婦產科 - 產

53 flashcards · Other · by Wanying Koh

1. pregnancy trimesters

   First Trimester (0 to 13 Weeks) Second Trimester (14 to 26 Weeks) Third Trimester (27 to 40 Weeks)

2. spiral a. remodelling to form uteroplacental circulation occurs at what weeks

   initial: first week after implantation second stage: week 12 - 20

3. twin-to-twin transfusion occurs in which type of twin pregnancy weight difference between two twins

   monochorionic diamniotic pregnancies 15-20% weight difference (+ HCT difference >5 g/dL)

4. pregnancy changes in mother's body Hct PaCO2 WBC HR

   Hct - dec (physiological anemia) PaCO2 - dec WBC - inc (RBC inc) HR - inc (C/O inc, SV inc)

5. different gender twins only seen in which type of twin pregnancy

   DIchorionic DIamniotic (can be same gender too) (other types of twin preg - only SAME gender)

6. banana sign indicative of

   cerebellum 向 foramen magnum 突出

7. Dx

   holoprosencephaly failure of the prosencephalon (the embryonic forebrain) to sufficiently divide into double lobes of the cerebral hemispheres. The result is a single-lobed brain structure and severe skull and facial defects.

8. chromosome anomaly 分別為什麼疾病 trisomy 18 trisomy 21 trisomy 13

   Turn Edward Down 13, 18, 21 18 - Edward's syndrome 21 - Down syndrome 13 - Turner syndrome

9. cystic hygroma present in which chromosome anomaly syndromes

   most common: trisomy 13 (Turner syndrome) 2nd most common: trisomy 21 (Down syndrome)

10. lemon sign indicative of

    open spina bifida

11. 產檢時加做 fragile X syndrome amniocentesis 的 indication

    previous birth(s) of fragile X syndrome children (done at wk 16-20)

12. 47, XXY 什麼疾病 是否跟父母年齡有關 是否會增加risk of subsequent child having dz 如何檢查prior to birth

    Klinefelter's syndrome 可能相關 不會 amniocentesis during wk 16-20 of pregnancy: check for chromosome anomaly

13. 絨毛膜穿刺 chorionic villus sampling vs 羊膜穿刺 amniocentesis done during which weeks of pregnancy

    amniocentesis complications 早期破水 1-2% 流產 0.5% 絨毛膜羊膜炎 <0.1%

14. 產前遺傳診斷 indications

    recurrent miscarriage possible genetic abnormalities in current birth

15. intracytoplasmic sperm injection (ICSI) 是否會提高 genetic abnormalities 高齡父親 doesnt increase risk of down's syndrome

    yes true

16. small for gestational age definition

    weight < 10th percentile

17. fetal ascites 跟什麼最相關

    degree and severity of anemia (fetal ascites often the first finding in hydrops fetalis)

18. Turner syndrome gender incidence chromosome abnormality 是否是 the only monosomy that can survive till birth

    affects females 1/2500 Karyotype 45,X (monosomy X), or mosaicism (XO/XX, 45,X/46,XY) true

19. Turner syndrome s/s neck what type of congenital heart dz 身材 intelligence levels 是否有男生生殖器

    webbed neck 頸部水腫 coarctation of aorta 身材矮小 (adults won't be taller than 150cm) NORMAL intelligence levels 45,X/46,XY may have normal male phenotype, or underdeveloped male gonadal stts

20. 如何分辨 a/B thalassemia what chromosomes

    thalassemia Hb electrophoresis test for HbA2 a thalassemia: HbA2 <3.5% // chromo 16 B thalassemia: HbA2 >3.5% (Big Bro > 大哥 >) // chromo 11

21. 分辨 B thalassemia major / minor / intermedia

    major: HbF 90-96% intermedia: HbF （沒有太高） minor: HbA2 >3.5% (沒有達 HbF)

22. this is measurement of bloodflow of umbilical a. or umbilical v.?

    umbilical artery

23. vaginal bleeding + abd pain, low BP + Couvelaire uterus Dx

    Dx: placental abruption 胎盤剝離 vaginal bleeding + abd pain ---> 也可以是 uterine rupture DD: 無 Couvelaire uterus (胎盤剝離 causing 積血滲入uterus muscle layer --> bluish color)

24. placental abruption associated w which comorbidities 子宮內番 凝血障礙 產褥感染 子宮乏力

    coagulopathy

25. risk factors of neonatal respiratory distress syndrome

    male premature white race (use glucocorticoids prior to birth --> dec NRDS and severity)

26. maternal RF of shoulder dystocia

    obesity 產前 or GDM advanced maternal age hx of shoulder dystocia 妊娠增加體重多 (nulliparity NOT a risk factor)

27. threatened abortion 一定會cause abortion?

    only 5-10% abortion 大部分可以繼續 pregnancy, good prognosis

28. fetal intrauterine growth restriction + amniotic fluid index 3.2cm at week 38 no uterine contractions Rx

    admit and induce labor IUGR --> indication for labor induction AFI 3.2cm --> oligohydraminios (normal 5-25cm)

29. labor induction indications

    intrauterine growth restriction post-term pregnancy (>42weeks) 早期破水 preeclampsia eclampsia 胎死腹中 GDM

30. 置入性胎盤分類 accreta increta percreta

31. most common peripartum hysterectomy complication

    transfusion fever bladder injury

32. delayed placental 排出的 tx

    uterine massage + manual extraction 手伸入子宮腔

33. puerperal fever most common reason most serious reason

    泌尿道感染 C-section

34. if RF present for GDM, early screening required?

    yes , prior to week 24

35. GDM screening/confirmatory tests need fasting?

    initial 50g one-hour OGTT - no need fasting confirmatory 100g three-hour OGTT - NEED fasting

36. GDM tx

    metformin, glyburide, insulin therapy

37. GDM causes neonates blood abnormalities RBC bilirubin glucose calcium

    polycythemia (RBC inc hyperbilirubinemia (bil inc hypoglycemia (dec --> due to in uterus 暴露在高血糖，造成胎兒hyperinsulinemia, 出生後 hypoglycemia --> NOT mother hyperinsulinemia calcium dec 也會 ARDS

38. amniotic fluid embolism causes

    rapid labor meconium-stained amniotic fluid tears into uterine veins 纏成延滯 催生藥 vacuum use C-section preeclamsia advanced maternal age multiparity cervix laceration/產婦受傷 前置胎盤 胎盤剝離 (preterm delivery NOT risk factor)

39. trauma tx during pregnancy need to put pt in L decubitus position? chest compressions location need to be shifted upwards defibrillation dosing and location same as normal

    supine is ok same location as normal same dosing and location as normal

40. intrahepatic cholestasis of pregnancy cause of fetal demise due to which: AST cholesterol bile acids direct bilirubin

    bile acids accumulate in fetus or amnion fluid

41. pituitary prolactin adenoma dx

    clinical s/s (HA, visual disturbances) MRI visual field checks CANNOT use prolactin levels (as already high during pregnancy)

42. aspirin can be used in pregnancy under what conditions

    aspirin cannot be used in 一般 pregnancy , especially during 3rd trimester 除非 high risk for eclampsia recurrent miscarriage coagulopathy 放過 heart stent

43. in pregnancy: best meds for HTN GDM

    HTN - CCB, B blocker, hydralazine (CANNOT use ACEI/ARB) GDM - insulin

44. valvular disease in pregnancy, highest risk of death

    mitral stenosis

45. MgSO4 and muscle relaxants in surgery

    MgSO4 can increase neuromuscular block effects need to decrease dosage of muscle relaxants

46. normal amniotic fluid pH

    7-7.5 (nitrazine test + --> turn blue --> rupture of membrane) vaginal pH - 4.5-5.5

47. twin-to-twin transfusion syndrome

    <20wk /// >20wk donor: AF <2cm /// - recipient: AF >8cm /// AF >10cm

48. higher ectopic pregnancy risk salpingostomy or methotrexate tx

    salpingostomy

49. neural tube defect -most common at which spine level

    lumbar-sacral level

50. fundus at 2-3 fingers below xiphoid process (胎頭下降) 1 finger below xiphoid process 3 fingers below xiphoid process umbilicus umbilicus - pubic symphysis midpoint pubic symphysis

    40 36 28 20 16 12-14

51. androgen affects what hair

    pubic hair some girls may also have mustache, chin hair, chest, abdomen, back - affected by androgen. hair on hair, eyebrows, eyelash NOT affected

52. fetomaternal hemorrhage dx

    KB-test: mother's RBC not dyed (ghosts), dye foetal RBC - hemoglobin F

53. asymptomatic UTI in pregnancy ABx

    amoxicillin amoxicillin/clavulanate (Curam) cefuroxime