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50 Cards in this Set
- Front
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discriminatory zone of b-hCG with gestational sac in uterus
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1500-2000
low = early pregnancy OR ectopic high = ectopic super high = molar peaks at 10 wks at 100,000 |
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What is Naegele's Rule to calculate EDD based off LMP?
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(LMP - 3 months) + 7 days
*based on 28 d cycle eg: LMP - June 8; EDD - March 15 |
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Calculate EDD for LMP with 21 d cycle? 35 d cycle?
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21 d --- subtract 0 d
35 d --- add 14 d |
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changes in heme
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dilutional anemia
increased plasma volume x 50% increased RBC x 30% Coagulation factors increase Fibrinogen increases (TE-lic) |
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changes in renal
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GFR increases
lower BUN:Cr dilation of collecting system secondary to progesterone R>L since uterus lies to the R c/o sigmoid colon |
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changes in GI
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constipation
GERD nl LFTs increased alk phos from placenta production decreased total protein, albumin |
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changes in respiratory
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respiratory alkalosis
increased TV nl RR decreased FRC progesterone --> bronchodilates |
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changes in cardio
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increased CO
increased plasma volume decreased BP (2T, increased to baseline 3T) |
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decreased AFP
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Down's syndrome
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increased AFP
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omphamacele
NTDs multiples |
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what is the most common cause of abnormal AFP?
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wrong dating
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Anhydramnios, renal agenesis, flat facies, pulmonary hypoplasia
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Potter Syndrome
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sacral agenesis
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aka caudal regression syndrome
c/o Classic DM anomaly (rare) |
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what are the risk factors of placenta previa?
how does it present? |
RF = prior C-section/uterine surgery
presents = PAINLESS bleeding in 2T dx = US; must be delivered by C/S !placenta accreta --> hyst |
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what are the risk factors of placental abruption?
how does it present? |
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 |
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what is the pathogenesis of vasa previa?
how do does it present? |
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 |
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what is the number one cause of postpartum hemorrhage?
what are the risk factors? |
uterine atony
RF= tired uterus, grand multip, multiple gestation, polyhydramnios, chorio, magnesium, pitocin, long labor, macrosomia |
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what is the treatment for uterine atony/pph?
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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 |
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what are the risk factors for retained products?
what is the treatment? |
prematurity
placental abnormalities manual extraction of placenta tx = D&C |
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what are the risk factors for hereditary v. acquired coagulopathy?
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Hereditary = factor deficiencies
Acquired/DIC = preeclampsia, eclampsia, HELLP, abruption, amniotic fluid embolism |
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what are the risk factors for preterm labor? What is the treatment?
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RF = #1 prior preterm birth, multiple gestation, uterine anomalies, polyhydraminos, infection/chorio
tx = tocolytics (nifedipine, indocin, Mag) Steroids. GBS proph. |
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what are the risk factors for PPROM?
what is the treatment? |
RF = infection, labor, abruption, cord prolapse
tx = azithromycin. DO NOT TOCOLYZE to mask infection Steroids. Hospitalization til 34 wks. |
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what are the risk factors for preeclampsia?
tx? |
RF = extremes of age, nulliparity, new father, maternal disease (HTN, DM, collagen vascular disease, renal disease) multiple gestation
tx = 1. stabilize mother ... DELIVERY ** vaginal. |
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if laboring mother with dx of preeclampsia starts to seize, what should you do next?
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1. ABCs
2. stabilize mother NOT C/S |
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Describe the pathophysiology of gestational diabetes... what is the role of maternal glucose and insulin?
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Glucose crosses the placenta. Insulin does not.
Fetal insulin acts like GROWTH FACTOR = MACROSOMIA transient hypoglycemia postpartum |
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lemon/banana sign?
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NTD
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double bubble sign?
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duodenal atresia, increased with Down's
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omphalocele v. gastoschisis
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omphalocele = other malformations; in sac
gastoschisis = random mutation; no membrane |
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what are the fetal causes for oligohydraminos?
maternal causes? |
fetal = renal/bladder anomalies
maternal = compromised placenta, lupus, HTN |
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what are the fetal causes for polyhydraminos?
maternal causes? |
fetal = GI tract obstruction (tracho-esophageal fistula, duogenal atresia, ileal atresia)
maternal = DM |
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Pt presents with hyperemesis, size greater than dates, vaginal bleeding, hypertensive and sweating
tx? |
molar pregnancy
tx = suction D&C, follow beta for 6 m !choriocarcinoma |
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Pt presents with chronic pelvic pain, dysmenorrheal, dyspareunia, cyclic pain...
tx? |
endometriosis
exam: fixed retroverted uterus with uterosacral nodularity tx: 1. NSAIDS 2. OCPs 3. Lupron 4. Surgical ablation 5. hyst |
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Multip woman presents with pain and heavy bleeding...
on PE, boggy, enlarged uterus... tx? |
Adenomyosis
tx: hyst |
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Pt presents with heavy bleeding, urgency and frequency...
PE = enlarged irregular uterus tx? |
Fibroids
tx: 1. no treatment 2. Lupron 3. ?children -- myomectomy 4. ?no more children -- hyst ***estrogen dependent |
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pt with significant vulvar pruritus, cigarette paper or parchment paper characteristic...
tx? |
lichen sclerosis
tx: clobetasol |
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if pregnant with positive pap smear...
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1. always colpo HGSIL
2. NO endocervical curettes 3. ASCUS and LGSIL deferred to postpartum |
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?ovarian cyst and premenopausal... how do we manage?
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low oncology risk.
repeat US in 6 wks. ?CA125 |
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what are the risk factors for urinary prolapse?
tx? |
RF = childbirth, pregnancy, obesity, chronic cough, constipation
tx = 1. Kegels 2. Pessary 3. Surgery |
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tx for gonorrhea?
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ceftriaxone
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tx for chlamydia?
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azithromycin x1 or doxy
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tx for trich?
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flagyl/metronadizole
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dx and tx for syphillis?
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PAINLESS ulcer
dx= 1. RPR/VRDRL --> FTA ABS tx = 1. PCN 2. allergy -- Doxy or Erythro Pregnant --- desensitize and tx with PCN |
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painful ulcer with inguinal lymphadenopathy
tx? |
chancroid (H. ducreyi)
tx = azithro or ceftriaxone |
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painful, burning sores.
1st outbreak with prodrome tx? |
herpes
tx = valcyclovir, acyclovir |
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PID tx?
what about inpatient mgmt? |
ceftriaxone, doxy +/- flagyl
inpatient (TOA, failed outpatient, can't tolerate po) = cefoxitin/doxy gent/clinda |
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Pregnancy infection with chicken pox.
how do we ID? |
check IgG
+ = immune - = varicella Ig |
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Herpes infection during pregnancy
how do we tx? |
Valtrex at 36 wks.
inspect for lesions at labor -- ?C/S |
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Hep B prophylaxis during pregnancy
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Baby gets Hep B and Hep B Ig
|
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HIV positive pregnant woman
how do we manage? |
mother - multidrug therapy; C/S (v. <1000 viral load)
intrapartum AZT baby AZT for 6 mo; NO BREASTFEEDING |
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Pt presents with irregular periods, acanthos nigricans, facial hair, obese.
dx? tx? |
PCOS
dx: testosterone levels tx: metformin +/- clomide (clomiphene) |