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Step III

Step III - Ob/Gyn 1

QuestionAnswer
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