Part 3 Ditt Step 2 Day 14 Ob

Front 1

Which teratogen is known to cause:
Cardiac (Ebstein’s) anomaly

Back 1

Lithium

Front 2

Which teratogen is known to cause:

Craniofacial defects, IUGR, stillbirth, CNS malformation

Back 2

Warfarin (Coumadin)

Front 3

Which teratogen is known to cause:
Fingernail hypoplasia, craniofacial defects

Back 3

Carbamazepine (Tegretol, an anti-convulsant)

Front 4

Which teratogen is known to cause:
CNS, craniofacial, ear and cardiovascular defects

Back 4

Isotretinoin (Accutane, a synthetic analog of Vit A)

Front 5

Which teratogen is known to cause:
Goiter, cretinism

Back 5

Iodide

Front 6

Which teratogen is known to cause:

Cerebral infarcts,
mental retardation

Back 6

Cocaine

Front 7

Which teratogen is known to cause:
Clear cell vaginal cancer, adenosis, cervical incompetence

Back 7

Diethylstibestrol (DES)

Front 8

Which type of spontaneous abortion (SAB)?:
IUP on sono + vag bleeding prior to 20wks + closed internal cervical os

Back 8

Threatened abortion

Front 9

Which type of spontaneous abortion (SAB)?:
Nonviable IUP on sono + open cervical os + NO tissue passed

Back 9

Inevitable abortion

Front 10

Which type of spontaneous abortion (SAB)?:
Nonviable IUP (fetal demise) that has not passed (lack of uterine activity)

Back 10

Missed abortion

Front 11

Which type of spontaneous abortion (SAB)?:
Open cervical os + tissue at or beyond cervical os; some, but not all POC have passed

Back 11

Incomplete abortion

Front 12

Which type of spontaneous abortion (SAB)?:
All POC have been passed

Back 12

Complete abortion

Front 13

What are the indications for group B strep (GBS) prophylaxis?

Back 13

If GBS (+) on vaginalrectal culture in last 4 weeks
GBS bacteruria during current pregnancy
h/o early onset GBS in past pregnancy
signs of infection

Front 14

Which congenital infection is a/w the following defect?
Initially asymptomatic but later develops a unilateral hearing loss

Back 14

CMV

Front 15

Which congenital infection is a/w the following defect?
Hydrocephalus, intracranial calcifications, chorioretinitis

Back 15

Toxoplasmosis or CMV

Front 16

Which congenital infection is a/w the following defect?
Rash + deafness + cataracts

Back 16

Rubella

Front 17

Which congenital infection is a/w the following defect?
Hearing loss, chorioretinitis, intracranial calcifications

Back 17

CMV

Front 18

Which congenital infection is a/w the following defect?
PDA or Pulmonary Artery Stenosis

Back 18

Rubella

Front 19

Which congenital infection is a/w the following defect?
Anemia, blood-tinged nasal secretions, hepatosplenomegaly

Back 19

Syphilis

Front 20

Which congenital infection is a/w the following defect?
Temporal lobe encephalitis

Back 20

HSV

Front 21

What is the 1st line treatment for hyperemesis gravidarum?

Back 21

1st line: B6, Doxylamine (Unisom), Hydration
2nd line: Ondansetron (Zofran), Promethazine (Phenergan)

Front 22

What are the definitions of oligohydramnios & polyhydramnios?

Back 22

Oligohydramnios → AFI <5 on ultrasound
Polyhydramnios → AFI >25 on ultrasound

Front 23

What tests are used to confirm rupture of membranes?

Back 23

“pooling” of amniotic fluid in vaginal cault visible on sterile speculum exam
Nitrazine paper test: turns blue in the alkaline amniotic fluid (normally urine & vaginal secretions are acidic)
Ferning test: electrolyte rich amniotic fluid dried on a glass microscope slide crystallizes in a fern-leaf pattern
Oligohydramnios confirmed by ultrasound can also be useful

Front 24

What is the most frequent initial ultrasound finding for IUGR?

Back 24

Abdominal circumference <10% for gestational age

Front 25

In general, what are the AFI findings for oligohydramnios & polyhydramnios?

Back 25

Oligohydramnios: < 5
Polyhydramnios: > 25

Front 26

What might cause oligohydramnios in the 2nd trimester? 3rd tri?

Back 26

2nd: fetal renal abnormalities, maternal problems, amniocentesis
3rd: PROM, preeclampsia, abruptio placenta, idiopathic

Front 27

Gastroesophageal atresia might cause what effect on amniotic fluid level and why?

Back 27

Polyhydramnios (baby can’t swallow, leads to build up of amniotic fluid)

Front 28

By what mechanism do NSAIDs decrease amniotic fluid vol?

Back 28

NSAIDs ↓ blood flow

Front 29

What is the difference btw PROM & P-PROM?

Back 29

PROM: before labor
P-PROM: preterm, before labor

Front 30

What two tests on vaginal fluid can be used to detect a rupture of membranes?

Back 30

Ferning Test
Nitrazine paper test

Front 31

How is preterm labor at less than 34 weeks gestational age managed?

Back 31

Front 32

How is preterm labor at 34-37 wks gestational age managed?

Back 32

Active management if lung maturity proven, or beyond 34 wks
Steroids are of no benefit beyond 34 weeks
Ampicillin 2g IV then 1g IV q 4hrs

Front 33

What drugs are used as tocolytics?

Back 33

Front 34

What are the first steps in the work-up of an infertile couple?

Back 34

Front 35

What diagnostic study is used to identify an anatomic cause for infertility in females?

Back 35

Hysterosalpingogram (HSG)

Front 36

What are the diff anatomic causes of infertility in females?

Back 36

Scarring of fallopian tubes most commonly from prior STD
Endometriosis
Adhesions from prior surgery or pelvic inflammation (STD, appendicitis, IBD)
Tumor, fibroids (leiomyomata)
Traumatic disruption of normal anatomy
Congenital anomalies such as septate uterus

Front 37

HYQ: What is the treatment for metastatic choriocarcinoma?

Back 37

Hysterectomy to eradicate any drug-resistant local disease and shorten the course of chemotherapy
Chemotherapy
Single agent for stage I and II → Methotrexate or dactinomycin
Combination for Stage II-IV → (EMA/CO) Etoposide + Methotrexate + dactinomycin then cyclophosphamide + vincristine
If future fertility is desired → chemotherapy alone then hysterectomy only if chemotherapy is ineffective

Front 38

Compare the treatment of preterm labor at 33 and 3/7 weeks to the treatment at 34 and 3/7 weeks gestational age:

Back 38

33: expectant management, corticosteroids, prophylactic antibiotics, deliver after fetal lung maturity
34: induction of labor, antibiotic prophylaxis

Front 39

What drugs are used for tocolysis? What is the only FDA approved tocolytic?

Back 39

Nifedipine (Procardia) – calcium channel blocker
Terbutaline (Brethine) – β-adrenergic agonist
Ritodrine – β-adrenergic agonist – withdrawn from US market in 1993
Magnesium sulfate – works as calcium anatagonist to alter myometrial contractions
Indomethacin (Indocin) – blocks prostaglandins from inducing contractions
Only one FDA approved → Ritodrine, but no longer on market; IV Magnesium most commonly used

Front 40

What are the signs and symptoms of magnesium toxicity? What is the reversal agent?

Back 40

s/s: lose DTRs, respiratory paralysis, cardiac arrest
tx: Calcium gluconate

Front 41

What is the management of a woman in labor who has a complete placenta previa?

Back 41

Emergency C-section

Front 42

Why does the donor (smaller) twin in cases of twin-twin transfusion syndrome have a better prognosis?

Back 42

Corticosteroids mature the lungs

Front 43

What is the most common cause of infertility in a couple?

Back 43

Sperm problem (go for semen analysis)

Front 44

Explain the how twins can share an amniotic sack or chorion depending on when the split takes place after fertilization:

Back 44

MonoCHORIONIC twins are monozygotic (identical) twins that share the same placenta
MonoAMNIOTIC twins are in the same amnionic sac (bubble)
If the placenta divides, this takes place after the third day after fertilization

4 days: dichorionic, diamniotic (each twin has it's own placenta & own bubble/sac)

8 days: monochorionic, diamniotic ("Mono-di") - (these twins have to share a placenta but are swimming in their own bubble)

12 days: monochorionic, monoamniotic("Mo-mo") - (these twins are in the same bubble & share a placenta)
.

Front 45

HYQ: What is the definition of PROM?

Back 45

Premature Rupture Of Membranes before 37 weeks

Front 46

HYQ: When should you suspect chorioamnionitis in a pt with PROM?

Back 46

Fever + any of the following:
Maternal tachycardia
Fetal tachycardia
Maternal leukocytes
Uterine tenderness
Foul-smelling discharge

Front 47

HYQ: At what gestational age is labor managed actively instead of expectantly in preterm labor?

Back 47

After 34 weeks
Or after proven lung maturity

Front 48

HYQ: what are the risks factors for placental abruption?

Back 48

HTN, prior placental abruption, trauma, tobacco or cocaine use, PROM, multiple gestations, multiparity

Front 49

What is typically included in an infertility work-up?

Back 49

Semen analysis
Analysis of anovulatory cycles
Hysterosalingogram (HSG)

Front 50

A 19yo G2P1 presents at 9 weeks gestation. She is vomiting all day every day, and has lost 7% of her body weight. On ultrasound, no gestational sac is found, but rather, there is a “snow storm” appearance to the uterine contents. What is the management of this patient?

Back 50

Dx: Hyaditiform mole
Tx: D&C, monitor β-hCG, counsel on contraception (1 year)

Front 51

This same patient is lost to follow-up, only to present back to clinic 8 months later complaining of vaginal bleeding and hemoptysis. Her uterus is enlarged, but on ultrasound, there is no gestational sac. Rather, there is a uterine mass with a mix of hemorrhagic and necrotic areas with parametrial invasion. What is her prognosis?

Back 51

Dx: choriocarcinoma
Prog: good with hysterectomy