COMAT obgyn shelf 6 2015

ruhland1's version from 2015-07-23 12:44

Section 1

Question Answer
coarc aortaturner
turner findingcubitus valgus, hyperconvex nails
ut adhesions due to D and C causesasherman synd (infert)
kallmandn olfactory/GnRH migration (infert)
46XY but female phenotypeSwyer synd (possess all female genitalia)
40% turner45 X
60% turner are46 XX mosaic
1st assess to use if dn fetal movementNST
non reactive NSTless than 2 accell over 20 min
if non-reactive NST then useBPP
BPP parametersfetal breathing/tone/amnioticfluidvol and a repeated NST
BPP scoringeither 0 or 2
when is BPP score worrisome<4 (immediate delivery should be considered)
when is CST contrapreterm hx
if placental insuff/ IUGR is suspected thendo umbilical artery doppler velocimetery
MC cause of maternal death in parturients w/ preeclampsiastroke (cerebral hemm/infaract)
severe Preecl eyescotoma

Section 2

Question Answer
SUI=stress incontinece (dx w/ urodynamic testing)
stress incontinece definewhen pressure of bladder is more than uretheral closing pressure
suprapubic pain related to bladder fillinginterstitial cystitis
nocturia, involuntary detrusor contractionsoveractive bladder
uknown rubella statusobtain maternal antibody tities
hydropic chorionic villimole
mole txD and C
mole post txserial B-hcg for 6-12 mo
"donut" shaped echogenic area lateral to ovary =tubal ectopic
free fluid in pouch of douglas and GI pathosup acute appendicitis
inhomogenous echogenic area meansdonut shaped object (tubal ectopic)
up risk ectopicwhen smoking more than 20cig/day
up age *up ectopic risk
DES adverse9x risk ectopc due to abnormal tubal morphology and impaired fimbrial func
most reliable sign of uterine rupturenon-reassuring FHR pattern
MC FHR pattern abnormalitybrady
breast mass non-tender/firm/mobilrfibroadenoma
breast cx rate in women1/8 in lifetime
breast mass most sensitive prior to mensesfibrocystic changes (bilateral tender mobile nodules)
R upper outer quad, tender, immobile, skin retractionbreast malig

Section 3

Question Answer
breast abcess assocstaph aure
when do breast abscess occure2nd week postpartum
blunt trx on breastup fat nec
age up breast cx risk>50
SERUM(not urine!!)low PAAP-A and B-hCG thinktri 21
nuchal transluncecy on tri 21increased translucence(means less developed nerve system)
PAPP-A, B-hcg, u/s for fetal aneupolidy wk of screen9-13
when do aminocentesis wk15-20
when do CVS wk10-12
do CVS afteru/s and nuchal transluncy b/c more invasive
obtain this AB TITER at initial prenatal visitrubella
screened with CERVICAL SWAB in initial prenatalgonorrhea
hep screen indicated in ALL preg womenHBsAg (hep C for hi risk only)
ACE-i cause in fetus 2nd and 3rd trimdn renal (dn GFR)
thalidomide causesphocomelia (defect mesodermal layer)
phocomeliaabsent or shortened limbs
ACE-i in 1st trim teratoA/VSD, spina bifida, microceph

Section 4

Question Answer
GDM fasting>95
GDM 1 hr>120
GDM inital txmodify diet/exercise
avoid ____ in GDMoral antihyperglycemics
GDM screen wk24-28
+ GDM after 2 wks of diet/excerciseput on insulin
UTI lab suggestive of + dxpresence of leukocyte esterase
leukocyte esterasebyproduct of WBC in UTI
UA shows nitrates* has E.COLI bug
first line for sx SVT narrow QRSadenosine
adenosine moablocks AV node
when to avoid adenosineirregular wide-complex tachy (up hemodynamic instability)
2nd line SVT in pregverapamil metoprolol
B2 tolcolyticritrodine
terbutaline isB2 tocolytic
insulin on e-hypokalemia
mom w/ hyperglc and hyperinsuline and admin B2 ag causesfetal hypoglycemia
why B2 ags cause fetal hypoglcup B2 ag * glycogenlysis/up glucagon * up maternal glc * up maternal insulin * up insulin to fetus

Section 5

Question Answer
immediate treatment of variable decelrepositioning to decubitus
tachysystole txterbutaline
tachystole def>5 contract/10 min/ avg'd over 30 min period
tx of variable decel caused by oligohydamnioinfusion
contricts spiral arteriesoxytocin
Diagonal ESCaPeMEMORIZE for bishop (dilation,efface,station,consistency,position)
bishop score akacervix score
has foul aminotic fluid/purulent dischchorioamnionitis
preg+ acute onset unil lower quad painovarian torsion
premature separation of placenta due to ? is placental abruptionuterine bleeding into decidua basalis
fetal BRADY, abd pain, REVERSAL of fetal station thinkuterine rupture
UTI iatrogenicklebsiella
struvite stonesthink proteus (urease positive * up pH)
young women having sex UTIS. saprophyticus (novobiocin resistant)
MC cause of cystitisECOLI
POC=products of conception

Section 6

Question Answer
open os and paritally expelled products thinkincomplete spontaneous abort
closed os,vag bleed, +/- abd pain, U/S shows fetal tissuethreatened spontaneous abort
retained dead fetal products and closed osmissed abortion
most occur before 12 weekscomplete spontaneous abortion
incomplete abortion txtissue extraction w/ forceps if POCs can be visualized at cervical os
threatened miscarraige txexpectant mx
<12 wk want abortuse misoprostol instead of D and C
contra in GDMritrodine and terbutaline
contra in Myas GravisMagnesium
contra in PUDzindomethacine
use ? to tx premature contractionsCCB(nifedipine) esp in asthma/DM/indomethacin contra
1st line tx for premature contractions <32wks GAindomethacin
-1 through -2.5 SDosteopenia
>2.5 SDosteopor
>2.5 SD + Frxsevere osteopor
inadequate vit D use causesosteomalicia
osteomalaciaX-ray show radioLUCENT bands instead of OPAQUE

Section 7

Question Answer
arthritis, renal failure, change neuro, serositis, hema/immuno markers thinkSLE
erythematous raised patchesmucocutanneous menifestations w/ SLE
erythema multiformedusty central area with red halo
heliotropered eruption on eyelid
heliotrope rash + gottron papule thinkdermatomyositis
firm lumps next to flexor surfacesRA
ANA SMITH1st= most sensitive SLE dx 2nd= most specific SLE dx
anti citullinatedRA
anti jopolymyositis/dermatomyositis
anti rosjorgen
sjorgenSSA antibodies
anti topoisomerase Iscleroderma
limted scleroderma=CREST synd
anti phospholipd+ in SLE
SLE causeshemolytic anemia,reticulocytosis,leukopenia,lyphopenia,thrombocytopenia
tram track=thickened capilary walls (membranous glomneph)
see this in renal insuff in SLEtramtrack (subendothelia immune complex depositis)
"wire loop"SLE kidney
BM stain in SLEdiffuse granular IgG and C3
diabetic nephropathyhyaline deposits
inflam infiltrate in kidney thinkAIN (muddy casts)
linear immunoflour in glom BMgoodpasture
goodpasturerenal dysfunc + hemoptysis