USMLE Step 2 OB/GYN Exam Questions 1426 Questions with 100% Correct Answers – COMPLETE SOLUTION

USMLE Step 2 OB/GYN Exam Questions 1426 Questions with 100% Correct Answers – COMPLETE SOLUTION Document Content and Description Below USMLE Step 2 OB/GYN Exam Questions 1426 Questions with 100% Correct Answers – COMPLETE SOLUTION Q001. what is the genital system developed from? - A001. mesoderm Q002. what portion of the e mbryo gives rise to the reproductive system? - A002. Urogenital ridges Q003. what portion of the ovary contains the developing follicles? - A003. cortex Q004. what is the first indication of the sex in the embryo? - A004. formation of the tunica albuginea Q005. the primordial germ cells can be identified during the 4th week of development where? - A005. Yolk sac Q006. Embryo:; what results following the absence of the uterus? - A006. Paramesonepheric (Mullerian)ducts degenerate Q007. Embryo:; what results in the formation of a double uterus?; technical name of this? - "A007. Inferior part of the Mullerian ducts do not fuse; ""Uterus didelphys""" Q008. Embryo:; what results in the absence of the vagina? - A008. Vaginal plate does not develop Q009. Embryo:; what results in vaginal atresia? - A009. Vaginal plate does not canalize Q010. Embryo:; what does the labia minora develop from? - A010. Urogenital folds Q011. Embryo:; what does the labia majora develop from? - A011. Labioscrotal swelling Q012. Embryo:; what does the clitoris develop from? - A012. Genital tubercleQ013. Embryo:; what does the fallopian tube develop from? - A013. Mullerian ducts Q014. Embryo:; what (2) structures does the vagina originate from? - A014. Urogenital sinus; Mullerian ducts Q015. what are the innominate bones composed of?; (3) - A015. Ileum,; Ischium,; Pubis Q016. what separates the false pelvis from the true pelvis? - A016. Linea terminalis Q017. which pelvis does the fetus pass during labor? - A017. True pelvis Q018. what plane separates the false pelvis from the true pelvis? - A018. Pelvic Inlet Q019. at what plane does the arrest of fetal descent occur? - A019. Plane of Least diameter Q020. what is the value of the obstetric conjugate? - A020. 10.0 - 11.0 Q021. what is the value of the transverse diameter of the pelvic inlet? - A021. 13.5 Q022. what is the value of the Bispinous diameter of the pelvic midplane? - A022. 10 Q023. what is the transverse diameter of the Greatest Diameter? - A023. 12.5 Q024. what is the most common pelvic type? - A024. Gynecoid Q025. what is found in the labia majora but not the labia minora? - A025. Hair folliclesQ026. Name type of epithelium:; Bartholin ducts - A026. Transitional Q027. Name type of epithelium:; Skene duct - A027. Transitional Q028. Name type of epithelium:; Urethra - A028. Transitional Q029. Name type of epithelium:; Endocervical canal - A029. Columnar Q030. what is the name of the part of the uterus where the fallopian tubes enter? - A030. Cornu Q031. what are the (2) main anatomic divisions of the uterus? - A031. Corpus,; Cervix Q032. what (2) arteries supply the uterus? - A032. Uterine artery,; Ovarian artery Q033. where do the uterine veins enter the venous system? - A033. Internal iliac veins Q034. what portion of the fallopian tube boarders the ovary? - A034. Infundibulum Q035. what ligament supports the ovary? - A035. Broad ligament Q036. before puberty, what is the ratio of the body of the uterus and the cervix length? - A036. 0. Q037. what is the portion of the broad ligament b/t the ovaries and fallopian tube? - A037. Mesosalpinx Q038. what ligaments prevent uterine prolaspe? - A038. Uterosacral ligaments Q039. when do Oogonia stop developing? - A039. just before birthQ040. how are trisomy pregnancies detected? - A040. Chorionic villus sampling Q041. Genetics Dx:; microcephaly, distinctive facial features - A041. Cri-du-chat Q042. what occurs with failure of testicular development in a XY zygote? - A042. patient develops as a female with uterus, tubes, vagina, and vulva (no ovaries) Q043. what is the most common cause of mental retardation? - A043. Fragile X syndrome Q044. what amount of folic acid should be taken by a pregnant woman who already has a child with a neural tube defect? - A044. 4 mg Q045. when is the developing brain most susceptable to teratogens? - A045. 3 - 16 weeks Q046. when is the developing neural tube most susceptable to teratogens? - A046. 2 - 4 weeks Q047. when is the developing heart most susceptible to teratogens? - A047. 3 - 6 weeks Q048. Cause of Teratogenic effect:; intrauterine growth retardation, fetal hypotension, pulmonary hypoplasia - A048. ACEi Q049. Cause of Teratogenic effect:; skeletal defects, cleft palate - A049. Antiepileptics Q050. Cause of Teratogenic effect:; CNS and ear defects, cleft lip/palate, cardiac and great velles defects; (2) - A050. Cyclophosphamide; Accutane Q051. Cause of Teratogenic effect:; nasal hypoplasia, vertebral abnormalities, CNS malformations - A051. WarfarinQ052. Cause of Teratogenic effect:; limb reduction, VSD, GI atresia - A052. Thalidomide Q053. Cause of Teratogenic effect:; vaginal and cervical cancer, genital tract abnormalities - A053. DES; (Diethylstilbestrol) Q054. Cause of Teratogenic effect:; staining of primary teeth - A054. Tetracycline Q055. what mouth problem increases with pregnancy? - A055. Gingival Disease Q056. how does glucose cross the placenta? - A056. faciliated diffusion Q057. how do amino acids cross the placenta? - A057. active transport Q058. how does pregnancy effect appetite?; gastric motility? cause - A058. apetite Increases; motility Decreases; caused by increased progesterone Q059. how does pregnancy affect GB emptying? - A059. emptying is delayed Q060. how does pregnancy affect liver enzymes? - A060. Increase "Q061. when does ""morning sickness"" begin?" - A061. 4 - 8 weeks Q062. what causes Ptyalism? - A062. inability for patient to swallow normal amounts of saliva Q063. 2 occult heart problem that can be exacerbated by pregnancy - A063. #1 mitral valve stenosis: A-fib, SOB, dry cough (see hx of travel & rheumatic disease) #2 mitral valve prolapse: ejection murmur w/ a clickQ064. how many additional calories is allowed daily with pregnancy? - A064. 300 Q065. transit time in the stomach and small intestines increases by what percent in the second and third trimesters? - A065. 15 - 30% Q066. during pregnancy how does the tone of the gastroesophageal sphinctor change? - A066. it Decreases; (GERD increases) Q067. Definition:; pregnancy-related vascular swelling of the gums - A067. Epulis Q068. what pulmonary measurement is decreased throughout pregnancy? - A068. Carbon dioxide pressure Q069. what pulmonary measurement is decreased in late pregnancy? - A069. Functional Reserve Capacity; (FRC) Q070. what is the maternal acid-base balance in pregnancy? - A070. mild Respiratory Alkalosis because minute resp has changed Q071. the Tidal volume in pregnancy increases by what percent? - A071. 30 - 40% Q072. in a normal singleton pregnancy what is the percent increase of maternal blood volume? - A072. 0.45 Q073. in what position is maternal BP the highest? - A073. Seated Q074. what is the BP change in the lateral recumbent position of the inferior arm of a pregnant mother? - A074. BP in inferior arm is higher then superior armQ075. pregnancy-assoc systolic ejection murmurs are heard best where? - A075. over left upper sternal boarder Q076. compensation for the occlusion of the inferior vena cava by the pregnant uterus is accomplished by shunting blood through what? - A076. Paravertebral collateral circulation Q077. what causes inferior vena cava syndrome? - A077. compression by the gravid uterine corpus Q078. what causes the decrease in peripheral vascular resistance during pregnancy? - A078. increased Progesterone Q079. plasma volume begins to increase at the sixth week of pregnancy and reaches its maximum at what time? - A079. 30 - 34 weeks Q080. what hematologic parameter is decreased in pregnancy? - A080. Hematocrit Q081. what lab value related to iron is increased in pregnancy? - A081. Total Iron-binding capacity Q082. what CV risk increases with pregnancy? - A082. thromboembolism Q083. what does lack of maternal iron ingestion during pregnancy result in? - A083. Maternal Anemia Q084. what renal functions increase during pregnancy?; (3) - A084. GFR,; Renal Plasma Flow,; Renin Q085. during pregnancy, what happens to the ureter?? - A085. Dilation of the ureter more right than left: (can be mistaken as hydronephrosis) acog: uterus & ovarian vein sits on it first aid: high level of progesteroneQ086. what (3) urinary labs decrease in pregnancy? - A086. Creatinine,; Uric Acid,; Blood Urea Nitrogen Q087. Definition:; change in facial pigmentation during preganacy - A087. Chloasma Q088. what causes blurred vision during pregnancy? - A088. swelling of the lens Q089. what percent of total CO is channeled to the uterus during pregnancy? - A089. 0.2 Q090. what is the main metabolic change that occurs with pregnancy? - A090. Hyperglycemia "Q091. what causes the ""hemorrhoids"" that develop late in pregnancy?" - A091. elevated pelvic venous pressure Q092. what is the thyroid change in pregnancy? - A092. none...Euthyroid Q093. what is Diastasis recti? - A093. Midline separation of the rectus muscles Q094. how does the CO2 gradient b/t fetus and mother change in the later half of pregnancy? - A094. Increases Q095. how much does the BUN fall in the first trimester? - A095. 0.25 Q096. what is the urinary protein loss in pregnancy? - A096. 100 - 300 mg/24 hrs Q097. how long after the delivery will the hair loss assoc with pregnancy return? - A097. 6 - 12 months Q098. when does breast enlargement occur with pregnancy? - A098. first trimesterQ099. the vision changes in pregnancy assoc. with increased thickness of the cornea regresses within what time? - A099. 6 - 8 weeks postpartum Q100. why is supplemental vitamin K given to newborns? - A100. b/c of their fetal liver immaturity in the immediate newborn Q101. what is the change in serum bicarb levels during pregnancy? - A101. significantly lower Q102. the umbilical blood flow represents about what percent of the combined output of both fetal ventricles? - A102. 0.4 Q103. the fetal kidney forms urine at what rate? - A103. 400 - 1200 mL/day Q104. in the later half of pregnancy, umbilical blood flow is what? - A104. 300 mL/mg/minute Q105. what is the normal constant fetal heart rate? - A105. 120 - 180 bmp Q106. maternal diastolic BP and Mean Arterial volume nadir when? - A106. 16 - 20 weeks Q107. an increase in breast volume of what percent is common in pregnancy? - A107. 25 - 50% Q108. Definition:; the patient's initial perception of fetal movement; at how many weeks gestation is it normally felt? - A108. Quickening; felt at 20 weeks Q109. Definition:; congestion and a bluish color of the vagina - A109. Chadwick sign Q110. Definition:; a softening of the cervix on physical exam - A110. Hegar signQ111. when are fetal heart tones in a normal pregnancy hear by simple auscultation? - A111. 18 - 20 weeks Q112. commonly used electronic Doppler devices will detect fetal heart tones at how many weeks? - A112. 12 weeks gestation Q113. home urine preg tests become positive approx how many weeks following the first day of the last menstrural period? - A113. 4 weeks Q114. how high should progesterone be for a viable uterine pregnancy? - A114. > 25 ng/mL Q115. intrauterine pregnancy is detectable by transvaginal US when the beta-HCG is greater then what? - A115. mIU/mL Q116. in what percent of pregnant women is rubella titer positive? - A116. 0.85 Q117. specific screening for treponema is required following what positive test? - A117. Rapid Plasma reagin Q118. when can maternal alpha-fetoprotein testing be done? - A118. 15 - 18 weeks Q119. in a normal singleton pregnancy, from approx 16 - 18 weeks gestation until 36 weeks, the fundal height in cm is equal to what? - A119. the number of weeks gestational age Q120. what is the prescribed recommendation for weight gain during pregnancy? - A120. normally: 25 - 35 underweight BMI <20: 30-40 lbs normal wt BMI 20-25: 25-35 lbs overweight BMI 25-30: 15-25 lbs obese BMI >30: 10-20 lbsQ121. Definition:; when the patient reports a change in the shape of her abdomen and that the baby has gotten less heavy - A121. Lightening "Q122. what is the direct result of ""lightening""?" - A122. decreased fundal height Q123. a breech presentation occurs in what percent of deliveries? - A123. 0.035 Q124. estimation of gestional age by US is least accurate at what time during pregnancy? - A124. 36 - 38 weeks Q125. what is the normal fetal heart rate at term? - A125. 120 - 160 bpm Q126. a reactive nonstress test is characterized by a fetal heart rate increase of how many beats per minute? - A126. 15 Q127. what is an abnormal contraction stress test? - A127. fetal heart rate decreases in response to uterine contraction Q128. what is the number of contractions in a ten minute window that must occur for a contraction stress test to be measurable? - A128. 3 Q129. a biophysical profile in which there is one or more episodes of fetal breathing in 30 min, 3 or more descrete movements in 30 min, opening/closing of the fetal hand, a nonreactive nonstress test and no pockets of amnioticfluid greater then 1 cm would have a total score of what? - A129. 6 Q130. exclusive of the fetal HR reactivity, what is the biophysical profile considered most important? - A130. qualitative amniotic fluid volume Q131. repetative decelerations following each contraction when three contractions occur in a 10-min window is an indication of what? - A131. nonreassuring fetal statusQ132. tests of fetal lung maturity are generally used when delivery of a fetus is contemplated at a gestational age of less then how many weeks? - A132. 36 Q133. at how many weeks does phospholipid production increase resulting in a positive phosphatidylglycerol test? - A133. 32 - 33 weeks Q134. during a normal pregnancy, the patient should be encouraged to engage in non-weight-bearing activity at what interval? - A134. three times a week Q135. in pregnancy, psyllium hydrophilic mucilloid is used to manage what? - A135. constipation Q136. because of the position of the fetus, round ligament pain is more pronounced where? - A136. on the right side Q137. which Pregnancy Risk Factor indicates that human controlled studies do not exist? - A137. PRF B Q138. which Pregnancy Risk Factor means that the drug should only be given if the benefits outweigh the risks? - A138. PRF C Q139. which Pregnancy Risk Factor means that there is evidence that the fetus is at risk? - A139. PRF D Q140. which Pregnancy Risk Factor indicates that animal and human studies demonstrate fetal abnormalities, such that the risk outweighs any possible benefit? - A140. PRF X Q141. Definition:; progressive effacement and dilation of the cervix, resulting from rhythmic contractions of the uterine musculature - A141. Labor Q142. Definition:; Uterine contractions without cervical dilation - A142. False Labor; (Braxton-Hicks contractions)"Q143. what is ""bloody show"" associated with at term?" - A143. extrusion of endocervical gland mucous Q144. lower abdominal and groin pain are usually assoc with what type of labor? - A144. False labor Q145. Definition:; the descent of the fetal head into the pelvis and the changing contour of the abdomen late in pregnancy - A145. Lightening "Q146. what is the definition od ""fetal lie""?" - A146. relationship of the long axis of the fetus with the maternal long axis "Q147. what is the ""Presentation"" determined by?" - A147. portion of the fetus lowest in the birth canal "Q148. what is ""Position"" defined as?" - A148. relationship of the fetal presenting part of the right and left side of the pelvis Q149. the descent of the presenting part is identified by which Leopold maneuver? - A149. Third maneuver Q150. the location of the small parts is determined by which Leopold maneuver? - A150. Second maneuver Q151. determining what occupies the fundus is accomplished by what Leopold maneuver? - A151. First maneuver Q152. identifying the cephalic prominence is accomplished by what Leopold maneuver? - A152. Fourth maneuver "Q153. what is the most common ""fetal lie"" found during early labor?" - A153. Longitudinal"Q154. what is the most common ""fetal presentation"" found in early labor?" - A154. Vertex Q155. Definition:; the turning of the fetal head toward the sacrum - A155. Anterior Asynclitism Q156. what is the station of a patient in labor with the vertex at the level of the ischial spines? - A156. Zero Q157. At Zero station, where is the biparietal diameter of the fetal head in relation to the pelvic inlet? - A157. Passed below the pelvic inlet Q158. the clinical significance of the fetal head presenting at zero station is that the biparietal diameter of the fetal head has negotiated what? - A158. Pelvic inlet Q159. what is cervical effacement? - A159. the degree of cervical thinning Q160. how is the First Stage of Labor described? - A160. Onset of labor to full cervical dilation Q161. how is the Second Stage of Labor described? - A161. Complete dilation of the cervix to delivery of the infant Q162. how is the Third Stage of Labor described? - A162. Delivery of the infant to delivery of the placenta Q163. how is the Fourth Stage of Labor described? - A163. period extending up to two hours after delivery of the placenta Q164. the Active Phase of the first stage of labor is defined to begin when the cervix is how dilated? - A164. 4 cm Q165. what describes the cardinal movement of labor that allows the smaller diameter of the fetal head to present to the maternal pelvis? - A165. FlexionQ166. what describes the movement of the fetal head as it reaches the introitus? - A166. Extension of the fetal head "Q167. what describes the movement of the fetal head to ""face forward"" relative to the shoulders?" - A167. External rotation Q168. Definition:; movement of the presenting part through the birth canal - A168. Descent Q169. Times in Nulliparas:; 1) Latent phase of stage 1; 2) Active phase of stage 1; 3) Second stage of labor - A169. Nulliparas:; Latent phase of stage 1: 6.5 hours; Active phase of stage 1: 4.5 hours; Second stage of labor: 1 hour Q170. Times in Multiparas:; 1) Latent phase of stage 1; 2) Active phase of stage 1; 3) Second stage of labor - A170. Multiparas:; Latent phase of stage 1: 5 hours; Active phase of stage 1: 2.5 hours; Second stage of labor: 0.5 hours Q171. during the active phase of labor, if electronic monitoring is not used, the fetal heart rate should be auscultated how often? - A171. every 15 min Q172. during the second stage of labor, if electronic monitoring is not used, the fetal heart rate should be auscultated how often? - A172. each uterine contraction Q173. an external tocodynamometer provides information about what? - A173. Contraction frequency Q174. the sensory nerves form the lower birth canal and the perineum enter the spinal cord where? - A174. S2 - S4 Q175. What is an epidural best used for specifically compared to a spinal and pudendal? - A175. Epidural:; Active phase of labor and delivery; Spinal:; short-term for vaginal and abdominal delivery; perineal anesthesia for vaginal deliveryQ176. what is the major cause of maternal mortality from OB anesthesia? - A176. Aspiration of vomitus Q177. what is the MC result of compression of the fetal head during delivery? - A177. Molding Q178. what is the usual postpartum blood loss in a vaginal delivery? - A178. 500 mL Q179. what is the First-degree vaginal laceration at birth? - A179. involves the vaginal mucosa and perineal skin Q180. what is the Second-degree vaginal laceration at birth? - A180. involves the underlying fascia or muscle but not rectal sphinctor or rectal mucosa Q181. what is the Third-degree vaginal laceration at birth? - A181. extends through rectal sphinctor but not into the rectum Q182. what is the Fourth-degree vaginal laceration at birth? - A182. extends into the rectal mucosa Q183. during the delivery of the fetal head the likelihood of laceration or extension of episiotomy is decreased by what maneuver? - A183. Ritgen maneuver Q184. how many minutes should one wait for the spontaneous extrusion of the placenta? - A184. 30 minutes Q185. IUGR - What is it - A185. Wt. < 10th percentile; suspect if > 4 between fundal ht. (cm) and GA (weeks); asymmetric - 80%, placenta mediated: HTN, poor nutrition, maternal smoking; symmetric - fetal problem: cytogenetic, infection, anomalies Q186. IUGR - Dx - A186. Serial exams,; US every 3-4 weeks; NST, CST, BPP; DopplerQ187. IUGR - Tx - A187. Steroids; consider early delivery - esp. asymmetric; continuous FHR monitoring during labor; C-section if decelerations persist Q188. Oligohydramnios - What is it - A188. Excess loss of fluid - ROM (amniotic leak); decreased in fetal urine produced; fetal urinary tract abnorm; obstructive uropathy; chronic uteroplacental insufficiency; maternal HTN; severe toxemia; AFI < 5 on US Q189. Oligohydramnios - Complications - A189. Pulmonary hypoplasia; club foot; flattened facies; IUGR; fetal distress; fetal hypoxia - (umbilical cord compression) Q190. Oligohydramnios - Tx - A190. Rule out inaccurate gestational dates; Tx underlying cause,; if possible, amnioinfusion - NaCl Q191. Polyhydramnios - What is it - "A191. Excess of fluid; AFI > 20 on US; Maternal DM; ""baby can't swallow"": esoph atresia, TEF, duodenal atresia; anencephaly; multiple gestations; twin-twin transfusion syn" Q192. Polyhydramnios - Dx/Tx; complications? - A192. US for fetal anomalies; glucose test; Rh screening; Tx depends on cause cause preterm labor, cord prolapse, fetal malpresentation Q193. What is ABO incompatibility; what does it cause in newborns? - A193. Type O mom with type A & B baby; newborn will mild hemolytic disease; asymptomatic or mild anemia that resolves Q194. Rh Isoimmunization - What is it - A194. Ag protein on RBC; AD; maternal anti-Rh IgG ab => erythroblastosis fetalis; 2nd pregnancy - fast production by memory plasma cells Q195. Rh Isoimmunization - History/PE; What do you ask on History - A195. Ask about - prior delivery of Rh+ child, ectopic pregnancy, abortion, blood transfusions, amniocentesis, abdom trauma Q196. Rh Isoimmunization - Evaluation - A196. Maternal - on 1st visit, check ABO & Rh;if Rh- then check dad's Rh,; if dad Rh+ then, check mom's titer at 26-28 weeks; if pos., test serially for high titers (> 1:16), fetal - amniocentesis or US-guided umbilical bld sample, blood type, Coombs' titer, bilirubin level, HCT, reticulocytes; postnatally - fetal cord blood, Rh,HCT Q197. Rh Isoimmunization - Tx? What is the KB test? - A197. Prevention - . 1. at 28 weeks, if mom Rh- and dad Rh+ or status unknown, give RhoGAM (IgG anti-D); 2. at pospartum, if baby Rh+, give RhoG too; 3. give RhoGAM to Rh- moms if have had abortion, ectopic pregnancy, amniocentesis, vaginal bleeding, placenta previa, placental abruption, *Kleiheur-Betke KB test: check what post-partum dose of RhoG is needed to prevent sensitization (titer higer than 1:16) Q198. Rh Isoimmunization: reading if mom is sensitized; tx - Complications - A198. sensitized Rhmoms with titers > 1:16 monitor closely, serial US, amniocentesis in severe cases - enhance lung maturity, intrauterine blood transfusion, init preterm delivery complication: Fetal hypoxia = lactic acidosis = heart failure = hydrops fetalis & death; kernicterus; prematurity Q199. Gestational Trophoblastic Dis - What is it - A199. Prolif of trophoblastic tissue, range of diseases, benign or malignant; risk factors: age < 20 or > 40, def. in folate or B-carotene; hydatidiform mole - 80%, benign, may progress to malignant; complete, sperm fertilize empty ovum, 46XX; paternal derived incomplete/partial fertilized by 2 sperm, 69XXY; has fetal tissue; choriocarcinoma; placental site trophoblastic tumor Q200. Gestational Trophoblastic Dis- History/PE - A200. History - 1st trimester uterine bleeding; hyperemesis gravidarum; preeclampsia-eclampsia <24 weeks; excessive uterine enlargement; hyperthyroidism; PE - no fetal heartbeat, enlarged ovaries with b/l theca-lutein cysts, expulsion of grapelike cluster, blood in cervical os Q201. Gestational Trophoblastic Dis- Dx - "A201. High B-hCG (> 100,000 mlU/mL); ""snowstorm"" on pelvic US; no fetus; CXR - may have lung mets"Q202. Gestational Trophoblastic Dis- Tx - A202. D&C; monitor B-hCG; no pregnancy for 1 yr; if malignant - methotrexate, dactinomycin; residual uterine disease - hysterectomy Q203. Gestational Trophoblastic Dis- Complications - A203. Malignant GTD; pulmonary or CNS mets; trophoblastic PE, acute respiratory insufficiency Q204. Placenta Abruptio - What is it - A204. Premature separation of normally implanted placenta; any degree of separation; MCC of late-trimester bleeding; MCC of painful late-trimester bleeding Q205. Placenta Abruptio - Risk factors - A205. HTN; abdominal/pelvic trauma; tobacco; coke; previous abruption; premature membrane rupture; rapid decompression of; overdistended uterus Q206. 36 year old G2P1 35 weeks vaginal bleeding & constant back pain, contractions q 1-2 mins, cervix closed; FHR 160 minimal variablilty, dx? - A206. Abruptio placenta *abd or back pn*, FHR abnormality, (dark red) vaginal bleeding Q207. Placenta Abruptio - Dx - A207. Mainly clinical (US sensitivity 50%); check for retroplacental clot Q208. Placenta Abruptio - Tx - A208. Mild - admit, stabilize, IV, fetal monitoring, type and cross blood, bed rest; moderate to severe - immediate delivery; if both stable: amniotomy, vaginal delivery; if distress: C-section Q209. (uw) 36 year old G1P0 38 weeks sudden vag bleeding + severe abd pn. Urinalysis 3+ protein. Greatest risk of developing: a. DIC b. intra-abd hemorrhage c. retained placenta d. septic shock e. umbilical cord prolpase - A209.a. DIC abruptio placenta complications: 1. Hemorrhagic shock 2. DIC > ATN 3. fetal hypoxia; 4. couvelaire uterus Q210. Placenta Previa - What is it - A210. Abnorm implant of placenta:; total - covers internal os; partial - partially covers; marginal - at edge of os; low-lying - near os without reaching it Q211. Placenta Previa - Risk factors - A211. Prior C-sections; multiparity; advanced maternal age; multiple gestation; prior placenta previa Q212. Placenta Previa - Sxs - A212. Usually first occurs in late preg; painless, bright red bleeding; may be heavy; usually no fetal distress Q213. Placenta Previa - Dx - A213. US Q214. Placenta Previa - Management - A214. No vaginal exam; premature fetus - stabilize; tocolytics (MgSO4); serial US; detect fetal lung maturity - by amnio and augment; Delivery indicated if - persistent labor, life-threatening bleeding, fetal distress, fetal lung maturity, 36 weeks GA; deliver by C-section; vaginal - lower edge of placenta > 2cm from internal os Q215. Placenta Previa - Complications - A215. Increased risk of pl. accreta; vasa previa; preterm delivery; PROM; IUGR; congenital anomalies Q216. PROM - What is it - A216. ROM before onset of labor; > 37 weeks gestation; may be due to - vaginal or cervical infections; abnorm membrane physiology; cervical incompetence Q217. PPROM (preterm PROM) - What is it; Risk factors - A217. ROM < 37 weeks gestation risk factors:; low socioeconomic status; young maternal age; smoking; STDsQ218. Prolonged ROM - What is it - A218. ROM > 24 hours prior to labor Q219. PROM - History/PE - A219. Gush of clear or blood-tinged vaginal fluid; may have uterine contractions Q220. PROM - Evaluation - A220. Sterile speculum exam - amniotic fluid (in vaginal vault); meconium; vernix caseosa; positive nitrazine paper test; positive fern test; US - assess fluid volume; cultures; smears; no digital vaginal exam; check for chorioamnionitis - fetal heart tracing; maternal temp; WBC count; uterine tenderness Q221. PROM - Tx - A221. Balance risk of infection vs. fetal immaturity (pre or post week 34) if no sign of infection - 1. if no contractions, then tocolytics: B agonists, MgSO4, Ca2+ ch blocker, NSAID (indomethacin also close PDA) 2. prophylactic Antibiotics 3. lung development: corticosteroids; if signs of infection or fetal distress - Antibiotics, induce labor Q222. PROM - Complications - A222. Increased risk of; preterm L&D; chorioamnionitis; placental abruptio; cord prolapse Q223. Preterm Labor - What is it; Risk factors - A223. Onset of labor bet. 20-37 weeks; primary cause of neonatal M&M; risk factors - multiple gestation, infection, PROM, uterine anomalies, previous preterm L or D, polyhydramnios, placental abruptio, poor maternal nutrition, low socioeconomic status; Most patients have no identifiable risk factors Q224. Preterm Labor - History/PE - A224. May have menstrual-like cramps; onset of low back pain; pelvic pressure; new vaginal discharge or bleedingQ225. Preterm Labor - Dx - A225. Regular contractions >3, 30 sec. each, over 30 min. concurrent cervical change; sterile speculum exam; US; UA/UC; cultures for - chlamydia, gonorrhea, GBS Q226. Preterm Labor - Tx - A226. Hydration; bed rest; tocolytics; steroids; GBS prophylaxis - PCN or ampicillin Q227. Preterm Labor - Complications - A227. RDS; IVH; PDA; NEC; ROP; BPD; death Q228. Fetal Malpresentation - What is it; Risk factors - A228. Any presentation not vertex (Normal is vertex); MC malpresentation - breech Risk factors; prematurity; prior breech delivery; uterine anomalies; poly- or oligohydramnios; multiple gestations; PPROM; hydrocephalus; anencephaly; placenta previa Q229. Fetal Malpresentation - What are the subtypes - A229. Frank - thighs flexed and knees extend; footling - 1 or both legs extended below the butt; complete - thighs and knees flexed Q230. Fetal Malpresentation - Dx - A230. Leopold maneuver Q231. Fetal Malpresentation - Tx - A231. Follow external version - risks of placental abruptio, cord compression; prepare for emergency C-sect; elective C-section; breech vaginal delivery only if delivery imminent Q232. Postpartum Hemorrhage - What is it; MCC; MC Risk Factor - A232. > 500 mL for vaginal delivery, > 1000 mL for C-section; MCC - bleeding at placental implantation site; MC risk factor - uterine atony due to overdistention Q233. Postpartum Hemorrhage - Dx - "A233. Palpation of soft, enlarged, ""boggy"" uterus; explore for lacerations and retained placental tissues" Q234. Postpartum Hemorrhage - Tx - A234. Bimanual uterine massage; oxytocin infusion; methergine - if not HTN; prostin (PGF2a) - if no asthmaQ235. Mastitis - What is it - A235. Cellulitis of perigland tissue; caused by - nipple trauma from breastfeeding & staph from baby's nostrils => nipple ducts Q236. 36 year old right breast pain x 2 ds, fever, muscle ache, fatigue; use breast pump, fever 38.8 (101.9), beast erythema, tender, upper outer quadrant, no fluctuance, right axillary lymphadenopathy, NBS? a. continue breast feeding, abx b. continue breast feeding, mammography c. stop breast feeding, abx d. stop breast feed, mammograph - A236. a. continue breast feeding & abx; pt has mastitis Inflammatory breast cancer has skin thickening & dimpling Q237. Mastitis -Tx - A237. Continue breastfeeding!; po Antibiotics - dicloxacillin or cephalexin PCN, erythro; incise and drain abscess (if present) Q238. 32 year old G1P1 left breast pain & swelling, breast-feeding, hx of fibrocystic breast disease, patch of erythema from areola to lateral edge of breast, 3 cm, fluctuance; NBS? - A238. Needle aspiration & abx; incision & drainage only if no response to aspiration Q239. Sheehan's Syndrome - What is it - A239. Postpartum pituitary necrosis; pituitary ischemia & necrosis => ant. pituitary insuff. due to massive obstetric blood loss & hypovol shock; decreased prolactin Q240. Sheehan's Syndrome - History - A240. No lactation; menstrual disorder; fatigue; loss of pubic & axillary hair Q241. Postpartum Fever- What is it - A241. Genital tract infection; temp >= 38 C at least 2 of 1st 10 postpartum days; not including 1st 24 hrs. Q242. Postpartum Fever- Risk Factors - A242. MC - endometrial infection; C-section; emergent Csection; PROM; prolonged labor; multiple intrapartum vag exams; intrauterine manipulationsQ243. Postpartum Fever- Causes (7 W's) - A243. Wind - atelectasis, pneumonia; water - UTI; wound - incision, episiotomy; walk - DVT, PE; wonder drug; womb - endomyometritis; weaning - breast engorgement, abscess, mastitis Q244. Postpartum Fever- Dx - A244. UA/UC; BC; pelvic exam - rule out hematoma; rule out lochial block Q245. Postpartum Fever- Tx - A245. Admit; broad-spectrum IV Antibiotics - clindamycin, gentamicin until afebrile for 48 hrs. if complicated - add ampicillin; if 3 drugs not effective after 48 hrs. - consider other Dxs Q246. Breastfeeding - What inhibits prolactin release; what horm