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69 Cards in this Set

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How can you measure fetal lung maturity?
lecithin: sphingomyelin ration
Round ligament syndrome
-Round ligament supports the top of the uterus
-Right one can mimic appendicitis pain
-Pain associated with activity
-usually happens about 18 wks/early first trimester
What is the most important supplement to give a pregnant woman and why?
-folic acid
-decreases incidence of neural tube defects
physiologic anemia
moms have low hemoglobin concentration bc plasma volume increase faster than red cell volume
fetal heart rate
normal: 120-160
Tachy: >160
Brady: <120 (moderate=70-89 and severe= <70)
Should be variability (HR increases at least 15 beats per minute for less than 30 seconds)
What does a saw tooth pattern on an EKG mean?
Fetal hydrops
Most accurate way to asses the date of pregnancy?
Crown Rump Length (CRL)
ancenephaly
failure of brain and skull to form
exencephaly
exterioration of abnormally formed brain
encephalocele
cystic extention of the brain through skull and scalp defects
spina bifida
malformations resulting from failure of fusion of vertebral bodies
meningiocele
extension of meninges through defect
meningiomylocele
spinal cord extends through the defect
How much folic acid should a woman take?
400 micrograms with no hx of NTD
4 mg if hx of NTD
Most common chromosomal abnormality causing mental retardation? What are the screening tests?
Down's syndrome
Quad screen: MSAFP, hCG, estriol and inhibin
How does estrogen affect the lining of the endometrium?
Makes it grow
How does progesterone affect the lining of the endometrium?
stops the multiplication of cells
unopposed estrogen?
estrogen w/o progesterone-inhibited growth of the endometrium
most important factor for malignant potential in the endometrium?
atypia
What is the hallmark of both endometrial hyperpasia and endometrial carcinoma?
AUB
Triad of risk factors for endometrial carcinoma?
Obesity, HTN and diabetes
3 types of endometrial hyperplasia without atypia? How would you tx?
-simple hyperplasia, compex hyperplasia, and adenomatous hyperplasia.
-tx medically with progesterone
How is atypical hyperplasia treated?
hysterectomy
Main symptom of polyps?
abnormal bleeding
Grades of differentiation of endometrium?
Grade 1) Highly differentiated
2) moderately differentiated
3) entirely undifferentiated
Invasion of endometrial cancer? Good vs bad prognosis?
-First two layers of invasion are the muscle and into the cervix (can access lymph nodes if it gets worse)
-Once tumor gets into cervix it acts like cervical cancer and this is BAD NEWS
T or F abnormal bleeding in a postmenopausal women is likely to be benign
T (only 15-20% have cancer)
follicular cysts
-clear, thin walled, solitary
-1-5 cm
-if greater than 5 then there is a problem
-often resolve spontaneously
Benign ovarian neoplasms
-only 25% are neoplastic (not cancer just growth)
-epithelial cell origin
serous cystadenomas
-MC of epithelial tumors
-85% unilateral
-b/l serous cysts have increased potential for malignancy
Mucinous cystadenomas
-95% unilateral
-May be huge
Germ cell tumors
-Benign cystic teratoma (dermoid) (MC)
-80% of neoplasms under age 20
-Derived from one or more primary germ layers
Benign cystic teratoma
-Most common ovarian neoplasm (all ages)
-All have malignant potential
-10-20% b/l
stroma cell origin
-made up of theca and granulosa cells
-granulosa-theca cell tumors
-sertoli leydig cell tumors
-fibromas
granulosa theca cell tumors
-make estrogen
-older women who have this will function like pre-menopausal women
Fibromas
-not fibroids of muscle tissue
-most common benign solid tumor
-large fibromas may be associated with meigs' syndrome
important factors for malignant potential?
size, simple/complex and u/l vs b/l
Which ovarian neoplasm will give a positive preggers test?
Dysgerminoma
Risk factors for ovarian neoplasms?
-family hx
-BRCA1 or BRCA2
-age: 60% btwn 40-60 yo
-OCPs decrease risk (cancer is proliferative and the pill shuts the ovary down. It reduces the tendancy to proliferate)
pathogenesis of ovarian neoplasms?
primary spread by direct extension within peritoneal cavity by cells sloughing from ovarian surface
Staging of ovarian cancer
stage when surgery is done
tx of ovarian cancer
-debulk the tumor
-remove as much of the tumor as you can. Then give chemo.
-most imporatant part is to remove as much of the tumor as possible
Krukenber tumors
-from GI tract
-stomach primary site in 80%
-mostly b/l
-characteristic cell is signet ring
Which breech to deliver vaginally?
Frank breech
3 Ps?
Passenger (is the baby too big or in a difficult position?)
Passage (is the pelvis big enough for the baby)
Powers (are contractions forceful enough? give oxytocin)
latent vs active phase of labor?
Latent: onset of contractions but no dilation or effacement (just contractions)

active: sharp/abrupt upward turn in graphic pattern of labor bc of dilation
How do you evaluate abnormal labor?
-Serial pelvic exams 2 hrs during active phase
-look for effacement (in percentage 100% meas no different between internal and external os)
-look for station in relation to ischial spines (breech presentation or vertex)
Mastits vs engorgement?
Engorge: B/L, no redness, diffuse, distended, firm, nodular, low grade fever

Mastitis: u/l, red, high fever and flu like sx, main agent: staph aureus
Tx of mastitis vs engorgement
mastitis: allow nursing/pump, pump and dump when on meds (oral penicillinase) tylenol/motrin

engorge: support, ice, analgesics
risk factors for post-partum anxiety and depressionm?
personal family hx, prior PPD, family hx of psychiatric disorder, depression during pregnancy, martial instability, lack of support, younger maternal age, unwanted pregnancy, victim of violence and abuse, low self-esteem, high levels of anxiety, stressful during preggers
What immunizations are needed post-partum?
Rubella, anti-D immune globulin (rhogam), hepatitis B, TDaP (tetanus, diptheria, pertussis)
Uterine atony
if uterus is not well contracted and there is hemorrhage
Uterine atony tx
-fundal compression and massage (entire fist the vagina and put pressure on the uterus)
-empty bladder
-oxytocin infusion
-methylergonavine maleate (methergine C/I in pre-clampsia)
-prostaglandins F2 alpha (hemabate), E1 analogue (cytotec)
-B-lynch suture
-Manual compression
If the uterus is firm but there is still hemorrhaging what should you do?
look for lacerations
Risk factors for endometritis?
c-section, duration of labor, duration of ruptured membranes (greater than 18 hrs), choiroamniontits, preterm labor, multiple exams, internal monitoring, bacterial vaginosis
Threatened vs inevitable abortion
Threatened: painless bleeding < 20wks cervix is closed

inevtable abortion: significant bleeding/ and or ruptured membranes < 20wks with cervical dilation
Anti-phospholipid syndrome
Anti-phospholipids antibiodies + recurrent pregnancy lost

Causes thrombosis which targets utero-placental circulation and can lead to fetal loss or intrauterine growth retardation
Causes of spontaneous abortion
-immune dysfunction, anatomic abnormalities (late 1st timester and early 2nd), Chromosomal abnormalities (1st trimester), Maternal problems (infx, thrombophilia), Horomanal
Preeclampsia
HTN, edema, proteinuria
severe preeclampsia
-HTN, edema, proteinuria (severe)
-headache/ visual disturbances
-thrombocytopenia
-oliguria
-oligohydramnios
Chronic HTN in preggers
-IUGR: chronic starvation of the fetus throughout the entire pregnanacy
-Mild if systolic <180 and diastolic <110
-DO NOT USE ACE INHIBITORS (use CaCBs)
-elevated bc increased resistance (vasoconstriction) or increased flow
Physical exam for preeclampisa
-rapid weight gain
-edema of UE or face
-BP siting and supine high
-Liver tenderness (subcapsular hemorrhages, section of liver will have periportal necrosis
-herreflexia
-Monitor kick count
Tx for preeclampsia
-Prevent convulsions
-DELIVER
-Mg Sulfate (at time of diagnosis)
-Do cesarean section unless there are other problems with labor
How would you establish the estimated date of confinement
-280 days from first day of last menstrual period and also looking at ultrasound
-if EDC of U/S and FDLMP is less than 7 days apart then use the FDLMP
-If there is greater than a 7 day different between the two then use U/S
post-maturity or dysmaturity syndrome
-Dx made by pediatrician
-"little oldman" look (loss of subQ fat, parchment type skin)
-meconium staining
-baby stops growing
Macrosomia
->4500g
-birth trauma
-poor nutrition (oligohydramnios, meconium aspiration syndrome, placental dysfunction)
-Deliver trauma, Brachial plexus injury
effacement
shortening of cervical length
engagement
baby's head is lowering
Bishop score
90-15 = cervical ripening, <8 is not easy to induce
-position
-effacement
-dilation
-sofness
-baby's head