UWorld Flashcards
Serum markers for neural tube defect.
AFP up, all other markers normal
Serum markers for Trisomy 21 vs 18.
21 = betaHCG (up), Inhibin A (up), AFP (down), Estriol (down)
18 = betaHCG (down), Inhibin A (down), AFP (down), Estriol (normal)
Treatment of postpartum endometriris
Clindamycin and gentamicin
Next step in management for postpartum hemorrhage
Genital tract inspection (look for unrecognized laceration)
Infant with claw hand. Dx? Mechanism? Other symptoms?
Dx = Klumpke Palsy
Mechanism = shoulder dystocia causing traction on C8 T1
Other symptom = Horner’s
Prenatal testing at 10 weeks
Cell free DNA.
High sensitivity and specificity for aneuploidy
Timeline for chorionic villus sampling performed? Amniocentesis?
CVS = 10-13 wks Amnio = 15-20 wks
Chlamydia treatment
Azithromycin
* if resistant to azithromycin the use Doxycycline (but NOT in pregnancy)
At what gestational age do we perform the oral glucose challenge test?
24-28 wks
At what gestational age do we perform Group B Strep culture?
35-37 wks
Why does peripheral edema occur during pregnancy?
Plasma volume expansion
How often to administer shots of Depot Medroxyprogesterone Acetate (DMPA) intramuscularly?
Every 3 months
Cause of infertility after intrauterine surgery
Asherman syndrome (due to development of intrauterine synechiae = adhesions)
What is placenta previa
When the placenta covers the cervix
Differential of bleeding during pregnancy.
Placenta previa (placenta covers cervix) = Painless bleeding ad NORMAL fetal heart tracing
Placental abruption = YES fetal heart rate tracing abnormalities (e.g. decelerations, bradycardia)
Uterine rupture = Often occurs during labor, YES fetal heart tracing abnormalities (e.g. decelerations, bradycardia)
Vasa previa (fetal blood vessels cover cervix) = rapid deterioration of fetal heart tracings as the hemorrhage is primarily of fetal origin
What test is used to diagnose intrauterine fetal demise? Treatment and follow-up?
Test to diagnose = Transabdominal ultrasound must show absence of fetal cardiac activity (Doppler is NOT enough)
Tx = vaginal delivery
Follow-up =
- Fetal autopsy + karyotype
- Placental evaluation
- Maternal evaluation for antiphospholipid antibody syndriome and fetomaternal hemorrhage (KB test)
Pathophysiology of preeclampsia
Chronic uteroplacental insufficiency
What complication is likely to present in the neonate to a mother that has preeclampsia
Fetal growth restriction
Define late and post-term pregnancy
Late-term pregnancy > 41 wks
Post-term pregnancy > 42 wks
What is the risk to the mother and the fetus if pregnancy is prolonged beyond 42 wks?
Risk of Oligohydramnios (due to uretoplacental insufficiency)
What does a Fetal Heart Rate demonstrating sinusoidal pattern mean?
Sinusoidal pattern = severe fetal anemia
Fetal cord compression - What is the fetal heart rate monitor pattern?
Variable decelerations
Oligohydramnios - What is the fetal heart rate monitor pattern?
Variable decelerations
What is chorioamnionitis?
What is the fetal heart rate monitor pattern?
Chorioamnionitis = intraamniotic infection
FHR monitor = fetal tachycardia (>160 bpm)
What is uterine atony? Treatment?
Uterus fails to contract after delivery, causing heavy postpartum bleeding.
Tx = Bimanual uterine massage and/or oxytocin (uterotonic)
What does the physical exam of the uterus show in uterine atony?
Enlarged, boggy uterus
What do you see on bleeding labs of patients with vWF deficiency?
Normal PT and PTT
Prolonged bleeding time
How to treat acute bleeding caused by vWF deficiency?
Desmopressin
What is the exact definition of preeclampsia?
(1) High BP = SBP > 140 or DBP > 90
(2) Proteinuria or Signs of end-organ dysfunction
(3) Gestational age > 20 wks
What are the 6 severe features that define “Preeclampsia with severe features”?
(1) SBP > 160 or DBP > 110
(2) Thrombocytopenia
(3) High Creatinine
(4) High Transaminases
(5) Pulmonary edema
(6) Visual or Cerebral symptoms
What is the management of patients with preeclampsia?
Without severe features = deliver after 37 wks
With severe features = deliver after 34 weeks
+ MgSulfate + Antihypertensives
Preeclampsia definition (criteria) - exact numbers
(1) Hypertension (BP > 140/90)
(2) > 20 wks gestation
(3) Proteinuria OR organ damage
Define proteinuria of preeclampsia
Proteinuria =
> 300 mg protein /24 hrs
protein/Creatinine ratio > 0.3
Dipstick 1+ or higher
When is labetalol contraindicated in the treatment of hypertension in pregnancy
Labetalol is a beta blocker so it should not be used if patient’s pulse is less than 60 (bradycardia)
What oral medication is a choice to control hypertension of pregnancy and it what scenario should it NOT be used
Nefidipine (PO)
Do NOT use if pt has emesis
1st line treatment for magnesium toxicity
IV calcium gluconate
What kind of patients are at risk for magnesium toxicity?
Patients with renal disease
What is the mechanism and use of the drug Clomiphene?
Clomiphene is an estrogen receptor antagonist in the hypothalamus. Thus, it prevents feedback inhibition of GnRH. Therefore clomiphene leads to increased secretion of LH and FSH.
Clomiphene is used to treat infertility due to anovulation (e.g. PCOS)
Acne and male-pattern hair during pregnancy: Cause? Management?
Cause = elevated beta HCG leads to ovarian hyperstimulation causing development of bilateral luteoma (solid mass) or theca lutein cysts, which release androgens. Management = Will resolve after delivery
How to differentiate lactational mastitis and breast abcess.
Lactational mastitis and breast abscess both present with unilateral breast pain and flulike symptoms (fever, myalgias).
However Breast Abscess is a fluctuant (moveable) mass AND is associated with axillary lymphadenopathy.
How will galactocele present?
NO pain.
NO fever
Subareolar, mobile, well-circumscribed mass.
How will plugged breast duct present?
YES pain
NO fever
Focal tenderness and firmness.
Preterm labor is below how many weeks?
Below 37 weeks
How to manage preterm labor depending on the gestational age.
Less than 37 weeks, all preterm should receive Betamethasone + Penicilin if GBS status unknown.
Less than 34 weeks = Add Tocolytics
Less than 32 weeks = Add magnesium sulfate