COMAT obgyn shelf 9 2015

ruhland1's version from 2015-07-20 15:38

Section 1

Question Answer
4 cm dil and painful contract1st stage, active
recieve neuraxial analgesia1st stage, active
mild ireeg1st, latent
oxytocinmoa is up G-coupled * up intracellular Ca in uerine myofibrils
oxytocin increaseslocal prostglandin production
PGE1 indicmissed abortions, induces labor, tx PPHemm
dinoprostone vs misoprostoldino=PGE2 and $$ , misoprostol=PGE1 an cheap
prostglandins/e F,chill,N/V/D
vaginal gelPGE2 dinoprostone
favorable cervix + pinduce labor *use amniomoty
amniotomymust confirm fetus is vertex, also umbilical cord is not near os to prevent prolapse
laminaria japonicummechanical hygroscopic dilator made from seaweed
laminira indiccervical dilation for pregnancy termination
laminira moaosmotic -> swell -> controlled dilation by mechanical pressure

Section 2

Question Answer
passive movement that permits smallest diam of fetal headflexion
passes in flexionsuboccipitobregmatic diam (smallest diam fetal head)
descentof fetal head toward pelvic floor
highest rate of descentdeceleration phase of 1st and 2nd stage
shoulder delivered under pubic symphysis* up expulsion
fetal head flexion to ? as travels beneath symphsis pubisextension
fetus resumes face forward positionexternal rot movement
external rotocciput and spine on same plane
internal rotocciput rotates from transverse to OA or OP position
6ext rot
ED is FInEEEmnemonic for 7 cardinal mvmt of labor
Cardinal mvmt storyyou get engaged. descend down aisle, flex(bow) to preist, turn towards eachoter (int rot), extend your hands get the rings, ext rotate( face concregation), expulsed from church

Section 3

Question Answer
top on differential if sexually active female w/ pelvic painTHINK PREGNANCY!
preg + abdominal pain * must r/oectopic
+ preg and r/o ectopic nowtx CACG (no doxycycline in preg!
uterusT9-L2 bil
fallopian tubesT10-L2 ipsi
chlorpromazineD2 antag * up galactorrhea (multiducts)
prolatin sx up * usebromocriptine
solitary duct + serous/bloodyintraductal papilloma
use MRI to evalprolactinoma
physiologic normal nipple dischargehyperprolactin and/or idiopathic
accelerationdue to fetal movemnt
reassuring accelatleast 2 accel atleast 15 beats above baseline for atleast 15 seconds each
sinusoidal patternfetal hypoxemia 2ndary to fetal anemia
early decelnadir coincides with peak of contraction
variable decelfetal cord compression
late deceluteroplacental insuff / fetal hypox

Section 4

Question Answer
severe fetal anemiasinusoid
>100,000 CFU in in urethradx is asx bacteruria
dx cystitiscarries 30-40% risk to acute pyeloneph
abx for asx bacturiaamox, ampi, nitrofuran, cephalexin
TMP-SMXcontra b/c TMP os folate antag
ciprocontra in preg (up potential risk catilage damage
AZTamoxicillin is preferred in UTI
twin up risk uterine atony
uterine atonysoft, nontender, enlarged "boggy" uterus
2 MC cause of PPHemmmaternal pelvic trauma
fetal macrosomiaup vag trx
excessive traction on umb cord during placental delivery up uterine inversion
classic presentation of uterine ruppatient who previously had a C-section and now is trying a vaginal birth
uterine atony 1st line is bimanual uterine massage
tx if blood loss >2000 mlpacked RBC (2-4 units)
PPHemm last resorthysterectomy
methylergonovine3rd line tx in UAtony that is refractory to uterine massage and oxytocin
contra in preecl and htnmethylergovine (b/c increase bp)
why is misoprostol>oxytocin in developinglow cost and heat stable

Section 5

Question Answer
painless chancreprimary syph
palm sole rash + regional LAD(lymphadenopathy)2ndary syph
syph screenVDRL/RPR
confirms syphFTA-ABS
gardenellabac vagin
+ whiff and clue cellsgardenella
gardenella txflaggyl
haemoph "do cry"chancroid
MC cuase of cervicitischylmydia
chylmidiagram stain not present, no culture (intracellular)
cutured on Thayer-Martingonorrhea
gonorrheamonoarticular septic arth
MC cause of septic arth in young adultgonorrhea
bultinucleated giant cellsTzanck HSV 1/2
HSV visible lesionsmust C-section
HPVcauliflower-like lz
16/18cervical cx
abnormal papdo HPV test/colposcopy
HPV vaxgiven in preteen years 3 doses over six month
cervical petechiae and vaginitistrichomona
trichomonas txflaggyl
up douche/dm/hiv/msp (multi sex partner)up candidiasis
yeast inftx is 1x fluconazole or topical antifungal
cervical motion tenderness is only sx and dyspareuniachylmidia
genital vesiclesHSV-2
discrete papillary exophytic lesion on superior inner thighHPV

Section 6