Uoft Obstetrics And Gynecology, 3Rd Year

Front 1

What is Chadwick's sign?

Back 1

Discoloration of the walls of the vagina and cervix; a presumptive sign of pregnancy

Front 2

What is Chloasma?

Back 2

a tan or dark facial skin discoloration; presumptive sign in the diagnosis of pregnancy

Front 3

What is Hegar's sign?

Back 3

Softening of the cervix; a PROBABLE sign of pregnancy

Front 4

List 4 POSITIVE signs in the diagnosis of pregnancy?

Back 4

1. Auscultation of the fetal heart; 2. Perception of movement by an experienced examiner; 3. Demonstration of a fetus by ultrasound; 4. Positive pregnancy test

Front 5

betaHCG is produced by...?

Back 5

the placenta

Front 6

The serum of a pregnant woman will be positive for beta-HCG how many days post-conception?

Back 6

9 days

Front 7

plasma levels of beta-HCG double every 48 hours until it hits a maximum at ___ to ___ weeks gestation?

Back 7

8 to 10 weeks gestation

Front 8

What is Naegle's rule?

Back 8

- LMP + 9 calendar months + 7 days;
- LMP - 3 calendar months + 7 days

(based on 28-30 day menstrual cycle; adjust as per cycle length)

Front 9

How often does beta-HCG double?

Back 9

After 9 days post-conception when it first appears, it proceeds to double once every 48 hours to a maximum at 8-10 weeks gestation, when it plateaus.

Front 10

If beta-HCG is higher than expected consider...(2 things)?

Back 10

twins or a molar pregnancy

Front 11

In preconception vs. conception, how often and at what dose should someone be taking folic acid?

Back 11

0.4 mg daily preconception and in the first three months after conception

Front 12

Which B-vitamin is folic acid?

Back 12

Water soluble form (along with folate) of vitamin B9.

Front 13

In which cases should a woman take 5mg of folic acid?

Back 13

If has diabetes, epilepsy, or a family history of Neural Tube Defects (NTD) or previous child with NTD

Front 14

Cervical cerclage is also known as (another name for this)?

Back 14

tracheloplasty

Front 15

Presumptive signs of pregnancy?

Back 15

1. amenorrhea,
2. Chadwick's,
3. striae,
4. Chloasma,
5. fetal movments (perception of)
6. breast changes
7. Subjective feelings (fatigue, urinary frequency, N/V (nausea/vomiting) , constipation, dyspepsia

Front 16

The 'sign' that indicates softening of the cervix is..

Back 16

Hegar's sign

Front 17

How is a fetus demonstrated by ultrasound at 5 week's time?

Back 17

intrauterine sac visible by 5 weeks amenorrhea

Front 18

How is a fetus demonstrated by ultrasound at 6 week's time?

Back 18

fetal pole

Front 19

How is a fetus demonstrated by ultrasound between 7 to 8 week's time?

Back 19

fetal cardiac activity

Front 20

In the targeted review covering preconception issues, which 7 categories should you cover?

Back 20

1. Age
2. BMI
3. Immunization status
4. Genetic/Familial/Ethnic risk
5. Medical Illnesses
6. Obstetric Hx
7. Lifestyle Issues

Front 21

In the targeted review of preconception issues, you're particularly interested in knowing the immunization status for which two diseases?

Back 21

Rubella and Varicella Zoster

Front 22

Which of the following meds is not safe during pregnancy: ACE inhibitors, labetolol, methyldopa?

Back 22

ACE inhibitors!

Front 23

If you want to achieve anticoagulation preconception or during preganancy, you should consider ___ instead of ____ due to the chance of a certain type of embryopathy?

Back 23

Consider Heparin or Low Molecular Weight Heparin instead of Coumadin, which can lead to warfarin embryopathy

Front 24

Two medications you may use for the treatment of pre-eclamptic toxaemia (PET) are...?

Back 24

ASA or Heparin

Front 25

average length of pregnancy is...(days/lunar months/weeks from LMP)?

Back 25

280 days, 10 lunar months, or 40 weeks from LMP (38 weeks from ovulation/conception)

Front 26

U/S is accurate within ___ week(s) in the first trimester, ___ week(s) in the second trimester and ___ week(s) in the third trimester?

Back 26

1 week in first trimester, 2 in second, and 3 in third

Front 27

What is the position of the fundus of the uterus at 12 weeks, 16 weeks, 20 weeks, term?

Back 27

at the symphysis: 12 weeks
between symphysis and umbilicus: 16 weeks
at umbilicus: 20 weeks
at xyphoid: term

Front 28

When is the position of the fundus of the uterus at (in weeks) at the xyphoid, umbilicus, inbetween the umbilicus and symphysis, and at the symphysis?

Back 28

@ 12 weeks: symphysis
@ 16 weeks: between umbilicus and symphysis
@ 20 weeks: umbilicus
@ Term: Xyphoid

Front 29

Give 4 examples of maternal issues that would identify a pregnancy as being "at-risk"?

Back 29

1. Pre-eclampsia (pregnancy induced HTN without proteinuria or with proteinuria
2. Gestational diabetes
3. ICP: intrahepatic cholestasis of pregnancy
4. PUPPPS: Pruritic Urticarial Plaques and Papules of Pregnancy

Front 30

Give 5 examples of 'fetal issues' that would identify a pregnancy as being at risk?

Back 30

1. growth restriction/macrosomia
2. anomalies (chromosomal/structural)
3. cardiac arrythmias
4. hydrops (immune and non-immune)
5. malpresentation

Front 31

List 7 placental/obstetrical issues that would indicate a pregnancy as being at risk?

Back 31

1. short cervix
2. uterine irritability / preterm labor
3. antepartum hemorrhage
4. preterm prelabor rupture of the membranes
5. abnormal placentation
6. polyhydramnios/oligohydramnios
7. post term pregnancy

Front 32

how is fetal growth assessed each visit during prenatal assessments?

Back 32

indirectly through symphysis fundal height

Front 33

T/F: Accuracy of U/S estimation of growth increases in late pregnancy and with larger fetuses?

Back 33

FALSE! U/S estimation of fetal growth actually DECREASES in late pregnancy and with larger fetuses

Front 34

PET (pre-eclamptic toxaemia) is most worrisome for a pregnant woman because it may lead to ...?

Back 34

The high blood pressure associated with pre-eclamptic toxaemia (PET) or toxaemia of pregnancy is frequently associated with PLACENTAL ABRUPTION.

Front 35

Give two examples of acceptable kick count procols?

Back 35

6 kicks in one hour, 10 in 2 hours

Front 36

What does a NST (non stress test) consist of?

Back 36

continuous assessment of fetal heart rate using external doppler for 20 minutes

Front 37

when is an NST (non stress test) NON-REASSURING?

Back 37

NST is NON-reassuring If there is:
1. spontaneous decels
2. poor-absent beat to beat variability

Front 38

when is a non stress test reassuring (comment on baseline FHR, fetal movements, variability)?

Back 38

NST is reassuring if there is:
1. baseline FHR 120-160
2. 2 accelerations of FH to 15 beats above the baseline HR, lasting 15 seconds each
3. the tracing displays beat to beat variablilty (5 beats above/below the baseline)

Front 39

The contraction stress test has been largely replaced by the ...?

Back 39

biophysical profile

Front 40

The contraction stress test may still be used to assess ability of the fetus to withstand labour as in which condition?

Back 40

IUGR (intrauterine growth restriction)

Front 41

How is a contraction stress test performed?

Back 41

oxytocin infusion is used to result in 3 contractions in 10 minutes; repeated late decelerations indicative of fetal distress requiring immediate delivery

Front 42

Between which weeks is the complete obstetrical scan (or anatomy scan) performed?

Back 42

18-20 weeks

Front 43

BPP may be scored out of 10 if a ___ test is included?

Back 43

NST (non stess test)

Front 44

4 components studied in the BPP are...?

Back 44

Gross body movements, Fetal tone, breathing movements, amniotic fluid index

Front 45

what is a 'good' amniotic fluid index?

Back 45

single pocket of 2cm x 2cm adequate for BPP

Front 46

In the BPP, how many gross body movements should be seen in 30 minutes?

Back 46

3 gross body movements in 30 minutes

Front 47

How long is a BPP (ie. within what time duration must the various criteria be met)?

Back 47

BPP is 30 minutes long

Front 48

What kind of fetal tone observation would yield a 2 in a BPP?

Back 48

one episode of active extension with return to flexion of limb or trunk (hand opening and closing also acceptable)

Front 49

What kind of breathing movements would be assessed as 'good' in BPP?

Back 49

one 30 second episode of fetal breathing movements (fetal diaphragm or kidneys seen to move up and down, chest wall in and out)

Front 50

How is the AFI (amniotic fluid index) calculated?

Back 50

By drawing imaginary perpendicular lines through the woman's umbilicius and adding up the maximum vertical pocket in each quadrant (5-25 cms is considered normal but normal AFI varies with gestation and curves exist to better judge increased or decreased fluid.

Front 51

Established vessels in doppler flow studies include the ___ artery and the ___ artery?

Back 51

umbilical artery (UA) and the Middle Cerebral Artery (MCA)

Front 52

What is the prevalence of amenorrhea not due to pregnancy, lactation or menopause?

Back 52

3-4%

Front 53

What is primary amenorrhea?

Back 53

Absence of SVB (spontaneous vaginal bleeding) by 14 yo in girls without other signs of secondary sexual development. In the presence of otherwise normal development of breasts and pubic hair, primary amenorrhea is diagnosed only at age of 16 yo.

Front 54

In the presence of otherwise normal development of breasts and pubic hair, primary amenorrhea is diagnosed only at ___ years of age?

Back 54

16 years of age

Front 55

What is secondary amenorrhea?

Back 55

defined clinically as the absence of menstruation for at least 6 months in a woman with previously normal and regular menses. For women with prior oligomenorrhea, the diagnosis necessitates up to 12 months without menstrual blood flow or at least 6 cycle times.

Front 56

What is oligomenorrhea?

Back 56

light or infrequent menstruation (menstrual periods that occur at intervals greater than 35 days and only occur 4 - 9 times per year). Often included in this definition is that women had regular cycles before.