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OBGYN COMAT Review | 100% Correct
Answers | Verified | Latest 2024 Version
When can fetal heart tones be detected w/doppler? - ✔✔ 10 - 12 weeks When is fetal movement appreciated? - ✔✔ 17 - 18 weeks When should you get a "quantitative" beta-hCG - ✔✔
- to diagnose & follow ectopic pregnancy
- monitor trophoblastic dz
- screen for fetal aneuploidy What supplement is given in pregnancy to decrease neural tube defects for all reproductive-age women?
- ✔✔Folic acid supplements What additional supplements are given for complete vegeterians - ✔✔vitamin D & vitamin B What kind of immunoglobulins can cross the placenta? - ✔✔IgG Prenatal screening at the initial visit - ✔✔Heme= CBC, Rh factor, Type & Screen ID= UA & culture, rubella Ab titer, HBsAg, RPR/VDRL, cervical G/C, PPD, IV, Pap smear (to check for dysplasia). If indicated: HbA1C, Sickle cell screening. Can also discuss genetic screening (Tay-Sachs dz, Cystic Fibrosis). When are prenatal visits conducted? - ✔✔Weeks 0-28= every 4 weeks (7*4=28) Weeks 29-35= every 2 weeks Weeks 36-birth= every week
When is a quad screen conducted? - ✔✔ 15 - 22 weeks When's an ultrasound for full anatomic screen done? - ✔✔ 18 - 20 weeks When is the 1 hr glucose challenge test for gestational DM done? - ✔✔ 24 - 28 weeks When is RhoGAM given to Rh- women? - ✔✔ 28 - 30 weeks When's GBS culture done? (and cervical culture for N gonorrhoeae & Chlamydia in selected populations). - ✔✔ 35 - 40 weeks or 32- 37 weeks when can a nuchal transparency test be ordered? - ✔✔ 9 - 14 weeks 4 elements of the Quad Screen - ✔✔maternal serum AFP B-hCG Estradiol Inhibin A What's associated with ELEVATED maternal serum AFP (MSAFP)? (<2.5 MoMs) - ✔✔Open neural tube defects (spina bifida, anencephaly) Abdominal wall defects (gastroschisis, omphalocele) Multiple gestation Incorrect gestational dating Fetal death Placental abnormailities (like rupture) What's associated with REDUCED maternal serufm AFP (MSAFP) (<0.5 MoM) - ✔✔Trisomy 21 & 18
Syphilis What's the definition of spontaneous abortion? - ✔✔Loss of products of conception (POC) before 20th week of pregnancy. Major birth defect caused by lithium - ✔✔Congenital heart disease (Ebstein's anomaly) Defects associated w/streptomycin & kanamycin - ✔✔Aminoglycosides--> hearing loss & CN VIII damage Birth defects caused by tetracyclines - ✔✔Permanent yellow-brown discoloration of deciduous teeth; hypoplasia of tooth enamel. Major defects associated w/valproic acid - ✔✔Neural tube defects (spina bifida) Minor craniofacial defects Which drugs can cause thymic agenesis? - ✔✔Vitamin A & derivatives. Intracranial calcifications & ring-enhancing lesions on MRI of fetus/child is associated with... - ✔✔Toxoplasmosis Symptoms of Congenital Rubella infection - ✔✔Purpuric "blueberry muffin" rash Cataracts Mental retardation, hearing loss, PDA Periventricular calcifications & petechial rash can be seen with which congenital infection? - ✔✔CMV Treatment for congenital toxoplasmosis infection - ✔✔Pyrimethamine & sulfadiazine Treatment for syphilis - ✔✔Penicillin
Diagnosis of CMV - ✔✔Urine culture; PCR of amniotic fluid Which TORCHeS infections can be diagnosed w/serologic testing? - ✔✔Toxoplasmosis, Rubella, & HSV Dark-field microscopy can be used to diagnose... - ✔✔syphilis Type of abortion: NO POC expelled; closed os. No fetal cardiac motion & no uterine bleeding. - ✔✔Missed abortion Type of abortion: No POC expelled, closed os; uterine bleeding +/- abdominal pain - ✔✔Threatened abortion Type of abortion: no POC expelled; open os - ✔✔Inevitable Type of abortion: some POC expelled; open os. - ✔✔Incomplete What's the definition of "recurrent" spontaneous abortions - ✔✔2 or more consecutive SABs or A total of 3 SABs in 1 year. Most likely cause of recurrent SAB's in pregnancy in early vs later pregnancy? - ✔✔early= most often chromosomal abnormalities late= most often hypercoagulable states (SLE, factor V leiden, Protein S deficiency) what should you suspect in a hx of painless cervical dilation & delivery of normal fetus between weeks 18 - 32? - ✔✔Incompetent cervix. What's important in diagnosis of a woman w/recurrent SAB's? - ✔✔Karyotype both parents. Hypercoagulability workup of mother. *Evaluate for uterine abnormalities.
What are the parameters of BPP? - ✔✔"Test Baby, MAN!" T= fetal Tone B=fetal Breathing M=fetal Movement A=Amniotic fluid volume (5-23) N=Nonstress test Note: each parameter is given a score of 2 (normal) or 0 (abnormal). what are the score interpretations for BPP - ✔✔ 8 - 10= reassuring: fetal well-being 6= equivocal 0 - 4= very worrisome for fetal asphyxia What's the first step in the diagnosis of hyperemesis gravidarum? - ✔✔Rule out molar pregnancy w/ultrasound +/- beta-hCG How is gestational diabetes diagnosed? - ✔✔At 24-28 weeks**= 1 hour 50g glucose challenge test. values> 140 mg/dL are abnormal. Confirm with oral 3 hour (100 g) glucose tolerance test showing any 2 of the following: Fasting >95 mg/dL 1 - hr>180 mg/dL 2 - hr>155 mg/dL 3 - hr>140 mg/dL What are the keys to managing gestational diabetes? - ✔✔1. ADA (American Diabetes Association) diet
- Insulin if needed
- ultrasound for fetal growth
- NST beginning at 30-32 weeks if GDMA2 (gestational diabetes mellitus A2: aka requiring insulin or an oral hypoglycemic).
what are the glycemic goals for mother's w/pregestational diabetes? - ✔✔Fasting morning < 2 - hour postprandial < When should a c-section be considered in a pregestational diabetes? - ✔✔In setting of an estimated fetal weight (EFW) >4500 grams What's the difference between gestational HTN & chronic hypertension in pregnancy? - ✔✔Gestational HTN develops at >20 weeks. What must be avoided when treating pregnant women w/HTN? - ✔✔DON'T give ACEIs or diuretics. which antihypertensives are popular in pregnancy? - ✔✔methyldopa, labetalol, nifedipine Preeclampsia - ✔✔BP > 140/90 on 2 occasions >6 hrs apart. Proteinuria (>300 mg/24 hrs, or 1-2+ urine dipsticks) Edema Severe preeclampsia - ✔✔BP>160/110 on 2 occasions >6 hrs apart. Proteinuria (>5g/24 hrs or 3-4 + urine dipsticks) or oliguria (<500 mL/24 hours) Cerebral changes: headache, somnolence Visual changes: blurred vision, scotomata Other: hyperactive reflexes/clonus; RUQ pain; HELLP syndrome. Most common signs preceding an eclamptic attack - ✔✔headache, visual changes, RUQ/epigastric pain. Only cure for preeclampsia/eclampsia - ✔✔Delivery of the fetus how do you treat magnesiums toxicity? - ✔✔IV calcium gluconate
when is RhoGAM given? - ✔✔28 weeks when mother is Rh- and father is Rh+ or unknown. Also given postpartum if baby is Rh+. Complications of Rh Isoimmunizations - ✔✔Hydrops fetalis when fetal Hemoglobin <7 (accumulation of fluid in unwanted places) Fetal hypoxia & acidosis kernicterus prematurity death hydrops fetalis - ✔✔Hydrops fetalis is a serious fetal condition defined as abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin edema. In some patients, it may also be associated with polyhydramnios and placental edema. What are the variants of malignant gestational trophoblastic disease? - ✔✔invasive moles & choriocarcinoma Complete mole - ✔✔Sperm fertilizes empty ovum; 46 XX; no fetal tissue Partial mole - ✔✔2 sperm fertilize ovum; 46 XXY; contains fetal tissue. how does gestational trophoblastic dz present? - ✔✔Uterine bleeding hyperemesis gravidarum preeclampsia/eclampsia at <24 weeks uterine size greater than dates diagnosis of GTD? - ✔✔Grapelike molar clusters into vagina Markedly elevated serum b-hCG (usually >100,000 mIU/mL) Pelvic ultrasound= snowstorm appearance w/o gestational sac or fetus present.
treatment of GTD? - ✔✔evacuate uterus and follow w/weekly beta-hCG Tx malignant dz w/chemo (methotrexate or dactinomycin) Major tests for seeing if membranes have ruptured? - ✔✔Nitrazine paper test (+ if paper turns blue: indicates alkaline pH of amniotic fluid) Fern test (+ if ferning pattern seen under microscope after amniotic fluid dries on glass slide). If uncertain: can do ultrasound-guided transabominal instillation of indigo carmine dye to check for leakage Definition "preterm labor" - ✔✔Onset of labor between 20-37 weeks gestation When should antenatal corticosteroids be given, & which oines? - ✔✔Dexamethasone or betamethasone prior to 32 weeks (in absence of intra-amniotic infection). What to do in ruptured membranes w/signs of infection or fetal distress - ✔✔give antibiotics (ampicillin & gentamicin) & induce labor What is required to diagnose preterm labor? - ✔✔regular uterine contractions (3 or more of 30 seconds each over a 30 min period) and concurrent cervical change at <37 weeks gestation Treatment of preterm labor - ✔✔-hydration & bed rest
- tocolytic therapy
- steroids to help w/fetal lung maturation
- penicillin or ampicillin for GBS prophyslaxis if preterm delivery is likely. postpartum hemorrhage dfn - ✔✔Loss of >500 mL blood for vaginal delivery or >1000 mL for c-section
age cutoff for "premature" menopause - ✔✔40 yrs old. Change of hormones in menopasue - ✔✔Ovaries become less sensitive to LH & FSH...So LH and FSH levels increase (& estrogen fluctuates) Combined hormonal methods of contraception protect against which cancers? - ✔✔Endometrial & ovarian cancers. What's the definition of primary amenorrhea? - ✔✔Absence of menses by age 16 w/secondary sexual development present... Or the absence of secondary sexual characteristics by age 14 What are the major causes of absence of secondary sexual characteristics in primary amenorrhea? - ✔✔Absent secondary sexual characteristics= no estrogen production...
- constitutional growth delay
- primary ovarian insufficiency (most commonly Turners)
- Central hypogonadism Differential for primary amenorrhea with presence of secondary sexual characteristics? - ✔✔Primary amenorrhea w/secondary sex characteristics= estrogen production but other anatomic or genetic problems...
- Mullerian agenesis (absence of 2/3 of vagina & uterine abnormalities)
- Imperforate hymen
- Complete androgen insensitivity how do patients present w/complete androgen insensitivity? - ✔✔Breast development (aromatization of testosterone to estrogen) but are amenorrheic & lack pubic hair. How to diagnose someone w/primary amenorrhea? - ✔✔1. Get a pregnancy test!
- Obtain bone age radiograph (to evaluate constitutional growth delay etc)
- Ultrasound to evaluate ovaries
- If normal breast development but no uterus- get karyotype to evaluate for androgen insensitivity syndrome (XY)
- If normal breast development WITH uterus- measure prolactin & get MRI to assess pituitary gland. Interpretation of bone radiographs in setting of primary amenorrhea? - ✔✔If pt is of short statue (bone age <12 yrs) but normal growth velocity= constitutional growth delay If bone age is >12 yrs but still no signs of puberty, get LH/FSH levels to evaluate where on HPA axis the problem is. Definition of secondary amenorrhea - ✔✔absence of menses for 6 consecutive months in women who have passed menarche. Diagnosis of secondary amenorrhea - ✔✔1. get pregnancy test
- if - pregnancy test, measure TSH & prolactin (note: increased prolactin inhibits release of LH & FSH).
- Initiate a progestin challenge
- If signs of hyperglycemia or hypotension: do 1mg overnight dexamethasone suppression test to distinguish CAH, Cushing's, & Addison's.
- If clinical virilization: measure testosterone, DHEAS, & 17-hydroxyprogesterone. (mild pattern= PCOS, CAH or Cushing's)...(moderate to severe= look for ovarian or adrenal tumor). treatment for prolactinomas - ✔✔bromocriptine or cabergoline tx of premature ovarian failure (<40 yrs) - ✔✔if uterus is present, tx w/estrogen plus progestin replacement threapy. dfn endometriosis - ✔✔functional endometrial glands & stroma outside uterus dfn adenomyosis - ✔✔endometrial tissue in the myometrium of the uterus History/PE of endometriosis vs adenomyosis - ✔✔Endometriosis= CYCLICAL pelvic and/or rectal pain & dyspareunia
or Colposcopy Next step in nonpregnant women w/cervical cytology showing ASC-H (atypical squamous cells that can't exclude High-grade squamous intraepithelial lesion) - ✔✔colposcopy Next step in LSIL (low-grade intraepithelial lesion) - ✔✔Nonpregnant/premenopausal= colposcopy Postmenopausal= reflex HPV testing, colposcopy , or repeat Pap at 6 & 12 months Pregnant women= defer colposcopy until 6 weeks postpartum Next step in LSIL for nonpregnant/premenopausal women after colposcopy - ✔✔If unsatisfactory or no visible lesion= endocervical sampling If CIN 2,3= ablation or excision If no CIN 2,3= repeat pap at 6 &12 months OR conduct HPV testing at 12 months Ovarian Tumor Markers: Epithelial - ✔✔CA- 125 Ovarian Tumor Markers Endodermal sinus - ✔✔AFP Ovarian Tumor Markers Embryonal carcinoma - ✔✔AFP, hCG
Ovarian Tumor Markers Choriocarcinoma - ✔✔hCG Ovarian Tumor Markers Dysgerminoma - ✔✔LDH Ovarian Tumor Markers Granulosa Cell - ✔✔inhibin why can hypothyroidism lead to precocious puberty? - ✔✔Bc high TSH levels stimulates LH & FSH receptors (they all hare an alpha-subunit). treatment of precocious puberty caused by CAH - ✔✔cortisol replacement Which type of cervical squamous cell dysplasia warrents colposcopy during pregnancy? - ✔✔HSIL Tanner stages - ✔✔Stage 1=prepubertal (raised papilla/nipple only & no hair growth) stage 2= breast budding, areolar enlargement, slight growth of fine labial hair. stage 3= further breast & areolar enlargement, further hair growth stage 4= areola remains elevated over breast; hair becomes coarser & spreads over much of pubic region stage 5= mature breast-> areola recedes to level of breast while papilla remains extended; coarse hair extends from pubic region to medial thighs. How can thyroid affect puberty? - ✔✔Precocious puberty can occur in response to chronic hypothyroidism bc high TSH stimulates LH & FSH receptors (they all share the same alpha subunit)
Cushing syndrome Best diagnostic tool for endometriosis? - ✔✔Laparoscopy (which will show "powder-burn" lesions & cyst on involved areas) Patients w/PCOS are at increased risk of what kind of cancer? - ✔✔Endometrial (bc high levels of androgens are converted peripherally, leading to high levels of estrogens) Treatment for PCOS - ✔✔exercise & weight loss OCPs (or 7 days of progestin each month if can't do OCPs) Spironolactone (can help hirsuitism if OCP's not sufficient). Clomiphene (for fertility help) Metformin Statin (lower lipid & testosterone levels) Treatment for vaginitis? - ✔✔Gardnerella-> metronidazole (or clindamycin) Trichomonas-> metronidazole and treat partner Candida-> fluconazole once PO (or topical clotrimazole, miconazole, or nystatin) How to diagnose cervicitis - ✔✔Enzyme immunoassays can detect both N gonorrhoeae & Chlamydia. DNA probes & DNA amplification (PCR)= very sensitive Treatment of cervicitis - ✔✔Ceftriaxone (for N gonorrhea) & doxycline (not in pregnancy....can use azithromycin) What should you suspect if a patient with known PID presents with signs of sepsis or peritonitis? - ✔✔Tubo-ovarian abscess What's used to confirm the diagnosis of syphilis - ✔✔FTA-ABS (fluorescent treponemal antibody absorption) MHA-TP (microhemaglutination assay for antibodies to treponemes)...
note: VDRL & RPR are screening tests...FTA-ABS and MHA-TP are confirmation tests Which subtypes of HPV are associated with genital warts vs cervical cancer? - ✔✔Genital warts--> types 6 & 11 Cervical cancer--> types 16 & 18 Presentation of chancroid - ✔✔Caused by H ducreyi (gram negative rod); causes painful ulcer & possible inguinal lymphadenopathy that can cause significant inguinal swelling (bubo formation). Tx= ceftriaxone, erythromycin, or azithromycin Two causes of painless genital ulcers (not including syphilis) - ✔✔Lymphogranuloma venereum (L1/2/ serotypes of Chlamydia)--> painless ulcer that develops into significant inguinal buboes after 1 month. Granuloma inguinale (from Klebsiella granulomatus); painless ulcer w/beefy red base & irregular borders; Giemsa stain shows Donovan bodies (red encapsulated intracellular bacteria) Treatment for uterine fibroids - ✔✔Follow asymptomatic fibroids w/ultrasound to look for abnormal growth. GnRH agonists temporarily to reduce size (like before surgery). Myomectomy (if women want to retain fertility); hysterectomy (if fertility not an issue). Uterine artery embolization (selectively infarct small fibroids...hig hlikelihood of impaired fertility). **note--> uterine fibroids are estrogen sensitive, so they don't continue to grow after menopause! Main types of benign ovarian masses? - ✔✔Functional ovarian cell (granulosa or theca cell) origin Epithelial cell origin Germ cell origin Follicular cyst (granulosa cyst) Corpus luteum cyst (theca cells) Stromal cell tumor (granulosa, theca,or Sertoli Leydig cells)
