OBGyn - Quiz

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OBGyn - Quiz
2013-06-17 22:55:46

Gyn resources from apgo
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  1. Trichomoniasis
    • Sx: persistent yellow, frothy discharge, external vulvar irritation, no odor, erythematous patches on cervix ("strawberry cervicitis"), 
    • Microscope: motile ovoid protozoa with flagella
    • Tx:
  2. Bacterial vaginosis
    • Trichomonas
    • frothy, yellow-green vaginal discharge with strong odor
    • clue cells: characterized by adherent coccobacillary bacteria that obscure the edges of the cells
    • Fishy odor: KOH releases amines from the cell
  3. Candidiasis
    • Yeast vaginitis
    • Thick, white clumpy discharge
    • Sx: erythema, swelling, intense pruritis
  4. Primary herpes
    testing limitations
    • painful ulcers involving vulva
    • fluid filled, open or crusted
    • cultures: highly specific, but 10-20% false negative rate
  5. Elective cesarean sections:
    what GA?
    39 weeks
  6. Anencephaly
    • Neural tube defect
    • absence of major portion of brain, skull, and scalp
  7. Neural tube defects
    • 1.4 to 2/1000
    • Previous NTD pregnancy: 3-4%
  8. Risks of amniocentesis
    • Second trimester:
    • -1 to 2% risk of amniotic fluid leakage
    • -0.5% fetal loss rate
    • -transient transvaginal spotting
    • -0.1% risk of chorioamnionitis
    • -rare risk of cell culture failure
  9. Risk of chorionic villus sampling
    Performed at GA <9 weeks: fetal limb reduction defects
  10. Tetracycline
    adverse reactions related to pregnancy
    • Tetracycline: contraindicated in all three trimesters
    • Skeletal abnormalities, staining and hypoplasia of budding fetal teeth, bone hypoplasia, fatal maternal liver decompensation
  11. Sulfonamide
    • Kernicterus in the newborn (billirubin-induced brain dysfunction)
    • Contraindicated during the last 2 to 6 weeks of pregnancy
  12. Streptomycin
    prolonged tx of TB in pregnancy, streptomycin has been associated with fetal hearing loss
  13. Chloramphenicol
    • Gray baby syndrome: infants can't metabolize the drug
    • toxic levels reached by day 4, can lead to death within 1 to 2 days
  14. Monozygotic twinning
    • 1 set per 250 births
    • unaffected by race, heredity, age, parity, or infertility agents
    • Division after formation of embryonic disk will result in conjoined twins
    • 20 to 30% have dichorionic placentation
  15. Dizygotic twins
    dichorionic and diamniotic, regardleses of the sex of the twins
  16. Single umbilical artery
    • Frequency in singletons: 0.7 to 0.8%
    • frequency in abortuses: 2.5%
    • Frequency in twins: 5%
    • Increased incidence in newborns of diabetic mothers
    • White > blacks (2:1)
  17. Vasa previa
    • fetal vessels cross the internal oss
    • Increases risk of rupture of membranes to be accompanied by rupture of a fetal vessel, leading to exsanguination
  18. Bilateral hydronephrosis and hydroureter in pregnancy
    Normal or abnormal?
    • Normal!
    • Tends to be greater on the right side (due to dextrorotation of the uterus)
  19. Urine dipstic in pregnancy
    normal findings
    • Trace glucosuria: 1 in 6 women
    • Trace protein: common in normal pregnancies
    • Abnormal: WBCs and blood (infection)
  20. Dyspnea in pregnancy
    • Often physiologic
    • increased tidal lung volume
    • increased minute ventilation
    • systolic ejection murmur = increased blood flow across the aortic and pulmonic valves
  21. Succenturiate placenta
    one or more smaller accessory lobes that develop in the membranes at a distance from the main placenta
  22. Fenestrated placenta
    Rare anomaly where the central portion of the placenta is a rare anomaly where the central portion of the placenta is missing
  23. Membranous placenta
    • All fetal membranes are covered by villi
    • Placenta develops as a thin membranous structure
  24. Obstetric conjugate
    • The shortest distance between the sacral promontory and the symphysis pubis
    • Generally measures 10.5 cm
  25. Diagnoal conjugate
    Distance from the lower margin of the symphysis to the sacral promontory
  26. True conjugate
    From the top of the symphysis to the sacral promontory
  27. Interspinous diameter
    • Transverse measurement of the midplane
    • generally the smallest diameter of the plevis
  28. Gynecoid pelvis
    • classic female pelvis
    • Posterior sagittal diameter of the inlet only slightly shorter than the anterior sagittal diameter
  29. Android pelvis
    • posterior sagittal diameter at the inlet is much shorter than the anterior sagital diameter
    • Limits the use of the posterior space by the fetal head
  30. Anthropoid pelvis
    • Anteroposterior (AP) diameter of the inlet is greater than the transverse diameter
    • Oval with large sacrosciatic notches and convergent side walls
  31. Platypelloid pelvis
    • flattened with a short AP and wide trnasverse diameter
    • Wide sacrosciatic notches are common
  32. Fetal heart tracing:
    sinusoidal pattern
    Seen in : Rh-isoimmunized fetuses, normal fetuses, associated with maternal medication
  33. Fetal heart rate
    Saltitory pattern
    • episodes of brief and acute hypoxia in the previously normally oxygenated fetus
    • Seen during labor; not before
  34. Indicators of fetal lung maturity
    • Lecithin/sphingomyelin ratio of 2.0:1
    • ratio is close to 1 until ~34 weeks
    • ratio is predictive of RDS risk
  35. Reverse diastolic flow in ubilical artery ultrasound
    worrysome: fetal status is deteriorating
  36. biophysical profile
    • FHR monitoring (nonstress testing)
    • amniotic fluid volume:single vertical pocket exceding 2cm
    • fetal breathing: one or more episode of fetal breathing movements of 30s or more within 30 min
    • fetal body movements: three or more discrete body or limb movements within 30 min
    • fetal body tones: one or more episode of extension of fetal extremity with return to flexion, or opening or closing of hand
    • Scoring: each gets 0 to 2; normal is 8 to 10, score less than 4 promps delivery
    • False-negative rate: 0.1%
    • False-positive rate: relatively frequent
    • Bad signs: oligohydramnios, spontaneous decelerations
  37. Caloric intake in pregnancy
    weight gain
    • Daily increase of 300kcal is recommended
    • Total weight gain: 25 to 35 lb
    • T2-T3: normal weight gain is about 1lb/week
  38. Round ligament pain
    • sharp, exacerbated by movement and exercise
    • due to stretching of the ligaments from the gravid uterus
    • Right side > left (dextrorotation)
    • Tx: local heat and analgesics
  39. External cephalic version
    • fetus with breech presentation is manipulated through the abdominal wall
    • If not performed, 80% will remain breach
    • Success rate: 60%, better if unengaged breech and normal AFI
  40. Bishop score
    • Dilation, effacement, station, consistency, position
    • more points, more favorable
    • Favorable position: anterior
  41. management of 41 week, 1/0%/-3, posterior and firm cervix?
    BPP testing
  42. Management of 39 weeks, AFI 1.5, unfavorable cervix
    • Admit to hospital for cervical ripening and induction of labor
    • Oligohydramnios at term should be delivered
  43. Management of 41 week, decreased fetal movements x24hrs, FHR 180 bpm with absent variability
    cervix long/closed/-2
    Cesarean section (emergent)
  44. Management 34 week, decreased fetal movements
    Nonstress test
  45. Expected delivery date
    + 1 year, minus 3 months, + 7 days
  46. vaginal delivery + postpartum tubal
    c/s with tubal
    vaginal delivery + postpartum tubal has less risk
  47. Twin-to-twin transfusion syndrome
    • Donor twin: always anemic, due to direct transfer of blood to the recipient
    • Recipient twin: polycythemic; may also suffer thromboses secondary to hypertransfusion and subsequent hemoconcentration
    • Donor placenta: pale, atrophied
    • Recipient placenta: congested and enlarged
    • Hydramnios can develop in either twin, but is more frequent in the recipient
  48. Cervical insufficiency/incompetence
    • Dx: presence of painless cervical dilation with a h/o pregnancy loss in the second trimester or early-third-trimester preterm delivery 
    • Cerclage: 3 or more of the above. NOT for first trimester losses
    • Cervical length <25mm or funneling of more than 25% or both is associated with increased risk of preterm delivery
  49. Complete abortion
    expulsion of all fetal and placental tissue from the uterine cavity
  50. Incomplete abortion
    Passage of some but not all placental tissue through the cervix
  51. Threatened abortion
    Uterine bleeding without any cervical dilation
  52. Missed abortion
    Fetal death without expulsion of any fetal or maternal tissue for at least 8 weeks
  53. Inevitable abortion
    Uterine bleeding with cervical dilation without passage of tisseu
  54. Pre-eclampsia
    Dx criteria
    • BP >140/90 after 20 weeks GA in women with previously normal BP
    • Proteinuria: >300mg on 24hr urine
    • Severe preeclampsia: >160/110, proteinuria >5g or 3+, oliguria of <500ml in 24hr, cerebral or visual disturbances, pulmonary edema or cyanosis, RUQ pain, impaired liver function, thrombocytopenia, fetal growth restriction
  55. Pre-eclampsia risk factors
    • Previous pre-eclamptic pregnancies
    • Chronic HTN
    • Pregestational DM
    • Mulitfetal gestations
    • Vascular or CT disease
    • Nephropathy
    • Antiphospholipid syndrome
    • obesity
    • older age
    • AA race
  56. Eclapsia
    • stabilize
    • Magnesium - prevent further seizures
    • anti-hypertensives
    • deliver in timely fashion
  57. hydatiform mole
    most common symptom
    • Vaginal bleeding, enlarged-for-dates uterus
    • other sx: hypertension, proteinuria, hyperthyroidism
  58. hydatiform moles
    tx and follow up
    • D&C (if incomplete abortion)
    • weekly hCG titers
    • check for metastatic disease
  59. Hydatiform mole:
    Single-agent chemotherapy use after D&C
    • Used if levels of hCG remain elevated 8 weeks after evacuation
    • 50% of pts who have persistently high hCG will develop malignant sequelae
    • metastases: need to use combination chemotherapy
  60. Culdocentesis
    • Removal of fluid from the pelvic cavity via ultrasound guided needle (?)
    • Uses: confirm ruptured tubal pregnancy accompanied by hemoperitoneum (as long as it has not clotted)
  61. Salpingostomy
    • can be done via laparoscopic surgery
    • parallel incision in the tube, removing the ectopic pregnancy
  62. Salpingectomy
    • often done via laparotomy (or mini laparotomy)
    • Removal of tube, or portion of tube that has the pregnancy
  63. Risks for ectopic pregnancies
    • Pelvic inflammatory disease (previous)
    • operative procedures on the fallopian tubes
    • tubal sterilization (fulgaration > clips, rings)
    • DES exposure
    • induction of ovulation
    • IUD use
  64. hyperemesis gravidarum
    • intractable vomiting of pregnancy associated with disturbed nutrition:
    • weight loss
    • ketonuria
    • electrolye abnormalities (potassium depletion)
    • Jaundice (later finding)
  65. Hyperemesis gravidarum treatment
    • parenteral fluids and electrolytes
    • sedation
    • rest, vitamins, antiemetics
  66. PROM management:
    febrile, contracting regularly, 24 weeks,
    • #1: Antibiotics
    • steroids, tocolytics... not helpful when delivery is imminent
  67. Chorioamnionitis
    • presence of maternal fever, tachycardia, uterine tenderness
    • leukocyte counts are nonspecific
  68. history of vaginal bleeding:
    first step in evaluating?
    • ultrasound, to determine placental location
    • Digital exam after the placenta is shown to not be previa
  69. When is maternal Rubella infection most dangeroud?
    • Risk: teratogenic
    • 1st trimester infection: 80% risk to fetus
    • 2nd trimester infection: 25% by the end
  70. Tx of choice for N. gonorrheae infections in patients allergic to penicillin
    -non pregnant
    • Pregnant: Spectinomycin, erythromycin
    • Non-pregnant: ceftriaxone 250mg IM + Azithromycin 1g PO or Doxycycline 100mg PO BID x 7 days
  71. Toxoplasmosis
    Protozoal infection caused by toxoplasma gondii results from ingestion undercooked or raw meat
  72. Appendicitis in pregnancy
    • Incidence is unchanged: 1 in 2000
    • Dx is more difficult: leukocytosis, nausea, vomiting are common in pregnancy
  73. Asymptomatic bacteriuria in pregnancy
    risk of developing acute infection?
    • Prevalence: 2 to 12%
    • Higher incidence in black multips with sickle cell trait
    • 20 to 40% of women with ASB develop an acute infection during that pregnancy
  74. Tx of choice for UTI in pregnant patient?
    • Ampicillin and cephalosporins
    • Avoid: sulfonamides (disrupt albumin binding to bilirubin), Nitrofurantoin (nausea), tetracyclines (dental staining in the fetus)
  75. Heart sound changes in pregnancy
    • 90% have systolic ejection murmurs
    • 20% have soft diastolic murmur
  76. PUPPP
    • Pruritic urticarial papules and plaques of pregnancy
    • more common in nulliparous women
    • T2 and T3
    • -Erythematous papules and plaques that are intensely pruritic
    • presentation: abdomen first, buttocks, thighs, extremities, sparing the face

  77. Birth defects in diabetic patients
    • incidence of major malformations in women with DM: 5 to 10%
    • Cardiac: 38% (VSD, etc.)
    • MSK: 15%
    • CNS: 10%