AMCB Study Material With Complete Solution

Methergine - Answer 0.2 mg IM May repeat in 5 min Then q 2-4 hr Onset of action: 2-5 min Peaks @ 20-30 min *CI in HTN/pre-e* Hemabate - Answer 250 mcg IM May repeat q 15-90 min, x 8 doses if needed Peaks @ 30 min *CI in asthma* Misoprostol (Cytotec) - Answer 600-800 mcg SL or 800-1000 mcg per rectum x 1 dose Onset of action: 3-5 min Peaks @ 40-60 min (rectal); @ 30 min (SL) TXA - Answer 1 gm IV, may repeat after 30 min. Inhibits fibrinolysis so has potential risk of thrombosis. *CI w/clotting disorders!* Trichomoniasis: Tx during pregnancy - Answer Metronidazole 2 g PO × 1 during any trimester. Trichomoniasis: tx (not in preg) - Answer Metronidazole 2 g PO x 1 Tinidazole 2 g PO x 1 or Metronidazole 500 mg PO BID x 7 days Bacterial Vaginosis: Tx during pregnancy - Answer Metronidazole 500 mg PO BID x 7 days or Metro gel 0.75% vag suppos @ hs x 5 days Other alternatives: Tinidazole 2 g PO x 2 days Tinidazole 1 g PO x 5 days Clindamycin 300 mg PO BID x 7 days Clindamycin ovules 100 mg intravaginally @ hs x 3 days Vulvovaginal candidiasis - Answer Fluconazole 150 mg PO x 1 *(avoid in pregnancy)* Rx intravaginal: Butoconazole, terconazole OTC intravaginal: Clotrimazole, miconazole, tioconazole Chlamydia: Tx (not in pregnancy) - Answer Azithromycin 1 g PO x 1 or Doxycycline 100 mg PO BID x 7 days or Erythromycin 500 mg PO QID x 7 days Chlamydia: Tx in pregnancy - Answer Azithromycin 1 g PO x 1 Amoxicillin 500 mg PO TID x 7 days Erythromycin 500 mg PO QID x 7 days Doxyclycline= CI in pregnancy Condyloma Acuminata/Anogenital Warts: Tx in pregnancy - Answer Wart removal may be considered Imiquimod=low risk but should be avoided d/t scarcity of data Podofilox, podophyllin, sinetechins should be avoided! Provider administered tx of warts/HPV - Answer -Cryotherapy w/liquid nitrogen- repeat 1-2 weeks x 6 wks -Surgical removal w/tangential shave excision, curretage, laser, or electrosurgery -Trichloracetic or bichloroacetic acid Patient applied treatment for warts/HPV - Answer (use only on external warts) -Imiquimod 3.75%-5% cream-- safety in preg unknown -Podofilox 0.5% gel/sol'n--safety in preg unknown -Sinecatechins 15% ointment Firstline Tx for BP >160/110 - Answer Labetalol Hydralazine Nifedipine *Sodium nitroprusside when HTN resistant to other meds--admin by anesthesia, MFM, etc* AP tx of HIV positive pt - Answer HAART 1. Two nucleoside analogues (zidovudine, didanosine, zalcitabine, or lamivudine) -AND- 2. Protease inhibitor (indinavir, ritonavir, etc) *Start after first tri unless need tx now* # of days after birth it can take for sx's of drug withdrawal in neonates to develop - Answer 14 days Tell me about parvovirus - Answer Parvovirus spreads through respiratory secretions, such as saliva, sputum, or nasal mucus; when an infected person coughs or sneezes; through blood or blood products; and vertically from pregnant person to infant. There is no cure/treatment Most common complication: cholestasis of pregnancy - Answer -occurs in 2nd/3rd tri usually -char. by pruritus and elevation in serum bile acid conc. -onset-- dev of pruritus- may be intolerable; often generalized but predominates on palms and soles of the feet and is worse at night. HIV testing - Answer Antibody testing: 1. screening- EIA or ELISA (checks for proteins the body makes in presence of HIV 2. CDC no longer recommends Western Blot as form of confirmation testing Direct Viral Screens 1. Nucleic acid testing if suspect acute retrovirus syndrome or recent infection 2. Confirm w/subsequent ab testing to document seroconversion TORCH infections - Answer Toxoplasmosis Other Rubella Cytomegalovirus Herpes When is cervical cerclage performed? - Answer 12-24 weeks (some say 16-24 weeks) CL < 20 mm Makena - Answer IM- indicated with HISTORY OF PTB MagSO for fetal neuroprotection @ what gestation? - Answer 24-32w Tocolytics & steroids @ what gestation? - Answer 24-34w When is the presence of FFN normal? - Answer Before 20w and after 37w Vaginal progesterone - Answer @ 16-37 weeks CL < 25 mm (and intact membranes) In the second stage of labor, how frequently should the blood pressure of low-risk women be checked? - Answer Every 15 min Hyperemesis Gravidarum: r/f - Answer Dx of exclusion r/f= poss genetic link, motion sickness, migraines HG: dx criteria - Answer Severe/intractable vomiting, unknown etiology, wt loss of at least 5% of pre-preg wt; ketonuria, e-lyte imb, thyroid and liver abn HG: mgmt/tx - Answer Ginger 1 g/day in divided doses Pyridoxine (B6) 10-25 mg qid or tid (max 200 mg/day) Diclegis (pyridoxine 10 mg + doxylamine 10 mg) Metoclopramide 5-10 mg q 6-8 hrs Promethazine 25 mg q4h rectal suppos Ondansetron Normal MCV - Answer 80-100 Normal RBC - Answer 4-6 million Normal transferrin in first trimester - Answer 254-344 mg/dL hemodynamic changes during the initial postpartum period include: A) elevated cardiac output for as long as 48 hours after the birth. B) decreased white blood count (WBC) during the first 72 hours after the birth. C) elevated blood pressure for 48 hours after the birth. D) decreased urine output for the first 24 hours after the birth. - Answer A) elevated cardiac output for as long as 48 hours after the birth. Presentation of gHTN - Answer New onset BP elevation after 20 WG, w/o proteinuria or severe features. ? Weeks of organogenesis - Answer 3rd-8th wk. By the end, *all major organs are formed except lungs* 4th week gestation - Answer partitioning of the heart, arm and leg buds formed, umbilical cord is "unsheathed" 6th week of gestation - Answer head is larger than body. the heart is 100% formed. fingers and toes present. 12th week of gestation - Answer uterus palpable @ symph pubus, fetus making spontaneous movements 16th week of gestation - Answer can see sex on usn 28th week of gestation - Answer EFW 1100 g; 90% survival rate oligohydramnios: AFI and max deepest vert pocke - Answer AFI<5 -or- max deepest vertical pocket <2 cm Maternal causes of oligo - Answer uteroplacental insufficiency HTN DM drugs (prostaglandin synthesis inhibitors, ACEI's) idiopathic Management of oligohydramnios - Answer -sono for fetal anomalies, growth restriction - NST and AFI (or biophysical profile) once or twice weekly until delivery - del @ 37-38 WG rather than expectant management -amnioinfusion in IP for tx of repetitive variable decels Polyhydramnios: AFI and max deepest vert pocket - Answer AFI >24 cm Max deepest pocket >8 cm Maternal/fetal/placental causes of poly - Answer *fetal esophageal atresia* fetal infection twin-twin transfusion isoimmunization multiple gestation GDM Outcomes of poly - Answer Linked to macrosomia, PTL, increased PPH d/t uterine stretching, increased risk for cord prolapse w/ROM, erythroblastosis Management of poly - Answer tx only if sx and benefits outweigh risks -serial NST/BPP starting @ 34 WG -amnio to decr AFV if severe (>35cm) -indomethacin- impairs prod of lung fluid, incr fluid movement thru fetal membranes, or decr fetal urine prod Chorion - Answer Outermost layer of the two membranes surrounding the blastocyst; then *develops the chorionic villi*.... Chorionic villi forms..... - Answer forms the fetal part of the placenta/pertains to fetal circulation.... establishes connection b/t the endometrium and gives rise to the placenta Syncytiotrophoblast - Answer lining of chorionic villi; produces hCG and human placental lactogen *in contact w/the maternal blood or dicidua* Cytotrophoblast - Answer inner layer of trophoblast Amnion - Answer innermost layer of the fetal membrane @ end of 3rd month, forms the amniochorionic sac- aka- bag of waters Stages of Embryonic Development - Answer zygote blastomeres morula blastocyst -- implants in uterine wall and devs into... (also devs a placenta) ....embryo, then.. fetus Implantation occurs __________ after fertilization. - Answer 6-7 days autosomal recessive - Answer Sickle cell CF Tay Sachs An autosomal recessive trait is expressed only when both copies of the gene are the same. Fetal implications of GDM - Answer IUGR, macrosomia, and polyhydramnios. Common complications in pregnancies w/sickle cell anemia - Answer UTI Infections and pulmonary complications Autosomal dominant disorders - Answer Huntington disease Marfan's Achondroplasia human placental lactogen (hPL) - Answer the placental hormone that inhibits maternal insulin activity during pregnancy stimulates the functional development of the mammary glands hCG - Answer secreted by the placenta to help maintain CL fxn and prod of progesterone Estradiol - Answer Steroid hormone: 17B. Responsible for growth of the uterus, fallopian tubes, vagina, and breast dev Estriol - Answer Steroid hormone: excreted by placenta in pregnancy Progesterone - Answer a steroid hormone released by the CL- preps the uterus for implantation of the fertilized ovum and maintaining the preg Aldosterone - Answer Steroid hormone: regulates the body's sodium and water balance Cortisol - Answer Steroid hormone: plays role in metab of fats, glucose, and proteins. In hormonal contraception all of the following are actions related to estrogen EXCEPT: a. stabilizing the endometrium b. inhibiting the release of LH c. suppressing FSH d. inhibiting the development of a dominant follicle - Answer b. inhibiting the release of LH. This is not an action of estrogen; it is an action of progestins. The primary action of estrogen in hormonal contraception is to stabilize the endometrium, thereby providing cycle control and minimizing breakthrough bleeding. It also suppresses FSH and inhibits development of a dominant follicle. All of the following are complementary or alternative measures that may help a patient with acne except? a. OCP's b. Anti-inflammatory herbs c. Zinc d. Vitamin B6 - Answer a. OCP's.