Step 2 Ob Gyn Flashcards
(114 cards)
1
Q
when do you get a Quantitative Beta hCG?
A
- diagnose and follow ectopic pregnancy
- to monitor trophoblastic disease
- to screen for fetal aneuploidy
2
Q
When is the gestational sack visible by ultrasound?
A
Five weeks gestational age
3
Q
What defines an embryo?
A
0 to 8 weeks
4
Q
What defines a fetus?
A
8 weeks to delivery
5
Q
What as an infant?
A
Delivery to one year
6
Q
What is the term pregnancy?
A
37 weeks or later
7
Q
What is a preterm pregnancy
A
20 to 36 weeks
8
Q
What renal change occurs during pregnancy
A
Increased GFR ~50%, increased renal flow
9
Q
How does blood pressure change during pregnancy
A
Decreases 10% by 34 weeks then normalizes
10
Q
How does heart rate change during pregnancy
A
Gradually increases twenty percent
11
Q
How does cardiac output change during pregnancy
A
Increases
12
Q
How’s peripheral vascular resistance changing pregnancy
A
Decreases
13
Q
How does peripheral venous distention change during pregnancy?
A
Progressively increasing
14
Q
What is the effect of an increase title volume during pregnancy?
A
Create an increased CO2 gradient for the fetus for gas exchange
15
Q
How does fibrinogen change during pregnancy?
A
Increases
16
Q
What is the recommended folic acid supplementation during pregnancy
A
0.4 mg a day
4 mg a day if h/o neural tube defects in prior pregnancies
17
Q
Rh negative when do you give Rhogam?
A
Week 28 and postpartum if the fetus is Rh positive
18
Q
What drug: fetal renal tubular dysplasia and neonatal renal failure, oligohydramnios, IU GR, lack of cranial ossification
A
ACEis
19
Q
What drugs: growth restriction before and after birth, mental retardation, mid facial hypoplasia, renal and cardiac defects
A
alcohol
20
Q
What drug: virilization of female, advanced genital development in males
A
Androgens
21
Q
What drugs: note to defects, fingernail hypoplasia, microcephaly, developmental delay, IUGR
A
Carbamazepine
22
Q
What drugs: bowel atresia, congenital malformations of the heart, face and GU tract, microcephaly, IUGR, cerebral instructions
A
Cocaine
23
Q
What drugs: clear cell adenocarcinoma of the vagina or cervix, vaginal adenosis, Amber melodies of the cervix and uterus or testes possible infertility
A
DES
24
Q
What drug: increase spontaneous abortion rate, stillbirths
A
Lead
25
What drug: congenital heart disease
Lithium
26
What drugs: increased spontaneous abortion rate
Methotrexate
27
What drugs: cerebral atrophy, microcephaly, mental retardation, spasticity, Seizures, or blindness
Organic Mercury
28
What drugs: IUGR, mental retardation, microcephaly, dysmorphic craniofacial features, cardiac defects, fingernail hyperplasia
Phenytoin
29
What drugs: microcephaly, mental retardation
Radiation
30
What drug: hearing loss cranial nerve eight damage
streptomycin and kanamycin
31
What drug: permanent teeth discoloration, hypoplasia of tooth enamel
Tetracycline
32
What drug: neural tube defects, minor craniofacial defects
valproic acid
33
What drugs: increased SAB rate, thymic agenesis, cardiovascular defects, craniofacial dysmorphism, micropthalmia, cleft lip or palate, mental retardation
Vitamin A
34
Nasal hypoplasia and stippled bone epiphyses, developmental delay, IUGR, ophthalmologic abnormalities
Warfarin
35
Mgmt of fetus with anomaly incompatible with life
allow labor to procede
36
First stage arrest definition
no cervical change for >4 hours with adequate contractions or no cervical change for >6 hours with INadequate contractions
37
When screen for GDM?
first visit in pts with a history of diabetes, otherwise 24-28 weeks
38
when check AFP?
15-20 weeks
39
when check for GBS?
35-37 weeks
40
when hear fetal heart tones
10 to 12 wks on US
41
when is US most accurate at estimating the fetal age?
16-20 weks biparietal diameter on US
42
when order US to evaluate fetus?
- size date discrepancy >2-3cm
- suspect fetal death or demise
- RF for pregnancy related problems ex. SLE, DM, HTN, renal disease
43
should ASA be avoided in pregnancy?
yes, unless pts have Anti phospholipid syndrome
44
what are rare disorders associated with prolonged gestation?
anencephaly and placental sulfatase deficiency
45
what can a low AFP indicate?
Down syndrome, fetal demise, inaccurate dates
46
what can a high AFP represent?
neural tube defects, ventral wall defects, multiple gestation or inaccurate dates
47
what do if AFP elevated?
repeat it
if remains elevated--> US to look for anatomical abnormality
US uncertain--> amnio
48
rec for Downs syndrome screening
offer to all women prior to 20 weeks
49
best test when suspect intrauterine fetal demise
real-time ultrasound
50
what is the best diagnostic test for endometriosis?
laparoscopy
51
how confirm a true PCN allergy
skin testing
52
MCC elevated AFP
neural tube defects and abdominal wall defects , also multiple gestations
53
first line testing for thalassemia
CBC
54
pt with positive pregnancy test, but no evidence of ectopic pregnancy on imaging, next step?
repeat B hCG in 48 hours
55
what meds can be used as emergency contraception ootions
ulipristal pill (antiprogestin) delays ovulation
levonorgenstrel pill (progestin, delays ovulation)
OCPs ""
not mifepristone and misoprostol
56
MCC of a nonreactive non stress test?
fetal sleep cycle
use vibroacoustic stimluation to awaken fetus
57
patient with dyspareunia, dysmenorrhea and dyschezia: dx and tx
Endometriosis
OCPs + NSAIDS
if no improvement the laparoscopy
58
tx for chlamydia if asymptomatic
single dose azithro or 7 day course of doxy
59
what is the association between hypothyroidism and hyperprolactinemia?
TRH stimulates prolactin production
60
34 yo trying to get pregnant, 3 months of amenorrhea, next step?
IVF!
61
mgmt of threatened abortion
1. ascertain fetus is present and alive
2. reassurance and performance of US one week later
- bed rest
62
Downs Syndrome testing for woman at 10 wks gestation?
cell free fetal DNA
63
mgmt of a pregnant woman with severe nausea and vomiting
US to rule out trophoblastic dz or multifetal gestation
64
Tamoxifen increases risk of what?
endometrial cancer
65
tx preeclampsia
hydral or labetalol to decrease BP
| mag sulfate to prevent or tx eclamptic seizures
66
suppression of lactation
tight fitting bra and ice packs and analgesics
67
depressed DTRs indicate what? mgmt?
Mag sulfate tox
| stop mag sulfate and start Ca gluconate
68
#1 RF for clear cell adenocarcinoma?
in utero exposure to DES
69
sudden vaginal bleeding an a hypertonic, tender uterus: dx? mgmt?
placental abruption
| emergency C section
70
Dx: painless hemorrhage coinciding with rapid fetal deterioration and preceded by ROM
torn fetal vessel
vasa previa
see tachycardia followed by bradycardia and a sinusoidal pattern
dx: antenatal and trasvag doppler US
71
MCC heavy or prolonged menses in a young woman who recently started menstruating
anovulation
72
decreased aFP, bHCG, estriol and normal inhibin A
trisomy 18
73
increased AFP, nml bHCG, estriol adn inhibin A
neural tube or abdominal wall defect
74
mgmt of septic abortion
suction curreage
75
most accurate way to determine estimated gestational age?
US dating in the FIRST TRIMESTER
76
patients with complete androgen insensitivity with cryptorchid gonads: when intervene?
gonadectomy after puberty
77
mucopurulent discharge and erythematous, friable cervix: ddx
Cervicitis, either chlamydia or gonorrhea
78
cause of schistocytes and platelet consumption seen in HELLP
MAHA
overall cause of HELLP is abnormal placentation, but the specific cause of plt/RBC damage is due to systemic inflammation and platelet consumption
79
Does a woman with HELLP have to have a C section?
NO!
She needs to DELIVER
vaginal delivery is preferred in women in labor or with ROM and a vertex presentation, can induce!
80
which pregnant women should be vaccinated against the flu?
ALL of them
81
what is alloimmunity?
immune response to antigens from members of the same species
82
patient with orthostatic changes and cervical motion tenderness, dx?
ectopic pregnancy
83
what are common tocolytic drugs?
beta agonists
CCBs
NSAIDs
84
Bilateral breast discharge, brown, serous or milky or unilateral: next step in mgmt?
mammo +/- US
| surgical eval
85
bilateral breast discharge that is not milky, serous or bloody: next step in mgmt
likely physiologic
- pregnancy test
- serum TSH and prolactin
- consider pituitary MRI
86
fetal heart rate monitoring mneumonic?
VEAL CHOP
87
hemodynamically stable pt with an incomplete abortion: mgmt?
expectant, prostaglandins or surgical eval
88
what abx for mastitis
diclox or cephalexin
89
risk factors for vaginal squamous cell cancer
smoking
| HPV
90
MC symptoms of vaginal cancer?
vaginal bleeding
| malodorous vaginal discharge
91
what 3 criteria do you need for PID?
One: abdominal pain
two: adnexal tenderness
three: cervical motion tenderness
92
tx chlamydia pt for gonorrhea?
No...
93
tx gonorrhea pt for chlamydia
yes! unless testing is negative
94
tx for chlamydia in pregnant pt
erythromycin
95
What is the first test to order any women of reproductive age without uterine bleeding?
Pregnancy test
96
Why is dilation and curettage done in women older than age 35 with dysfunctional uterine bleeding?
To rule out endometrial cancer
also get H&H
97
Fertility evaluation after semen evaluation
Documentation of ovulation: basal bike temperature, luteal phase progesterone, and or a endometrial biopsy
98
What is the medical therapy to restore female fertility?
Clomiphene citrate to induce ovulation
if the woman is hypo estrogenic, use human menopausal gonadotropin which is a combination LH and FSH
99
At what age can primary amenorrhea be diagnosed? What is the first step in diagnosis?
The diagnosis of primary amenorrhea is made when a girl has not menstruated by the age 16 years.
patient should also be evaluated in the absence of secondary sexual characteristics by age 14 years, or in the absence menstruation within two years of developing secondary sex characteristics such as breast development, axillary and pubic hair.
The first step is to rule out pregnancy
100
What is the average age of menopause
51
101
Bilateral, multiple, cystic breast lesion are tender to the touch especially around ovulation
fibrocystic disease
102
step 2 mgmt of woman >35 with a breast mass
Bx and mammo
103
what are the major problems with IUDs?
increase risk of PID esp with actinomyces and ectopic pregnancies
104
classic cause of ambiguous genitalia?
adrenogenital syndrome aka CAH
tx: steroids and IV fluids immediately
105
do you know the gender of a child with ambiguous genitalia?
NO, need to karyotype
106
bunch of grapes protruding from pediatric vagina?
sarcoma botryoides, malignant tumor, type of embryonal rhabdomyosarcoma
107
Definition of precocious puberty?
girls
108
benefits of estrogen tx?
decreased osteoporosis and fractures
reduced hot flashes
decreased risk of colorectal cancer
109
risks of estrogen tx
```
Endometrial cancer
Coronary heart dz
VTE
breast cancer if estrogen and progesterone
stroke
gallbaldder dz
```
110
absolute contraindications to estrogen therapy
```
unexplained vaginal bleeding
active liver dz
history of thromboembolism
CAD
history of endometrial or breast cancer
pregnancy
```
111
what do before starting estrogen therapy
endometrial bx
US or
D+C to rule out endometrial hyperplasia or cancer
112
when stop OCPs in relation to surgery
1 month prior
| start 1 month after
113
what drugs can interfere with OCP metabolism and make them less effective
rifampin and antiepileptics
114
OCPs relation to ovarian and endometrial cancer?
decrease incidence of ovarian cancer by 50%, reduce endometrial cancer
