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• Preterm Premature Rupture of Membranes (PPROM) is a preterm pregnancy with premature rupture of membranes before the onset of contractions - Preterm (<37 weeks) AND premature rupture - Premature rupture of membrane (PROM) is a term pregnancy (≥37w) with rupture of membranes before the onset of contractions
• What is the estimated week of gestation if the measured fundal height is at the navel? 20 weeks fundal height ~ gestational age ± 3 weeks
• What is the likely diagnosis? Cellulitis a
• What is the likely diagnosis? Scabies
• What is the likely diagnosis? Molluscum contagiosum
• What birth weight is considered macrosomia? >4000g (or >8lbs 13oz)
• Before which gestational age should betamethasone (BMZ) always be given to mothers admitted to labour & delivery? Before 34 weeks Watch associated Bootcamp video
• What is the most common etiology of spontaneous abortion (SAB)? Fetal chromosomal abnormalities (~60%) Particularly autosomal trisomies
• How does prior C-section and placenta previa change the risk of placenta accreta? Increase accreta = placenta stuck on uterus ... gotta go digging deeper for gold if there's prior scarring/bad implantation
• Placenta accreta occurs when placental villi attach directly onto the myometrium leading to inability to separate from uterus during delivery
• What are Braxton Hicks contractions? Uterine contractions w/o cervical changes Irregular, weak uterine contractions that do not increase in frequency, intensity or duration. These contractions may be noticed by the patient starting in the second trimester. They usually occur infrequently (typically ≤ 2/hour), last for up to 1 minute, and are not associated with cervical changes or descent of the presenting part. They typically stop with rest, walking, and/or a change in position.
• What is the classic triad of signs of placental separation (during delivery)? Cord lengthening Gushing of vaginal blood Uterine fundal rebound
• What is the nitrazine test for rupture of membranes (ROM)? pH indication of amniotic fluid; alkaline amniotic fluid turns it blue False-positive results can result from blood, semen or vaginitis contamination
• If rupture of membranes (ROM) has occured, you can confirm with the following: - Vaginal pooling via speculum exam - Nitrazine positive vaginal fluid - Ferning appearance on glass slide Nitrazine test turns blue Ferning on glass slide You will see pooling of vaginal fluid in the posterior vagina. With this, you either have a choice grabbing the fluid and put it on the slide to look for ferning, or perform nitrazine test and see if it turns blue, which is normal y
• "What are the ""3 P's"" for the causes of abnormal labor? Power (uterine contractions) Passenger (fetus) Passage (pelvis)" - Power is the only thing we can modify (oxytocin); we can't do much about the other two - Consider C-section for the other two if arrest of active phase is diagnosed
• What is the cause of late FHR decelerations? Uteroplacental insufficiency and insufficient fetal blood flow/oxygenation - Hence can be caused by abruptio placentae, excessive uterine contractions, maternal hypotension, maternal anaemia, IUGR - Associated with progressive fetal hypoxia and acidemia
• What constitutes a reactive nonstress test (NST)? 2 FHR accelerations in 20 minutes - NST is recorded for a maximum 40 minutes - Remember, a FHR acceleration is an increase by ≥ 15 bpm for ≥ 15 seconds
• What is the contraindication for Prostaglandin F2α (hemabate) in postpartum hemorrhage? Asthma Smooth muscle constrictor for decreasing uterine bleeding but also bronchoconstricts
• What is the most common cause of abnormal uterine bleeding (AUB)? Anovulatory cycles - 2/2 PCOS, peri-menopausal anovulation - Especially around menarche or menopause
• What is the most common cause of abnormal uterine bleeding in postmenopausal women? Atrophic vaginitis Due to the loss of estrogen after menopause and the subsequent drying and atrophy of vaginal dermal tissue; treat with estrogen cream; however, still get biopsy to r/o endometrial cancer
• What malignancy must be ruled out in all postmenopausal women with uterine bleeding? Endometrial carcinoma - Ruled out with endometrial biopsy - Vaginal bleeding in a postmenopausal woman is cancer until proven otherwise
• What is the treatment for anovulatory bleeding? Medroxyprogesterone acetate (Provera) or OCPs Provera = medroxyprogesterone; these will take control of the axis, thus regulating the cycle
• What procedure offers a definitive diagnosis for endometriosis? Diagnostic laparoscopy Only way to visualize the ectopic endometrial tissue and adhesions
• Which antidiabetic is used to treat infertility in polycystic ovarian syndrome (PCOS)? Metformin helps with inducing ovulation (clomiphene is better, though)
• What class of drugs is known to prevent ovarian cancer? OCPs decrease damage to ovaries from ovulation
• How is ectopic pregnancy diagnosed? Quantitative β-hCG Ultrasound When β-hCG reaches 3,500 IU/L, a gestational sac is often visible via transvaginal ultrasound. Lack of this visualization is worrisome for ectopic pregnancy. However, β-hCG can be low in ectopics, so do an U/S anyway.
• What is the medical treatment for ectopic pregnancy? Methotrexate Gestational size must be < 3 cm, β-HCG < 5000, and no fetal heart tones must be present (success of methotrexate requires early gestation)
• What is the only IUD that can increase bleeding? Paragard (copper IUD) Hence, avoid it in women with heavier menses
• Which imaging study is most sensitive for pyloric stenosis? Ultrasound U/S can also detect pyloric muscle diameter and thickness
• What is the diagnosis in an infant with an omega-shaped epiglottis and collapse of the supraglottic structures during inspiration? It is improved by placing the infant in the prone position. Laryngomalacia MCC of chronic stridor in infants Osmosis:
• Follicular conjunctivitis and pannus (neovascularization) formation in the cornea are seen with trachoma
• What is the most important first step in management for patients with Somatic Symptom Disorder? Schedule regular monthly visits to establish a single physician as the primary caregiver - This minimizes unnecessary testing - Schedule individual psychotherapy and do not hospitalize the patient!
• A young pt presents w/ cough, wheezing, and dyspnea. His PMHx is significant for allergic rhinitis, nasal polyps, and eczema. Physical exam reveals wheezing in the BL upper lobes and a prolonged expiratory phase. What is the most likely Dx? Asthma
• Asthma key points: - seen in younger pts, especially if there is a hx of allergies/eczema - wheezing, dyspnea, cough (remember, wheezing is simply the flow of air through a constricted airway) - PE: wheezing, prolonged expiratory phase - PE: hyperinflation & hyperresonance are ominous signs and signify greater airway constriction - PE: severe dyspnea (accessory muscle use and/or no lung sounds) = status asthmaticus = medical emergency - chronic vs. acute management has big difference.
• What is the best diagnostic test for asthma? PFTs showing ↓ FEV1/FVC
• Which antipsychotic medication occasionally causes hypothermia by disrupting thermoregulation and the body's shivering mechanism? Fluphenazine Fluphenazine freezes (causes hypothermia)
• What cause of infectious, nonbloody diarrhea (w/o WBC in the stool) is associated with camping/hiking and unfiltered fresh water? Giardia lamblia
• The most likely atypical antipsychotic to cause tardive dyskinesia is risperidone, and the least likely is clozapine Whisper to the 1st generation room It is good management to replace an alternative antipsychotic with clozapine if tardive dyskinesia is present if antipsychotic dose reduction is not possible due to risk of worsening psychosis
• ASCUS and HPV (+) — what is best next step? Colposcopy Atypical squamous cells of undetermined significance
• At 24-hours, a newborn should have produced 3-4 stools and 6 wet diapers