Ob/gyn Clerkship

Front 1

Weight Gain Recommendations during Pregnancy (based on BMI)

Back 1

Obese: 11-20 lbs
Overweight: 15-25 lbs
Normal: 25-35 lbs
Underweight: 28-40 lbs

Front 2

Criteria for dx of PID

Back 2

Fever (>38 C)
Leukocytosis
Elevated ESR
Purulent cervical discharge
Cervical motion tenderness
Adnexal tenderness
Lower abdominal tenderness

Front 3

3D's of Endometriosis

Back 3

dyspareunia, dyschezia, dysmenorrhea

Front 4

Uterine stippling/powder gun burns/lesions

Back 4

Endometriosis

Front 5

how do u get endometriosis

Back 5

the biggie = retrograde flow

Front 6

during procedure, ligament that feels like nodularity and has endometriosis

Back 6

uterosacral ligament

Front 7

3 key histo findings of endometriosis

Back 7

-ectopic endo glands,
-ectopic endo stroma,
-hemorrhage into adjacent stroma

Front 8

When should women be screened for GBS?

Back 8

35 - 37 weeks gestational age

Front 9

Pelvic Organ Prolapse

Back 9

"a condition in which descent of a pelvic organ into or beyond the vagina, perineum, or anal canal has occurred. This relaxation can occur in one or multiple areas of the vagina.

The following terms are used to describe where the prolapse can arise:
➜Anterior wall prolapse: Cystocele (bladder), Urethrocele (urethra); ➜Posterior wall prolapse: Rectocele (rectum), Enterocele(small/large bowel),
➜Apical prolapse: Uterine prolapse (uterus), Vaginal vault prolapse (vaginal cuff)

see UW question ID 4224 for more..."

Front 10

Descriptive term for Kallman's syndrome

Back 10

Hypogonadotropic hypogonadism w/ anosmia

Front 11

In the setting of placenta previa with massive uncontrollable bleeding, what are some of the possible causes/complications that could be causing the extensive bleeding?

Back 11

Placenta Accreta (an abnormal insertion of the placenta thru the uterine wall) Uterine Atony DIC Placental Abruption

Front 12

What risks to the fetus does Gestational Diabetes cause? (Name 7)

Back 12

Macrosomia, Hypocalcemia, Hypoglycemia Hyperviscosity (due to polycythemia 2/2 fetal hypoxia that occurs b/c of ↑ basal metabolic rate induced by hyperglycemia in utero), Respiratory difficulties Cardiomyopathy, CHF

Front 13

Mild Preeclampsia

Back 13

BP > 140/90 24-hr Protein > 0.3 gm / 24 hr (aka > 300 mg/24 hr) (aka ≥ 1+ proteinuria, confirmed by 24-hr protein) AFTER 20 weeks of gestation

Front 14

Normal Amniotic Fluid Index (AFI) reference range

Back 14

5 - 25

(< 5 is oligohydramnios, > 25 is polyhydramnios)

Front 15

To inidcate fetal lung maturity, L/S ratio should be:

Back 15

> 2

Front 16

IUGR is defined as

Back 16

IUGR = an estimated fetal weight ≤ 10th percentile

Front 17

Clinical triad seen in Interstitial Cystitis

Back 17

Urgency, Frequency, & Chronic Pelvic Pain (aka Painful Bladder Syndrome, definition: a chronic condition associated with pelvic pain worsened by bladder filling or intercourse accompanied by urinary frequency, urgency, & nocturia)

Front 18

Accepted treatment options for asymptomatic bacteriuria of pregnancy:

Back 18

7-day course of Nitrofurantoin, Amoxicillin, or a 1st-gen cephalosporin (Cephalexin)

Front 19

PCOS puts women at risk for

Back 19

Endometrial carcinoma (or just endometrial hyperplasia)

Front 20

How do granulosa cell tumors present

Back 20

Well they have a bimodal age distribution, so….. *In younger children present with Precocoius Puberty *In older patients presents with Postmenopausal Bleeding.

Front 21

11 things that switch it from Mild Preeclampsia to Severe Preeclampsia

Back 21

1-BP (> 160/110 every 6 hours)
2-Symptoms (vision Δ's, severe H/A, RUQ pain)
3-Oliguria <500 cc/24 hr
4-IUGR (< 5th percentile)
5-Proteinuria (>5,000 mg/24 hr)
6-Platelets < 100,000
7-AST or ALT ≥ 70
8-Oligohydramnios
9-Pulm Edema
10-IUFD
11-Seizures

Front 22

Fitzhugh-Curtis syndrome

Back 22

A possible complication of PID; this is a perihepatitis from the ascending infection resulting in RUQ pain & tenderness and LFT elevations

Front 23

How can drugs cause hirsutism & virilazation? What drugs?

Back 23

Drugs can cause H & V by acting on the liver and decreasing the amount of Sex Hormone Binding Globulin (SHBG) produced, leaving a greater percentage of free testosterone in circulation.
Corticosteroids, Androgens, Minoxidil, Phenytoin, Diazoxide, & Clyclosporin

Front 24

If DHEAS is normal, the androgen excess is likely from a _________ source

Back 24

Ovarian source (b/c DHEAS is made solely by the adrenals)

Front 25

1st line UTI drugs in pregnancy: (3)

Back 25

Amoxicillin, Nitrofurantoin, and Cephalexin

Front 26

What UTI drugs are contraindicated in pregnancy (3)

Back 26

Tetracyclines, Fluoroquinolones, and TMP-SMX

Front 27

Risks assoc'd w/ OCP use

Back 27

VTE, Stroke, MI, Breast cancer, Cervical cancer, Cholestasis or Cholecystitis, ↑ TG, HTN, & worsening Diabetes

Front 28

Benefits of OCP use

Back 28

Protective against Endometrial cancer, Ovarian cancer, Benign breast disease & PID/Salpingitis; Dysmenorrhea & Menorrhagia (anemia), Decrease functional cysts, help treat PCOS, Hirsutism, & acne; Correct bleeding tendencies, help tx low bone mass,treat Primary or Secondary Ovarian Failure, Endometriosis (continuous hormones), Chronic pelvic pain,

Front 29

What type of glucose test is indicated in the initial workup of a patient with PCOS?

Back 29

standard 2-hour Oral Glucose Tolerance Test (OGTT)--it identifies impaired glucose tolerance better than a fasting glucose!!!

Front 30

What is the single most useful parameter in predicting fetal weight by US in cases of suspected FGR?

Back 30

Abdominal circumference

Front 31

Absolute contraindication to Raloxifene use

Back 31

Hx of DVT

Front 32

When is endometrial biopsy indicated in cases of dysfunctional uterine bleeding?

Back 32

If the patient is:
-Age > 35
-Hypertension
-Diabetes
-Obese

Front 33

Increased levels of AFP are seen w/:

Back 33

1-Neural tube defects
2-Abdominal wall defects (omphalocele, gastroschisis)
3-Multiple gestation
4-Inaccurate gestational age

Front 34

Thyroid function tests in pregnancy

Back 34

Elevated total T4 & T3 (2/2 elevated TBG), with normal free T4 & T3 and normal TSH

Front 35

Postterm pregnancies (≥ 42 weeks) are at increased risk of ____________, and they can be managed by ____________ or _______________.

Back 35

↑ risk of Oligohydramnios;
Manage with either induction of labor or twice weekly assessment of fetal well-being

Front 36

Risk factors for Placenta Previa (5)

Back 36

◉ Advanced Maternal Age
◉Multiparity
◉Multiple gestations
◉Prior c-section
◉Smoking

Front 37

Mgmt of LSIL (Low-grade Squamous Intraepithelial lesion of cervix) in a premenopausal female vs a postmenopausal female

Back 37

▶Premenopausal: Follow-up with Colposcopy

▶Postmenopausal: 3 options: can do mimed. colposcopy, reflex HPV testing, or repeated Pap smears at 6 & 12 months

Front 38

Tx of DUB in an adolescent female (for mild, moderate, and severe/moderate w/ active bleeding)

Back 38

◉Mild DUB: iron-supplementation
◉Moderate DUB w/o active bleeding: Progestin
◉Severe or moderate with active bleeding DUB: High-dose Estrogen

Front 39

Early decelerations: assoc'd with ____________ and are they reassuring or non-reassuring?

Back 39

Fetal head compression; Assuring

Front 40

Late decelerations: assoc'd with ____________ and are they reassuring or non-reassuring?

Back 40

Uteroplacental insufficiency and fetal hypoxia & acidosis; Non-reassuring

Front 41

Variable decelerations: assoc'd with ____________ and are they reassuring or non-reassuring?

Back 41

Cord compression; Nonreassuring if repetitive

Front 42

Fetal sleep presents with ___________

Back 42

Decreased long-term variability

Front 43

An antepartum hemorrhage w/ fetal heart changes progressing from tachycardia to bradycardia and finally to a sinusoidal pattern occurring suddenly after ROM suggests the diagnosis of:

Back 43

Vase Previa (w/ ruptured fetal umbilical vessel).

*Note-since the bleeding is fetal in origin, the maternal vital signs will stay stable.

Front 44

Primary amenorrhea

Back 44

No menarche by age 16

Front 45

Secondary amenorrhea

Back 45

>3 cycle intervals or >6 months

Front 46

Most common cause Primary Amenorrhea

Back 46

chromosomal hypogonadism (ex Turners) (gonadal dysgenesis)

Front 47

Most common cause of Secondary Amenorrhea

Back 47

Pregnancy

Front 48

3 hallmarks of POF

Back 48

age < 40, amenorrhea, ↑ FSH

Front 49

PCOS diagnosis

Back 49

Hyperandrogenism and either Oligomenorrhea/Amenorrhea or polycystic ovaries by US

Front 50

Another name for PID

Back 50

Acute Salpingitis

Front 51

If Pap smear shows ASCUS, what are the 3 options for management?

Back 51

1- Perform HPV testing. If positive, will need to proceed with colposcopy.

2- Perform colposcopy.

3-Close follow-up with repeat Pap smear at 6 & 12 months (then if negative, can go back to annual)

Front 52

Tx for recurrent pregnancy loss due to antiphospholipid antibody syndrome

Back 52

Aspirin & Heparin

Front 53

OBSTETRICAL COMPLICATIONS OF DIABETES (TYPE 1 OR 2)

Back 53

.

Front 54

OBSTETRICAL COMPLICATIONS OF GESTATIONAL DIABETES ON

Back 54

.

Front 55

Velvety red vulva/Fiery red background with mottled with whitish hyperkeratotic areas/white plaques

Back 55

Paget's disease of the vulva

Front 56

Treatment for squamous cell carcinoma of the vulva:
-Stage I
-Stage II, III, IV

Back 56

-Stage I: Radical local excision

-Stage II, III, IV: Radical Vulvectomy (& groin node dissection)

Front 57

Criteria for Gestational Hypertension

Back 57

a sustained or transient BP of ≥ 140 or ≥ 90 occurring after 20 WGA, without proteinuria or end-organ damage

Front 58

Contraindications to expectant management of severe preeclampsia <32 weeks

Back 58

○ Thrombocytopenia (platelets < 100,000)
○ inability to control blood pressure with maximum doses of 2 antihypertensive medications
○ non-reassuring fetal surveillance,
○ liver function test elevated more than 2 times normal,
○ eclampsia,
○ persistent CNS (central nervous system) symptoms and oliguria.

Front 59

Risk factors for Osteoporosis (11)

Back 59

1- Early menopause
2- Glucocoritcoid therapy
3- Sedentary lifestyle
4- Alcohol consumption
5- Hyperthyroidism
6- Hyperparathyroidism
7- Anticonvulsant therapy
8- Vit D deficiency
9- Fam hx of early or severe osteoporosis
10- Chronic liver disease
11- Chronic renal disease

Front 60

Differential for Acute Pelvic Pain:

Back 60

A ROPE:

Appendicitis/Abcess/Abortion
Ruptured ovarian cyst
Ovarian torsion
PID (tubo-ovarian abcess)
Ectopic pregnancy

Front 61

First step in working up suspected appendicitis in pregnancy:

Back 61

Graded Compression Ultrasound

(The diagnosis is made based on clinical findings and graded compression ultrasonography that is sensitive and specific especially before 35 weeks gestation.)

Front 62

Most SSRI's are ok for use in pregnancy, with the exception of:

Back 62

Paxil (Paroxetine)-----which was recently made category D b/c found to ↑ risk of retail cardiac malformations & persistent pulmonary hypertension

Front 63

What problems can maternal obesity cause in pregnancy? (5)

Back 63

1- Hypertension
2- Gestational Diabetes
3- Preeclampsia
4- Fetal Macrosomia
5- Higher rates of C-sections & postpartum complications

Front 64

Best noninvasive test for diagnosis of fetal anemia (for ex, in an Rh-sensitized mom)

Back 64

Middle Cerebral Artery peak systolic velocity (done with Doppler ultrasound)

(note from online site: a normal fetal MCA S : D ratio should always be higher than the umbilical arterial S : D ratio.)

Front 65

Findings in fetus when he has Fetal Hydrops/Hemolytic disease of the newborn (b/c mom has Anti-D antibodies)

Back 65

Fetal anemia --> Hyperbilirubinemia + Kernicterus + Heart failure, edema, ascites, pericardial effusion --> death

Front 66

Name 9 things associated with Breech presentation:

Back 66

1- Prematurity
2- Multiple pregnancy
3- Genetic disorders
4- Polyhydramnios
5- Hydrocephaly
6- Anencephaly
7- Placenta previa
8- Uterine anomalies
9- Uterine fibroids

Front 67

Latent phase of Stage 1 of labor is considered prolonged if it is >____ in a nulliparous and >____ in a multiparous woman?

Back 67

Nulli: > 20 hours

Multi: > 14 hours

Front 68

______________ and _______________ have the best 5-year success rates for patients with Stress Incontinence due to Urethral Hypermobility (straining Q-tip angle >30 degrees from horizon.)

Back 68

Retropubic urethropexies (Burch and Marshall Marchetti) and Sling procedures

Front 69

_____________ procedures are the best procedures for patients with Stress Incontinence due to Intrinsic Sphincter Deficiency, but with little to no mobility of the urethra

Back 69

Urethral bulking procedures

Front 70

__________ incontinence is characterized by failure to empty the bladder adequately with a post void residual volume > ____. This is due to ______________________.

Back 70

Overflow incontinence

PVR > 300 cc (normal = < 50 cc)

Underactive detrusor muscle (neurologic disorders, diabetes or multiple sclerosis) or Obstruction (postoperative or severe prolapse).

Front 71

Description of ovarian masses that can be Observed, rather than treated surgically:

Back 71

Those that are < 5 cm and not suspicious for malignancy and are asymptomatic

Front 72

A patient with a known history of endometriosis who is unable to conceive and has an otherwise negative workup for infertility, will benefit from:

Back 72

ovarian stimulation with Clomiphene Citrate, with or without intrauterine insemination.

(a laparoscopy with treatment of endometriosis can increase fertility rates but, in this patient, is better reserved if she fails medical treatment)

Front 73

2 classic physical exam findings in Endometriosis:

Back 73

Nodularities on the uterosacral ligament/tender nodularity on the back of the uterus
and
Fixed retroverted uterus

Front 74

Effect of HRT on HDL and LDL

Back 74

Increases HDL and decreases LDL (good effect on lipid profile)

Front 75

How does Medroxyprogesterone Acetate (MPA), 10 mg every day, taken for 10 days each month, regulate the cycle of someone with irregular periods.

Back 75

Progestins inhibit further endometrial growth, CONVERTING THE PROLIFERATIVE ENDOMETRIUM TO SECRETORY ENDOMETRIUM.

(Patients with anovulatory bleeding have predominantly proliferative endometrium from unopposed stimulation by estrogen. Progestins inhibit further endometrial growth, converting the proliferative to secretory endometrium. Withdrawal of the progestin then mimics the effect of the involution of the corpus luteum, creating a normal sloughing of the endometrium. Stimulation of rapid endometrial growth, conversion of proliferative to secretory endometrium, and regeneration of the functional layer describe effects of estrogen on the endometrium. Inhibin is increased in the luteal phase.)

Front 76

How do oral contraceptives relieve primary dysmenorrhea?

Back 76

By inhibiting the synthesis of prostaglandins in the endometrium, thereby creating endometrial atrophy

Front 77

Prolactin secretion (& PRL) is stimulated by _______ and ____________; and inhibited by __________.

Back 77

Prolactin Stimulated by TSH/TRH & Serotonin,

Prolactin Inhibited by Dopamine.

Front 78

How does hyperprolactinemia cause amenorrhea/oligomenorrhea and anovulation?

Back 78

It inhibits the pulsatile release of GnRH.

Front 79

Increased TSH causes what changes in other hormone levels

Back 79

↓ FSH & LH

↑ Prolactin

Front 80

What is a Clomiphene citrate test used to assess?

Back 80

Ovulatory reserve

-->Give clomiphene citrate on days 5-9 of cycle (a SERM that increases release of gonadoropins) -- FSH levels are measured (if elevated test is abnormal)

Front 81

What vitamin deficiencies have been associate with PMS? (3)

Back 81

Vitamins A, E, and B6

Front 82

Best position for inspecting for asymmetry in breasts?

Back 82

Leaning forward

Front 83

Risk Factors for Molar Pregnancy

Back 83

-Young maternal age
-Advanced maternal age (<20 or >40)
-Prior molar pregnancy
-Prior spontaneous abortion
-Diet deficient in vitamin A
-Asian ethnicity
-Histocompatibility between patient and partner may be associated with increased risk of metastatic GTN.

Front 84

Classical clinical triad for a hydatidiform mole:

Back 84

1- Markedly elevated β-hCG (> 100,000)

2- Enlarged uterus

3- Hyperemesis gravidum

Front 85

When gestational trophoblastic disease is suspected (Molar preg or choriocarcinoma), what is the appropriate next step in management?

Back 85

Measurement of quantitative β-hCG; then, if it's greater than expected, proceed to ultrasound

Front 86

How soon after molar pregnancy can you attempt to get pregnant again?

Back 86

Wait 'til 6 months after the B-hCG levels have normalized

Front 87

What medical management can be used for fibroids to shrink their size before hysterectomy or myomectomy; or as primary treatment in someone close to menopause?

Back 87

GnRH agonists

Front 88

Which type of fibroid is most likely to cause subfertility?

Back 88

Submucosal fibroids

Front 89

Treatment for all endometrial cancers

Back 89

Total abdominal Hysterectomy,
with bilateral Salpingo-Oophorectomy,
with Pelvic and Para-aortic lymphadenopathy,
w/ Pelvic/Peritoneal washings for cytology (loose or free cancer cells)

*surgical staging is alway the first step

Front 90

Risk factors for Endometrial carcinoma (10)

Back 90

◇ Obesity
◇ Early menarche or Late menopause
◇ Unoposed estrogen therapy
-PCOS
-Estrogen-producing tumors (granulosa cell tumors)
◇ Nulliparity (esp when assoc'd w/ anovulation)
◇ Tamoxifen use (for breast cancer)
◇ Diabetes
◇ Endometrial hyperplasia (highest risk is with atypia)

◇ Liver disease (healthy liver would metabolize estrogen)
◇ Previous radiation ( ↑ sarcomas)
◇ Hypertension

*Atypical endometrial hyperplasia, and Obesity confers the greatest risk of developing endometrial carcinoma, esp when the pt is > 50 lb over ideal body weight (10-fold increase in risk for weight)

Front 91

Risk factors for Ovarian cancer

Back 91

○ Family history
○ Nulliparity
○ Early menarche or Late menopause
○ White race
○ Increasing age
○ Residence in North America or Northern Europe

Front 92

Ultrasound & Clinical findings for Functional Ovarian Cyst

Back 92

Unilocular simple cyst without avid of blood, soft tissue elements, or excrescences

Can just be an asymptomatic adnexal mass or unilateral pelvic or abdominal pain

Front 93

Clinical characteristics of Serous Cystadenoma

Back 93

Generally larger than functional cysts and may present with increasing abdominal girth

Front 94

Ultrasound characteristics of Mucinous Cystadenoma

Back 94

Tend to be Multilocular and quite large

Front 95

Ultrasound characteristics of Dermoid tumors

Back 95

Usually have solid components (& cystic components) or appear echogenic on ultrasound (and may contain teeth, hair, cartilage, bone, and fat)

Front 96

How can you reduce your chance of ovarian cancer?

Back 96

OCP's

Long-term suppression of ovulation appears to be protective against the development of ovarian cancer.

Front 97

Low amniotic fluid ____________ or high _____________ in the amniotic fluid is an indication of an intramniotic infection. (found based on amniocentesis)

Back 97

Low amniotic fluid Glucose or High Interleukin-6

Front 98

Mnemonic for Fetal Heart Tracings, what each finding correlates to:
(and description of each)

Back 98

V E A L
C H O P

(V-C, E-H, A-O, L-P)

Variable decels--Cord compression (nuchalcord, oligohyd)

Early decels -- Head compression

Accelerations -- Oxygenation

Late decels -- Placental insufficiency (uteroplacental)

VARIABLE--Unlike early and late decelerations, variable decelerations are not gradual. This works to your advantage, as their relative ABRUPTness makes them easy to pick out in a monitoring strip.

EARLY--The “early” in “early deceleration” refers to the lowest point of the deceleration occurring at the same time as the peak of the contraction (MIRRORs contraction). They are a result of increased vagal tone secondary to head compression and are generally benign when they occur during the 1st or 2nd stage of labor – but they can be a sign of cephalopelvic disproportion if they persist.

LATE--The “Late” in “Late decelerations” refers to the lowest point of the deceleration occurring after the peak of the contraction. Maternal contractions constrict the placental blood supply, thereby limiting the fetus’ blood supply to what’s already stored in the placental reserve. In the case of uteroplacental insufficiency, this lack of oxygen results in a deceleration which occurs as a result of (i.e. after) the contraction.

Front 99

➜What does the Oxytocin challenge test (Contraction stress test) assess for?

➜Which is normal/good: positive or negative?

Back 99

➜Contraction stress test assesses uteroplacental insufficiency and looks for persistent late decelerations after contractions (3/10 minutes);

➜Negative is good; POSITIVE is BAD (defined as late decel's following 50% or more of CTX in a 10-min window and raises concerns of fetal compromise...delivery is usu warranted

Front 100

In relation to FHTs, Uterine hyperstimulation may cause

Back 100

Prolonged fetal bradycardia.

Front 101

In relation to FHTs, Prolonged periods of fetal tachycardia are frequently found with___________ or ______________.

Back 101

Maternal fever or Chorioamnionitis

Front 102

Regular contractions with fetal tachycardia in the presence of prolonged ruptured membranes are most likely due to _________________.

Back 102

Infection (i.e. chorioamnionitis)

Front 103

In relation to FHTs, Maternal drugs may cause:

Back 103

Loss of variability.

Front 104

Risk factors/things associated with Retained Placenta (4)

Back 104

■ Prior C-section
■ Leiomyomas (fibroids)
■ Prior uterine curretage
■ Succenturiate lobe of placenta

Front 105

Risk factors for Uterine Atony

Back 105

➢ Precipitous or Prolonged labor
➢ Multiparity
➢ Oxytocin use in labor
➢ General anesthetics
➢ Macrosomia
➢ Hydramnios
➢ Twins
➢ Chorioamnionitis

Front 106

Patient with hypertension and preeclampsia has postpartum hemorrhage...what uterotonic agent is contraindicated?

Back 106

Methylergonovine

Front 107

Postterm pregnancies are associated with (at risk for): (5)

Back 107

✥ Macrosomia
✥ Oligohydramnios
✥ Meconium aspiration
✥ Uteroplacental insufficiency
✥ Dysmaturity

Front 108

Name 5 things that Postterm pregnancies are associated with:

Back 108

✧ Placental Sulfatase deficiency
✧ Fetal adrenal hypoplasia
✧ Anencephaly
✧ Extrauterine pregnancy
✧ Inaccurate or unknown dates

Front 109

Initial tests for every pregnant patient

***RECHECK WITH FIRST AID, ETC***

Back 109

✶ Ab type
✶ CBC
✶ Urine culture
✶ Rubella immunity
✶ Varicella immunity
✶ Chlamydia testing
✶ Syphilis testing
✶ Hep B antigen
✶ HIV test
✶ Influenza vaccine (during flu season)
✶ Offer genetic screening for Cystic Fibrosis
✶ Offer Down syndrome testing
✶ Cervical cytology (if it fits in with their routine screening)

Front 110

Tests for specific, at-risk pregnant patients

***RECHECK WITH FIRST AID, ETC***

Back 110

FOR AT-RISK Pregger pt's:

❀ TB
❀ Toxoplasmosis
❀ Hemoglobin electrophoresis (if high risk ethnic background or MCV < 80 unrelated to iron def.)
❀ Lead levels if at risk based on their history
❀ Thyroid function only if symptomatic, personal or family history, or associated condition (i.e..diabetes)
❀ Glucola at 1st visit if high-risk for gestational diabetes

Front 111

Placental Abruption mangement for delivery....vaginal delivery or C-section?

***MAYBE RECHECK WITH FIRSTA AID, OTHER SOURCE***

Back 111

Of course 1st IV large bore needles and Foley

➜ Pt with plac. abruption and is already IN LABOR (CTX + dilation), then VAGINAL DELIVERY....manage aggressively to ensure a rapid bag delivery b/c this will remove the retroplacental hemorrhage which acts as the impetus for DIC & hemorrhage in the setting of plac. abruption

➜C-SECTION is indicated if
a) there are obstetrical indications for it (placenta pre via, dystocia, breech, prior C-section)
b) Or if there's rapid deterioration of mother or baby, and risk of serious complications is imminent (and labor hasn't begun or is only in an early stage)

Front 112

Management of Threatened Abortion

Back 112

Once you have confirmed with US that fetus is alive and well, then just Reassurance and outpatient follow-up (do US 1 week later)

Front 113

When is Delivery indicated in HELLP syndrome? (3)

Back 113

1) Woman BEYOND 34 WEEKS GESTATION

2) When fetal lungs are mature

3) In presence of signs of fetal or maternal deterioration

Front 114

___________ is the gold standard for diagnosis if Endometriosis.

Back 114

Laparoscopy

Front 115

Work up of patient with Primary Amenorrhea, with YES UTERUS, NO BREASTS:

Back 115

MEASURE FSH

(If high FSH➜ peripheral cause, do karyotype; If low➜ central cause, do pituitary MRI)

Front 116

A patient with severe preeclampsia suddenly develops a generalized tonic-clonic seizure. Magnesium is started immediately. Is Magnesium sulfate given to prevent seizures, control seizures, or both?

Back 116

Magnesium is given to prevent further seizures.

Eclamptic seizures are of very short duration (few seconds) and magnesium sulfate infusions or IM injections given on a regular basis is mainly to prevent the further development of seizures.

Front 117

Glucose Tolerance test values

Back 117

....****

Front 118

QUAD screen: findings in Downs, findings in Trisomy 18 & 13

Back 118

Downs (h's up): Inhibin ⬆, β-hCG ⬆, MSAFP ⬇, Estriol ⬇

Trisomy 18/13 (all down): Inhibin ⬇, β-hCG ⬇, MSAFP ⬇, Estriol ⬇

Front 119

Risk factors for Breast Cancer

Back 119

✰ Female
✰ Older age
✰ A personal history of breast cancer
✰ Breast cancer in 1st degree relative
✰ BRCA1 & BRCA 2 mutations (assoc'd w/ early onset)
✰ A high-fat & low-fiber diet
✰ A history of fibrocystic change with cellular atypia
✰ ↑ exposure to estrogen
✩ nulliparity
✩ early menarche/late menopause
✩ first full term pregnancy after age 35

Front 120

You decide to place an intrauterine pressure catheter (IUPC). On placement, approximately 300 cc of frank blood and amniotic fluid flow out of the vagina. What is the most appropriate next step in the management of this patient?

uWise

Back 120

You liekly perforated the uterus with the IUPC. Withdraw the IUPC, check fetal heart tones, then replace IUPC if heart tones are reassuring.

Front 121

What's something that's less likely to occur with vacuum-assisted delivery as oppose to forceps?

Back 121

Vacuum-->less likely to get maternal lacerations

Front 122

What are the non-contraceptive health benefits of female sterilization.

Back 122

Reduction in OVARIAN CANCER, mechanism not understood.

Front 123

19 yo G1P0 @ 6 weeks by LMP presents w/ vaginal spotting. hCG 750, prog 3.8. physical exam normal. next step?

Back 123

recheck hCG in 48 hrs. still could be a viable pregnancy. progesterone suppositories will nto help because progesterone level is below viable level.

Front 124

Patient w/ hx of endometriosis is unable to conceive. Negative workup for infertility (HSP and father's sperm normal). Next step?

Back 124

Clomiphene citrate (SERM) for ovarian stimulation. can add intrauterine insemination. If these fail consider IVF/adoption.

Front 125

_______ is the most important prognostic indicator in endometrial cancer.

Back 125

graDE -- EnDometrial cancer

the word grade has an E and a D in it and so does EnDometrial!!!

Front 126

___________ is the most important prognostic indicator in ovarian cancer and vaginal cancer.

Back 126

Stage

Front 127

29 yo G0 presents f/u. Hx PID and Right TOA 14 mo ago. c/o pelvic pain, dypareunia x 10 mo. U/S +right FT mass. desires fertility. Right adnexa normal. Most appropriate next step?

Back 127

Laparoscopic right sapingectomy and lysis of any adhesions.

RSO not indicated because right ovary not involved and patient wants kids still.

Front 128

5'4'' 220lbs @ 12 weeks gestation and nullparious wants to know how her size may effect pregnancy. MC problem...

Back 128

HTN.

Increased maternal morbidity results from obesity and includes HTN, Gestational DM, pre-E, macrosomia and high rates of post partum complications. w/ BMI of 38 she is @ increaesd risk of Pre-E and HTN.

Front 129

A 15-year-old G1P0 woman at 40 weeks gestation presents to Labor and Delivery with contractions. At 10:00 am, her cervical exam shows that she is 2 centimeters dilated, 70% effaced and the vertex is at 0 station. Clinical pelvimetry reveals an adequate pelvis and membranes are intact. The fetus is in a cephalic presentation, with no concern about macrosomia. Contractions are occurring every 3 to 4 minutes, based on the external monitor. Fetal surveillance is reassuring and the patient is stable. Her labor slowly progresses and, at 1:00 pm, the patient has spontaneous rupture of membranes. Fetal surveillance remains reassuring. Her cervical exam is 4 centimeters dilated, 100% effaced, and 0 station. At 4:00 pm, the patient’s cervical exam is unchanged (4/100/0). Contractions are occurring every 5 to 6 minutes. Which of the following is the most appropriate next step in the management of this patient?

Back 129

Begin oxytocin augmentation.
( Begin Pitocin to increase frequency and strength of contractions. If not cervical change afterwards, do an IUPC.)

Prompt restated: 15 yo G1P0 at 40w is in latent phase of stage I for 6hrs with contractions q5-6minutes. Next step?

Front 130

What the requirements for a instrument assisted vaginal delivery?

Back 130

complete dilation, head engagement, vertex presentation, clinical assessment of fetal size and maternal pelvis, known position of fetal head, adequate pain control and ROM

Front 131

Risk factors for placental abruption (Abruptio placenta)

Back 131

-Maternal HTN or pre-eclampsia (hypertension = #1)
-Placental abruption in previous pregnancy
-Trauma
-Rapid decompression of a hydramnios
-Short umbilical cord
-Tobacco use and cocaine abuse
-Folate deficiency

Front 132

Sudden onset of abdominal pain, fetal heart rate abnormalities, and recession of the presenting part during active labor:

Back 132

indicates probable Uterine Rupture

(RF's are pre-existing uterine scars or abdominal trauma)

Front 133

Most common preventable cause of Fetal growth restriction in the US:

Back 133

Smoking