OBGYN Shelf Comat 1 2015

ruhland1's version from 2015-07-22 14:55

Section 1

Question Answer
Preeclampsiahtn after 20 weeks of preg w/ either prouria or onset of 1 of 5 findings
severe Preeclampsia bp>160/110 on 2 occasions at least 4 hours apart
severe Preeclampsia plt<100,000
severe Preeclampsia liverRUQ pain, 2x normal enzymes
severe Preeclampsia kidneycreatinine >1.1 mg/dL or a dbling of [ ] in absence of other rdz
severe Preeclampsia lungedema
severe Preeclampsia mindonset cerebral/visual
GA to dx Precl20 wk
Preecl MOAglobular vasc hyperreactivity -> dn intravasc vol -> up SVR, up uterine vasvon w/in myomet, dn uterine/placental bflow
causes vasocon in PreclTXA2 up, PGI2 dn
hypercoag paradox in Precldn coag 2ndary to dn plt (<100k) and up PTT
Preeclampsia bp>140/90

Section 1a

Question Answer
Preeclampsia bp measureatleast on 2 occasions 4 hours apart
Preeclampsia prouris300mg in 24hr
Preeclampsia pro/crea ration> 0.3mg/dL
Preeclampsia dipstick+1
Preeclamp defat 20wk + GA >140/90 + pro uria
confirm Preeclampsia but not prouria how?>140/90 and 1 of these (x<100k plt, crea> 1.1mg/dL, 2x [ ] Liver enzymes, pulm edmea, cerebral/visual sx)
oliguria can definerenal insuff crit in preecl
oliguria crit<0.3mL/kg or <500 mL/day
Preeclampsia riskmultiple gest
Preeclampsia riskage at either extreme of reproduction
Af Am / HispanicPreeclampsia risk
hyadidtaform molePreeclampsia risk
Preeclampsia riskextrauterine preg

Section 2

Question Answer
ddx hyperemesis gravidum from morning sickHy Gr= intractable V w/ deH2O, up metab pH, dn K+, dn Na+, dn Cl-, up HCT, dn lb >5%
hyperemesis gravidum peak8-12 wk
cap refill normal<2 sec
anorexia, N/V/F, leukocytosisacute cholecystitis (up stone)
RUQ pain w/ palpMurphy
dn glc, up up LFT, jaudice, anorexiaAFLP (acute fatty liver of pregnancy)
AFLPacute fatty liver of preg
morning sick onset5-6 wk
morning sick resolve16-18 wk
morning sick supplementVit B6
morning sick finingud e- ud lb
self limited rapid onset N/V/Dviral gastroenteritis
1%simple hyperp w/o atypia chance to malig
3%complex hyper p w/o atypia
9%simple hyperp w/ atypia
27%complex hyperp w/ atypia
colposcopyuse magnifying device to look at vulva,vgagina, cervix
female ext genitaliavulva

Section 3

Question Answer
cervical cx in situprecx lz requires ablation/excision
local ablationcyrotherapy
excisionLEEP, laser
cold-knife conizationexcision
cervical cx is ___ mc cx in women3rd
35-391st crest of bimodal age cerival cx distb
60-642nd crest of bimodal age cervical cx distb
70% of cervical cxHPV 16 and 18
ASCatpical squamous cells
USundetermined significance
ASC-US a PAP smear finding
AGCa pap smear finding
Atypical Glandular CellsAGC
LSILlow grade intra epithelial lesions

Section 3a

Question Answer
HSILhigh grade intra epithelia lz
AGC, LSIL, HSILmust under go colposcopy w biopsy in order to STAGE dz
CINcervical intraepithelia neop (classifys lz based on degree of dysplasia)
CIN III =stage 0
CIN III findingnoninvasive "precx" lz w/ tmx cells are present but have not penetrated the BM and spread
CIN III txremoval
how you know CIN III tx workednegative ablative/excisional margins
neg margins of cervical tx followupfollow up 1 yr for repeat pap
pos marginsfollow up 6 mo pap +/- repeat biop
when to have prophylytic hysterectomy in cervixfind CIN II/III, older, no more kids
CIN IImoderate dysplasia
tx for lx <4cm confined to cervix / upper 2/3 vaghysterect with concomitant RAD/chemo, or less drastic if young and want kids
mild CIN I txserial monitoring with colposcopy

Section 4

Question Answer
GDM screen24-28 wk
50g oral glc (glucacola) followed by serum glc at 1 hourGDM 1st screen procedure
+ 1 hour screen glc>130-140
+ 1st hour screen do whatdo 3 hour oral glc tolerance test
3 hour oral glc test procedure100g oral glc after 8 hours fasting and do serial glc measure at hours 1,2 and 3.
(+) 3 hours glc2 readings above normal for the 4 testing times at fast,0hr,1hr,2hr,3hr
the 4 testing times for 3 hr glcfast and hours 1,2,3 (need (+) in 2 of 4 * dx is (+) )
GDM memorizethreshold values of blood glc, glc tolerance, random glc, and A1C
fasting glc (+) DM dx includes non-preg>126
random glc (+) DM dx includes non-preg>200
GDM AFIpolyhydraminos

Section 5

Question Answer
asx bacturialow birth weight and preterm
25% asx UTIwill progress into acute pyeloneph
bacturia (+) dx> 100,000 colony/ml clean-catch or >100 colony/ML in catheterized urine culture
UTI initial txpenicillin and ceph (cephalexin)
find bact UTI early in preg and tx, now do?repeat culture 1-2wk after tx and again each trimester
neonate rubella sense dnhearing
neonate rubella, the child isdevelopmentally delayed
neonate rubella growthreduced
neonate rubella organdn heart dn eye
why avoid rubella vax in preglive attenuated virus * up risk of teratogen, but still vax
rubella non immune txget vax'ed anyways
10-20% of adults in USA susceptible to rubella
varicella zoster pneumonia40% maternal mort
if preg and chickpox non immuneimmediate vax postpartum
normal BMI so can gain __lbs in preg25-35
1st trimester lb gain3-6lb
2nd tri lb gain0.5-1 a week
0.5-1lb a week3rd tri gain (same as 2nd tri)

Section 6

Question Answer
early deceldn FHR concomitatnt to uterine contraction
early decel causefetal head compression (up Vagal activation)
recurrent late decel/sinusoid/persistent tachyfetal hemm
maternal-fetal inftachy on FHR
late deceluteroplacental insuff
acceleration abrupt up in FHR lasting less than TWO min outside of contractions
cause of accelerationsfetal movement
variable decelif in >50% contractions * up fetal acidosis
FHR110-160 range
regular UT contractions less than 37 wkpreterm labor
extreme preterm labor<27 wk
spontaneous abortionloss at <20wks or less than 500gs
incomplete abortionpain + UT contract + open cevix w/ products of conception protruding from os or in the vag
excludes abortion definationsbeyond 20 wks gest
bleeding into decidua basalisup risk placental abrupt
placental abrupt findingDIC
mild irregular contractnormal finding in all stages of preg
cervix dilated + contractionsmeets dx crit for preterm labor

Section 7

Question Answer
60% maternal deathsoccured after a live birth
% death from Pulm Embo after live birth21
% death from HTN after live birth19
BMI maternal death risk factor29
obese and bloodup DM up HTN * up risk VTE (venousthromboembo)
obese why up risk of fetal demisehyperlipid, dn prostacyclin, dn awareness fetal mvmt, noct apnea * up transient O2 desat
why is C-sec have increased risk of matern mortthe procedure is an indication for problems associated w/ preganancy and delivery, so its not that itself increases risk, but rather risks indicate it.
pregnancy mortality in Af Am3-4x higher than whites
25% maternal deaths in this group>35 yo

Section 8

Question Answer
female painful deep seated nodules in gluteal cleft/upper inner thigh or intertrigenous areashidraednitis suppurativa
ddx hidraenitis suppurativa from pilonidal dzHS prefers intertriginous areas
unilateral soft painless mass medial to labia minorabartholin duct cyst
lined with cornified epi and contains lamellated keratinepidermal cyst
polyposis, epidermal cyst, osteomaGardener Syndrome
Gardner geneAPC
APC chr5
teen that has difficulty inserting tampon or dyspareunia Mullerian remnant cyst clue
form on lateral/posterior vag wallsMullerian remnant cyst
marsupializea surgery to treat deep cysts to avoid significant bleed (Mullerian remnant cyst)
infection at or near interglut cleftpilonidal cyst
tichilemmal cyst =pilar cyst
mobile fluis filled massed in hair locationstichiellema cyst
recuurent perianal pain when bending forwardpilonidal cyst
pilonidal cyst factnot a true one (located in intergluteal cleft
contains fibrous tissue and thick keratinized fluidtrchilemmal/pilar cyst
painless vulvar massbartholin cyst
wolffian remnantGartner Cyst (difficulty insert tampons/dyspareunia)