10_20 OBGYN Word Scramble
|
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
| Question | Answer |
| on US what measurements most accurate for est GA | ~6-10 or 12 wks use crown rump, 12-18 use biparietal |
| determination of pregnancy--cut off hCG | 25mU/ml |
| how polyhydramnios defined? Oligo? | AFI>25 it's poly, if <5 it's oligo |
| where is top of fundus if 16wk? 20wk? | 1/2 pubis to umbilicus for 16wk, at umbilicus for 20wk |
| causes of symmetric IUGR | usu insult in 1st trimester, due to fetal problems, ie aneuploidy or early infxn |
| causes of asymmetric IUGR and when occur | insult occurs >20wks, placental problems incl HTN and poor nutrition |
| reasons why fundal size may be too small | 1) fetal (IUGR, fetal demise), 2) amniotic fluid (oligohydramios) |
| reasons for 2nd trimester loss | usu maternal, 1) uterine duplication, septum or submucous leiomyoma, 2) incompetent cervix |
| placental causes for fetal demise | abruptio placenta, infxn not allowing O2 xchg, macrosomia in DM outgrowing placenta |
| how dx antiphospholipid syndrome | need 1 of history: venous thrombosis, PE, stroke, reptd preg losses, fetal demise, and 1 of labs: cardiolipin Abs, lupus anticoag, incrsd PTT |
| what labs indicate anti phospholipid syndrome | cardiolipin Abs, lupus anticoag, incrsd PTT |
| if fetal demise in late 2nd tri--what do | need to induce labor (earlier can do D&C in 1st tri, D&E in 2nd tri) |
| describe hydatiform mole types and cxns | 1) Complete (MC): 2 sperms w egg w/o a nucleus=46XX all from dad. Grape like vesicles w/o a fetus. 20% malignancy; 2) Incomplete: 2 sperms w nml egg->69XXY. No vesicles, fetus present, 5% malignancy |
| which hydatiform mole is more concerning for cancer | complete (46XX all from dad) |
| clinical findings suggestive of hydatiform mole | bleeding <16wks (MC), pre eclampsia <20wks, severe hyperemesis, new onset hyperthyroid, very high bHCG |
| if uterus larger than dates and bHCG very high, think… | hydatiform mole |
| US showing snowstorm pattern, unrecognizable detail of gestational sac…think | hydatiform mole |
| what w/u needed for hydatiform mole | bHCG for f/u, CXR to check for mets, D&C, need to make sure on contraception and follow bHCG ea mo for 1 yr if benign or good px malignant, 5 yrs if poor px malignant |
| when use chemo in hydatiform mole? Which agent? | malignant dz or recurrent dz, use MTX or actinomycin |
| sites of ectopic preg | MC is oviduct (95%), then uterine cornu, then abd |
| risk factors for ectopic preg | salpingitis (MC), previous ectopic preg, tubal ligation/sx, IUD |
| clinical findings suggestive of ectopic preg | amenorrhea, vaginal bleeding, abd pain incl cervical motion tenderness or adnexal tenderness |
| cut offs for bHCG and US=ectopic preg | if bHCG>1500 and no gestational sac visualized |
| what are good px factors for gestationl tropho tumor | low bCHG (<40000) and mets to lung or pelvis (not brain or liver) |
| what are screening tools for Downs | 1st tri=PAPP, nuchal translucency, and mAFP, 2nd tri=triple screen/quad screen |
| causes of high MSAFP | neural tube, ventral wall, renal…twins and placental bleeding gives false high |
| what quad screen would suggest Downs | hi bHCG and inhibin, low MSAFP, estriol |
| what PAPP value suggests Downs | low along w high bHCG |
| what constitutes a negative CST | no late deccels w 3 cxns in 10min |
| what 5 parameters are measured in a BPP | NST reactivity, gross mvmts, extremity tone (flexion/extension), breathing, AFI |
| if 4-6 on a BPP what should you do | deliver if 36wks or grtr, rept in 24hr if <36wks |
| what constitutes a reactive NST | accels (2 in 20min) |
| glucola amt and when can dx with frank GDM w/o 3hr | 50g glucose, if blood glucose in 1hr >140 is cut off do 3hr; can dx w/o 3hr if single fasting 110 or grtr or was 200 on glucola |
| amt of glu given and cut offs for 3hr GTT | 100g given, cut offs: 95/180/155/140 [only need 2 abnml] |
| management of mild PreE | Mg during labor and 24 hr postpartum, keep DBP 90-100, give steroids <34wk, antenatal BPP/AFI and grwth q 3wks (need to check bc IUGR counts as sPreE), c linic q1 wk; once 37wk deliver |
| management of sPreE | in patient, at 23-32wks can do expectant management as long as no end organ damage, >32 wks deliver |
| management of HELLP | stabilize pt and deliver--can't manage |
| management of preterm labor | tocolytics (Mg, terbutaline), steroids if 24-34 (24-28wks decrs risk IVH, 28-34 decrs RDS and help lung maturation) |
| cut offs for UTI | 100K CFU if midstream, 10K if cath |
| incidence of twin w spontaneous ovulation and fertility tx | 1:90 spontaneous, 1:10 if clomiphene, 1:3 if gonadotropins |
| causes of 3rd tri bleeding (PainLESS and PainFUL) | PainLESS: placenta previa, vasa previa; PainFUL: abruptio placenta, uterine rupture |
| what's MC OB cause of DIC | abruptio placenta |
| ROM leading to VB and fetal brady cardia, diagnosis is? | vasa previa |
| what features make preE severe? | if BP 160/110, 5g protein in 24hr, Cr 1.2, plt <100K, hemolysis (ie incrsd LDH), incrsd ALT/AST or sympt of epigastric pain, persistent HA, visual disturbances |
| which preE/gHTN pts are most likely to develop HTN later? | gHTN (NOT preE) |
| medical problems put at risk for preE? Demographics? | DM, cHTN, renal dz, SLE (vascular or connective tissue dz); demographics: nullip, age<20 or >34 |
| contraindications for expectant management or preE | plts <100,000, DBP >100 on 2 anti-HTN, non reassuring fetal signs, LFTS>2x nml, eclampsia, CNS sympt, and oliguria |
| name criteria for DM B, C, D | B: onset <20 duration <10; C: 10-19, duration 10-19; D: <10, >20, vascular cxns |
| what are the White cxns letters for end organ damage | F=nephropathy, R=proliferative retinopathy, T=renal transplant, H=heart disease (Athero) |
| what electrolyte disturbances can see in neonate of DM mother | hypoCa+ bc of immature parathyroid (+ hypogly) |
| what are goals for glu while in preg | fasting <90, 1hr <140, 2hr <140 |
| what are doses of insulin for DM in preg by trimester | 0.8U/kg for 1st tri, 1.0 for 2nd, 1.2 for 3rd |
| how are insulin doses distributed | 2/3 in am and 1/3 in eve, in am give 2/3 NPH and 1/3 regular, in eve 1/2 and 1/2 |
| besides control of glu with Rx, what other Rx do DM need | 4mg/d of folate bc incrsd risk of neural tube |
| at what EFW do c/s in DM? non DM? | if baby EFW >4.5kg but >5kg in non DM |
| when do antenatal testing in DM | if insulin dependent, macrosomia, or h/o still birth start testing at 32wk w NST and AFI 2x/wk |
| how tx pyelo in preg | need IV Abx until afebrile and CVA tenderness resolves, then 14d of oral and need to retest urine. Rx: cefotetan or ceftriax OR amp and gent |
| what are lab findings for acute cholestasis of preg | incrsd bile acids, +/- ALT/AST and pruritis |
| tx for acute cholestasis of preg | ursodeoxycholic acid (helps bile flow) w cholestyramine (prevents bile reabsorption) and anti His |
| tx of Graves during preg | use methimazole or PTU to make mom euthyroid--maternal IgG cross placenta |
| what syndrome can appear like acute cholestasis of preg | PUPP=pruritic uriticarial papules and plaques of preg--but these appear perimbulical and don't affect preg |
| management of the preg if cholestasis is present | if severe deliver 36wks if fetal lung matures, if not severe deliver by 38 |
| tx PUPP | steroids and anti His |
| what's presentation ? | which part of baby is presenting over os, ie cephalic |
| what's attitude ? | if chin of baby is flexed (MC) or extended |
| what's position ? | portion of baby ag pelvis, MC occiput anterior |
| what parameters define sinusoidal tracing | sinusoidal pattern w freq 3-5min and lasts >20min |
| what causes variable decels? Early decels? Late decels? | variable=cord compression, early=head compression, late=uteroplacental insuffic |
| what makes cat I tracing | FHR 110-160, moderate variability, no late or variable decels, may have early decels |
| cat III tracing | absent variability AND ANY of : recurrent late or variable decels, bradycardia |
| what are indication for c/s | nonreassuring FHT, prev c/s or myomectomy, arrest of labor, placental abnmlties, abnml presentation +/- mltpl gestations |
| what are the 5 cardinal mvmts of labor | EDFIEERE=engagement, descent, flexion, internal rotation, extension, external rotation, expulsion |
| 3 stages of labor | 1 latent=(Effacement), ends w accel of cervical dilation ~4-5; 1 active=cardinal mvmts of labor begin, ends w complete dilation; Stage 2=descent (ends w delivery of baby); Stage 3=expulsion, delivery of placenta |
| times for ea stage of labor | 1 latent=14 for multipara, 20 for primi; 1 active=1.2cm/hr for primi, 1.5 for multi; 2=2 hr primi, 1 hr for multi +1hr if epidural; 3=30min |
| tx of prolonged latent phase | ambulation or sedation, avoid oxytocin or c/s |
| tx of prolonged active | oxytocin if ctx inadequate |
| w/o IUPC how can tell if ctx are inadequate | if last less than 45 sec and <3 in 10min |
| how define prolonged 2nd stage | (from complete dilation to delivery of baby=descent), >2hrs of active pushing if primi or 1 hr multip (+1 epidural) |
| criteria for PTL | 20-37wks GA, ctxs (3 lasting 30 sec in 20min), resulting in cervical change (dilation or effacement) **have to have all of these, can't just be having ctxs |
| when deliver someone w PROM | deliver right away: lungs mature (ie lecithin: sphingo >2 or + phosphatidylglycerol), chorio (ie maternal F unexplained), non reassuring FHT/BPP |
| if PROM and >36 wks | deliver, may need to ripen cervix before IOL |
| if PROM and <36wks how manage | goal prolong preg: bed rest w DVT prophylaxis, steroid for lung maturity if <32 wks, Abx after swab for GBS (they give even if GBS -); monitor w NST/BPP and deliver immed if non reassuring |
| tocolytic agents and who you CAN't use them in | Mg (don't use in myasthenia gravis), b adrenergic (terbutaline, ritodrine, don't use in DM bc incrs glu), indomethacin (don't use >32wks bc close PDA), CCB (nifedipine) |
| tx uterine atony, when can't use certain agents | uterine massage, oxytocin, methylergonovine (methergine), PGF2/carboprost **can't use methergine in HTN or PreE, can't use carboprost in asthmatics |
| etiology of fever after c/s depending on POD | POD 0=wind (atelectasis), 1-2=water UTI, 2-3=womb endometriosis, 4-5=wound, 5-6 walk incl septic pelvic thrombophlebitis |
| 2 MC cause of painful genital ulcers | HSV (MC) and chancroid (H Ducreyi) |
| tx for chancroid | azithro or ceftriax (same as for gonorrhea) |
| MC painless genital ulcers | syphillis, lymphogranuloma venereum (from C trachomatis L type--rare in US), granuloma inguinale (donovanosis-rare in US) |
| describe lymphogranuloma venereum (from C trachomatis L type) | painless vulvar ulcer that heals, then painful inguinal LAD, these LN rupture become draining abscesses or fistulas ( groove sign =depression bw groops of inguinal LAD) |
| treatment of lymophogranuloma venereum | doxy 21d or erythro 3-6wks, drain fluctulant LN so don't burst |
| beefy red painless vulvar ulcer--think what? | granuloma inguinale (donovanosis) |
| tx for granuloma inguinale (donovanosis) | doxycycline or bactrim 21 d |
| tx for condyloma acuminatum | podophyllin, TCA, imiquimod (no systemic tx available) |
| tx for chlamydia, gonorrhea | chlamydia: azithro 1 dose PO or doxy 7d; gonorrhea: ceftriaxone IM 1x or azithro 1 dose + NEED TX chlamydia |
| tx of PID | if outpatient 14 d of ceftriax or cefoxitin and add metronidazole if suspect anaerobes [I've also seen ceftriax + doxy] |
| 3 causes of vaginal discharge and how to differentiate | bac vaginosis, candida, trichomonas vaginitis |
| tx trichomonas vaginitis | metronidazole (same as bac vaginosis but need to treat sex partner) |
| types of abnml placenta attachment | previa=att is near or covering os, accreta=attach to myometrium, increta=goes through myometrium, percreta=to uterine serosa |
| tx for stress incontinence | kegel exercises, urethroplexy (move urethra up back into pelvic cavity) |
| tx for urge incontinence | antichol (oxybutinin, ie ditropan and tolterodine (detrol)), propantheline ( Pro-Bantheline ), B adrenergic (Ursipas) |
| contrast sympt for difft types of incontinence | stress: small amts urine w cough/sneeze, not at night, cystometry nml; urge: detrusor ctx involuntarily w larger amts urine, incl at night but can occur cough/sneeze, cystometry hypertonic bladder; hypotonic: constantly lose small amts day and night |
| tx of hypotonic | cholinergic (bethanecol), a adrenergic blocker (phenoxybenzamine) |
| 3 common sympt of endometriosis | dysmenorrhea, dyspareunia, constipation |
| tx of endometriosis | progestin, OCPs |
| describe adneomyosis, sympt, treatment | endometrial glands and stroma in myometrial wall (ie type of endometriosis) w cyclic bleeding (dysmenorrhea or menorrhagia), tx=hysterectomy |
| risks for endometrial hyperplasia and cancer | unopposed estrogen (nulliparity, late menopause), DM, HTN, obesity |
| tx endometrial hyperplasia | if w/o atypia cyclic progestins may reverse it, would need f/u bx 3-6mos; if done w childbearing do hysterectomy |
| what can lead to pseudomyxoma peritonei | mucinous cystadenoma of ovary |
| risks for ovarian cancer | BRCA gene, fam hx, grtr |
| tx for fibrocystic breast | reduce caffeine, vit E, OCPs, bromocriptine, tamoxifen |
| 4 types of malignant breast tumors | infiltrating ductal (MC 80%), infiltrating lobular (more often bilateral and better px), inflammatory, Pagets |
| what's the diff simple mastectomy v modified radical | modified radical also take axillary nodes [radical is when also remove chest wall mscl, don't do that anymore] |
| what tx if hormone receptor + (ie estrogen, progesterone) | tx w tamoxifen (selective estrogen receptor modulator) |
| absolute contraindication to OCPs | CVS: any thromboembolic event, CAD; Cancer: breast, endomet, melanoma; Liver: abnml LFTs, liver tumor; undiagnosed uterine bleeding |
| relative contraindication to OCPs | DM, SC, HTN, hyperlipidemia, migraines, depression, smoking, >35yo |
| how OCPs effect risks for cancers | decrsd risk of endometrial and ovarian and colon, incrsd cervical and maybe breast cancer as well as CAD and thromboembolic dz |
| subQ progestin names, advantages | Jadelle/Implanon/Norplant, rapid return of fertility s/p removal |
| what are signs/sympt of placental abruption | uterine tachysystole, VB, FHR very high w sinusoidal pattern (fetal anemia) |
| if PTL and mom has F | look for source of infxn, incl intramnionic--so don't give steroids until r/o intramniotic infxn |
| when is fetal fibronectin helpful | 24-34wk, in sympt women >95% that won't deliver in next 14d |
| smoking puts at risk for | placenta abruption, placenta previa, fetal grwth restriction, preE, infxn |
| when is cerclage usu placed | 12-16wks |
| when is cerclage usu removed | 37wks |
| tx of mastitis | dicloxacillin |
| paper thin, bluish vulva, most likely dx? How dx? Tx? | most likely lichen sclerosis seen in post menopause w itching, dx w bx, tx w clobestrol |
| what differentiate lichen sclerosis from, how tx the two? | squamos hyperplasia which has more white, firm, cartilaginous lesion and tx w steroids (v high dose clobestrol for lichen sclerosis) |
| tx PCOS? What if want to be preg? | OCPs, progestin (also wgt loss and if want preg use clomphene +/- metformin) |
| what ovarian tumors can cause elevated androgens | Sertoli-Leydig and hilar cell |
| Cushing's disease: how respond to dexamethasone test | suppressed by low doses but not high doses |
| how tx hereditary hirsutism, how does it work | spironolactone; inhibits 5alpha reductase in hair follicle which causes terminal differentiation of the hair follicle |
| pale areola and blind pouch vagina--dx? Tx? | androgen insensitivity; need to remove intra-abdominal testicles |
| irreg VB PP continues for >4-6wks, think? Test for? | gestational troph neoplasia, test bHCG if above nml its choriocarcinoma or trophoblastic tumor |
| how is tx of breast cancer different for preg woman | same exc no radiation at all during preg and no chemo during 1st tri, can undergo surgery |
| order of puberty | thelarche (breast), adrenarche (pubic/axillary hair), then hgt wgt and then menarche |
| treatments for osteoporosis | alendronate (fosamax, a biphosphanate), or raloxifene (SERM where estrogen agonist in bone but antagonist in breast and endometrium) |
| what's the diff bw true and pseduo precocious puberty | true or central=gonadotropin, just the hypothal-pituit-ovarian axis is activated early; pseudo or peripheral=estrogen comes from ovaries but not from gonadotropins |
| ex of pseudo precocious puberty | McCune Albright, granulosa cell tumor of ovary |
| what type of tumor has high AFP | yolk sac |
| if abnml pap, when do need to do colpo in preg? What can't do? | CIN1 can be deferred till PP, HGSIL or smthg like that should have colpo--can do everything exc ECC |
| what progesterone level indicates nml IUP | >25, if <5 then nonviable preg |
| cytotec aka | misprostol |
| tx for shoulder dystocia | try McRoberts where flex mom's thighs ag abdomen w suprapubic pressure, also corkscrew 180 degrees |
| painLESS 3rd tri bleeding think | placenta previa |
| amenorrhea PP and low thyroid, think | Sheehan's=infarct of pit leading to low thyr, FSH/LH, cortisol (ACTH is from pituitary along w TSH) |
| tx of PE in preg | IV heparin 5-7 days, then 3mos subQ and low dose heparin for remainder of preg and up to 4wk PP |
| when steroids given for pts going into labor? What does it help w at difft GA? | steroids if 24-34 (24-28wks decrs risk IVH, 28-34 decrs RDS and help lung maturation) |
| what need to check while preg pt on Mg | UOP (since excreted by kidney), pul edema/respir depression, loss of DTR |
| which ovarian tumors secrete estrogen? Androgen? | estrogen=granulosa cell; androgen=Sertoli-Leydig |
| how differentiate mullerian agenesis and androgen insensitivity | both have absent uterus, blind vagina, & nml breast, but mullerian often has renal abnmlties, should have nml testosterone and nml pubic hair (androgen insensitiv has decrsd) |
| 1ry amenorrhea think | Turner but be sure to check preg test |
| MC time for mastitis and how treat | 3-4wks PP, tx w dicloxacillin |
| tx endometritis | gent and clinda [I've also seen amp and gent listed] |
| how difft HELLP and acute fatty liver of preg | if have renal damage w elevated Cr and coag then its acute fatty liver of preg |
| what do if bHCG isn't rising properly | do a D&C, if see chorionic villi then it was a miscarriage, if don't see chorionic villi then likely ectopic and consider MTX |
| what do if bHCG is high enough that should see gestational sac, and yet don't | very likely ectopic preg, consider laparoscopy |
| in woman w prev c/s, what would be most worrisome for placenta accreta | if 3x c/s and placenta previa, ~40% will have placenta accreta and tx is hysterectomy! |
| hormones altered in Sheehans | low TSH, low prolactin, low FSH and LH [remember GnRH is from hypothal] |
| how do OCPs help endometriosis | suppresses hypothal axis so less estrogen is produced |
| when must treat PID as inpatient | Temp >38.5, nulliparity, IUD, HIV, preg, poor f/u, teenager,e tc |
| w/u if ASCUS and no HPV testing | rept pap q4-6mos until 2x nml, if 2nd abnml then colpo |
| what screen for in Ashkenazi jew | Fanconi anemia, Tay-Sachs, CF, and Niemann-Pick (all AR, Tay Sach MC) |
| how OCPs help w PMS | endometrial atrophy leads to less prostaglandins |
| how manage ASCUS depending on HPV | if HPV - do 1 yr f/u pap, if + do colpo |
| ASCUS-H management | do colpo, ECC |
| AGCUS management | colpo, ECC, EMB |
| LGIS management | colpo, if CIN2 can wait if CIN3 LEEP |
| when use cryo in cervical dysplasia | persistent CIN1 (2yrs) |
| when use CKC | CIS, adeno in situ |
Created by:
ehstephns
Popular Midwifery sets