Obstetrics From Step 2 Secrets

Front 1

A pt on birth control has amenorrhea, what is the most common cause?

Back 1

Pregnancy, no contraception is 100%

Front 2

Si/sx of pregnancy

Back 2

amenorrhea, morning sickness, weight gain, linea nigra, melasma, fetal heart tones,

Front 3

Hegar's sign

Back 3

softening and compressibility of the lower uterine segment

Front 4

Chadwick's sign

Back 4

dark discoloration of the vulva and vaginal walls

Front 5

Define macrosomia

Back 5

a newborn that weighs more than 4 kg (9 lbs), usually because of maternal diabetes

Front 6

It's the first prenatal visit. What do you order?

Back 6

Pap smear, UA, CBC, type and screen, syphilis, rubella, glucose if risk factors present, GC and chlamydia for every teenager and pt with risk factors

Front 7

When do you screen for maternal diabetes?

Back 7

At the first visit if risk factors present. If not, screen at 24-28 weeks.

Front 8

How do you screen for maternal diabetes?

Back 8

Get a fasting serum glucose and glucose levels 1-2 hours after an oral glucose load.

Front 9

When do you do a triple screen?

Back 9

16-20 weeks

Front 10

How does Down Syndrome present on triple screen?

Back 10

low AFP, low estriol, high hCG

Front 11

When can fetal heart tones be picked up by doppler?

Back 11

10-12 weeks

Front 12

When can fetal heart tones be picked up by stethescope?

Back 12

16-20 weeks

Front 13

When does the uterus reach the umbilicus?

Back 13

20 weeks

Front 14

When is ultrasound the most accurate in estimating the fetal age?

Back 14

At 16-20 weeks

Front 15

What is a hydatiform mole?

Back 15

It's when the products of conception basically become a tumor.

Front 16

Sx of a hydatiform mole?

Back 16

Preeclampsia before third trimester, hCG that does not return to zero after delivery (or abortion or miscarriage) or one that rises rapidly during pregnancy, 1st or 2nd trimester bleeding with possible expulsion of "grapes," excessive nausea/vomiting, uterine size/date discrepancy, "snow storm" appearance on ultrasound

Front 17

Define complete mole

Back 17

comes "completely" from the father, karyotype is 46XX, no fetal tissue

Front 18

Define incomplete mole

Back 18

karyotype 69XXY, fetal tissue present

Front 19

Tx of hydatiform moles

Back 19

dilation and curettage, hollow with serial measurements of hCG until they go to zero,

Front 20

What if a pt is treated for hydatiform mole, and their hCG doesn't go to zero?

Back 20

They have an invasive mole or choriocarcinoma. They need chemotherapy.

Front 21

What is a choriocarcinoma?

Back 21

An aggressive form of mole

Front 22

What chemo agents are used for moles?

Back 22

Methotrexate and actinomycin D

Front 23

Define IUGR

Back 23

fetal size below the tenth percentile for age.

Front 24

Three type of causes of IUGR

Back 24

Maternal (smoking, alcohol, drugs, lupus), Fetal (TORCH infections, congenital anomalies), and Placental (HTN, preeclampsia)

Front 25

When do you order a fetal ultrasound?

Back 25

size/date discrepancy, risk factors for IUGR, problems with previous pregnancies, fetal death, distress, suspected abortion

Front 26

What is a non-stress test?

Back 26

Done while mother is at rest, tracing of fetal heart tones is obtained for 20 minutes

Front 27

What is a normal non-stress test?

Back 27

A normal strip has at least 2 accelerations of fetal heart rate, each at 15 beats above baseline, lasting at least 15 seconds.

Front 28

How do you do a biophysical profile?

Back 28

it includes a non-stress test, and ultrasound measurement of amniotic fluid, fetal breathing movements, and general fetal movements

Front 29

What do you do if a fetus scores poorly on BPP?

Back 29

The next test is the contraction stress test

Front 30

What is a contraction stress test?

Back 30

It measures uteroplacental dysfunction. oxytocin is given and a fetal heart strip is monitored. If late decelerations are seen with each contraction, a c-section is usually performed

Front 31

Would you do a BPP in a high risk pregnancy without obvious problems?

Back 31

yes, if worried, do a BPP once-twice a week at the start of the third trimester

Front 32

Do you use aspirin in pregnancy?

Back 32

no, use tylenol, but there is an important exception--in pts with antiphospholipid syndrome, in whom aspirin may improve pregnancy outcome.

Front 33

Define post-term pregnancy

Back 33

more than 42 weeks gestation

Front 34

Why is morbidity and mortality increased in post-term pregnancies?

Back 34

Shoulder dystocia and difficult deliveries are increased

Front 35

What do you do for post-term pts?

Back 35

Induce labor if cervix is favorable. If it's not favorable, do biweekly BPPs until 43 weeks, then induce.

Front 36

What disorders are associated with prolonged gestation?

Back 36

anencephaly and placental sulfatase deficiency

Front 37

Describe some normal changes in pregnant pts

Back 37

Nausea, vomiting, heavy painful breasts, increased pigment in nipples, backache, linea nigra, melasma, striae gravidarum, ankle edema, heartburn, increasing urination frequency

Front 38

Causes of low AFP

Back 38

Down syndrome, fetal demise, inaccurate dates

Front 39

Causes of high AFP

Back 39

neural tube defects, ventral wall defects, multiple gestation, inaccurate dates

Front 40

What do you do with an abnormal AFP or triple screen?

Back 40

First, do ultrasound, then amniocentesis is needed for definitive diagnosis.

Front 41

When do you offer chorionic villous sampling?

Back 41

at 9-12 weeks

Front 42

Why is chorionic villous sampling done?

Back 42

Because it offers the chance for first trimester abortion.

Front 43

Can chorionic villous sampling detect neural tube defects?

Back 43

Nope, only genetic or chromosomal defects

Front 44

What kind of birth defects are caused by thalidomide?

Back 44

Phocomelia--limbs are missing with hands and feet attached directly to torso

Front 45

What kind of birth defects are caused by tetracycline?

Back 45

yellow or brown teeth

Front 46

What kind of birth defects are caused by aminoglycosides?

Back 46

deafness

Front 47

What kind of birth defects are caused by valproic acid?

Back 47

spina bifida, hypospadias

Front 48

What kind of birth defects are caused by progesterone?

Back 48

masculinization of female fetus

Front 49

What kind of birth defects are caused by cigarettes?

Back 49

IUGR, low birth weight, prematurity

Front 50

What kind of birth defects are caused by OCPs?

Back 50

VACTERL syndrome

Front 51

What is VACTERL syndrome?

Back 51

Vertebral, Anal, Cardiac, TracheoEsophaeal, Renal, and Limb malformations

Front 52

What kind of birth defects are caused by Lithium?

Back 52

Ebstein's cardiac anomaly

Front 53

What kind of birth defects are caused by radiation?

Back 53

IUGR, CNS defects, eye defects, leukemia

Front 54

What kind of birth defects are caused by alcohol?

Back 54

Fetal alcohol syndrome

Front 55

What kind of birth defects are caused by phenytoin?

Back 55

craniofacial, limb, and cerebrovascular defects, mental retardation

Front 56

What kind of birth defects are caused by warfarin?

Back 56

craniofacial defects, IUGR, CNS malformations, stillbirth

Front 57

What kind of birth defects are caused by carbamazepine?

Back 57

fingernail hypoplasia, craniofacial defects

Front 58

What kind of birth defects are caused by isotretinoin?

Back 58

CNS, craniofacial, ear, and cardiovascular defects

Front 59

What kind of birth defects are caused by iodine?

Back 59

Goiter, cretinism

Front 60

What kind of birth defects are caused by cocaine?

Back 60

cerebral infarcts, mental retardation

Front 61

What kind of birth defects are caused by diazepam?

Back 61

cleft lip and/or palate

Front 62

What kind of birth defects are caused by diethylstilbestrol?

Back 62

clear cell vaginal cancer, adenosis, cervical incompetence

Front 63

What kind of birth defects are caused by maternal diabetes?

Back 63

cardiovascular malformations, cleft lip and/or palate, caudal regression, neural tube defects, left colon hypoplasia/immaturity, macrosomia, microsomia (if mother has long-standing DM),

Front 64

What kinds of problems do infants born to diabetic mothers have after birth?

Back 64

increased risk of respiratory distress syndrome, postdelivery hypoglycemia,

Front 65

How do you treat diabetes during pregnancy?

Back 65

insulin (after diet and exercise), DON'T use oral hypoglycemics because they cross the placenta and cause fetal hypoglycemia

Front 66

What drugs are safe during pregnancy?

Back 66

acetaminophen, penicillin, cephalosporins, erythromycin, nitrofurantoin, H2 blockers, antacids, heparin, hydralazine, methyldopa, labetolol, insulin, docusate

Front 67

What does TORCH stand for?

Back 67

Toxoplasma, Other, Rubella, Cytomegalovirus, Herpes

Front 68

risk factors for toxoplasma?

Back 68

exposure to cats

Front 69

What kind of birth defects are caused by toxoplasma?

Back 69

intracranial calcifications, chorioretinitis

Front 70

What kind of birth defects are caused by varicella-zoster?

Back 70

limb hypoplasia, scarring of the skin

Front 71

What kind of birth defects are caused by syphilis?

Back 71

rhinitis, saber shins, Hutchinson's teeth, interstitial keratitis, skin lesions

Front 72

What kind of birth defects are caused by rubella?

Back 72

effects are worse in the first trimester, cardiovascular defects, deafness, cataracts, microphthalmia

Front 73

What kind of birth defects are caused by cytomegalovirus?

Back 73

deafness, cerebral calcifications, microphthalmia

Front 74

What kind of birth defects are caused by herpes?

Back 74

vesicular lesions, encephalitis, early fusion of cranial bones, sz's

Front 75

What percent of fetuses are infected with HIV from their mothers if the mothers do not receive treatment?

Back 75

25%

Front 76

How do you treat HIV in pregnant women?

Back 76

zidovudine (AZT) is given to the mother prenatally, and it's given to the infant for 6 weeks afer birth

Front 77

What percent of fetuses are infected with HIV from their mothers if the mothers receive treatment?

Back 77

8%

Front 78

When do you test an infant for HIV antibodies?

Back 78

between 6-18 months of age; Abs tests will be positive at birth because maternal antibodies cross the placenta

Front 79

How do you test newborns for HIV?

Back 79

HIV PCR, with follow up at 18 months with antibody test

Front 80

can breastmilk transmit HIV?

Back 80

yes

Front 81

What do you do if a woman has active visible genital herpes lesions during labor?

Back 81

do a c-section

Front 82

What do you do if a woman has a hx of genital herpes and goes into labor, and there's no visible lesions?

Back 82

proceed with vaginal birth

Front 83

What do you do if a laboring mother has chronic hepatitis B?

Back 83

give infant the first hep B vaccine and hepB immunoglobulin at birth.

Front 84

What do you do if a mother contracts chickenpox late in pregnancy?

Back 84

give the infant varicella-zoster immunoglobulin

Front 85

How do you treat GC/chlamydia during pregnancy?

Back 85

ceftriaxone and erythromycin or azithromycin

Front 86

How do you treat TB during pregnancy?

Back 86

same as in non-pregnant women. BUT don't use streptomycin (it's rarely use anyway). Make sure to give vitamin B6 with isoniazid.

Front 87

How do you know if the placenta has separated during the third phase of delivery?

Back 87

there is a fresh gush of blood, lengthening of the umbilical cord, and a rising fundus that is firm and globular

Front 88

If a pt has had a c-section, can they have a vaginal delivery during the next pregnancies?

Back 88

Maybe. If they have a vertical uterine incision, they have to have a repeat c-section. If they have a horizontal incision, they may deliver vaginally with only a slightly increased risk of uterine rupture.