Obstetrics and Gynecology Flashcards Preview

USMLE Step 2 CK > Obstetrics and Gynecology > Flashcards

Flashcards in Obstetrics and Gynecology Deck (29):

When would you offer an external cephalic version

If there is transerse lie or breech presentation at 37 weeks and vaginal delivery is not contraindicated


Diagnosis and treatment of gonorrhea and chlamydia

Dx: nucleic acid amplification test (gold standard) on urine or cervical swab

Empiric: ceftriaxone and azithromycin
Confirmed chlamydia only: azithromycin or doxycycline
Confirmed gonorrhea only: ceftriaxone and azythromycin

Hospitalization and IV cefoxitin or cefotetan plus oral doxycycline if pregnancy, failed outpatient treatment, inability to tolerate oral medications, noncompliant with therapy, severe presentation (e.g. high fever, vomiting), complications (e.g. tubo-ovarian abscess, perihepatitis)


Boggy, tender, globular uterus



Gestational diabetes blood glucose targets and treatment

Fasting ? 95, 1-hr postprandial ? 140, 2-hr postprandial ? 120
Tx: dietary modifications (first line), insulin, metformin, glyburide (second line)


Management of shoulder dystocia

Breath, do not push, lower head of the bed
Elevate legs (McRoberts position)
Call for help
Apply suprapubic pressure
Enlarge vaginal opening with episiotomy


Treatment for spontaneous abortion

Expectant management
Medical induction (misoprostol)
Suction curettage if infection or hemodynamically unstable


Indications for cerclage

History of second trimester delivery
Short cervical length (< 2.5 cm) via TVUS


Evaluation for primary amenorrhea

Pelvic exam or ultrasound
If uterus, check serum FSH
If FSH increased --> karyotype
If FSH decreased --> cranial MRI
If no uterus, check testosterone and do karyotype
If 46XX and normal female testosterone, Mullerian agenesis
If 46XY and normal male testosterone, androgen insensitivity syndrome


Diagnosis and management of pre-eclampsia

Risk factors: nulliparity, maternal age < 18

Dx: new-onset HTN > 20 weeks plus proteinuria and/or end-organ damage
Severe features: SBP > 160 or DBP > 110 (2 times > 4 hours apart), thrombocytopenia (< 100,000), increased creatinine (> 1.1), increased transaminases, pulmonary edema, visual or cerebral symptoms

Management: delivery > 37 (> 34 weeks if severe), magnesium sulfate (seizure prophylaxis), antihypertensives (IV labetalol, IV hydralazine, PO nifedipine)

Complications: fetal growth restriction/low birth weight, placental abruption, DIC, eclampsia


Treatment for ectopic pregnancy

Stable: methotrexate
Unstable: surgery


HELLP syndrome

Hemolysis, elevated liver enzymes, low platelets

Systemic inflammation and activation of complement and coagulation systems --> platelets rapidly consumed, microangiopathic hemolytic anemia causes hepatocellular necrosis and thrombi in the portal system causes elevated liver enzymes, liver swelling, and liver distension of hepatic capsule


Types of fetal growth restriction

Definition: ultrasound-estimated fetal weight < 10th percentile
Symmetric: global growth lag caused by chromosomal abnormalities or congenital infection in the first trimester
Asymmetric: "head-sparing" growth lag caused by uteroplacental insufficiency or maternal malnutrition in the 2nd/3rd trimester


Management and complications of intrauterine fetal demise

Management: dilation and evacuation or vagnial delivery is 20-23 weeks, vaginal delivery if ? 24 weeks
Complication: coagulopathy after several weeks of fetal retention


Diagnosis and management of placenta previa

Dx: transabdominal followed by transvaginal ultrasound, placenta within 2 cm of internal cervical os
Tx: pelvic rest (no intercourse, digital exams), scheduled cesarian at 36-37 weeks


Risk factors for cerebral palsy

Intrauterine growth restriction
Intrauterine infection
Antepartum hemorrhage
Placental pathology
Multiple gestation
Maternal alcohol consumption
Maternal tobacco use
Tx: physical, occupational, and speech therapies, baclofen and botulinum toxin for spasticity


Vaccines contraindicated during pregnancy

Live attenuated influenza


When to administer Rhogam?

For Rh- mothers, administer at 28 weeks or if spontaneous abortion or trauma

If baby Rh+, administer within 72 hours after delivery


Clinical features and treatment of magnesium toxicity

Magnesium sulfate is given to prevent eclamptic seizures and for fetal neuroprotection; renal insufficiency can cause hypermagnesemia
S&S: loss of deep tendon reflexes, somnolence, respiratory depression
Tx: IV calcium gluconate bolus


Treatment for lactation suppression

Comfortable, supporting bra
Avoidance of nipple stimulation and manipulation
Application of ice packs to the breasts
NSAIDs to reduce inflammation and pain


Management of hypothyroidism during pregnancy

Increase levothyroxine dose 30% at the time pregnancy is detected; adjust every 4 weeks based on TSH and total T4 using pregnancy-specific norms

The increasing need for thyroid hormone replacement is due to increased estrogen which induces increased levels of thyroxine-binding globulin decreasing the available T4/T3.


Management of Erb-Duchenne palsy

Damage to C5, C6, C7; a/w shoulder dystocia

Tx: gentle massage and physical therapy to prevent contractures

Prognosis depends on whether damage resulted from mild nerve stretching or compression as opposed to severe rupture or avulsion

80% of patients have spontaneous recovery within 3 months; surgical intervention can be considered if no improvement by age 3-6 months


Bartholin gland cysts

Soft, mobile, nontender masses located at the base of the labia majora (4 and 8 'oclock positions)

Tx: observation (if asymptomatic), I&D followed by Word catheter placement


Management of preterm labor

Preterm labor = regular contractions that cause cervical change < 37 weeks

Management: betamethasone, penicillin if GBS+ or unknown, tocolytics if < 34 weeks, magnesium sulfate if < 32 weeks


Types and causes of decelerations of fetal heart monitor

Early decelerations --> fetal head compression

Variable decelerations --> umbilical cord compression/prolapse, oligohydramnios

Late decerlations --> uteroplacental insufficiency


Treatment of condyloma acuminata

Caused by HPV 6, 11

Chemical: podophyllin resin, trichloroacetic acid

Immunologic: imiquimod

Surgical: cryotherapy, laser therapy, excision


Types of antepartum fetal surveillance

Nonstress test (reactive = > 2 accelerations)

Biophysical profile (normal = 8-10)

Contraction stress test (normal = no late or recurrent variable decelerations)

Doppler sonography of the umbilical artery to assess growth restriction (normal = high-velocity diastolic flow)


Parts of the biophysical profile

Each of the following are graded as normal (2 points) or abnormal (0 points) for a total of 10 points

1. Nonstress test (normal = > 2 accelerations)
2. amniotic fluid volume (normal = single pocket > 2x1 cm or amniotic fluid index > 5)
3. Fetal movements (normal = > 3 general body movements)
4. fetal tone (normal > 1 episode of flexion/extension of fetal limbs or spine)
5. fetal breathing movements (normal = > 1 breathing episode for > 30 seconds)


Side effect of epidural anesthesia


Anesthesia blocks sympathetic fibers --> decreased vascular tone --> vasodilation and venous pooling --> decreased venous return --> decreased cardiac output

Managment: prevention with IV fluids, positioning patient on left side to increase venous return, IV fluid bolus, vasopressors


Management of Kumpke palsy

damage to C8 and T1; a/w shoulder dystocia; may manifest as ipsilateral Horner syndrome

Tx: gentle massage and physical therapy to prevent contractures

In most cases function returns within a few months; surgical intervention if no improvement by age 3-9 months