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obstetric - gynecol STEP 2 > other in pregnancy > Flashcards

other in pregnancy Flashcards

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1
Q

Sheehan syndrome - clinical features

A
  1. Lactation failure
  2. amenorrhea, hor flashes, vaginal atrophy (low FSH, LH)
    Fatique, bradycardia (Low TSH)
    Anorexia, weight loss, hypotension (low ACTH)
    decreased lean body mass (Low GH)
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2
Q

uterus examination if pospartum hemorrhage and retained placental tissue

A

enlarged and atonic uterus

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3
Q

postpartum period - normal findings

A
  1. transient rigors/chills
  2. peripheral edema
  3. lochia rubra
  4. uterine contraction + involution
  5. breast engorgement
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4
Q

postpartum period - routine care

A
  1. rooming in/lactation support
  2. serial examination for uterine atony/bleeding
  3. perianal care
  4. voiding trial
  5. pain management
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5
Q

Cerclage is a procedure involving a suture or synthetic tape to reinforce the cervix in

A

patietns with history of 2nd trimester deliveries or short (less than 2.5 cm) cervical length

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6
Q

renal colicky in pregnant - next step

A

U/S

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7
Q

pregnancy and exercise - contraindications

A
  1. amniotic fluid leak
  2. cervical incompetence
  3. multiple gesation
  4. placenta abruption or previa
  5. premature labor
  6. preeclampsia/gestational hypertension
  7. severe heart or lung disease
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8
Q

pregnancy and exercise - unsafe activies

A
  1. contact sports
  2. high fall risk
  3. scuba diving
  4. hot yoga
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9
Q

amniotic fluid embolism - RF

A
  1. preeclampsia
  2. placenta previa or abruption
  3. 5 or more pregnancies
  4. cesarean or instrumental
  5. advanced maternal age
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10
Q

amniotic fluid embolism - complications

A
  1. cardiogenic shock
  2. hypoxemic resp failure
  3. DIC
  4. coma or seizures
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11
Q

amniotic fluid embolism - treatment

A

resp + hemodynamic support

+/- transfusion

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12
Q

3rd trimester - acute appnedcitisis - what is unique

A

pain is RUQ due to enlare uterus

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13
Q

Postpartum urinary retention - RF

A
  1. regional anesthesia
  2. operative vaginal delivary
  3. primiparity
  4. perineal injury
  5. cesarea
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14
Q

Postpartum urinary retention - clinical featrues

A

inability to void
incomplete emptuing
dribbling

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15
Q

postpartum urinary retention - management

A

self limited

intermitent urethral catheterization

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16
Q

the most appropriate 1st step in suspected appendicitis during pregnancy

A

U/S –> noncompression + dilation are diagnostic –> if not diagnostic –> MRI

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17
Q

peripartum cardiomyopathy - onset

A

after 36 wks

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18
Q

intrahepatic cholestasis of pregnancy

A
  • intense prurtus
  • elevated bile acids
  • elevated levels of liver aminotransferases
  • diagnosis of exclusion
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19
Q

acute fatty liver of pregnancy

A

malaise, RUQ pain, nausea, vomiting, sequelae of liver failure

  • hypoglycemia
  • mildly elevated liver enzymes
  • elevated bilirubin
  • possible DIC
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20
Q

Low back pain during pregnancy - etiology

A

enlarged uterus - exaggerated lordosis
joint ligament laxity due to high progesterone and relaxin
weak abdominal muscles –> decreased lumbar support

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21
Q

Low back pain during pregnancy - RF

A
  • excessive weight gain
  • chronic back pain
  • back pain in prior pregnancy
  • multiparty
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22
Q

Low back pain during pregnancy - imaging

A

not indicated

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23
Q

Low back pain during pregnancy - management

A
  • behavioural modification
  • heating pads
  • analgesics
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24
Q

multiple gestation - presentation

A
  1. exponential growth of uterus
  2. rapid weight gain by mother
  3. elevated β-HCG and MSAFP (levels higher than expected for estimated gestational age is the first clue to multiple gestation
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25
...... increase the possibility for multiple gestation
fertility drugs
26
diagnostic tests for multiple gestation
US is done to visualize fetuses
27
multiple gestation - complications
1. spontaneous abortion of one fetus 2. premature labor + delivery 3. placenta previa 4. anemia
28
nonclassic congenital adrenal hyperplasia - pathophys
AR, low 21-hydroxylase activity, Normal gluco-mineralocoticoids, high androgens
29
nonclassic congenital adrenal hyperplasia - clinical features
- early pubic/axilary hair growth - severe acne - hirsutism, oligomenorrhea in girls - high growth velocity + bone age - elevated 17 hydrxyprogesterone
30
nonclassic congenital adrenal hyperplasia - treatment
hydrocortisone
31
anterior vs posterior dislocation (appearance)
anterior: abducted and externally rotated posterior: adducted and internally rotated
32
osteoporosis nonmodifiable RFs
1. age 2. postmenopausal 3. low body weight 4. white or asian 5. malabsorption 6. hypercortisolism, hyperthyroidism, hyperparathyroidism 7. inflam disorders 8. chronic liver or renal disease + PRIOR HISTORY OF FRAGILITY FRACTURE (STRONGEST)
33
osteoporosis modifiable RF
1. smoking 2. excessive alcohol intake 3. sedentary lifestyle 4. medications 5. low vit D or Ca2+ 5. estrogen def
34
nitropruside during pregnancy
never
35
TSH in pregnancy
decreased
36
short cervix menas
less than 2 cm without history of preterm labor) | - less than 2,5 cm wih history of preterm labor)
37
shoulder dystocia - RF
1. fetal macrosomia 2. maternal obesity 3. excessive pregancy wight gain 4. Gestational DM 5. post-term pregnancy
38
treatment of asymptomatic endometriosis
no treatment, just observation
39
an abnormal biophysic profile is consistent with
fetal hypoxia
40
amphetamines in pregnancy are associated with
1. preterm delivery 2. preeclampsia 3. abruptio placentae 4. fetal growth restriction 5. intrauterine fetal demise
41
gastroschisis - RF
1st trimester NSAID use
42
labetolol - route of administration
IV
43
plugged duct
FOCAL (vs engorgement) tenderness + firmness or erythema, no fever (vs mastitis)
44
the most likely cause of the lack of accelerations in fetus
fetal sleep (last for 40 mins)
45
hypoxic brain injury - causes
acute uteroplacental insufficiency: labor stress or abruptuio placentae
46
postpartum bleeding after operative vaginal delivery - management
inspect genital tract injury
47
magnesium toxicity - treatment
- stop Mg | - start IV calcium gluconate bolus
48
diagnosis of chronic or preexisting HTN
more than 140 / 90 before 20 wks during 2 seperate measurements taken at least 4 hours apart
49
pregnant with not appropriate weight gain - Risks for
1. preterm | 2. fetal growth restriction
50
shoulder dystocia - complications
1. fractured clavicle 2. fractured humerus 3. Erb-Duchenne palsy 4. Klumpke palsy 5. perinatal asphyxia
51
perinatal asphyxia - manifestations
variable presentation dependingon duration of hypoxia | 2. altered mental status (eg. irritability, lethargy) resp or feeding difficulties, poor tone, seizure
52
leakage of the spinal fluid may occur if the dura is inadvertently punctured during epidural placement - this results in
leakage of spinal fluid (aka wet tap) --> postural headaches that are worse with sitting and improved with lying down after delivery
53
history of classic C-section or myomectomy with uterus entry - how to deliver
laparotomy + delivery
54
Mg - therapeutic levels
5-8 | toxic if more than 8.5
55
Mg toxicity - seizures?
NO
56
trichomonas vaginalis - screening in pregnancy
only in HIV (+)
57
intrahepatic cholestasis of pregnancy - jundice
uncommon | further evaluation
58
intrahepatic cholestasis of pregnancy - management
- symptom relief, pruritus resolves in wkees after delivery. - Ursodeoxycholic acid is commonly used - early delivery is recommended to avoid fetal complications
59
abruptio placenta - uterine size
increased
60
history of classic C-section or myomectomy with entrance - how to delivery
C-section, but if present in labor --> urgent laparotomy and delivery --> if the labor is ruptured, delivery through the rupture site, if it is not --> make c-section
61
intrahepatic cholestasis of pregnancy - obstetric risks
1. fetal demise 2. preterm delivery 3. meconium stain amniotic fluid 4. RDS
62
how to differentiate PCOS from CAH
elevated 17 hydroxyprogesterone in CAH
63
cervical mucous plug
barrier to ascending infections during pregnancy | - brown red or yellow thick
64
obesity mediated anovulation
normal LH + FSH (no production of progesterone)
65
malposition vs malpresentation
malpresentation is for ex breech | malposition is nonocciput anterior

obstetric - gynecol STEP 2 (22 decks)

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