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USMLE STEP 2 CK RETAKE > Obstetrics > Flashcards

Obstetrics Flashcards

(65 cards)

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1
Q

Types of Aneuploidy

A
  • Downs 21
  • Edwards 18
  • Patau 13
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2
Q

First Trimester Aneuploidy Screening

A
  • US-Nuchal Lucency
  • PAPP-A
  • hCG
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3
Q

Triple Screen/Quad Screen findings in Downs

A

hCG increased

AFP decreased

Estriol decreased

Inhibin A Increased

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4
Q

Triple Screen/Quad Screen Findings in Edwards

A

hCG decreased

AFP decreased

Estriol very decreased

Inhibin A decreased

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5
Q

Gestational Diabetes Screening

A

1 hr GTT- >140

3 hr GTT-

  • >95
  • >180
  • >155
  • >140
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6
Q

Risk Factors for Gestational DM

A
  • BMI >30
  • Hx GDM
  • Pre-Diabetic
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7
Q

Maternal anemia Dx Usually caused by

A

Iron deficiency anemia Hgb<10 or HCT <30

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8
Q

Asx Bacteriuria

Presentation

Dx, Tx

A

(+) UA, no symptoms

Tx:

  • Amoxicilin
  • nitrofurantoin
  • Repeat UA after treatment
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9
Q

Cystitis

Presentation

Dx, Tx

A

Pt: Urgency, frequency, dysuria

Tx:

  • Amoxicillin
  • Second line-nitrofurantoin
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10
Q

Pyelonephritis

Presentation

Dx, Tx

A

Pt:

  • urgency,
  • Frequency,
  • Dysuria
  • Fever and
  • CVA tenderness

Tx: Ceftriaxone

Reasses after a few days

  • No improvement=abscess 14 days Abx U/S for drainage
  • Improvement=Pyelo 10 days Abx
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11
Q

Positive UA findings

A
  • Nitrites
  • Leukocyte Esterase
  • Lots of WBCs
  • (+) Bacteriuria
  • No epithelial
  • Cells >100 cfu
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12
Q

Transcranial doppler

  1. used when,
  2. or what,
  3. risk,
  4. Extra facts
A
  1. >20 wks Assessment of fetal anemia,
  2. Alloimmunization
  3. No risk
  4. Highly sensitive
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13
Q

Chorionic villous sampling

  1. Used when,
  2. for what,
  3. risk,
  4. extra facts
A
  1. >10wks
  2. Assessment of genetic disorders
  3. slight risk
  4. for early detection and early termination
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14
Q

Hyperthyroidism in pregnancy

Presentation

dx, tx

A

“overactive patient” can lead to fetal demise

Dx:

  • TSH decreased,
  • T4 increased

Tx:

  • PTU
  • Methimazole
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15
Q

Hypothyroidism in pregnancy

Presentation

Dx, Tx

A

Everything “Slowed” down leads to cretinism

Dx:

  • TSH Increased,
  • T4 Decreased

Tx:

  • Levothyroxine,
  • f/u dosing every 4 weeks larger doses required during pregnancy
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16
Q

What Anti-Epileptic Drugs are safe in pregnancy

A

Levitiracetam=Lamotrigine

Phenobarbital for active seizing

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17
Q

Hypertension in pregnancy

Goal

medications safe in pregnancy

A
  • Goal is BP <140/<80
  • alpha-methyldopa
  • Labetalol
  • hydralazine
  • Screening should be tight for eclampsia
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18
Q

DM in pregnancy

Goals and testing

A
  • Change oral medications to insulin before pregnancy
  • use insulin during pregnancy,
  • higher insulin requirement during pregnancy
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19
Q

Stage 1 Latent phase of labor time

A
  • Nulliparous 20hr
  • Multiparous 14hr
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20
Q

Stage 1 Active phase of labor time (prolonged or arrested)

A
  • Nulliparous 4 hours or no change
  • Multiparous 5 hours no change
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21
Q

Stage 1 Active phase of labor dilation per time

A
  • Nulliparous 1.2cm/hr
  • Multiparous 1.3 cm/hr
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22
Q

Stage 2 phase of labor time

A
  • nulliparous 3 hours
  • multiparous 2 hours
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23
Q

What are the stages of labor

A

Stage 1:

  • 0cm to 6cm (Latent)
  • 6cm to 10cm (Active)

Stage 2:

  • 10cm to fetus delivery

Stage 3:

  • Fetus deliver to placental delivery
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24
Q

Stage 3 of labor time

A

<30 min

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25
Arrest of active phase of labor treatment
* prolonged-oxytocin * arrest-c-section * if at negative station c-section * positive station-forceps, vacuum
26
Preterm Gestational age
24- 37 weeks
27
Term Gestation Age
37-42 weeks
28
Premature Rupture of Membranes Presentation Dx, Tx
Usually due to infection GBS Pt: (+) ROM, (+) term, no contractions Dx: Clx, find the GBS Tx: Deliver * GBS positive or unknown=give ampicillin * GBS negative=wait and watch
29
Preterm Premature Rupture of Membranes Presentation Dx, Tx
Infection GBS Pt: (+) ROM, not at term, no contractions Dx: Clx Tx: \>34 wks=deliver \<24 wks=abortion 24-34wks=steroids
30
Prolonged Rupture of Membranes Presentation Dx, Tx
Ascending infection, GBS Pt: (+)ROM, no delivery \>18 hrs Tx: Deliver GBS (+), unknown=ampicillin GBS negative=wait F/u for endometritis (baby out),chorioamnionitis (baby in)= Ampicillin + getamicin +/- clindamycin
31
Risk Factors for preterm labor
Cigarette smoking young maternal age multiple gestations anatomical abnormalities
32
Preterm Labor Presentation Dx, Tx
Pt: (+) contractions, cervical changes, not at term Tx \>34 wks=deliver \<20 wks=abortion 20-34wks steroids and tocolytics
33
Mild Pre-eclampsia BP Timing U/A Sxs Tx F/U
BP-\>140/\>80 Timing-sustained, after 20wks U/A-\>300mg/dl, proteinuria Sxs-none Tx-\>37wks deliver \<37wks wait F/U weekly
34
Pre-eclampsia with severe features BP Timing U/A Sxs Tx
BP-\>160/\>110 Timing-Sustained, after 20wks U/A-\>5g/dl, proteinuria Sxs- severe features Tx-Mg and deliver (induction)
35
What are the severe features of Eclampsia
decreased platelets increased LFTs RUQ abdominal pain increased Cr (1.1, or 2x) Pulmonary edema Headaches, Vision Changes BP-\>160/\>110
36
HELLP Syndrome
Hemolysis Elevated LFTs Low Platelets
37
Antidote for magnesium toxicity
Calcium decreased deep tendon reflexes leading to decreased respiratory rate
38
Twinning with different genders
Di-zygotic, Di-chorionic, Di-Amniotic Risks: Preterm labor, malpresentation, PPH
39
2 placentas, same gender
Monozygotic, Di-chorionic, Di-amniotic
40
same gender, (+) septum, 2 sacs
Monozygotic, Monochorionic, Di-amniotic Twin Twin transfusion (skinny twin will do better)
41
same gender, no septum, 1 sac
Monoygotic, monochorionic, monoamniotic Conjoined twins, cord entanglement
42
PPH definition
500cc vaginal delivery 1000cc c-section
43
Uterine Atony Presentation Dx, Tx
Pt: Atonic uterus, PPH and boggy uterus Tx: Massage oxytocin Surgery
44
Uterine Inversion Presentation Dx, Tx
"Births itself", can be caused by traction or oxytocin Pt: PPH and absent uterus Tx: Tocylytics-then put it back
45
Placenta Accreta
burrows a little deeper
46
Placenta Increta
invades the myometrium
47
Placenta Percreta
Invades all the way though the endometrium
48
Retained Placenta Presentation Dx, Tx
Pt: PPH and firm uterus Tx: Dilation and curretage leading to TAG
49
Normal Fetal Heart Rate
between 110-160
50
High risk pregnancy or decreased fetal movement antenatal testing
Non stress test NST after vibroacoustic stimulation biophysical profile between 3-8 gestational age \<37 weeks =contraction stress test
51
Describe early Decels, and what causes them
Heart rate deceleration in line with the peak of contraction head compression
52
Describe variable decelerations and what causes them
Heart rate deceleration without relation to contractions cord compression
53
Describe late decelerations and what causes them
Heart rate deceleration occuring after the peak of contraction utero-placental insufficiency
54
Placenta Previa Presentation Dx, Tx
placenta lies across the cervical os presents with painless bleeding Dx: U/S= Transverse lie NST/CST=Fetal Distress Tx: Urgent C-Section
55
Vasa Previa Presentation Dx, Tx
Accessory lobe lies across the cervical os Blood vessels tear when the cervix dilates Presents with painless bleeding Dx: NST/CST=fetal distress Tx: Urgent C-Section
56
Uterine Rupture Presentation Dx, Tx
Vaginal Birth after C-section Presentation: Painful, "absent" uterus Loss of fetal station Tx: Crash Section
57
Placental Abruption Presentation Dx, Tx
Usually due to HTN or cocaine use, MVA Presentation: Painful Bleeding Dx: U/S, Vitals, HgB, AMS, CST/NST Tx: C-section
58
Group B Strep Infection Presentation Dx, Tx
Screening should occur at week 10 and again at week 35 there will be a healthy delivery but toxic baby Dx: Risk Factors-Any previous positive prolong ROM, Intrapartum Fever Tx: Ampicillin Cefazolin Clindamycin Vancomycin
59
HIV infection during pregnancy and delivery Dx, Tx
ELISA confirm with western blot if for baby Viral load Tx: 2+1 2 NRTI (Tenofovir +Emtricitabine) or (Zidovudine+Lanivudine) NNRTI (Nevirapine)
60
Toxoplasmosis Presentation Dx, Tx
Presentation-Mom=Mono like illness Baby=Brain calcifications, Ventriculomegaly, Seizure Disorder Dx: Toxo Ab (+)=do nothing Toxo Ab(-)=avoidance
61
Syphilis Presentation Dx, Tx
Presentation 1. Painless chancre 2. targetoid lesions affecting the palms and soles 3. Neuro Sxs Dx 1. Darkfield microscopy 2. RPR---FTA-Abs 3. CSF VDRL, RPR Tx= Penicillin
62
Rubella Congenital Infection Presentation Dx, Tx
Presentation: Baby-Blueberry muffin baby, Cataracts, Congenital heart defects, deafenss Tx: Vaccinate three months prior to pregnancy, avoidance
63
Herpes congenital Infection Presentation Dx, Tx
Painful burning prodrome, vesicels on an erythematous base Dx: PCR Tx: (val)acyclovir follow uup for blindness, preterm, IUGR
64
When do you use the Forceps or vaccum during delivery
Fetal distress or prolonged or arrested labor plus Full effacment and 2+ station
65
When do you use cervical cerclage
When there have been multiple second trimester losses ROM around week 14 Be sure to remove the cerclage at week 36

USMLE STEP 2 CK RETAKE (15 decks)

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