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Step III
Step III - Ob/Gyn 1
| Question | Answer |
|---|---|
| What is the definition of placental abruption | Separation of normal placenta from 20wks gestation through prior to birth |
| Sudden onset, PAINFUL uterine contractions, vaginal bleeding. Dx | Placental abruption |
| PAINLESS vaginal bleeding. Dx | Placenta previa |
| What is the difference b/t placenta accrete and percreta | Accreta = attachment of placenta into uterine wall; percreta = more severe where placenta attaches to uterine wall and extends to surrounding organs eg bladder |
| Pt has IUD and tets (+) for pregnancy. What do you do | Remove IUD in office manually with gentle traction on string |
| What are the next best steps for pts found w/ ASCUS | 1. repeat pap in 6 mos for 1 yr + colpo is smear abnL 2. perform reflex HPV testing now; resume annual screening if nL else do colpo if (+) HPV 3. immediate colpo |
| When should Group B strep be tested in pregnant pts | b/t 35-37 wks gestation |
| If pt is found positive for group B strep, what is the rec tx | Ampicillin during labor or at least 4 hr prior delivery |
| Gestational sac is seen at what week via transvag U/S | 4-5 weeks |
| Fetal heart motion is seen via U/S at what week | 4-5 weeks |
| Fetal heart TONES are heard with Doppler at what week | 8-10 weeks |
| Fetal motion felt by Dr. is palpable at what week | 20 wks |
| What are the routine screening tests in the first trimester | CBC, Direct/Indirect Coombs, pap smear, UA/Cx, Rubella Abs, HBsAg, VDRL/RPR, +/- glucose screen |
| What is the Direct/Indirect Coombs test testing in the pt | Blood type, Rh type, and Abs |
| When should pts be screened for glucose in the first trimester | >30yo, obesity, FmHx |
| If pt is not screened for glucose in first trimester then when should they be tested | 24-28 wks |
| How do you perform a glucose test for pregnant pts | At 24-28 wks do a fasting glucose as well as a glucose 1-2 hours after glucose load |
| When would a pap smear not be done in the first trimester screen | If pt had a nL pap in last 6 mos |
| When would you not do a Rubella Ab screen in the first trimester | If pt had good documentation of vaccine record |
| What is measured in a triple screen | AFP, estriol, βHCG |
| What is considered a (+) triple screen and what does it indicate | low AFP, low estriol, high βHCG; likely Down’s syndrome |
| What is added to triple screen to make a quad screen | Inhibin A |
| What is indicated with a (+) triple screen and HIGH inhibin A | Down’s syndrome |
| What test is done at every prenatal visit | UA |
| What test needs to be done for every pregnant teenager | Chlamydia and gonorrhea |
| What is MCC of anemia in pregnant pts | Iron defx |
| What WBC is considered abnL in pregnant pts | >16K |
| Pt has CBC done in first trimester and shows low Hb and low MCV. Next step | Replace iron |
| Iron supplement is replaced in pt suspected of having iron defx anemia but pt does not improve. Next step | Test for thalassemia |
| Pr has CBC done and shows low Hb, high MCV, high RDW. Dx and tx | Folate defx; give folate |
| Pt has CBC done and shows platelets <150K. Differential | HELLP and ITP |
| What is another name for the indirect Coombs test and what is it looking for | Atypical Ab test (AAT); atypical RBC Abs |
| When should Rh testing be done | At very first prenatal visit via direct Coombs which identifies if mom has anti-D Abs |
| If mom is Rh(-) and dad’s Rh is unknown/positive. When should RhoGAM be given | 28 weeks and immediately after delivery (w/i 72 hrs) |
| If mom’s screen shows anti-D Abs, should she be given RhoGAM | No, it’s too late |
| In what other situations should RhoGAM be given | CVS, amniocentesis, abortion, stillbirth, ectopic pregnancy, any procedure causing transplacental bleeding |
| UA is done on pt showing asymptomatic bacteruria. What do you do next | Tx. Always tx ASB! |
| What drugs are used in tx of ASB | Nitrofurantoin, cephalosporins, amoxicillin |
| Mom screens (-) for rubella Abs. When should you give vaccination | ONLY after delivery, NEVER during pregnancy |
| Mom screens (+) for HBsAg. What do you do next | Test for HBe Ag |
| Mom screens (+) for VDRL/RPR. What do you next | Confirm with FTA or MHATP (rarely done) |
| If mom is diagnosed with syphilis how do you treat | IM PCN |
| Mom has syphilis but is allergic to PCN. How do you tx | Desensitize the bitch and give her PCN afterwards |
| What is the screening test for HIV | ELISA |
| What is the confirmatory test for HIV and what is it looking for | Western blot; HIV core and envelope Ags |
| Mom has HIV and is on HAART therapy, should you stop | NO, keep her on it |
| If baby has (+)HIV Abs what does it mean | Mom gave baby passive immunization against HIV and baby does not necessarily have HIV infection |
| What infection can cause premature labor | Trichomonas vaginalis |
| What is the tx for (+) Chlamydia and gonorrhea | PO azithromycin/amoxicillin + IM ceftriaxone |
| What is the treatment for bacterial vaginosis | PO metronidazole or PO clindamycin |
| What is the tx for trichomonas | PO metro |
| Why should you avoid streptomycin in pregnancy | Causes ototoxicity in baby |
| Mom screens PPD (+). Next step | Obtain CXR to look for active disease |
| Mom has (+) PPD and (-) CXR. Tx | INH + B6 x9mos |
| Mom has (+) PPD , (+) CXR, (+) sputum. What is next step and Tx | Send sputum for cx; Triple therapy |
| What is the screening test for trisomy 21 | βHCG, pregnancy associated plasma protein A (PAPPA-), nuchal translucency |
| Who should be screened for trisomy 21 | High risk = >35yo or hx of trisomy 21 baby |
| Mom screens (+) for trisomy 21. What is the confirmatory test | CVS in first trimester |
| Where is inhibin A made and what can be said about the levels throughout pregnancy | Placenta and corpus luteum; should stay constant during 15-18wk so if it is HIGH, you suspect Down’s syndrome in baby |
| Mom has abnL value for MS-AFP during 2nd trimester. What to do next | U/S to see if gestational dating is correct; MS-AFP does not depend on gestational age but it’s testing is reliant on gestational dating b/c it tested @ 15-18wks and value should be constant/normal |
| When does first trimester screening test begin | 11-14 wks |
| When is Nuchal translucency test done and what may it indicate if present | At 1st trimester testing via U/S; Down’s, trisomy 18, or other fetal abnLs |
| What tests are offered during the second trimester | Quad screen, triple screen |
| Where is estriol made | FETAL liver and placenta |
| Where is AFP made and found | Made by fetus; found in amniotic fluid, fetal blood and small amounts in maternal serum |
| High AFP indicates | Neural tube defects, ventral wall defects, twin gestation, placental bleeding, sacrococcygeal teratoma, renal disease |
| Low AFP indicates | Down’s syndrome or Trisomy 18 |
| When is the quad/triple screen offered | 15-20wks |
| When is an amniocentesis done | 2nd trimester |
| When is the CVS done | 1st trimester |
| What is seen in the triple screen for suspected Trisomy 18 | AFP variable/LOW, βHCG and estriol are LOW |
| Pt has abnL MS-AFP and follow-up U/S shows error in dating. Next step | Repeat MS-AFP test |
| Pt has elevated MS-AFP and follow-up U/S confirms correct gestational dating. Next step | Amniocentesis to eval amniotic fluid AFP and Ach-E activity |
| What is the MCC of elevated MS-AFP | Incorrect gestational dating |
| If amniocentesis shows elevated Ach-E along with elevated MS-AFP what if the most likely dx | OPEN Neural tube defect (instead of abdominal wall or other defect) |
| If amniocentesis shows undetectable Ach-E along with elevated MS-AFP what if the most likely dx | Some other defect is present, not neural tube |
| When should folate supplementation be initiated and how much | At least 1 month prior to conception and into 1st trimester @ 4MG/day |
| What is a/w low levels of PAPP-A | chromosomal abnLs eg trisomy 13, 18, 21 and SGA |
| What is a/w increased levels of PAPP-A | LGA baby |
| MS-AFP incr, nL estriol and HCG. Dx | Neural tube defect |
| Low MS-AFP and estriol, incr HCG. Dx | Down’s syndrome |
| MS-AFP, estriol, HCG LOW. Dx | Trisomy 18, Edward’s syndrome |
| Low MS-AFP and estriol, very HIGH HCG. Dx | Molar pregnancy |
| MS-AFP and HCG incr, estriol nL. Dx | Multiple gestation |
| MF-AFP incr, estriol and HCG LOW. Dx | Stillbirth/death |
| If MS-AFP is LOW what is the next step | Amniocentesis for karyotyping |
| If the 1hr 50g OGTT is positive what do you do next to confirm gestational diabetes | 3hr 100g OGTT |
| What is an abnL 1hr 50g OGTT | Glucose >140 |
| What tests are given in 3rd trimester | 1hr 50g OGTT @ 24-28wks; CBC for iron defx anemia; Rh Abs (again); Vaginal and anal swab for GBS @ 35-37wks |
| If pt is (+) GBS in 3rd trimester what do you do | Give IV Abx now; IV PCN G or if allergy then IV clindamycin/erythromycin |
| Pt fasted overnight for 3hr 100g OGTT. At start her glucose value is >120. Dx | DM (not gestational) |
| What are the abnL values for glucose at 1, 2, 3 hrs | >140, >155, >180 |
| You perform the 3hr OGTT and only one value is abnL. Dx | Impaired glucose tolerance |
| You perform the 3hr OGTT and 2+ values are abnL. Dx | Gestational diabetes |
| What are the anti0emetics that are safe to use in pregnancy | Doxylamine, odansetron, metoclopramide, B6/pyridoxime, promethazine |
| After what week is considered late pregnancy bleeding | 20 wks |
| What are the possible causes of late pregnancy bleeding | Placenta abruptio, placenta previa, vasa previa, uterine rupture, vaginal lacerations |
| PAINFUL late pregnancy bleeding | Placenta abruption or uterine rupture |
| PAINFUL late pregnancy bleeding | Placenta previa or vasa previa |
| Rapidly occurring late decels +/- bradycardia = | Vasa previa |
Created by:
DrINFJ
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