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OB Gyn Ck 2

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mikenakhla's version from 2016-05-19 20:18

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Question Answer
Complications of late term or post term pregnancies includeoligohydramnios
• You can give Anti D immunoglobulin up to ____ after delivery if the newborn is Rh positive?72 hours
• NSAIDs and hormonal contraceptives failed to treat endometriosis. What do you do next?laparoscopy and biopsy. This is the only definitive way to diagnose endometriosis
• Patients with endometriosis are at increased risk forinfertility due to chronic inflammation and adhesion formation
• Physiologic acid base disturbance in pregnancy?primary respiratory acidosis. Progesterone stimulates respiratory center so you have increased respiratory drive, hyperventilation and hypocapnia
• Delayed or absent pubery? Low FSH and LH levels and can't smell ?kallmann syndrome. Normal karyotype
• Benign lymphangioma associated with turner's syndrome and the trisomies? Often round in neckcystic hygroma
• Normal creatinine in pregnancy?0.4 - 0.8. Severe if > 1.1 with preeclampsia
• Use these 3 meds to treat hypertensive emergencies in pregnancyhydralizine, labetalol, nifedipine
• ESR elevation isnormal in pregnancy
• Hypothyroidism in pregnancy? How do you treat?increase levothyroxine when pregnant
• Next course of action if mom is contracting and in labor but is preeclampsic/eclampsic?give mag sulfate and augment labor
• Side effect of epidural anesthesia?hypotension, blood pooling in veins after dilation due to sympathetic blockade
• Steroids are typically not given to premature laboring moms after34 weeks
• Cause of primary dysmenorrhea?increased prostaglandin release from the endometrium sloughing off during menses.
• Intrauterine fetal demise then developing coagulation abnormalities (low-normal fibrinogen and platelets), what do you do?induce labor to minimize DIC risk. If all coagulation parameters, go off patient preference (wait or induce)
• If patient is rubella non immune, what do you do?vaccinate postpartum
• What is a hyatiform mole?products of conception basically become a tumor, hCG level doesn't return to zero after delivery
• Preeclampsia before third trimester, think thispossible hydatiform mole
• First or second trimester bleeding with "grapes" from vagina". Think thishydatiform mole
• If hCG levels don't fall to zero after D&C of a hydatiform mole, what do you think of?how do you treat?invasive mole or choriocarcinoma. Treat with methotrexate or dactinomycin
• What is a positive contraction stress test? What do you do in most cases?late decelerations seen on fetal heart strip. C section performed
• Avoid aspirin in pregnancy besides these patients who may benefit from itantiphospholipid syndrome.
• Treatment options for antiphosphlipid syndrome in pregnancy?aspirin, LMWH or unfractioned heparin
• These two rare disorders are associated with prolonged gestation?anencephaly and placental sulfatase deficiency
• Low AFP? High? What do you do if it's elevated?down syndrome, high is neural tube or ventral wall defects. If elevated, repeat test
• White or yellowish vaginal mucous discharge that is non odorous in the absence of other symptoms?physiologic leukorrhea
• Prolonged rupture of membranes, prolonged labor, C section, etc are risk factor for this. Fever/uterine tenderness/foul smelling lochia in postpartum period. What is this and how do you treat it?endometritis. Treat with clindamycin and gentamicin. This is a polymicrobial infection.
• Cancer risk with PCOSendometrial cancer
• First trimester combined test for down syndrome?nuchal translucency via ultrasound and PAPP-A and hCG
• If woman has positive screening test for Down syndrome, what's the next step?ultrasound, but offer fetal karyotype determination via CVS and amniocentesis
• CVS can detect which disorders and which can it not detect?genetic or chromosomal, but not neural tube defects
• Yellow or brown teeth babies?tetracycline
• Deafness at birth, what teratogen?aminoglycosides
• OCPs during pregnancy can causeVACTERL syndrome
• Absence of long bones and flipper like appearance of hands with this teratogenic drugthalidomide
• Craniofacial defects, IUGR, CNS malformations, stillbirths possible with this teratogenic drugwarfarin
• Fingernail hypoplasia and craniofacial defects with this teratogenic drugcarbamazepine
• Cleft lip or palate with this teratogenic drugdiazepam (benzos)
• Treatment of infant hypoglycemia born to diabetic moms?glucose
• Intracranial calcifications and chorioretinitis with this infection during pregnancytoxo
• Limb hypoplasia and scarring of the skin with this infection during pregnancyvaricella zoster
• Saber shins, rhinitis, weird teeth, skin lesions with this infection during pregnancysyphilis
• Cardiovascular defects, deafness, cataracts, micropthalmia (one small eyeball) with this infection during pregnancyrubella infection. This is the worst
• Deafness, cerebral calcifications, micropthalmia (small eyeball)CMV
• Vesicular skin lesions with positive Tzanck smear with a mom with these lesionsHerpes
• Treatment for neonatal thyrotoxicosis in babies born to mom's with graves disease?methimazole and a beta blocker till the condition self resolves in a few weeks to months
• What do you do for baby if mom has chronic hep B?Give hep B and IVIG at birth
• What do you do if mom has chickenpox within last 5 days of pregnancy or first two days of delivery?give baby varicella zoster IG
• Treatment for gonorrhea in pregnancy? Chlamydia?ceftriaxone, and give azithro/amox/orerythro instead of doxy for chlamydia
• Which TB drug should be used with caution in pregnancy?pyrazinamide, but use it if drug resistant organism is suspected
• What is HELLP syndrome?hemolysis, elevated liver enzymes, low platelets, RUQ or epigastric pain
• Treatment for pre-eclampsia?if at term, delivery. If preterm and severe, delivery WHEN MOM IS STABLE. If mild, treat hypertension and advise bed rest
• Causes for polyhydramnios?maternal diabetes, multiple gestation, neural tube defects, GI anomalies, hydrops fetalis.
• Protraction disorder vs arrest disorder of labor?first is mom takes longer in labor but it's still progressing. Arrest is failure to progress (eg no changes in dilation for 2 hours or no change in descent seen over 1 hour).
• First step in prolonged or arrested labor? Then what?check to see if baby is in an abnormal lie or has a big head. If neither is present, treat with oxytocin, prostaglandin, etc. if they fail, C section at first sign of fetal distress
• Problems that can happen with using oxytocin to augment labor?uterine hyperstimulation (painful, overly frequent and poorly coordinated contractions), uterine rupture, hyponatremia (b/c it's got an ADH like effect). Discontinue oxytocin if any of these happen
• What do you do if you suspect an ectopic pregnancy?ultrasound. If patient is doing poorly do a laparoscopy
• Treatment options for ectopic pregnancy?surgery if greater than 3 cm, or methotrexate if less than that
• Early decelerations signify ___. Variable decelerations signifies ____. What do you do? Late signify ____. what do you do?head compression (normal) , cord compression (if fetal bradycardia is severe or doesn't resolve, check fetal oxygen sat or scalp pH), uteroplacental insufficiency (check fetal oxygen saturation or scalp pH and prepare for C section).
• Any fetal scalp pH less than ____ or fetal oxygenation is low, this is an indication for immediate cesarean delivery.7.2
• What do you do if shoulder dystocia or impaction happen during delivery?McRobert's maneuver to free shoulder or apply suprapubic pressure . If maneuvers fail, push baby back in and do a c section
• Always do this before a pelvic exam in the workup of third trimester bleedingultrasound. If previa is present, disturbing it may make things worse
• Painless bleeding in third trimesterprevia
• With this, blood can be behind the placenta. Mom has pain, uterine tenderness, increased uterine tone, fetal distressabruption placentae
• Abruptio placeta can cause this if fetal products enter maternal circulationDIC
• Treatment for abruptio placenta?fluids and blood if needed. Rapid delivery (vaginal preferred)
• Sudden pain, dramatic onset, maternal hypotension or shock and can feel weird parts in abdominal contour. What is this and how do you treat?uterine rupture, treat with immediate laparotomy and delivery. Hysterectomy usually required after delivery
• Maternal distress is usually more pronounced than fetal distress in this ___. Fetal distress is more pronounced in this ____uterine rupture, abrupt placenta and vasa previa (mom is basically asymptomatic here but fetus is in demise)
• Mom completely stable but bleeding and fetus is worsening. What is this? What test is performed to differentiate fetal and maternal blood and how do you treat this condition?this is vasa previa, an Apt test, and do immediate C section
• Preterm labor is between20 weeks and 37
• Tocolytics examples. When are they contraindicated?beta 2 agonists (terbutaline, ritodrine) and mag sulfate. If mom has pre eclampsia, severe hemorrhage, chorioamnionitis, IGUR, fetal demise
• Steroids are given between which weeks?24 and 34 for lung maturity
• Which maternal antibody can cross the placentaIgG. Elevated neonatal IgG is usually maternal antibodies, elevated IgM in baby is never normal
• If maternal Rh antibody titer is very high, how much RhoGam do you give in cases of placental hemorrhage?none, it's useless. Monitor fetus for hemolysis
• Sx of fetal hydrops (hemolytic disease of newborn causes this)ascites, pericardial effusions, edema, death
• Treatment of hemolytic disease of newborn?delivery if mature, transfusion intrauterinely, and phenobarb to help liver break down all the bilirubin
• Give rhogam to Rh- mom with an Rh+ dad or unknown in which situations?abortion, stillbirth, ectopic, amniocentesis, CVS, or anything else that causes TRANSPLACENTAL bleeding during pregnancy
• Preterm premature rupture of membranes PPROM is defined as what? what do you do with amniotic fluid/what are you looking for?rupture membranes before 36 or 37 weeks. Do a culture and gram stain of amniotic fluid, if negative, bed rest and frequent follow up. If positive for GBS, treat with penicillin G or ampicillin even if she's asymptomatic
• Treatment of chorioamnionitis?ampicillin and gentamicin while waiting culture results
• Treatment for uterine atony if oxytocin, prostaglandins, misoprostol, massage etc fail, what do you do? What if mom wants to have more babies?patient may need hysterectomy. Ligation of uterine vessels can be attempted if patient wants to retain fertility
• This is usually needed to stop bleeding with placenta accreta, increta, percreta?hysterectomy
• If postpartum fever doesn't improve with abx, what are you thinking ?pelvic abscess or pelvic thrombophlebitis.
• Sx of pelvic thrombophlebitis? Treatment? spiking fevers, no abscess, lack of response to Abx. Give heparin
• Physiologic thyroid changes in pregnancy?total T4 increased b/c of increased TBG. TSH is slightly low because free t4 and t3 are slightly higher.
• This liver test increases markedly phsiologicallyalk phos.
• Treatment for acute fatty liver of pregnancy?IV fluids, glucose, FFP to correct coagulopathies.
• Progesterone used asprevents preterm labor (tocolysis)
• Incomplete abortion, if patient is hemodynamically stableD&C, expectant management (eg, they can go home), and mistoprostol to get it out
• Maternal factor in respiratory distress of the newborn (not prematurity)diabetes. Because it delays maturity of surfactant production
• Infection of retained products of conception following an abortion. Medical emergency. What do you dobroad spectrum abx, suction curettage
• Most common causes of hyperandrognism in pregnancy? How do they look on ultrasound?luteomas and theca luteum cysts. Appear as solid masses on ultrasound (luteomas). No treatment necessary for luteomas. The others might be a result of a molar pregnancy and suction curettage is indicated if that's the underlying cause.
• When can you do external cephalic versions?as soon as they're term (37 weeks)
• Viral conjunctivitis vs bacterial?viral has clear, watery discharge with periauricular lymphadenopathy, highly contagious (look for sick contacts). Bacterial has purulent discharge and is classically in neonates
• Silver nitrate or erythromycin drops given to all newborns to prevent gonorrhea conjunctivitis can causechemical conjunctivitis. Starts within 12 hours and resolves itself within 48 hours. Chemical is the answer if conjunctivitis develops within first 24 hours of life
• Gonorrheal conjunctivits in a baby vs chlamydial? How do you treat both?mom has sx with gonorrheal, usually asymptomatic with chlamydia. Gonorrhea starts 2-5 days after birth. Chlamydia starts 5-14 days after birth. Treat gonorrhea with ceftriaxone or cefotaxime. Treat chlamydia with oral erythromycin
• Definition of still birthdeath after 20 weeks gestation. Includes during delivery
• When is cell free fetal DNA testing done? Who is it done in?at 10 weeks or later. Anybody over 35 is offered it. Everybody else is offered combined test in first trimester (PAPP-A, B HCG and nuchal transulcency via ultrasound) and quad sreen in second trimester
• HPV vaccine is recommended through which age?26 for women and 21 for men
• Looks like breast cancer (has calcifications on mamomogram), biopsy shows fat globules and foamy macrophages. What is this?fat necrosis of the breast, benign. Reassure and follow up. Associated with breast surgery (reduction/reconstruction) and trauma
• Every patient with elevated LH levels shouldget an MRI
• Choriocarcinoma may occur after ____ or ___. Most frequent site of spread?molar pregnancy OR normal pregnancy. LUNGS
• Preferred initial imaging for gynecological tumorspelvic ultrasound
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