Ob/gyn Review

Front 1

discriminatory zone of b-hCG with gestational sac in uterus

Back 1

1500-2000

low = early pregnancy OR ectopic
high = ectopic
super high = molar

peaks at 10 wks at 100,000

Front 2

What is Naegele's Rule to calculate EDD based off LMP?

Back 2

(LMP - 3 months) + 7 days
*based on 28 d cycle
eg: LMP - June 8; EDD - March 15

Front 3

Calculate EDD for LMP with 21 d cycle? 35 d cycle?

Back 3

21 d --- subtract 0 d
35 d --- add 14 d

Front 4

changes in heme

Back 4

dilutional anemia
increased plasma volume x 50%
increased RBC x 30%
Coagulation factors increase
Fibrinogen increases (TE-lic)

Front 5

changes in renal

Back 5

GFR increases
lower BUN:Cr
dilation of collecting system secondary to progesterone
R>L since uterus lies to the R c/o sigmoid colon

Front 6

changes in GI

Back 6

constipation
GERD
nl LFTs
increased alk phos from placenta production
decreased total protein, albumin

Front 7

changes in respiratory

Back 7

respiratory alkalosis
increased TV
nl RR
decreased FRC
progesterone --> bronchodilates

Front 8

changes in cardio

Back 8

increased CO
increased plasma volume
decreased BP (2T, increased to baseline 3T)

Front 9

decreased AFP

Back 9

Down's syndrome

Front 10

increased AFP

Back 10

omphamacele
NTDs
multiples

Front 11

what is the most common cause of abnormal AFP?

Back 11

wrong dating

Front 12

Anhydramnios, renal agenesis, flat facies, pulmonary hypoplasia

Back 12

Potter Syndrome

Front 13

sacral agenesis

Back 13

aka caudal regression syndrome

c/o Classic DM anomaly (rare)

Front 14

what are the risk factors of placenta previa?

how does it present?

Back 14

RF = prior C-section/uterine surgery

presents = PAINLESS bleeding in 2T

dx = US; must be delivered by C/S
!placenta accreta --> hyst

Front 15

what are the risk factors of placental abruption?

how does it present?

Back 15

RF = HTN, smoking, cocaine, trauma

presents = PAINFUL with ctx +/- fetal distress; ! DIC

dx: clinical, US does NOT r/o; KLEIHAUER-BETKE
if stable, deliver vaginally

Front 16

what is the pathogenesis of vasa previa?

how do does it present?

Back 16

umbilical vessels run thru membranes and course over cervical os. vessels rupture during LND.

presents = after AROM, immediate rupture and severe decels or bradycardia

tx= STAT C/S. high mortality
dx: APT test

Front 17

what is the number one cause of postpartum hemorrhage?

what are the risk factors?

Back 17

uterine atony

RF= tired uterus, grand multip, multiple gestation, polyhydramnios, chorio, magnesium, pitocin, long labor, macrosomia

Front 18

what is the treatment for uterine atony/pph?

Back 18

1. pitocin and bimanual compression
2. methergine (!with HTN)
3. hemabate (!with asthma)
4. misprostol (!fever, GI distress)
5. Balkri balloon
6. Uterine emoblization
7. Surgery -- B-lynch, ligate uterine aa, hyst

Front 19

what are the risk factors for retained products?

what is the treatment?

Back 19

prematurity
placental abnormalities
manual extraction of placenta

tx = D&C

Front 20

what are the risk factors for hereditary v. acquired coagulopathy?

Back 20

Hereditary = factor deficiencies

Acquired/DIC = preeclampsia, eclampsia, HELLP, abruption, amniotic fluid embolism

Front 21

what are the risk factors for preterm labor? What is the treatment?

Back 21

RF = #1 prior preterm birth, multiple gestation, uterine anomalies, polyhydraminos, infection/chorio

tx = tocolytics (nifedipine, indocin, Mag)
Steroids. GBS proph.

Front 22

what are the risk factors for PPROM?
what is the treatment?

Back 22

RF = infection, labor, abruption, cord prolapse

tx = azithromycin. DO NOT TOCOLYZE to mask infection
Steroids. Hospitalization til 34 wks.

Front 23

what are the risk factors for preeclampsia?
tx?

Back 23

RF = extremes of age, nulliparity, new father, maternal disease (HTN, DM, collagen vascular disease, renal disease) multiple gestation

tx = 1. stabilize mother ... DELIVERY ** vaginal.

Front 24

if laboring mother with dx of preeclampsia starts to seize, what should you do next?

Back 24

1. ABCs
2. stabilize mother
NOT C/S

Front 25

Describe the pathophysiology of gestational diabetes... what is the role of maternal glucose and insulin?

Back 25

Glucose crosses the placenta. Insulin does not.
Fetal insulin acts like GROWTH FACTOR = MACROSOMIA
transient hypoglycemia postpartum

Front 26

lemon/banana sign?

Back 26

NTD

Front 27

double bubble sign?

Back 27

duodenal atresia, increased with Down's

Front 28

omphalocele v. gastoschisis

Back 28

omphalocele = other malformations; in sac

gastoschisis = random mutation; no membrane

Front 29

what are the fetal causes for oligohydraminos?
maternal causes?

Back 29

fetal = renal/bladder anomalies

maternal = compromised placenta, lupus, HTN

Front 30

what are the fetal causes for polyhydraminos?
maternal causes?

Back 30

fetal = GI tract obstruction (tracho-esophageal fistula, duogenal atresia, ileal atresia)

maternal = DM

Front 31

Pt presents with hyperemesis, size greater than dates, vaginal bleeding, hypertensive and sweating

tx?

Back 31

molar pregnancy

tx = suction D&C, follow beta for 6 m
!choriocarcinoma

Front 32

Pt presents with chronic pelvic pain, dysmenorrheal, dyspareunia, cyclic pain...

tx?

Back 32

endometriosis

exam: fixed retroverted uterus with uterosacral nodularity

tx:
1. NSAIDS
2. OCPs
3. Lupron
4. Surgical ablation
5. hyst

Front 33

Multip woman presents with pain and heavy bleeding...
on PE, boggy, enlarged uterus...


tx?

Back 33

Adenomyosis

tx: hyst

Front 34

Pt presents with heavy bleeding, urgency and frequency...
PE = enlarged irregular uterus

tx?

Back 34

Fibroids

tx:
1. no treatment
2. Lupron
3. ?children -- myomectomy
4. ?no more children -- hyst
***estrogen dependent

Front 35

pt with significant vulvar pruritus, cigarette paper or parchment paper characteristic...

tx?

Back 35

lichen sclerosis

tx: clobetasol

Front 36

if pregnant with positive pap smear...

Back 36

1. always colpo HGSIL
2. NO endocervical curettes
3. ASCUS and LGSIL deferred to postpartum

Front 37

?ovarian cyst and premenopausal... how do we manage?

Back 37

low oncology risk.
repeat US in 6 wks.
?CA125

Front 38

what are the risk factors for urinary prolapse?

tx?

Back 38

RF = childbirth, pregnancy, obesity, chronic cough, constipation

tx =
1. Kegels
2. Pessary
3. Surgery

Front 39

tx for gonorrhea?

Back 39

ceftriaxone

Front 40

tx for chlamydia?

Back 40

azithromycin x1 or doxy

Front 41

tx for trich?

Back 41

flagyl/metronadizole

Front 42

dx and tx for syphillis?

Back 42

PAINLESS ulcer
dx=
1. RPR/VRDRL --> FTA ABS

tx =
1. PCN
2. allergy -- Doxy or Erythro
Pregnant --- desensitize and tx with PCN

Front 43

painful ulcer with inguinal lymphadenopathy

tx?

Back 43

chancroid (H. ducreyi)

tx = azithro or ceftriaxone

Front 44

painful, burning sores.
1st outbreak with prodrome

tx?

Back 44

herpes

tx = valcyclovir, acyclovir

Front 45

PID tx?

what about inpatient mgmt?

Back 45

ceftriaxone, doxy +/- flagyl

inpatient (TOA, failed outpatient, can't tolerate po) =
cefoxitin/doxy
gent/clinda

Front 46

Pregnancy infection with chicken pox.
how do we ID?

Back 46

check IgG
+ = immune
- = varicella Ig

Front 47

Herpes infection during pregnancy

how do we tx?

Back 47

Valtrex at 36 wks.

inspect for lesions at labor -- ?C/S

Front 48

Hep B prophylaxis during pregnancy

Back 48

Baby gets Hep B and Hep B Ig

Front 49

HIV positive pregnant woman

how do we manage?

Back 49

mother - multidrug therapy; C/S (v. <1000 viral load)

intrapartum AZT

baby AZT for 6 mo; NO BREASTFEEDING

Front 50

Pt presents with irregular periods, acanthos nigricans, facial hair, obese.

dx?

tx?

Back 50

PCOS

dx: testosterone levels

tx: metformin +/- clomide (clomiphene)