uworld1

Question 1

how are bpp scores evaluated?

Answer 1

8/10 = L
6/10 = equivocal
< 4 = deliver

Question 2

what is def. of oligohydramnios?

Answer 2

AFI < 5 cm

deepest vertical pocket < 2 cm

Question 3

what is def. of polyhydramnios?

Answer 3

AFI > 24 cm

deepest vertical pocket > 8 cm

Question 4

in metabolic compromise, what is order of abnormalities?

Answer 4

HR decels
absent fetal breathing
dec. body mov’t / tone

Question 5

which macrolide may cause acute cholestatic hepatitis in preegnancy?

Answer 5

erythromycin

Question 6

what is a nL NST?

Answer 6

> 2 accelerations in 20 min

Question 7

what is abnl NST?

Answer 7

< 2 accels

recurrent variable / late decels

Question 8

contraction stress test

Answer 8

external FHR w/ spontaneous / induced uterine contractions (oxytocin/nipple stimulation)

Question 9

nL CST result

Answer 9

no late recurrent variable decels

Question 10

abnl CST

Answer 10

late decles in > 50% of contractions

Question 11

what do late decels mean?

Answer 11

uteroplacental insufficiency

Question 12

umbilical artery doppler velocimetry

Answer 12

used for IUGR
nL = high velocity, diastolic low in umbilca artery
abnl = dec, absent, reversed end diastolic flow

Question 13

what meds cause a non reactive NST?

Answer 13

mgSO4, narcotics, steroids

Question 14

meaning of nL CST results

Answer 14

no late / recurrent variable decles –> low likelihood of stillbirth 1/1000 w/in 1 wk

Question 15

unsatisfacotry CST?

Answer 15

< 3 contractions of 40 seconds in 10 min

Question 16

unequivocal CST?

Answer 16

recurrent variable decels
intermittent late decels
decels on contractions > 90 s of q2 min

Question 17

systemic effects of tamoxifene?

Answer 17

dec. osteoporosis

incr. risk of endometrial cancer

Question 18

hormone profile of turner’s?

Answer 18

incr. FSH, low E

Question 19

bilateral renal agenesis fetus prognosis?

Answer 19

will die

Question 20

what is contraindicated w/ endometrial hyperplasia?

Answer 20

endometrial ablation contraindicated

prevents future eval by biopsies

Question 21

how to treat hyperplasia w/o atypia?

Answer 21

3% chance of cancer
treat w/ progestin
repeat biopsy in 3 mo to assess response

Question 22

how to treat hyperplasia w/ atypia?

Answer 22

1) hysterectomy

2) future pregnancy

Question 23

lichen sclerosis progresses to?

Answer 23

squamous cell carcinoma of the vulvar

Question 24

treatment for lichen sclerosis?

Answer 24

chronic inflammatory condition - vulvar itching + flaking
treatment: high-potency topical steroids (twice daily, 4 wks) –> less potent topical steroid / topical calcineurin inhibitor

Question 25

radical vulvectomy, when is it used?

Answer 25

invasive squamous cell carcinoma / melanoma | if basal cell carcinoma / = less disfiguring

Question 26

what is pathophysiology of pre-eclampsia?

Answer 26

placental endothelial cell dysfunction / vasospasm

Question 27

what are drawbacks of methyldopa in pregnancy for acute HTN episodes?

Answer 27

slow onset | sedating

Question 28

nitroprusside + HTN crisis?

Answer 28

last resort: cyanide = byproduct

Question 29

effect of hyperglycemia on fetus (mechanism)

Answer 29

hyperinsulinemia --> fetal hypoxia --> incr. erythropoiesis --> polycythemia --> ischemia/infarction

Question 30

effects of hyperglycemia on fetus post partum (lab values)

Answer 30

hypocalcemia (PTH suppression) hypoglycemia hyperbilirubinemia polycythemia

Question 31

features of severe pre-eclampsia

Answer 31

``` BP > 160/110 thrombocytopenia < 100K serum creatinine > 1.1 elevated transaminases pulmonary edema new onset visual/cerebral symptoms ```

Question 32

how does pregnancy incr. the likelihood of carpal tunnel?

Answer 32

estrogen --> incr. interstitial edema --> incr. carpal tunnel pressure

Question 33

what are features suggesting malignant discharge?

Answer 33

unilateral bloody/serous palpable skin changes

Question 34

what are the lab derangements in hyperemesis gravidarum?

Answer 34

hypokalemia, ketonuria

Question 35

clinical presentation of hyperemesis gravidarium?

Answer 35

severe, persistent vomiting ketonuria >5% loss of pre-pregnancy weight

Question 36

what is treatment for hyperemesis gravidarum?

Answer 36

hydration ginger pyridoxine +/- doxylamine

Question 37

what are risk factors for hyperemesis gravidarium (when does it present)

Answer 37

multifetal gestation / molar pregnancy | incr. placental mass --> highest hcg @ 10-12 wks (true for all women)

Question 38

what are causes of elevated maternal serum AFP?

Answer 38

produced by: fetal yolk sac, liver, GI tract open neural tube defects fetal abdominal wall defects (gastroschisis / omphalocele) multiple gestation fetal congenital nephrosis + benign obstructive uropathy

Question 39

what are some treatments for urge incontinence?

Answer 39

oxybutynin - anticholinergic

Question 40

for what type of incontinence is urethropexy used?

Answer 40

stress

Question 41

early decel - visual finding + etiology?

Answer 41

symmetric to contraction gradual (> 30s from nadir to onset) fetal head compression (possibly normal)

Question 42

late decel - visual finding + etiology?

Answer 42

occurs after contraction | cause: uteroplacental insufficiency

Question 43

variable decel - visual?

Answer 43

not necessarily assoc. w/ contractions abrupt (< 30s from nadir) (duration > 15 s, < 2 min)

Question 44

variable decel etiology

Answer 44

cord compression oligohydrmanios cord prolapse

Question 45

med treatment for acute abnL uterine bleeding?

Answer 45

``` high dose IV/oral estrogen high dose combined OCP high-dose progestin (if E contraindication) tranexamic acid (if both P/E contraindicated) ```

Question 46

what is mechanism of high E for acute uterine bleeding?

Answer 46

rapidly regrow endometrium from prolonged heavy bleeding

Question 47

fetal hydantoin syndrome

Answer 47

midfacial hypoplasia, microcephaly, cleft lip/palate, digital hypoplasia, hirsuitism, dev't delay

Question 48

signs of congenital syphilis

Answer 48

rhinitis (snuffles) + skin lesions | later: keratitis, hutchinson, saddle nose, deafness

Question 49

fetal hydantoin syndrome vs. fetal alcohol syndrome

Answer 49

fetal alcohol doesn't have cleft palate / excess hair

Question 50

where does placental abruption occur?

Answer 50

bleeding b/w decidua & placental interface --> placental detachment --> no exchange to fetus

Question 51

how to manage placental abruption?

Answer 51

- IV access | - if stable vitals + > 37 wks --> vaginal delivery (maybe w/ oxytocin augmentation)

Question 52

what must be r/o w/ placental abruption?

Answer 52

placental previa

Question 53

how does ABO incompatibility occur & how does it present?

Answer 53

group O mother w/ a group A / B mild anemia / neonatal jaundice - treatable w/ phototherapy milder response than Rh(D) incompatibility

Question 54

what is treatment for adenomyosis?

Answer 54

hysterectomy | no other options

Question 55

molar pregnancy progression to choriocarcinoma

Answer 55

20%

Question 56

molar pregnancy + ovary findings

Answer 56

theca lutein cysts

Question 57

pregnancy markers

Answer 57

progesterone > 25

Question 58

betamethasone what do you use it for?

Answer 58

- fetal lung maturity - prevents respiratory - prevents intercerebral hemorrhage - nec. entero

Question 59

when is Mg contraindicated

Answer 59

Myasthenia gravis - | poor renal function

Question 60

nL endometrial thickness post menopausal

Answer 60

<5mm

Question 61

when might IUDs be contraindicated?

Answer 61

in a fibroid uterus with changes to the cavity (i.e.: submucosal fibroids

Question 62

what are absolute contraindications to estrogen OCP?

Answer 62

DVT, PE, cardiovascular disease, stroke, breast/endometrial cancer, melanoma, hepatic tumor, abnL liver fuxn