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190 Cards in this Set
- Front
- Back
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MSAFP high or low in open neural tube defects?
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high
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MSAFP high or low in down syndrome?
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low
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Quad screen in trisomy 18
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all 4 low
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Quad screen in trisomy 21
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bhcg and inhibin high
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5 aspects of Bishop score
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(cervical exam during labor) 1) dilation
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Ebstein's anomaly
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congenital downward displacement of tricuspid valve into right ventricle; can be caused by lithium exposure in utero
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Does Graves disease improve or worsen with pregnancy?
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improves
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Do migraines improve or worsen with pregnancy?
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improve
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Does MS improve or worsen with pregnancy?
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improves
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Do gastric ulcers improve or worsen with pregnancy?
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improve
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BMI normal weight
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18.5-24.9
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BMI overweight
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25-29.9
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BMI obese
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>30
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BMI underweight
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<18.5
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DDX MAHA and thrombocytopenia during or post-partum?
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1) HEELP; 2) HUS/TTP; 3) preeclampsia; 4) AFLP (acute fatty liver of pregnancy); 5) DIC
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Symmetric IUGR
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most often due to fetal factors (congenital
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Asymmetric IUGR
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most often due to maternal factors (HTN
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How to confirm diagnosis of syphilis in first stage?
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darkfield microscopy
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Evaluation of primary amenorrhea
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absence of breast development indicates?
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Evaluation of primary amenorrhea
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presence of uterus indicates?
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Oxybutynin
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anticholinergic drug used to treat urinary incontinence secondary to overactive bladder muscles
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Bethanechol
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cholinergic drug used to treat urinary incontinence secondary to urinary retention due to anesthetics or diabetic neuropathy
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Gestational DM
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glucose intolerance FIRST diagnosed during pregnancy > 20 wks
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Abnormal glucose challenge test
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>140
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Abnormal GTT: fasting glucose
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>95
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Abnormal GTT: 1-hr
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>180
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Abnormal GTT: 2-hr
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>155
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Abnormal GTT: 3-hr
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>140
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Fasting AM glucose goal in pregnant woman with pregestational DM
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<90
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2-hr postprandial glucose goal in pregnant woman with pregestational DM
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<120
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At what estimated fetal weight (EFW) is c-section indicated in woman with DM?
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>4500g
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At what estimated fetal weight (EFW) is c-section indicated in woman without DM?
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>5000g
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Preeclampsia
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new onset HTN (>140/90) + proteinuria (>300mg/d) +/- non-dependent edema at >20wks
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Management of mild preeclampsia
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if pt far from term
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Management of severe preeclampsia
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1) control BP (labetalol or hydralazine); 2) prevent seizures (MgSO4); 3) deliver by induction or c-section if mother stable
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Bleeding >20 wks
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antepartum hemorrhage
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Bleeding <20 wks
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threatened abortion
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2 most common causes of antepartum hemorrhage
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1) placental abruption; 2) placenta previa
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Placental abruption
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PAINFUL
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Placenta previa
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PAINLESS
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Diagnosis placenta previa
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US
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Treatment of mild abruption
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expectant: admit
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Treatment of moderate to severe abruption
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immediate delivery
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Treatment of placenta previa
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expectant: tocolytics
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Polyhydramnios
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AFI >20
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Cause and karyotype of complete moles
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sperm fertilization of empty ovum; 46XX
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Cause and karyotype of incomplete (partial) moles
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2 sperm fertilize normal ovum; 69
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Premature rupture of membranes (PROM)
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spontaneous ROM >1hr before onset of labor
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Prolonged rupture of membranes
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rupture >18 hrs prior to delivery
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Amniotomy
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artificial rupture of membranes usually done to induce or accelerate labor
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Treatment for failure to progress through latent phase of labor
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1) therapeutic rest w/ IV analgesia; 2) oxytocin; 3) amniotomy; 4) cervical ripening
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Treatment for failure to progress though active phase of labor
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1) amniotomy; 2) oxytocin; 3) c-section if other attempts fail
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Preterm labor
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regular uterine contractions + concurrent cervical change at <37 wks
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Treatment of preterm labor
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1) IVF; 2) bed rest; 3) tocolytics (unless contraindicated); 4) steroids for fetal lung maturity; 5) PCN or ampicillin for GBS prophylaxis
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4 types of tocolytics
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1) B-agonists; 2) MgSO4; 3) CCB; 4) PGIs
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3 contraindications to tocolytics
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1) infection; 2) nonreassuring fetal status; 3) placental abruption
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Complications of prematurity
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1) RDS; 2) intraventricular hemorrhage; 3) PDA; 4) necrotizing enterocolitis; 5) retinopathy of prematurity; 6) bronchopulmonary dysplasia; 7) death
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Frank breech
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thighs are flexed and knees are extended
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Footling breech
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one or both legs are extended below the butt
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Complete breech
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thighs and knees are flexed
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Postpartum hemorrhage
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>500 mL blood loss (vaginal delivery; >1000mL (c-section)
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3 complications of postpartum hemorrhage
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1) acute blood loss; 2) anemia; 3) Sheehan's syndrome
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Sheehan's syndrome
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pituitary ischemia and necrosis --> anterior pituitary insufficiency secondary to massive obstetric hemorrhage and shock
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Treatment for endometritis
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clindamycin and gentamycin (broad-spect abx) until patients have been afebrile for 48 hrs
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7 Ws of postpartum fever
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1) womb (endomyometritis); 2) wind (atelectasis
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How does Sheehan's syndrome most commonly present?
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failure to lactate
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Contraindications to breast feeding
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1) HIV+; 2) active HBV/HCV; 3) use of certain meds (tetracyclines
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One of most commonly used tocolytics
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nifedipine (CCB)
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NSAID used as a tocolytic
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indomethacin
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Oxytocin
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NT released by the posterior pituitary involved in breast milk production and induction of labor
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Ovarian tumor marker for: epithelial CA
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CA-125
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Ovarian tumor marker for: endodermal sinus
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AFP
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Ovarian tumor marker for: embryonal carcinoma
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AFP
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Ovarian tumor marker for: choriocarcinoma
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hCG
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Ovarian tumor marker for: dysgerminoma
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LDH
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Ovarian tumor marker for: granulosa cell
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inhibin
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Non stress testing
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fetal heart rate tracing obtained for 20 mins normal has @ least 2 acc of HR @ least 15 bpm above baseline for 15 sec
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cauliflower like lesions multiple small raised lesions tx?
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HPV (condyloma acuminata) tx c/cyrotx
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watery d/c strawberry cervix tx?
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Trichomonas vaginalis tx c/metronidazole
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CI to labor induction and augmentation (6)
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1. Placenta or vasa previa 2. Umbilical cord prolapse 3. transverse fetal lie 4. active genital herpes 5. known cervical ca 6. prior classic (vertical) c/s (horizontal c/s pts can deliver vag c/inc risk)
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postpartum mother who develops SOB
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tachypnea
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passage of POC tx?
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Incomplete abortion tx c/IV fluids
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fetal death s/expulsion of tissue tx?
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Missed abortion tx c/D&C <14wks and delivery >14 wks
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when do you do contraction stress tests and what is it? what happens on a positive CST
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you do it if fetal scores are low on BPP CST test for uteroplacental dysfunction give oxytocin and monitor fetal heart strip CST is positive when late decels are seen
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fever
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tender rritable uterus tx?
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phenotypic female c/absence of pubic & axilla hair
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androgen insensitivity
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tx of DUB
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NSAIDs
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female pts c elevated DHEA should lead you to suspect
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PCOD
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when is fetal malpresentation acceptable
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face and brow presentation watchful waiting as most convert to vertex presentation if not c/s for any breech presentation shoulder presentation or incomplete or footling breech c/s mandatory
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rules on giving Rhogam
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if mom is Rh neg and dad is Rh pos give Rhogam @28 wks and 72 hrs after delivery
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sudden urges followed by med-large loss cuased by uninhibited bladder contractions
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detrusor instability
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variable decels signifies tx?
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in relation c/uterine contractions
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predisposing factors HTN
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trauma
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when are steroids given to enhance fetal lung maturity in PROM or PPROM
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less than 34wks
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lesions c/intracellular inclusions tx?
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molluscum contagiosum tx c/ cryotx
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reason why female athletes dont have periods
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excerised induced depression of GRH
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progesterone challenge for amenorrhea
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give progesterone if vag bleeding occurs = suff estrogen (check LH) no vag bleeding = insuff estrogen (check FSH if high pt has premature ovarian failure low/n FSH craniopharyngioma
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endometrial glands found c/in uterus dysmenorrhea
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menorrhagia large boggy uterus on u/s tx?
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ab pain
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adnexal tenderness
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concerning fetal presentation when is c/s mandatory
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for any breech presentation shoulder presentation or incomplete or footling breech c/s mandatory
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painless bleeding
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mother is completely stable but fetus shows worsening distress fetus shows tachyc initally then bradyc decompensates dx? tx?
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post partum pt goes into shock and no bleeding visible should make you think of what differential
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1. AF embolism 2. uterine inversion 3. concealed hemorrhage (uterine rupture)
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OCPs are protective against
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pregnancy
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dysuria
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pos bacteria cx tx?
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normal fetal breath movements
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@ least 30 breathing movements in 10 mins
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mucopurulent d/c gram neg diplococci tx?
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N. gonorrhea tx c/ceftriaxone
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endometrial glands outside of uterus dysmenorrhea
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dysparenuria
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classic pt
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overweight
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txs to augment uterine contractions
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oxytocin (watch for uterine hyperstim tx c/stopping oxytocin) prostaglandin E2 can cause uterine hyperstimulation amniotomy hastens labor but exposes fetus and uterine cavity to poss infex
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malodorous d/c
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fishy smell on KOH prep
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most effective parameter for estimation of fetal wt in cases of suspected IUGR
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abdominal circumference
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tx of leiomyomas
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hysterectomy when too large or symp too great myomectomy might restore fertility d/c to r/o endometrial ca
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mc regimen for emergency contraception
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ethinyl estradiol and levonorgestrol taken now and 12hrs later only useful up to 72hrs after sex
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when is gettting a fetal scalp pH necessary
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when abnormal fetal pattern persists after inital measures (position changes
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increasei in temp for more than 2 consecutive days in the first 10days postpartum
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endometritis
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late decel signifies
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comes after uterine contractions
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post menopausal females who have vulvar itch and dryness what do you suspect tx
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lichen sclerosis or vulvar ca in situ obtain biopsy tx c topical steroids (clobetasol or halobetasol) if lichen sclerosis sx for vulvar ca in situ
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an arrest of labor indicated by prominence of ischial spines
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midpelvic contraction
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MC cause of death in eclampsia
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hemorragic stroke
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if pt has grossly visible
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bleeding cervical lesion what should be done in addition to pap smear
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decreased long-term variability in fetal heart rate suggests
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fetal sleep
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biophysical profile consists of
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1. NST 2. AF index 3. Fetal breath movements 4. Fetal movements
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how does high levels of prolactin cause amenorrhea
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prolactin has an inhibitory effect on prod of GnRH in hypothalamus
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best test for detection of fetal chromosomal abnormality in first trimester of pregnancy
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chorionic villus sampling
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autoimmune dz manifests c ulceration in mouth and genital area assoc c uveitis
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Behcet's dz
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tx protocol for pregnant pt in toxoplasmosis
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first 2 trimesters = elective abortion however if she wants to continue 1st trimester = spiramycin 2nd & 3rd trimester = pyrimethamine and sulfadiazine
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normal fetal movements
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At least 3 body movements in 10 mins
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multiple shallow
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painful ulcers tx?
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uterine bleed c/cervical dilation and crampy ab pain no tissue expulsion
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Inevitable abortion
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inc post void residual pt unable to fully empty bladder due to neurological damage tx
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neurogenic bladder tx c in and out cath
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early decels signifies
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head compression and is normal
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bleeding is painless and profuse predisposing factor multiparity
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inc age
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uterine bleed s/cervical dilation no explusion of tissue tx?
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Threatened abortion tx c/fluids
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occurs c/cervical effacement
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a blood-tinged mucus plug may be released from cervical canal tx?
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change in normal angle btw bladder and vagina urine lost when laughing
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sneezing or inc IAP tx
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hx of prev uterine sx
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trauma
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the two STD men shouldnt be txed for along with women
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candida
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steps to root out amenorrhea
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1 preg test 2 progesterone challenge
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cottage cheese d/c pseudohyphae on KOH tx?
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Candida albicans tx c/topical/oral antifungal
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Low hcg is indicateive of
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abortion, ectopic pregnancy
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low progesterone levels indicates
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abnormal corpus luteum, ectopic pregnancy
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low hpl indicates
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decreased placental function
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arterial bp is lowest in which trimester
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second
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coagulation factors that increase in pregnancy are
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FACTORS 7-10 and fibronogen
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Are physiological murmurs in pregnancy pathological?
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no
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what are the symptoms of hyperemesis gravidarum
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intractable n/v, weight loss, ketonemia, electrolyte imbalances
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what effect does progesterone have on the body during pregnancy?
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relaxes smooth muscle, decreases gastric motility, decreases urethral motility
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during pregnancy, hcg doubles every
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48 hours
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what murmurs are physiologic in pregnancy?
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systolic and s3
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increased hcg indicates
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twin pregnancy or GTD
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is respiratory alkalosis normal during pregnancy?
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yes, d/t decrease pCO2 and increase in pH
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increased estrogen causes what dermatological manifestations?
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spider angiomata and palmar erythema
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how soon after conception does pregnancy test become positive?
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10-14 days post fertilization, date of menses
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Increased estrogen leads to what thyroid elevation?
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TIBG
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is a pregnant woman usually hyperthyroid?
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no, because the free t3 and t4 are wnl
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what tests are given during a prenatal visit?
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CBC, Rh, Syphillis, Rubella, Hep B, G&C cultures, PPD, pap, HIV, UA test for GBS
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when do u give rubella vaccine if woman is not vaccinated?
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post partum d/t live vaccine is CI
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TX of hyperemesis
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vit b6, doxylamine
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at what GA is the fundal height equal to the gestational age?
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20-32 weeks
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what are the tests done at second trimester?
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glucose tolerance, genetic, neural tube screen, anemia, syphilis
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at 32-36 weeks, what do you check for?
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GBS and g&c
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nuchal translucency tests for what and when?
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trisomy 21 at 10-14 wks GA
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chorionic villus samples test for what and when do u do it?
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fetal karyotype at 9-13 wks GA
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mulitple marker screen measures what?
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AFP, bhcg, estriol, inhibin a
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low bhcg, inhibin a, afp, estriol indicates what?
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trisomy 18
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elevated bhcg and inhibin a, low afp and estriol?
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trisomy 21
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when do you do multiple marker screen?
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15-20 wks GA
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define reactive NST
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15 beats x 15 sec, 2x in 20 min
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what does it mean to have a nonreactive nst?
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fetus may be sleeping, mom sedated or GA<32
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what is a negative contraction stress test?
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reassuring fetal heart rate tracing with no late decels
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short stature, webbed neck, amenorrhea, infertility, streak gonads
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Turner's Syndrome (45 X)
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tall stature, testicular atrophy, gynecomastia, low IQ
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Kleinfelter's Syndrome (47,XXY)
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mental retardation, holoprosencephaly, polydactyly, rocker-bottom feet
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Trisomy 13
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mental retardation, microcephaly, micrognathia, rocker-bottom feet, clinched fists
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Trisomy 18 (Edward's Syndrome)
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how much folic acid is needed if mom has hx of NTD babies?
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4mg/day
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how much folic acid needed for mom with no hx of NTD?
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0.4mg/day
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2 common presentations of NTD are
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spina bifida and anencephaly
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what effect does cocaine have on pregnancy
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placental abruption
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what effects does marijuana have on pregnancy
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none
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what drug is a/w epstein's anomaly
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lithium
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what antibx causes ototoxicity?
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streptomycin CN 7
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what antibx causes teeth discoloration and inhibition of bone growth?
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tetracycline
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what antibx causes tendon rupture in kids
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floroquinolones
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is aspirin a teratogen?
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no, affects perinatal period
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what does aspirin do to kids?
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increase bleeding and platelet dysfx
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what causes oligohydramnios and premature closure of ductus arteriosus?
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NSAIDS
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what causes fetal hydatoin syndrome?
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dilantin
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what is fetal hydantoin syndrome?
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IUGR, limb reduction defects, microcephaly, mental retardation
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valproic acid increases what in fetuses?
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spina bifida
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carbamazepine increases risk for what in fetuses?
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spina bifida
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