Obstetrics Flashcards
(232 cards)
1
Q
Role of estrogen in combined OCPs?
A
FSH suppression
2
Q
Effect of FSH suppression by combined OCPs?
A
Prevents maturation of follicle
3
Q
Role of progesterone in combined OCPs?
A
LH suppression
4
Q
Effect of FSH suppression by combined OCPs?
A
Prevents ovulation (LH surge), Promotes cervical mucosal thickening
5
Q
Shared effect of estrogen and progesterone in combined OCPs?
A
Thinning of endometrial lining … inhibits implantation of fertilized ovum
6
Q
Which form of birth control is indicated for females immediately after delivery?
A
Progesterone-only OCPs
7
Q
Why are Progesterone-only OCPs indicated immediately after delivery?
A
Progesterone cannot pass into breast milk
8
Q
Why might lactation be thought to serve as contraception?
A
Increased prolactin inhibits release of GnRH … No ovulation with low LH/FSH
9
Q
Route of contraception administered by Norplant?
A
Releases small amount of progestin
10
Q
AE of Norplant?
A
Break-through pregnancy (ectopic)
11
Q
Definition of melasma?
A
Dark pigmentation of face
12
Q
Risk factors for melasma?
A
OCP use, Pregnancy
13
Q
Recommended dose of Ca2+ for pregnant females < 19 yo?
A
1300 mg
14
Q
Recommended dose of Ca2+ for pregnant females > 19 yo?
A
1000 mg
15
Q
Recommended dose of Fe for pregnant females?
A
30 mg
16
Q
Recommended dose of Folate for pregnant females?
A
1 mg
17
Q
Recommended dose of Folate for pregnant females with HX of pregnancy with NTD?
A
4 mg
18
Q
Average weight gain during pregnancy?
A
20-40 lbs
19
Q
Which screening should be performed during 1st trimester for African, Asian females?
A
Thalassemia
20
Q
Which screening should be performed during 1st trimester for AA females?
A
Sickle Cell
21
Q
3 effect of Sickle Cell disease during pregnancy?
A
Increased risk of crisis … CHF, Pulmonary infarction, Pre-eclampsia
22
Q
Treatment of choice for pregnant female who is HIV (+)?
A
IV zidovudine during delivery; Oral zidovudine to baby
23
Q
How long should Zidovudine be administered to baby born to HIV (+) mother?
A
6 weeks
24
Q
Best route of delivery for HIV (+) female?
A
C-section
25
Normal risk of vertical transmission of HIV?
25%
26
Risk of vertical transmission of HIV after administration of zidovudine?
8%
27
Should female with HIV breastfeed?
No … HIV is absolute contraindication to breastfeeding
28
If pregnant female is not immune to Rubella, should you give the vaccine?
No … MMR vaccine is live-attenuated
29
On routine GYN exam, unilateral adnexal mass is palpated in young asymptomatic female – diagnosis?
Failure of dominant follicle to rupture
30
Treatment for Failure of dominant follicle to rupture?
None
31
US of pregnant female shows corpus luteum cysts – next step in workup?
Observe … cyst will begin to shrink at 10 weeks, disappear at 16 weeks
32
What accounts for increased nausea/vomiting in pregnancy?
Increased estrogen, progesterone, β-HCG
33
Definition of Chadwick’s sign?
Blue discoloration of cervix
34
Definition of Goodell’s sign?
Cervical softening
35
At what point in pregnancy does β-HCG have 100% sensitivity?
11 days after missed period
36
In which condition is β-HCG very low?
Ectopic pregnancy
37
In which condition is β-HCG very high?
Hydatidiform mole
38
What is doubling time of β-HCG during normal pregnancy?
2 days
39
At what point in pregnancy does β-HCG level peak in pregnancy?
8-10 weeks
40
Most reliable method of determining gestational age?
US
41
How do you determine gestational age with US?
Gestational sac diameter (in mm) + 30
42
2 aspects of clinical presentation for molar pregnancy?
Painless vaginal bleeding; Hyperemesis
43
Change to uterus size in setting of molar pregnancy?
Larger than expected
44
Prognosis for 80% of hydatidiform moles?
Benign
45
During pregnancy, cardiac output increases by …
40%
46
Which type of murmur is always pathologic when heard during pregnancy?
Diastolic
47
Hematologic change seen in pregnancy?
Increased coagulability
48
Which type of murmur is normal when heard in pregnancy?
Systolic
49
Change to BUN and creatinine in pregnancy?
Increase … due to fluid expansion
50
Which 2 pulmonary values increase during pregnancy?
Tidal volume, O2 consumption
51
Which 2 pulmonary values decrease during pregnancy?
Residual volume, FRC
52
Which molecule is responsible for insulin resistance in pregnancy?
HPL (Human Placental Lactogen)
53
What accounts for improvement in PUD during pregnancy?
Increased prostaglandin production
54
Which 2 neurologic conditions might improve during pregnancy?
MS, Migraines
55
Which endocrine condition might improve during pregnancy?
Graves disease
56
2 contraindications to use of IUD?
Vaginal/cervical infection; HX of infertility
57
What size of uterus is contraindicated in IUD use?
Depth of uterus \<6 cm
58
Contraindication to use of Diaphragm as birth control?
Latex allergy of patient or partner
59
2 AEs of Diaphragm as birth control?
UTI, Toxic shock syndrome
60
Which pathogen is associated with IUD placement?
Actinomyces israelii
61
Role of estrogen in combined OCPs?
FSH suppression
62
Effect of FSH suppression by combined OCPs?
Prevents maturation of follicle
63
Role of progesterone in combined OCPs?
LH suppression
64
Effect of FSH suppression by combined OCPs?
Prevents ovulation (LH surge), Promotes cervical mucosal thickening
65
Shared effect of estrogen and progesterone in combined OCPs?
Thinning of endometrial lining … inhibits implantation of fertilized ovum
66
Which form of birth control is indicated for females immediately after delivery?
Progesterone-only OCPs
67
Why are Progesterone-only OCPs indicated immediately after delivery?
Progesterone cannot pass into breast milk
68
Why might lactation be thought to serve as contraception?
Increased prolactin inhibits release of GnRH … No ovulation with low LH/FSH
69
On 2nd trimester US, thickened nuchal translucency is associated with …
Down Syndrome
70
Which NTD screening should be provided to females \< 35 yo?
AFP
71
Change to serum AFP in NTD?
High
72
3 other etiologies of high serum AFP?
Multiple gestation, Duodenal atresia, Gestational age error
73
Change to serum AFP in Down Syndrome?
Low
74
Which NTD screening should be provided to females \> 35 yo?
Triple marker … AFP, Estriol, β-HCG
75
4 components of Quad Screen for NTD?
AFP, Estriol, β-HCG, Inhibin A
76
5 screenings that should be performed during 3rd trimester?
Gestational DM, GBS, Chlamydia/gonorrhea, RH blood type, HSV
77
At what stage in gestation should female be evaluated for gestational DM?
Between 24-28
78
Treatment for vaginal birth if 3rd trimester GBS screening is (+)?
Intrapartum IV penicillin
79
In addition to Down Syndrome, what is another complication of pregnancy \> 35 yo?
Multiple fetal losses
80
Renal abnormality associated with Turner’s Syndrome?
Horseshoe kidney
81
35 yo female presents at 15 weeks; Triple marker screen shows increased AFP – what is next step in management?
Amniocentesis
82
Role of amniocentesis in female \>35 yo with increased AFP?
Determine fetal karyotype
83
Best method of determining fetal RH isoimmunization and fetal CBC?
Percutaneous umbilical cord sample
84
Complication of amniocentesis?
Amniotic fluid embolus
85
Clinical presentation of Amniotic fluid embolus?
Pregnant female with hypotension, tachycardia, bronchospasm, cyanosis
86
Hematologic complication of Amniotic fluid embolus?
DIC
87
Treatment for Amniotic fluid embolus?
Intubation
88
Role of Chorionic villi sampling during pregnancy?
Best diagnostic way to detect fetal chromosomal abnormalities
89
Indication for testing fetal lung maturity?
If premature delivery is necessary
90
Normal L:S ratio in fetal lung maturity testing?
\> 2:1
91
L:S ratio during fetal lung maturity testing stands for …
Lecithin : Sphingomyelinase
92
Which substance increases lecithin and surfactant during pregnancy?
Corticosteroids
93
2 complications of gestational DM?
Shoulder dystocia, Uterine atony
94
In setting of shoulder dystocia, fetal anterior shoulder will impact …
Maternal symphysis
95
DOC for diabetic nephropathy?
Labetolol … (ACEIs = teratogenic)
96
What type of Ig does RH (-) mother produce against RH (+) fetus?
IgG
97
What IgG titer in mother is significant?
1:16
98
When should RhoGAM by administered?
28 weeks AND within 72 hours of delivery
99
Alternate name for RhoGAM?
IgG anti-D
100
What is does of RhoGAM that is administered both antepartum and postpartum?
1500 IU IV/IM
101
During an acute HTN episode, what is the target BP for pregnant female?
Drop BP to mild-moderate level … (don’t normalized completely to \<120/80)
102
2 DOCs for HTN crisis in pregnant females?
Labetalol, Hydralazine
103
1 DOC for mild-moderate HTN during pregnancy?
Methyldopa
104
3 complications of tobacco use during pregnancy?
Placental abruption, Placenta previa, IUGR
105
Fetal Hydantoin Syndrome is associated with increased risk of …
Neuroblastoma
106
Change to eyes in setting of Fetal Hydantoin Syndrome?
Coloboma
107
Best management of asymptomatic pregnant female who presents on initial visit, found to have bacteriuria?
Treat with ampicillin, cefalexin, nitrofurantoin
108
34 yo female G3P2A0 presents with recurrent cystitis – what is best management?
Treat with nitrofurantoin for ENTIRE pregnancy
109
Best management for pregnant female who presents with pyelonephritis?
Admission, IV ABX
110
Best management for pregnant female who is concerned that she may have been exposed to chickenpox?
If mother is NOT immunized … Check varicella titer, give IgG within 72 hours
111
Best management of fetus born to mother with possible chickenpox exposure?
Give infant IgG if mother was exposed within 3-5 days before/after delivery
112
DOC for Toxoplasmosis during 1st trimester pregnancy?
Spiramycin
113
DOC for Toxoplasmosis during 2nd/3rd trimester pregnancy?
Pyrimethamine, Sulfadiazine
114
When during gestation is travelling outside of country considered to be safe?
18-32 weeks
115
Are inhaled and systemic steroids safe to use during pregnancy in patients with asthma?
Yes
116
28 yo female G2P1A0 presents with non-tender LLE swelling after sitting in car for 3 hours; What is best management?
Perform venous Doppler, Administer IV heparin
117
What accounts for hypercoagulability during NML pregnancy?
Increased levels of coagulation factors – fibrinogen, VWF, Factor VIII
118
How long should anti-coagulation meds be continued in pregnant female after delivery?
Until 6 weeks post-partum
119
Change to spine during 3rd trimester pregnancy?
Increased lumbar lordosis
120
What accounts for low back pain during 3rd trimester pregnancy?
Relaxion of pelvic girdle ligaments
121
2 most common pathogens responsible for PID?
Chlamydia, Gonorrhea
122
Best Outpatient treatment for PID?
Ampicillin + Sulbactam + Doxycycline
123
Best Inpatient treatment for PID?
Cefotetan + Doxycycline
124
3 circumstances in which patients should be admitted for PID?
PID during pregnancy; PID with underlying HIV; PID with ovarian abscess
125
Change to β-HCG for gestational age in setting of ectopic pregnancy?
Low
126
Which type of imaging is most sensitive for detection of ectopic pregnancy?
Transvaginal US
127
Procedure used during treatment of ectopic pregnancy?
Exploratory laparotomy
128
DOC for treatment of ectopic pregnancy?
Methotrexate
129
Pattern of β-HCG trends in setting of ectopic pregnancy that is responsive to methotrexate treatment?
β-HCG = high on 4th day; β-HCG = drops by 15% on 7th day
130
Alternate name for pseudocyesis?
Pseudo-pregnancy
131
Best management of pseudocyesis?
Referral to psychiatry
132
Exercise recommendation during pregnancy?
Exercise = beneficial; Should be continued throughout pregnancy
133
State of cervix in setting of threatened abortion?
Closed
134
2 steps of workup for threatened abortion?
Check β-HCG level; Check fetal cardiac activity
135
State of cervix in setting of inevitable abortion?
Open
136
First step of workup for inevitable abortion with protrusion of products of conception through cervix?
Send fetal tissue for chromosomal analysis
137
Most common cause of abortion during 1st trimester?
Chromosomal abnormalities
138
Important step of treatment for mothers after inevitable abortion?
Treat RH- mothers with RH Ig to suppress immune response (in preparation for subsequent pregnancies)
139
During monitoring of β-HCG after complete abortion, levels do not return to zero – diagnosis?
Incomplete abortion
140
State of cervix in missed abortion?
Closed
141
State of cervix in complete abortion?
Closed
142
Appearance of intrauterine cavity in setting of missed abortion?
Nonviable fetus
143
Appearance of intrauterine cavity in setting of complete abortion?
Empty
144
Complication of missed abortion?
DIC
145
2 aspects of treatment for septic abortion?
D&C, ABX
146
2 ABX of choice used during treatment of septic abortion?
Levofloxacin, Metronidazole
147
Diagnostic test for Asherman Syndrome?
Hysteroscopy
148
Change to LH in setting of Asherman Syndrome?
NML
149
Change to FSH in setting of Asherman Syndrome?
NML
150
What is next best step of workup for mother who has not felt fetal movement for 8+ hours?
Real-time US
151
Most common cause of early recurrent abortion?
Chromosomal abnormality
152
Most common cause of late recurrent abortion?
Incompetent cervix
153
Treatment for incompetent cervix?
Cerclage
154
Important step of treatment to perform for incompetent cervix, before placement of cerclage?
Culture cervix for gonorrhea/chlamydia/streptococcus
155
Risk factor for placenta previa?
Prior c-section
156
Clinical presentation of placenta previa?
Painless vaginal bleeding
157
Ideal delivery of female with placenta previa?
C-section
158
Clinical presentation of placenta abruption?
Painful vaginal bleeding
159
3 risk factors for placenta abruption?
Cocaine use, Injury, Smoking
160
4 DOC for treatment of thyroid storm during pregnancy?
β-blockers, PTU, Corticosteroids, Iodine
161
β-blockers, PTU, Corticosteroids, Iodine Appearance of blood smear in setting of HELLP Syndrome?
Schistocytes
162
What is most effective treatment for HELLP Syndrome?
Delivery of fetus
163
Metabolic change associated with Acute Fatty Liver of Pregnancy?
Hypoglycemia
164
Complication of Acute Fatty Liver of Pregnancy?
DIC
165
Best recommendation about pregnancy for females with Acute Fatty Liver of Pregnancy?
Patient should be advised against pregnancy
166
21 yo female presents at 35 weeks gestation for intense pruritis and dark urine – diagnosis?
Intrahepatic cholestasis of pregnancy
167
Hallmark lab value seen in setting of intrahepatic cholestasis of pregnancy?
Increased bile acids
168
Where is pruritis most intense during intrahepatic cholestasis of pregnancy?
Palms, Soles
169
Classic triad of symptoms seen in Pre-eclampsia?
HTN, Proteinuria, Edema
170
Ocular symptom seen in severe pre-eclampsia?
Retinal hemorrhage
171
How long should IV MgSO4 be administered to patient with severe pre-eclampsia?
24 hours after delivery
172
Definition of eclampsia?
Pre-eclampsia with seizure OR coma
173
Treatment of eclampsia during pregnancy is contraindicated in patients with which condition?
Graves disease
174
2 DOCs for eclampsia that is non-responsive to MgSO4?
Diazepam, Phenytoin
175
Why is BP control important during treatment of eclampsia?
Hemorrhagic CVA is common cause of death in setting of eclampsia
176
Definitive treatment of eclampsia?
Delivery of fetus
177
Clinical presentation of patient with magnesium toxicity after being treated for eclampsia with MgSO4?
Hyporeflexia
178
DOC for treatment of magnesium toxicity?
IV calcium gluconate
179
Risk factor for development of chorioamnionitis?
Prolonged rupture of membranes
180
Classic triad of maternal clinical symptoms associated with chorioamnionitis?
Maternal tachycardia, leukocytosis, uterine TTP
181
Fetal clinical presentation of chorioamnionitis?
Tachycardia
182
Treatment of chorioamnionitis?
ABX + Delivery
183
Normal fetal HR?
110-160 BPM
184
Take immediate action if fetal HR is less than …
90 BPM
185
2 methods of prenatal assessment?
Non-stress test, Biophysical profile
186
What is considered to be a Normal fetal NST?
2 accelerations of 15 BPM, lasting 15 seconds … within 20 minutes
187
Next step of workup if fetal NST is non-reactive?
Perform BPP
188
5 components of BPP?
NST, Amniotic fluid, Breathing, Movement, Tone
189
Normal BPP score?
8-10
190
BPP score that suggests immediate delivery?
0-2
191
Purpose of Contraction Stress Test?
Determine effect of uterine contractions on fetal HR
192
3 types of fetal HR decelerations?
Early, Late, Variable
193
Description of early deceleration?
Nadir of deceleration occurs at same time at peak of contraction
194
Description of late deceleration?
Deceleration begins at peak of contraction
195
Description of variable deceleration?
Decelerations don’t always occur with contractions; Shoulders
196
Etiology of early deceleration?
Head compression
197
Prognosis for early deceleration?
NML
198
Etiology of late deceleration?
Uteroplacental insufficiency
199
Prognosis for late deceleration?
Serious … Immediate C-section
200
Etiology of variable deceleration?
Cord compression
201
Prognosis for variable deceleration?
Change position of mother
202
Definition of normal labor?
Uterine contractions that induce dilation and effacement of cervix
203
\_\_\_ refers to progressive thinning/shortening of the cervix during labor
Effacement
204
\_\_\_ refers to failed progression of labor after cervix has dilated to 6 cm
Prolonged active phase labor
205
Management of prolonged active phase labor in female with hypotonic uterine contractions?
IV oxytocin
206
Management of prolonged active phase labor in female with hypertonic uterine contractions?
Morphine
207
\_\_\_ refers to failed progression of labor after full dilation of cervix to 10 cm
Prolonged 2nd stage labor
208
At what point is delivery of placenta considered to be abnormal?
30+ minutes after fetus delivery
209
First procedure that is used during delivery of baby with shoulder dystocia?
McRoberts maneuver
210
Description of McRoberts maneuver?
Flex mother’s hip as far back as possible; Exert downward traction on fetus’ head
211
Procedure that is used during delivery of baby with shoulder dystocia, if McRoberts maneuver is unsuccessful?
Zavanelli maneuver
212
Description of Zavanelli maneuver?
Push baby’s head up through vagina; Deliver baby via C-Section
213
Best management of prolapsed umbilical cord?
OB emergency; Immediate C-section delivery is indicated
214
Best management of fetus who presents in Breech position \<37 weeks gestation?
Observation
215
\_\_\_ refers to subcutaneous extraperiosteal fluid collection with ill-defined margins, caused by pressure of dilated cervix on presenting part of scalp
Caput Succedaneum
(Caput crosses; Subgalleal crosses)
216
Characteristic of fluid collection seen in Caput Succedaneum?
Extends across suture lines
217
Best management of Caput Succedaneum?
Observation … Fluid collection will resolve spontaneously
218
\_\_\_ refers to subperiosteal bleeding caused by prolonged 2nd stage labor
Cephalhematoma
(Cephalhematoma does not cross)
219
Characteristic of fluid collection seen in Cephalhematoma?
Does NOT extend across suture lines
220
Best initial management of premature labor?
Bed rest; Hydration
221
2nd step of premature labor management?
Tocolytic drugs + Corticosteroids + ABX (GBS)
222
3 examples of tocolytic drugs used during management of premature labor?
MgSO4, Terbutaline, Nifedipine
223
Where is pain felt during Braxton Hicks contractions?
Only felt in front of abdomen
224
Where is pain felt during true contractions?
Begin in lower back; Move to front of abdomen
225
Most common cause of postpartum hemorrhage?
Uterine atony
226
Initial treatment of uterine atony causing postpartum hemorrhage?
Uterine massage + Oxytocin
227
2nd most common cause of postpartum hemorrhage?
Trauma to uterus/cervix/vagina … macrosomia, operative delivery
228
Best management of postpartum psychosis?
Psychiatric evaluation
229
Which medication is NOT recommended in setting of lactation suppression?
Bromocriptine
230
Effect of breast implants on autoimmune disorders (RA, SLE)?
None
231
Effect of breast implants on increased risk of CA?
None
232
When should females with breast implants begin mammograms?
Continue mammogram plan as usual
