Simmons studying

Question 1

What are the relative contraindications for methotrexate for abortifacient (4)

Answer 1

1) mass >4cm
2) fetal cardiac activity
3) b-hCG >5,000
4) refusal to accept blood products

Question 2

what are the absolute contraindications for methotrexate use for abortive (10)

Answer 2

1) intrauterine pregnancy
2) elevated liver enzymes
3) decreased renal function
4) breast feeding
5) poor follow up
6) immunocompromise
7) pulmonary disease
8) peptic ulcer
9) ruptured cyst/ ectopic
10) sensitivity to metho

Question 3

How do we give metho?

Answer 3

single dose IM injection
If ineffective, usually another dose given
if thats ineffective surgery is option

Question 4

How to follow up with metho treatment for abortive

Answer 4

Need repeat beta in 4 and 7 days. from day 4-7 we expect 15% decrease to claim effectiveness.

Question 5

What should the patient expect for metho treatment?

Answer 5

nausea, pain at the site of ectopic because of retraction of the mass, vaginal spotting.

Question 6

what should the patient avoid after given metho treatment

Answer 6

vitamin C/prenatal vitamins and sunlight

Question 7

Why avoid Folic acid after metho?

what about vitamin C?

Answer 7

The mechanism of action is deplete folic acid. thus it could counteract methotrexate’s mechanism of action.
Vitamin C may increase the metho action making it more toxic.

Question 8

Discriminatory zone for ultrasound detection of ectopic pregnancy?

Answer 8

b-hCG >2,000

Question 9

what are the most common causes for fetal meningitis

Answer 9

1) beta-strep
2) listeria
3) E. coli

Question 10

what is the importance of Rh factor?

Answer 10

Rhesus factor is always tested. If mother is negative then she will produce antibodies to the red blood cell antigen causing hemolysis. If she has a baby that is Rh (+) then the baby will die of hydrops fetalis

Question 11

increased number of pregnancies puts the mother at risk for what?

Answer 11

hemorrhage and prolapse.

Question 12

How do we treat Rh negative mothersd

Answer 12

RhoGAM

Question 13

what is rhogam

Answer 13

immunoglobulin

Question 14

what is the definition of labor?

Answer 14

cervical change/time

Question 15

When must you have placental delivery?

Answer 15

within 30 min

Question 16

what is the normal dose of folic acid

Answer 16

400ug daily

Question 17

what percentage of pregnancies are unplanned

Answer 17

50%

Question 18

what age is too old for pregnancies?

Answer 18

34 for multiple pregnancies and 35 for single pregnancy

Question 19

what is the most accurate way to determine pregnancy?

Answer 19

1st trimester ultrasound

Question 20

what is the another way to determine pregnancy date?

Answer 20

Neagles rule: last menstrual period. add one week and 1 year and then subtract 3 months

Question 21

Are serological tests used to determine gestational age?

Answer 21

No. They are GA non-specific

Question 22

Whats the best indicator of gestational if only doing one test

Answer 22

second trimester ultrasound

Question 23

What is fundal height

Answer 23

the length in cm from the pubic bone to the top of the uterus. Good indicator of the size fo the baby and how far along the pregnancy is.
The fundal height should be +/-2 of the weeks gestation. Thus, if 30 weeks along the fundal height should be 28/32.

Question 24

what is APGAR

Answer 24

appearance, pulse, grimmace, activity, respiration

Question 25

what are the causes of AUB?

Answer 25

structural and nonstructural. PALM-COEIN | polyp, adenomyoma, leimyoma, malignancy, cogulopathy, endometrial, iatrogenic, not-yet specified.

Question 26

When do women feel fetal movements?>

Answer 26

usually around 20 weeks

Question 27

Decelerations type and causes

Answer 27

variable-cord compression, early-head compression, accelerations-good, late decel-placental insufficiency

Question 28

define early deceleration

Answer 28

If the decel occurs with contractions.

Question 29

Variability at gestational ages --what do we expect to see?

Answer 29

28wks--any variability 28-32wks --10sec X 10bpm >32wks --15sec X 15bpm

Question 30

prolonged accelerations vs deceleration s

Answer 30

accels good. Decels bad --could indicate cord compression due to oligohydramnios

Question 31

normal range of fetal heart beats

Answer 31

110-160

Question 32

what can inhibit contractions

Answer 32

terbutaline

Question 33

G and P

Answer 33

gravida and paragravida Gravida is the number of pregnancies para is the number of times the uterus is emptied.

Question 34

how is para separated

Answer 34

full term, preterm, abortions, living.

Question 35

how frequently does bHCG double?

Answer 35

every 48 hours

Question 36

what is misoprostal used for (4)

Answer 36

1) abortifacient 2) postpartum hemorrhage 3) gastritis 4) induction of labor

Question 37

What dose of miso do we give for postpartum hemorrhage>

Answer 37

large rectal dose (4-5 pills)

Question 38

What dose of miso do we give for abortive

Answer 38

1/4 pill oral. 24-48 hours after mifepristone

Question 39

what does misoprostal do

Answer 39

causes myometrial contractions

Question 40

mefipristone type of drug and what does it do

Answer 40

progrestational glucocorticoid inhibits progresterone, induces bleeding.

Question 41

what does progesterone do?

Answer 41

prepares the uterine lining for implantations and contributes to overall fetal health.

Question 42

what do we give magnesium for?

Answer 42

to stop seizures in preeclampsia

Question 43

how do we check for Mag toxicity

Answer 43

headache? vision changes? ringing in the ears? trouble breathing? upper right quardant pain? dizziness? then we check their heart, lungs, reflexes and dystonia.

Question 44

preeclampsia definition

Answer 44

1) systolic blood pressure greater than equal to 140 and a diastolic greater than or equal to 90 on two occasions at least 4 hours apart or 2) a systolic greater than 160 or a diastolic greater than 110 or higher.

Question 45

what is the anitdote for magnesium toxicityf

Answer 45

calcium gluconate

Question 46

what is the therapeutic dose for magnesium

Answer 46

>4

Question 47

what are the risks of misoprostal overdose

Answer 47

uterine atony and rupturing of intact uterus

Question 48

why not give a previous C-section pitocin?

Answer 48

rupture.

Question 49

why not give a previous C-section misoprostol?

Answer 49

rupture

Question 50

what labs do we order for preeclampsia work up and why

Answer 50

CBCd (schistocytes, platelets), LDH (cell rupture/tissue damage), comprehensive metabolic panel (for kidney and liver function), uric acid (cell breakdown)

Question 51

how do we test if you have broken your water

Answer 51

ultrasound (AFI), alkaline pH testing, slide for test --slide test for ferning.

Question 52

what is HELLP

Answer 52

hemolysis, elevated liver and low platelets

Question 53

how do we treat for GBS

Answer 53

ampicillin

Question 54

what tests do we perform at 28wks?

Answer 54

gestational diabetes, TDAP, RhoGAM

Question 55

what tests do we preform at 35 wks?

Answer 55

GBS

Question 56

How often do we do pap smears?

Answer 56

depends on age 21-30 every 3 years 30-65 3 years, or with cotest 5 years.

Question 57

when can stop doing paps?

Answer 57

65 if the last 10 years have been adhered to.

Question 58

when to start paps if immunocompromised?

Answer 58

immediately upon diagnosis and continue annually. If immunocompromised from birth (maternal transference) then begin screening at the onset of sexual activity

Question 59

definition of hypersystolic uterus

Answer 59

>5 contractions/10 min

Question 60

questions for triage?

Answer 60

contractions? rush of fluid? bloody? fetal movements?

Question 61

what are the criteria for administration of pitocin

Answer 61

<200 montevideo units (since 200 is sufficient)

Question 62

how to calculate montevideo units?

Answer 62

sum of the amplitudes of contractions-baseline multiplied by the number of contractions at 10 min.

Question 63

post op questions

Answer 63

how are you feeling? are you in any pain? tolerate food or drinking? gone to the bathroom? have you gotten up and moved, yet?

Question 64

what are the types of leiomyomas

Answer 64

subserosal, submucosal, peduculated, intramural, abdominal

Question 65

what are some of the non-medical causes of anovulation?

Answer 65

PCOS, pregnancy, hypothyroidism, pituitary dysfunction, turner's syndrome

Question 66

What are the treatments for AUB

Answer 66

IV equine estrogen, progesterone, combined contraceptives, tranexamic acid

Question 67

what is the adenexal size that can cause torsion>

Answer 67

>5cm

Question 68

what ultrasound findings are suggestive of cancer

Answer 68

increased vascularity, multiceptated, papillary or solid component, ascites, >10cm

Question 69

tumor markers for germline tumors

Answer 69

beta-hCG, LDH, AFP, inhibin A, CA-125

Question 70

what is the mutation rate for a mature teratoma

Answer 70

0.2-3% low

Question 71

list some non-malignant masses

Answer 71

teratoma, ectopic pregnancy, serous cystadenoma, endometrioma, corpus luteum

Question 72

what is first line treatment of nausea in pregnancy

Answer 72

doxylamine and pyridoxine

Question 73

what are the components of the quad screen?

Answer 73

Inhibin A, b-hCG, AFP, estriol

Question 74

what are the bone related adverse side effects of bisphosphonates?

Answer 74

osteonecrosis of the jaw

Question 75

what are the values and interpretations of progesterone in pregnancy?

Answer 75

>20 normal, <5 abnormal, 5-20.

Question 76

What is the rate of tubal ligation failure

Answer 76

1:300

Question 77

What do oral contraceptives do to the ovary, endometrial lining and the cervix (cervical mucous)?

Answer 77

inhibit ovulation, thin the endometrial lining and thicken the cervical mucous