by 5-7 days

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3
Q

What antibiotics are used for chorioamnionitis?

A

Clinda/gent

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4
Q

MOA of Hemabate? Contraindication?

A

PGF2a, potent SM constrictor that can cause bronchospasm –> contraindicated in asthma

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5
Q

MOA of Methergine? Contraindication?

A

Alkaloid SM constrictor contraindicated in HTN or pre-E

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6
Q

What conditions are late and postterm pregnancies associated with?

A 
Macrosomia
Oligohydramnios
Uteroplacental insufficiency
Meconium aspiration
Dysmaturity
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7
Q

What does progesterone < 5 indicate?

A

Abnormal or extrauterine pregnancy

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8
Q

Trend in B-hCG during pregnancy?

A

Doubles q2days until 42 days old

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9
Q

Criteria that needs to be met before MTX for ectopic?

A
  • Hemodynamic stability
  • Non-ruptured
  • Mass < 4cm and no FHR OR < 3.5 cm with FHR
  • Normal LFTs and renal function
  • Reliable patient F/U
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10
Q

Common tests in patient with hx recurrent abortions (first trimester losses)?

A

Lupus anticoagulant, anticardiolipin, DM, thyroid dz

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11
Q

When should cervical cerclage be placed?

A

14 wks

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12
Q

What type of contraception helps decrease risk of developing ovarian and endometrial cancers?

A

OCPs
First developed HIGH dose OCPs have been linked to slight increase in breast cancer but most recent lower dose OCPs are not.

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13
Q

How are progesterone IUDs regarding cancer?

A

May decrease endometrial cancer risk but does nOT affect risk of ovarian cancer (vs. OCPs which decrease both risks)

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14
Q

How long does unpredictable bleeding last for Depo-Provera shot?

A

2-3 months

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15
Q

Most minimally invasive means for pregnancy termination?

A

PGE1 (mifepristone + miso-rostol)

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16
Q

GA cutoff for vacuum-aspiration for pregnancy termination?

A

<8weeks

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17
Q

Complication specifically associated with LEEP?

A

Cervical stenosis

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18
Q

How to make diagnosis of hypothalamic-pituitary amenorrhea?

A

FSH level–expected to be low

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19
Q

Treatment for hirsutism?

A

OCPs +/- spironolactone

Leuprolide or depo (NOT on OCPs)

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20
Q

How do LH levels change in PCOS? How does this affect androgen production?

A

Increased in pulsatile manner –> increased ovarian production of androgens by theca cells in ovaries

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21
Q

What do you expect on pathology for fibroids?

A

Well-circumscribed, non-encapsulated myometrium

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22
Q

Where is estrogen produced in postmenopausal women?

A

NOT ovaries.
Extraglandular conversion of androstenedione and testosterone to estrogen in peripheral fat cells.
Post-menopausal ovaries, however, are known to produce androgens!

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23
Q

What test can help assess ovarian reserve in older age women?

A

Anti-mullerian hormone

24
Q

Treatment for mild PMS?

A

Supression of hypothalamtic-pituitary-ovarian axis with OCPs

25
Q

Presentation for paget’s disease of vulva?

A

Fiery red with whitish hyperkeratotic areas

Associated with breast cancer (less so than paget’s of breast)

26
Q

What is considered a “short cervix?”

A

Can measure by TVUS during second trimester to assess for preterm labor risk.

<2cm without Hx preterm
<2.5cm with hx preterm

27
Q

Symptoms of primary ovarian insufficiency?

A

Similar to menopause from low estrogen production –> oligomenorrhea/amenorrhea, infertility, hot flashes, elevated FSH

28
Q

Risk factors for vaginal hematoma?

A

Operative vaginal delivery
BW => 4000g/8.8lb
Nulliparity
Prolonged 2nd stage

29
Q

Management for vaginal hematoma

A

Nonexpanding –> observe

Expanding –> embolization, surgery

30
Q

Fetal sequelae from maternal SLE?

A

Primarily cutaneous (scalp or periorbital rash) and cardiac (most serious being AV block, leading to cardiomyopathy and hydros fetalis)

31
Q

Pre-E management?

A

Seizure ppx + anti-HTN

W/o severe features = delivery at => 37 wks

With severe features = delivery at => 34 wks

32
Q

What reflexes are intact and missing in Erb’s palsy? Klumpke’s?

A

Erb (C5-6) = decreased/absent moro/biceps, intact grasp

Klumpke (C7-T1) = decreased/absent grasp, intact moro/biceps

33
Q

Clinical features for intrahepatic cholestasis of pregnancy? When does it develop?

A

Develops in 3rd trimester.

Patients present with generalized itching worse on hands/feet, NO associated rash, RUQ pain

34
Q

Obstetric risks for intrahepatic cholestasis?

A

IUFD, PTD, meconium-stained amniotic fluid, NRDS

35
Q

Management for intrahepatic cholestasis of pregnancy

A

Delivery by 37 GA, ursodeoxycholic acid, antihistamines for itching, frequent antepartum monitoring (NSTs)

36
Q

Presentation of ulcers for HSV vs. H. ducreyi

A

HSV = small painful vesicles on erythematous base , mild LDN

H. ducreyi = large painful deep ulcers with gray/yellow exudate, well demarcated borders with soft-friable base, severe LDN that may suppurate

37
Q

Syphilis vs Chlamydia ulcers

A

Syphilis = single painless ulcer (chancre), regular borders and hard base

Chlamydia = small painless shallow ulcers, can progress to PAINFUL fluctuant adenitis (buboes)

38
Q

Pathophysiology of urethral diverticulum

A

Abnormal localized outpouching of urethral mucosa that can collect/store urine 2/2 recurrent periurethral gland infection along anterior vaginal wall

Results in post-void dribbling, recurrent UTIs, and bloody/purulent discharge

39
Q

Potential causes of maternal tachycardia?

A 
Fever (eg IAI)
Beta sympathomimetics (terbutaline)
Nebulizers (Albuterol)
Ephedrine (reverses maternal hypotension)
Illicit drugs
Maternal thyroid dz 
Fetal blood loss (eg 2/2 abruption)
Fetal cardiac anomalies
40
Q

Normal cord pH?

A

7.2-7.3 makes baby happy!

41
Q

Inpatient vs outpatient treatment for PID

A

Inpatient: IV cefoxitin + doxy
Outpatient: PO ceftriaxone + doxy

42
Q

Presentation for PID

A 
Intermittent pelvic pain --> constant as inflammation spreads through peritoneal cavity
Abnormal bleeding (vaginal spotting with wiping)
43
Q

Injury to what nerve would result in decreased voiding sensation?

A

Pudendal nerve especially 2/2 perineal trauma from prolonged second stage of labor and/or perineal laceration

44
Q

Where does melasma affect?

A

Sun-exposed areas on face

45
Q

Pathophysiology of melasma?

A

Likely occurs when UV radiation triggers melanocyte proliferation and pigment deposition in sun-exposed areas –> light brown irregularly shaped macules

46
Q

hPL

A

Human placental lactogen aka somatomammotropin production is increased during third trimester –> pancreatic B cell hyperplasia –> increased insulin resistance

47
Q

Definition of IUFD

A

Fetal death => 20 weeks

48
Q

Management of IUFD

A

20-23 wks D&C or vaginal delivery

=>24 weeks vaginal delivery

risk of coagulopathy after several weeks of fetal retention

49
Q

Initial management of mixed urinary incontinence?

A

Keep voiding diary that classifies predominant type of urinary incontinence in order to determine optimal treatment

50
Q

Management for simple breast cyst?

A

If <30 evaluation with U/S +/- mammogram (if >30 would assess with mammogram +/-U/S), needle aspiration if desires and f/u in 2-4 months–potential to re-accumulate. If normal then, can resume routine annual WWE.

51
Q

Components of BPP

A

1) NST
2) AFI or single deepest pocket
3) Movement (=>3)
4) Tone (=>1 flexion/extension)
5) Breathing (=>1 breathing episode lasting =>30 sec)

52
Q

Define active phase arrest

A

No change in cervical dilation => 4 hr with adequate cxns OR no change => 6 hrs with inadequate cxns

53
Q

Different tests to evaluate for amenorrhea?

A

First UPT. If negative FSH, TSH, and prolactin levels to assess for cause of secondary amenorrhea.

54
Q

What risks is tamoxifen use associated with?

A

Endometrial cancer/polps and VTE

Estrogen receptor agonist and antagonist (depends on tissue)

55
Q

What is the time window postpartum that Rhogam could be given?

A

Within 72 hours after delivery

OB/GYN (1 decks)

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