UWise Flashcards
1
Q
How should a finding of ASC-US be managed?
A
- for most cases, perform reflex HPV testing; if HPV testing is performed and negative, repeat co-testing in 3 years, but if HPV testing is performed and positive, perform colposcopy
- the exception is women age 21-24 since HPV is quite common in this age group; HPV testing is unnecessary and repeat cytology should be performed in one year
2
Q
What cervical cancer screening recommendation exists for women 30-65 who have no history of abnormal pap smears?
A
perform co-testing every five years (preferred) or cytology every three years (acceptable)
3
Q
How should a finding of HSIL on cervical cytology be managed?
A
with colposcopy
4
Q
What is the advantage of a LEEP procedure over cryotherapy?
A
LEEP provides a tissue sample for post-procedure analysis, which cryotherapy does not do
5
Q
How should a finding of HSIL on cervical cytology be managed if the colposcopy that follows is deemed inadequate?
A
they should have an excisional procedure performed such as a LEEP
6
Q
What are the symptoms of PID?
A
lower abdominal pain, adnexal and cervical motion tenderness, fever, and vaginal discharge
7
Q
What are the classic findings associated with trichomoniasis?
A
a yellow, frothy, vaginal discharge and a strawberry cervix
8
Q
What are the microscopic findings associated with herpes infection?
A
multinucleated giant cells and inflammation
9
Q
What is the preferred method for testing for genital herpes?
A
culture is the gold standard
10
Q
What would cause a herpes culture to be negative in someone with recurrent genital herpes?
A
culture has a relatively high false negative rate because while specificity is very high, sensitivity is somewhat low; furthermore, culture is best performed early in the course of the lesions rather than late
11
Q
How should a finding of LSIL on cervical cytology be managed?
A
- in women 21-24, repeat cytology in one year
- in women over 24, perform reflex HPV testing; if testing is positive, perform a colposcopy, otherwise, repeat cotesting in one year
12
Q
How should abnormal pap smear findings be managed?
A
- in women 21-24 with low grade findings (LSIL, ASC-US) repeat cytology in one year without performing HPV testing
- in women over 24 with low grade findings, reflex HPV testing should be performed; if this is negative repeat cotesting in three years if ASC-US and in one year if LSIL; if testing is positive, consider it a high grade finding
- high grade findings (HSIL, ASC-H, AGC, or HPV-pos) should always be followed with a colposcopy
13
Q
For whom is DEXA screening recommended?
A
women over age 65 and those under 65 with significant risk factors
14
Q
What is ACOG’s recommendation for mammography in patients with normal risk?
A
annual screening beginning at age 40
15
Q
Patients with normal risk for CRC receive colonoscopies every 10 years. What qualifies patients as being of higher risk and what screening recommendation is in place for those individuals?
A
- individuals with a family member who developed CRC before age 60 are at greater risk
- they should undergo colonoscopy every 5 years beginning at age 40 or 10 years before the youngest affected family member
16
Q
What is the strongest predictor of osteoporosis in a woman?
A
her family history
17
Q
What is the normal acid-base change observed in pregnant women?
A
increased minute ventilation during pregnancy leads to a compensated respiratory alkalosis
18
Q
Why does minute ventilation increase during pregnancy?
A
although there is no change in respiratory rate, the tidal volume increases
19
Q
Describe expected changes in the following PFT parameters during normal pregnancy:
- inspiratory capacity
- tidal volume
- respiratory rate
- minute ventilation
- functional reserve capacity
- expiratory reserve capacity
- residual volume
A
- inspiratory capacity: increased
- tidal volume: increased
- respiratory rate: unchanged
- minute ventilation: increased
- functional reserve capacity: decreased
- expiratory reserve capacity: decreased
- residual volume: decreased
20
Q
Why are pregnant women at greater risk for edema?
A
because their plasma osmolality decreases
21
Q
Name four common causes of pulmonary edema in preganncy?
A
- tocolytic use
- cardiac disease
- fluid overload
- pre-eclampsia
22
Q
Are systolic or diastolic murmurs in pregnancy always abnormal?
A
- diastolic are always abnormal
- up to 95% of pregnant women will have a systolic murmur due to increased plasma volume
23
Q
What is the most common location for metastatic disease in those with gestational trophoblastic disease? How does this affect management of a molar pregnancy?
A
the lungs, so those with a molar pregnancy should have CXR done to look for mets
24
Q
What are the current recommendations for weight gain during pregnancy?
A
- underweight: gain 28-40 pounds
- normal weight: gain 25-35 pounds
- overweight: gain 15-25 pounds
- obese: gain 11-20 pounds
25
What is the preferred method for screening patients for HbS carrier status? Why?
hemoglobin electrophoresis is the preferred method rather than solubility testing because electrophoresis can detect other hemoglobinopathies
26
Those of Ashkenazi Jewish heritage should receive what carrier screening tests?
those for Fanconi anemia, Tay-Sachs, Niemann Pick disease, and CF
27
What is the carrier frequency of CF for non-Hispanic whites?
1/25
28
Valproate is associated with what congenital anomalies?
hydrocephalus, neural tube defects, and craniofacial abnormalities
29
Uncontrolled diabetes primarily increases the risk of congenital anomalies affecting which systems?
- primarily cardiac and CNS
| - secondarily limbs and genitourinary
30
Describe chorionic villus sampling.
- it is a sampling of the chorionic frondosum, which contains the most mitotically active villi in the placenta
- this is performed at 10-12 weeks gestation
- it can be used to detect chromosomal abnormalities or for DNA testing; it will not detect congenital anomalies
31
What is the best method for detecting trisomy 21? When can it be performeD?
cell free DNA testing is the most accurate and can be performed from 9 weeks until delivery
32
What are first trimester combined testing and sequential testing?
- first trimester combined includes an NT with B-hCG and PAPP-A levels
- sequential testing includes an NT and PAPP-A level followed by a quad screen
33
What testing is available for trisomy 21 during the second trimester?
- in the second trimester, triple and quad screening are available
- triple examines B-hCG, estriol, and AFP levels; quad screening adds an inhibin A level
34
What is the most accurate assessment of gestational age?
a first trimester ultrasound
35
Under what circumstances should ultrasound rather than LMP be used to estimate gestational age?
- if ultrasound performed between 14-16 weeks differs from LMP by more than 7 days
- if ultrasound performed between 16-22 weeks differs from LMP by more than 10 days
36
What is the recommended daily dose of folic acid for low and high risk patients?
- low risk: 0.4 mg/day
| - high risk: 4.0 mg/day
37
What is the most common cause of an elevated msAFP during pregnancy?
underestimation of gestational age, only 5-10% of cases are attributable to neural tube defects
38
What is the risk to a pregnancy with ibuprofen?
it is contraindicated after 32 weeks because of the risk for premature closure of the ductus arteriosus
39
Who is amniocentesis offered to for aneuploidy screening?
women over age 35 and those in whom a quad screen is abnormal
40
How should GBS be managed during pregnancy?
- screening should be performed at 35-37 weeks in all but those who already have a history of GBS
- if the culture comes back positive or the patient has a GBS history, intrapartum antibiotic prophylaxis is needed
41
How is maternal diabetes likely to affect the baby's size?
- gestational and type II diabetes are more likely to lead to an LGA baby being born
- type I diabetes is associated with SGA babies
42
What affect does twin-twin transfusion typically have on the two twins in utero?
- the donor is likely to experience oligohydramnios and IUGR
| - the recipient is likely to experience polyhydramnios and fluid overload leading to heart failure and hydrops
43
Gestational diabetes carries what risks in the neonatal period?
- hypoglycemia
- polycythemia
- hypocalcemia
- hyperbilirubinemia
- RDS
44
How should a neonate be treated if the mother is HIV positive?
administer zidovudine immediately after birth and then begin HIV testing at 24 hours
45
Describe Sheehan's Syndrome.
- a pregnancy-related infarction of the anterior pituitary, limiting future production of TSH, gonadotropin, and ACTH
- typically follows significant PPH because during pregnancy the gland grows without complementary growth of the vasculature; during labor and delivery, blood loss can precipitate ischemia and infarction
- presents with poor lactation, loss of pubic hair, and fatigue after delivery
46
What is the greatest risk factor for postpartum endometritis? What are other risk factors?
- the mode of delivery plays the most significant role with c/s increasing the prevalence compared with vaginal delivery
- with vaginal delivery, however, PROM, prolonged labor, multiple vaginal exams, internal fetal monitoring, and manual removal of the placenta are associated with higher rates of endometritis
47
What is the most common cause of postpartum fever?
endometritis
48
Postpartum Endometritis
- the most common cause of postpartum fever
- typically presents with uterine fundal tenderness and fever
- most commonly caused by a polymicrobial infection of aerobes and anaerobes
- risk is highest following c-section but with a vaginal delivery, PROM, prolonged labor, multiple vaginal exams, manual removal of the placenta, and internal fetal monitoring are all significant risk factors
49
How are postpartum blues and postpartum depression differentiated?
- blues last less than 2 weeks whereas depression begins somewhere between 2 weeks and 6 months after delivery
- more importantly, depression, and not blues, is associated with ambivalence to the newborn
50
What is given to reverse the pulmonary toxicity associated with magnesium infusions?
calcium gluconate
51
What 24-hour urine protein level serves as the threshold for pre-eclampsia with and without severe features?
- greater than 0.3 grams is without severe features
| - greater than 5.0 grams constitutes severe features
52
What role does hydralazine play in the treatment of hypertensive disease during pregnancy?
it is predominately used to control BP in the acute setting
53
How should pre-eclampsia be managed?
- with delivery if greater than 34 weeks gestation or unstable
- with expectant management if less than 34 weeks and stable
54
What is the therapeutic serum level of magnesium? What happens at higher levels?
- 4-7 mEq/L is therapeutic
- loss of DTRs tends to occur at 7-10 mEq/L
- pulmonary depression from 11-15 mEq/L
- cardiac arrest from 15+ mEq/L
55
What are contraindications to expectant management of severe pre-eclampsia?
- inability to control BP with maximal doses of two agents
- non-reassuring fetal status
- LFTs more than two times normal
- platelet counts less than 100K
- eclampsia
- persistent CNS symptoms
56
What is the most significant risk factor for pre-eclampsia?
chronic renal disease
57
What is the most significant risk factor for pre-eclampsia?
chronic renal disease
58
What is the risk of isoimmunization if a fetus is Rh+ and the mother is Rh-?
2% antepartum and 7% after full term delivery
59
What is the best non-invasive test to assess fetal anemia in utero?
middle cerebral artery peak systolic flow velocity
60
How is the dosage of Rhogam determined?
300 mcg is sufficient to neutralize 30 cc of fetal whole blood or 15 cc of fetal RBCs
61
What mnemonic is used to recall the risk posed by atypical antibodies?
Lewis Lives, Duffy Dies, and Kell Kills
62
Which amniotic fluid measurement is the best for assessing the severity of Rh hemolytic disease?
amniotic fluid bilirubin level
63
What progesterone level is consistent with a healthy pregnancy?
25 ng/mL
64
What are the requirements for use of methotrexate to treat an ectopic pregnancy?
- patient is hemodynamically stable
- mass is less than 4 cm and without a fetal heart rate or less than 3.5 cm with a fetal heart rate
- normal LFTs, renal function, and WBC count
- the ability to follow-up if the patient's status should change
65
What presenting features would suggest that an ectopic pregnancy has rupture?
- peritoneal signs
| - signs of hypovolemia including hypotension and tachycardia
66
When is a salpingostomy appropriate care for an ectopic pregnancy and when is salpingectomy appropriate?
- salpingostomy is appropriate when the tube is still intact
| - salpingectomy is the preferred treatment for a ruptured ectopic
67
Describe the signs and symptoms of a uterine perforation.
- lower abdominal pain, uterus tender to palpation, rebound tenderness, and guarding
- nausea and fever
- scant vaginal bleeding
68
What is the most common abnormal karyotype discovered in spontaneous abortions?
an autosomal trisomy, specifically trisomy 16
69
Name three systemic maternal diseases associated with early pregnancy loss?
- lupus
- diabetes mellitus
- chronic renal disease
70
What is the main benefit of medical abortion compared with expectant management?
it shortens the time to expulsion
71
Describe a non-medical intervention that can be used to protect against dyspareunia.
continued sexual activity improves blood flow and guards against atrophy
72
What is the primary source for female vaginal lubrication during intercourse?
a transudate of fluid across the vaginal mucosa as the tissue becomes increasingly engorged with blood
73
What is the preferred treatment for vaginismus?
use of vaginal dilators
74
What findings, when found in the setting of an elevated AFP, would suggest multiple gestations?
a B-hCG or fundal height larger than expected
75
What ultrasound findings are consistent with a dizygotic twin gestation?
- a dividing membrane thickness greater than 2 mm
- twin peak (aka lambda) sign
- different fetal genders
- separate placentas
76
What are the risks associated with a twin gestation compared to a singleton?
- greater risk for prematurity
- greater risk for mortality
- higher rates of cerebral palsy and IUGR
- congenital anomalies, particularly amongst monozygotic twins
77
What intervention has been shown to be effective at reducing the risk of having a preterm, low birth weight twin gestation?
early, adequate weight gain
78
Twin twin transfusion syndrome is more likely in what category of twin gestation?
monochorionic, diamniotic gestations
79
Which complication of multiple gestations is associated with the most fetal/neonatal morbidity and mortality?
preterm delivery
80
What would cause an intrapartum placental abruption?
polyhydramnios could lead to a distended uterus and with rupture of membranes, the decompression can lead to placental abruption, presenting as bleeding
81
Which two STDs may require repeated testing to look for seroconversion after a sexual assault? How long after the incident can it take before these two infections are identified?
- Syphillus may take up to 6 weeks
| - HIV may take up to 6 months
82
What is ulipristal?
an emergency contraceptive, effective for up to 5 days
83
Where is the best place to distribute literature related to intimate partner violence?
in a private area such as the restroom; otherwise, the partner may see the information and prevent the patient from accessing resources
84
What are two important rules to follow when providing information about or screening for intimate partner violence?
- offer resources in private
| - avoid use of stigmatizing words like abuse, rape, etc.
85
During what period of gestation are toxic exposures most likely to cause microcephaly or intellectual disability?
weeks 8-15
86
Factor V Leiden mutation is associated with what obstetric complications?
stillbirth, pre-e, placental abruption, and IUGR
87
How is cervical insufficiency likely to present?
- history or risk factors for such an event
| - presenting as painless cervical dilation leading to a feeling of pelvic pressure with bulging membranes and fetal loss
88
AMA is a risk for what obstetric complications?
- still birth
- pre-e
- IUGR
- gestational diabetes
89
What are the typical stages of grief and their respective order?
- denial
- anger
- bargaining
- depression
- acceptance
90
What are the ultrasound criteria for a missed abortion?
crown rump length of greater than 7 mm with no cardiac activity
91
List risk factors for breech presentation.
- prematurity
- uterine anomalies or fibroids
- hydrocephaly and anencephaly
- placenta previa
- polyhydramnios
- multiple gestations
92
How is prolonged latent phase defined and treated?
- defined as a latent phase more than 20 hours in a nulliparous woman and more than 14 hours in a multiparous woman
- treated with rest or augmentation of labor
93
What fetal presentation is most associated with cord prolapse?
a back up transverse lie
94
What is the McRobert's maneuver?
- the first maneuver attempted in cases of shoulder dystocia
| - it involves hyper flexing the mothers hips, which has the effect of widening the pelvis and flattening he lumbar spine
95
How is terbutaline used in labor and delivery?
it serves as a tocolytic
96
How is GBS treated intrapartum?
ampicillin is the preferred medication
97
What contraindications exist for the following tocolytics:
- magnesium sulfate
- terbutaline
- ritodrine
- indomethacin
- magnesium sulfate: myasthenia gravis
- terbutaline: diabetes and to stop preterm labor
- ritodrine: diabetes
- indomethacin: after 33 weeks due to premature closure of the ductus arteriosus
98
What are the benefits of administering btmz during preterm labor?
reduces the risk of intracerebral hemorrhage, RDS, and necrotizing enterocolitis
99
What role does fibronectin level play in the assessment of preterm labor?
- it is used in women with symptoms of preterm labor between 24-35 weeks gestation and as a screening tool for asymptomatic women between 22-30 wesk
- it has a high negative predictive value; symptomatic patients with a negative test are unlikely to deliver in the next 14 days and asymptomatic patients are unlikely to deliver before 35 weeks gestation
100
How does magnesium sulfate act as a tocolytic?
it competes with calcium for entry into cells
101
How does atosiban act as a tocolytic?
it is an oxytocin receptor antagonist
102
What role do tocolytics play in PPROM?
they are only used for 48 hours in order to administer corticosteroids, use beyond that time period increases risk for things like infection
103
What causes variable decelerations?
cord compression, frequently due to diminished fluid levels as in PPROM
104
Which antibiotics are used in cases of PPROM? What are the advantages of this?
ampicillin and erythromycin are used because they can prolong the latency phase and reduce the risk of infection, including choiorioamnionitis and neonatal sepsis
105
What antibiotics are used to treat suspected chorioamnionitis?
gentamicin and clindamycin
106
What drug has been shown to reduce the risk of premature labor? How is it used?
17a-hydroxyprogesterone is given weekly from 16 or 20 weeks until 36 weeks gestation
107
When is delivery indicated in patients with PPROM?
34 weeks at the latest
108
What is the goal for patients with pre-e without severe features and those with PPROM with are stable and not in labor?
delay delivery until 34 weeks
109
What are two possible causes of a false positive nitrazine test?
semen or blood in the vaginal vault
110
At what point is magnesium no longer recommended for neuroprotection?
after 32 weeks
111
Why do obstetricians use the left lateral position?
it improves maternal circulation, including uterine and thus placental blood flow
112
What measures should be taken in response to late decelerations?
- left lateral positioning and treatment of maternal hypotension
- maternal oxygen supplementation
- discontinuation of pitosin
- intrauterine resuscitation with tocolytics and IV fluids
113
What is the appropriate management for a fetal heart tracing with minimal variability and no accelerations?
- begin with digital fetal scalp stimulation
| - then progress to vibroacoustic stimulation, scalp pH testing, or an allis clamp test
114
Which patients are at risk for postpartum hemorrhage due to a genital laceration?
those who experience precipitous labor, have a macrosomic child, or undergo operative vaginal delivery
115
What is the use of and typical contraindication of PGF-2a?
it is a uterotonic agent contraindicated in patients with asthma
116
What is the use of and contraindication to methylergonovine?
it is a uterotonic agent contraindicated in patients with hypertension or pre-e because it will also cause vasoconstriction
117
What are the risk factors for uterine inversion?
factors that lead to uterine distension and most importantly, excessive traction on the umbilical cord when attempting to deliver the placenta
118
How is postpartum hemorrhage defined?
more than 500cc or more than 1000cc blood loss following a vaginal or c-section, respectively
119
What is the first step in management of postpartum hemorrhage?
- assure appropriate back up, establish IV access, and stabilize the patient
- ensure there are no genital lacerations or retained placenta and check to see if the uterine fundus is firm and contracted
120
Ligation of which two arteries is most likely to benefit a woman experiencing postpartum hemorrhage?
ligation of the uterine or internal iliac artery
121
What is the most common cause of delayed postpartum hemorrhage?
vWF deficiency
122
Which antibiotics are used to treat postpartum endometritis?
clindamycin and gentamicin because it is a polymicrobial infection with anaerobes and aerobes
123
What physiologic change can lead to a fever without any other symptoms or signs in the postpartum period?
breast engorgement if there is milk let down but the baby is not yet feeding well
124
How is septic pelvic thrombophlebitis treated?
add anticoagulation to antibiotic therapy
125
What is the most common cause of fever on post-op day 1?
the lungs, specifically, atelectasis can be associated with fever but aspiration pneumonia must also be considered
126
What is the most significant side effect of fluoxetine?
sleep disturbance, particularly insomnia
127
What effects is in utero exposure to SSRIs associated with?
exposure during the third trimester is associated extrapyramidal signs and with withdrawal symptoms
128
List four things that postterm pregnancy has been associated with?
placental sulfatase deficiency, fetal adrenal hypoplasia, anencephaly, and inaccurate dating
129
What complications have been associated with late term and postterm pregnancy?
macrosomia, oligohydramnios, meconium aspiration, uteroplacental insufficiency, and dysmaturity
130
Describe an infant who has suffered from dysmaturity.
- they are typically born postterm
- they are described as withered, meconium stained (yellowish-green skin), long fingernails, and fragile
- there is often a small placenta
131
How does blood loss after a medical abortion compare to that after a surgical abortion?
medical abortions are associated with greater blood loss
132
At what point in a pregnancy can medical and manual aspiration abortion no longer be offered?
- medical can be offered during the first 7 weeks
| - manual aspiration can be offered during the first 8 weeks
133
Why can oxytocin not be used as an abortifacient early in pregnancy?
because there has not yet been an up-regulation of oxytocin receptors to stimulate
134
What is the most likely cause of excessive bleeding following a medical abortion? How should this be treated?
it is most likely the result of retained products of conception and should be treated with surgical evacuation of that material
135
What is the proper follow up after a suction DnC?
post-procedural antibiotics, usually 200 mg doxycycline
136
What antibiotic regimen is typically used when performing a suction DnC?
- 100 mg doxycycline before the procedure
| - 200 mg doxycycline after the procedure
137
What are the two best treatments for stress incontinence?
- a mid urethral sling has the highest success rate for those with stress incontinence secondary to hypermobility
- urethral bulking has the highest success rate for those with stress incontinence secondary to inherent sphincter deficinecy
138
What are B3-adrenergic agonists used for?
detrusor relaxation
