Previous class OB review exam 2018 Flashcards Quizlet PDF

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Previous class OB review exam 2018

174 terms

ca

Terms in this set (174) ____ is responsible for

LH

initiating menstruation and ovulation hypotension if lying

SVC syndrome (should lie on left on side)

supine the hypothalamus

luteinizing hormone and follicle stimulating hormo

produces gonadotropinreleasing hormone, which stimulates the pituitary to produce what 2 hormones? menstrual bleeding marks the first day of which phase?

follicular

fetal heart beats are heard after ____ weeks

12

normal heart rate for

110-160 BPM

fetus hagers sign

uterus is more palpable d/t softening of the isthmu (early pregnancy sign)

chadwicks sign

blue cervix (normally pink, early pregnancy sign)

naegle's rule

add 7 days to the first day of LMP and then count months

things you want to

- if baby is breached (when feet or buttocks is first

know before delivery

abnormal) - GBS (36 wks) - dilation is 10 cm - baby position - baby is at the ischia spine stage 0 - history of previous C-section -> rip the scar causi hypovolemic shock and bleeding - want to know if placenta is ready for delivery (sig separation) down syndrome

low levels of alphafeto protein are indicative of what? if low levels of alphafeto protein are found indicating down syndrome, what test h

ld b d

t

amniocentesis

quad screening

alpha feto protein B-hCG estradiol inhibin A

when is triple

15-20 weeks

screening measured? antepartum (prenatal)

32nd week - and then move to every 2 weeks betw

visits should be at 4

weeks 32 and 36 and then 1 week for the remainde

week intervals until

the pregnancy

which week? normal weight gain

25-35 pounds (3-4 pounds per month)

during pregnancy risk factors for genetic

- advanced maternal/paternal age

disorders

- exposure to drugs - ethnicity - family history - exposure to potentially harmful substances

heartburn tx

conservative: - avoid triggering foods - small portions but more frequent - sit up after eating

7 cardinal movements

preterm labor

130 is positive) - those with normal glucose should be reassessed 3 yrs - those with pre-diabetes should be assessed annu

gestation diabetes tx

- goal is for fasting glucose < 95 - mainstay: diet 30 cals/kg/day of ideal body weig - if no success, regular insulin (will not cross placen affect baby) - oral hypoglycemic agents: glyburide & metformi

pts with gestational

type 2 diabetes mellitus

diabetes are more likely to develop what? gestational HTN

inc BP (>140/90) NO proteinuria > 20 wks returns to normal post partum if < 20 wks = chronic HTN

pre-eclampsia

HTN (>140/90) proteinuria edema > 20 wks

severe pre-eclampsia

HTN (>160/110)* also can have any of these: proteinuria oligouria cerebral or visual disturbances edema cyanosis hepatic dysfynction thrombocytopenia IUGR

eclampsia

the additional presence of convulsions or coma (g mal/tonic clonic seizures) in a women with preeclampsia that is not explained by a neurological disorder life threatening

HELLP syndrome

Hemolysis Elevated Liver enzymes Low Platelet count

what is usually a

HELLP syndrome

variant of preeclampsia what can you give for

bethamethasone

fetal lung maturity what can you give to

folate

prevent neuro sx what can you give for seizures

IV/IM magnesium sulfate

what antihypertensives can you give

labetalol methyldopa nifedapine hydralazine

should you deliver

only for pre-eclampsia or severe pre-eclampsia

baby with eclampsia?

do NOT deliver baby if eclampsia

what should be done

padded tongue blade

first to treat eclampsia

restraints adequate airway O2 IV access

- placental location

placenta previa

close to or over the internal cervical os placenta previa dx

US amniocentesis to confirm fetal lung maturity

placenta previa tx

- vaginal delivery if partial/marginal - C/S if complete - tocolytics -> inhibits uterina contractions (nifeidap commonly used)

abnormal attachment of placental tissue to the uterine myometrium that leads to incomplete separation of the l

t

t

t

placenta accreta

which placental disorders have painless

placent previa placenta accreta

bleeding in 3rd

placenta increta

trimester that ceases in

placenta percreta

1-2 hrs occurs if the placental

placenta increta

tissue extends further into the myometrium (further than placenta accreta) placental abruption RF

- cardiovascular; HTN

occurs if the placental

placenta percreta

tissue extends completely through the myometrium to the serose and sometimes into adjacent organs such as the bladder asymptomatic

e. coli

bacteruria MCC asymptomatic

urine culture

bacteruria dx asymptomatic

CAN:

bacteruria tx

cephalexin ampicillin nitrofurantoin

i fl

ti

f th

l

h iti

costovertebral tenderness

pyelonephritis

fever back/flank pain pyelonephritis dx

urine/blood culture definitive WBC casts, nitrates

pyelonephritis tx

cephalosporin or ampicillin + gentamycin

what can

increased uterine activity

pyelonephritis cause

preterm labor

premature rupture of

fernig test*

membranes dx full cervical dilation

10 cm

stages of labor

1st stage: interval bt onset of labor & full cervical d (10cm) 2nd stage: complete cervical dilation till delivery o infant (when mother begins pushing w/ contraction 3rd stage: begins immediately after delivery & end delivery of placenta 4th stage: 2 hrs after, physiologic adjustment

optimal diameters of

internal rotation

the fetal head to the bony pelvis occurs after delivery of

external rotation

the head a surgical incision of

episiotomy

contraindications for induction of labor

1. placenta or vasa previa 2. cord presentation 3. abnormal/unstable fetal lie 4. presenting above the inlet

which drug induces

IV oxytocin

labor? 2 cervical ripening

misoprostol (prostaglandin)

drugs administered

prostaglandin E2

vaginally frank breech

bottom first with legs extended over chest with fee front of face

complete breech

bottom first with legs indian style

if greater than __ weeks

34

then induce labor for

start abx if not in labor

PROM

corticosteroids before 32 weeks to mature fetal lu GBS prophylaxis

what agents delay

tocolytics (stop uterine contractions)

delivery

most frequently used: magnesium sulfate* indomethacin nifedipine corticosteroids 24-34 wks

footling breech tx

c section

what is the recommended

they should have a c-section the 2nd time around prevent bleeding out, shock, & death

delivery method for women with prior csections? infection of the fetal

chorioamnionitis

membranes and amniotic fluid chorioamnionitis

e. coli

causes

GBS - can cause sepsis

post-partum, the

returns to pelvic: 2 weeks

uterus returns to the

normal size: 6 weeks

pelvic by __ weeks and is normal size by __ weeks blood clots from the

lochia:

uterus which are

- lochia rubra: menses like bleeding consisting of b

expelled as the

and necrotic decidual (uterine lining during pregna

myometrial fibers

tissue

contract

- lochia alba: whitish discharge do NOT use tampons to absorb

MCC of mastitis

S. aureus

mastitis tx

PCN G dicloxacillin

initial tx for postpartum

bimanual uterine massage

risk factors for postpartum

- duration of labor* - duration of rupture*

endometritis

- presence of amnionitis during labor can get discharge* diminished or absent bowel sounds

postpartum

IV broad spectrum abs*:

endometritis tx

cefotetan cefoxitin

should you continue

YES!

breast feeding with

stop breast feeding only if form an abscess, contin

mastitis?

feeding with the other breast

- depression that

postpartum depression

begins 2 weeks-12

- younger women are MC to get affected

months post partum & lasts about 3-14 months - may have thoughts of harming baby - 2-4 days post partum

postpartum blues

depression - resolves within 10 days - no thoughts of harming baby the part of the baby that is presenting first in the pelvis

presentation

baby's position in relation to the ischial

station

spine relationship of the long

lie

axis of the fetus to the long axis of the mother how thin the cervix is

effacement

maternal blood

second trimester

pressure decreases most during which trimester? initial evaluation of

basal body temps

infertility in a 25 yr old which immunoglobulin

IgG

crosses the placenta? fern frond pattern

An estrogenic effect without the influence of

indicates what?

progesterone indicating no ovulation

if the cervical os is

100% (cervical os is fully dilated)

non-distinguishable from the vagina, what is the percentage of effacement? if the fetal head is at

0 (positive stations are below the maternal ischial s

the level of the

while negative stations are above the ischial spines

maternal ischial spine, h t t ti

i th

most common underlying cause of

uterine atony

early postpartum hemorrhage what is the earliest and

elevated BP

most reliable clinical manifestation of preeclampsia? Which of the following

(u) A. Transition is the last phase of the first stage o

is associated with

labor. Complete cervical dilation marks the end of

meconium-stained

stage of labor.

amniotic fluid during

(u) B. Meconium passage occurs most commonly i

labor?

term deliveries, not pre-term deliveries. Passage o

A. transition

meconium is related to mature development of the

B. prematurity

gastrointestinal tract and is rarely seen before 36 w

C. fast labor

gestation.

D. fetal distress

(u) C. Prolonged labor, not fast labor, is associated potential passage of meconium into the amniotic f (c) D. Passage of meconium is associated with feta distress usually due to asphyxia.

A 29 year-old female presents for routine

(u) A. A serological test for syphilis, usually the VD part of the routine obstetrical tests ordered at a pa

prenatal visit at 26

initial prenatal visit.

weeks gestation. She

(u) B. Genetic testing should be offered routinely t

has no complaints and

patients over the age of 35. Amniocentesis is usua

has completed all the

performed routinely at 16-18 weeks gestation if ind

initial routine

(u) C. Maternal serum alpha-fetoprotein testing is

obstetrical diagnostic

routinely done between 15-18 weeks gestation to s

tests to date. Her

for neural tube defects.

physical examination

(c) D. Glucose screening, usually with a 1-hour Gluc

and all initial

routinely performed between 24-28 weeks gestati

diagnostic evaluations

evaluate for glucose intolerance.

are unremarkable. Which of the following is the most appropriate diagnostic test to order at this time? A. VDRL B. amniocentesis C. maternal serum alpha-fetoprotein D. 1-hour post-Glucola blood glucose

Which of the following is a major risk factor for

(u) A. Alcohol intake has not been associated with increased risk of ectopic pregnancy.

an ectopic pregnancy?

(u) B. Advanced maternal age, not younger matern

A. alcohol intake

is an established risk factor for ectopic pregnancy

B. young maternal age

(c) C. A previous history of salpingitis is a major risk

C. history of salpingitis

factor for ectopic pregnancy since damage to the

D. low dose oral

fallopian tube prevents the fertilized ovum from re

contraceptive use

the uterus prior to implantation. (u) D. Oral contraceptive use prevents ovulation an therefore decreases the over-all risk of pregnancy including ectopic pregnancies. While high levels o estrogen and progesterone are thought possibly t increase the risk of ectopic pregnancy because th hormones slow the movement of the fertilized egg through the fallopian tube, no proven association been established.

A 27 year-old G1P0 female presents

(u) A. Vaginal bleeding and cramp-like lower abdo pain are usually present in an inevitable abortion. T

complaining of

cervical os is also frequently partially open.

painless spotting since

(c) B. Vaginal bleeding that occurs prior to the 20th

this morning. She is

of gestation is classified as a threatened abortion.

known to be 12 weeks

usually not a major feature and vaginal examinatio

pregnant. Pelvic

usually reveals a closed cervical os.

examination reveals

(u) C. Vaginal bleeding accompanied by cramp-like

the presence of blood

cervical dilatation, and passage of some products

within the vagina with a

conception constitutes an incomplete abortion.

closed cervical os. The

(u) D. After all products of conception are passed,

uterus is consistent

uterus contracts and vaginal bleeding stops. The c

with a 10-12 week

os closes, but the uterus is smaller than the suspec

gestation and

gestational age following a complete abortion.

nontender to palpation. Which of the following is the most likely diagnosis? A. inevitable abortion B. threatened abortion C. incomplete abortion D. complete abortion

In which of the following maternal-

(u) A. See D for explanation. (u) B. See D for explanation.

fetal blood type

(u) C. See D for explanation.

pairings should the

(c) D. Rho-GAM is indicated for an unsensitized Rh

mother receive Rho-

negative patient who has had a spontaneous or ind

GAM?

abortion, ectopic pregnancy, or at the time of

A. A positive mother, O

amniocentesis. It is also indicated at 28 weeks gest

negative infant

and within 72 hours of delivery of an Rh-positive in

B. A negative mother, O negative infant C. AB positive mother, spontaneous abortion D. AB negative mother, spontaneous abortion

On examination of a

(u) A. Hegar's sign is the softening of the cervix tha

pregnant patient the

often occurs with pregnancy.

physician assistant

(u) B. McDonald's sign is when the uterus becomes

notes a bluish or

flexible at the uterocervical junction at 7-8 weeks.

purplish discoloration

(u) C. Cullen's sign is a purplish discoloration

of the vagina and

periumbilical and noted in pancreatitis.

cervix. This is called

(c) D. Chadwick's sign is a bluish or purplish discolo

A. Hegar's sign.

of the vagina and cervix.

B. McDonald's sign. C. Cullen's sign D. Chadwick's sign

On examination of a pregnant patient the

(u) A. See B for explanation. (c) B. At 20-22 weeks, the fundal height is typically

physician assistant

level of the umbilicus.

notes the fundal height

(u) C. See B for explanation.

is at the level of the

(u) D. See B for explanation.

umbilicus. This corresponds to what gestational age? A. 16 weeks B. 20 weeks C. 24 weeks D. 28 weeks Pharmacologic

(h) A. Oral hypoglycemic agents have no role in th

treatment of a patient

treatment of gestational diabetes as these drugs m

with gestational

cross the placenta and harm the fetus.

diabetes should

(c) B. Regular insulin is the drug of choice as this w

consist of which of the

maintain the mother's blood sugar but not cross th

following?

placenta.

A.Oral hypoglycemic

(h) C. Oral corticosteroids have no role in the treat

agents

of gestational diabetes. Corticosteroids will cause

B. Regular insulin

blood glucose to increase.

C. Oral corticosteroids

(u) D. Glucagon is given to patients when their bloo

D. Glucagon

glucose is abnormally low. Glucagon stimulates gluconeogenesis.

A 30 year-old female presents to the

(u) A. This is primarily a third trimester cause of vag bleeding.

emergency

(c) B. Infertility increases the risk of developing ect

department with a

pregnancy. The onset of vaginal bleeding, pelvic p

syncopal episode. She

and formation of an adnexal mass makes this the m

has a history of

likely diagnosis.

irregular menstrual

(u) C. Pelvic inflammatory disease typically presen

cycles and infertility.

fever, abdominal pain, purulent vaginal discharge,

She has scanty,

cervical motion tenderness.

persistent vaginal

(u) D. Acute pelvic pain may occur secondary to

bleeding ...