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51 Cards in this Set
- Front
- Back
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Q300. Physio Changes in Pregnancy - Endocrine
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A300. Increased thyroid blood flow => thyroid increased in size; increased - TBG; increased bound T3 & T4, and total; unchanged - free T4; increased - total & free cortisol; adrenal gland unchanged in size; HPL - maintains fetal glucose levels => prolonged postprandial hyperglycemia, fasting hyperinsulinemia,; fasting Hypertriglyceridemia, exaggerated starvation ketosis
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Q301. Physio Changes in Pregnancy - GI
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A301. N/V resolves by 14-16 weeks; increased acid reflux; aspiration; constipation; predisposed to gallstones
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Q302. Physio Changes in Pregnancy - Hematology
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A302. "physiologic anemia" - increased plasma vol (50%) & RBC mass (30%) => decreased H&H => normal pregnancy Hb is 10-12; WBC increased; ESR increased; platelets unchanged; hypercoagulable state; increased factors 7, 9, 10 & C; MC nonobstetric cause of postpartum death - thromboembolic disease
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Q303. Physio Changes in Pregnancy - Musculoskeletal
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A303. Increased motility – sacroiliac, sacrococcygeal, pubic joints
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Q304. Physio Changes in Pregnancy - Pulmonary
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A304. TV - increased; RR unchanged; TV x RR = VE (min. ventilation) so, VE increased; decreased - RV (IRV, ERV, TLC); increased - alveolar & arterial PO2; decreased - alveolar & arterial PCO2; so, resp. alkalosis => increased renal loss of bicarb => alkaline urine; "dyspnea of pregnancy" - from increased VE and decreased PCO2
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Q305. Physio Changes in Pregnancy - Renal
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A305. Increased renal blood flow => kidneys increased in size (until 3 mos. postpartum); ureters - diameter increased, right > left (due to progesterone); dilation of collecting system, can be mistaken for hydronephrosis; increased - GFR (by 50%), renal plasma flow, Cr clearance, aldosterone, all leads to - decreased BUN, Cr, uric acid; urine glucose increased because reabsorb threshhold decreased
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Q306. Physio Changes in Pregnancy - Skin
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A306. striae – abdomen, breast, thighs; spider angiomas; palmar erythema; hyperpigmentation - linea nigra – midline, chloasma – face, perineum; diastasis recti
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Q307. Physio Changes in Pregnancy - Uterus
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A307. 12 weeks, uterus - contracts anterior abdo wall, displaces intestines, felt above symphysis pubis; Braxton Hicks - irreg painless contractions throughout pregnancy => freq., rhythmic in 3rd trimester (false labor)
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Q308. Physio Changes in Pregnancy - Vagina
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A308. Thick, acidic secretions; Chadwick's sign
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Q309. Prenatal Care and Nutrition - Estimated Delivery Date; Gestational Age
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A309. Nagele's rule - EDD; 1st day of LMP + 9 mos.+7 days; GA determined by - uterine size; heart tones (10 weeks); quickening (17-18 weeks); US - crown rump (5-12 weeks); biparietal diameter (20-30weeks)
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Q310. Prenatal Care and Nutrition - Weight Gain
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A310. gain 25-35 lbs. obese to gain less; thin women to gain more; need 2,000-2,500 kcal/day; need additional - 300 kcal/day during pregnancy; 500 kcal/day in breastfeeding
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Q311. Prenatal Care and Nutrition - Nutrition
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A311. Prenatal vitamins; 1 mg/day of folate; 30-60 mg/day of elemental iron
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Q312. Prenatal Labs - Initial Visit
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A312. CBC; UA/UC; pap smear; blood type, Rh; Ab screen; rubella Ab titer; HBV surface Ag test; syphilis screen - RPR, VDRL; cervical gonorrhea and; chlamydia cultures; PPD; glucose testing; sickle prep; HIV
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Q313. Prenatal Labs - 15-19 weeks
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A313. Maternal serum AFP (MSAFP) or triple screen - MSAFP, estriol, B-hCG; offer amniocentesis if >35 y/o
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Q314. Prenatal Labs - 18-20 weeks
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A314. US - GA (if needed); fetal anatomy; amniotic fluid volume; placental location
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Q315. Prenatal Labs - 26-28 weeks
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A315. Glucose loading test (GLT); HCT
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Q316. Prenatal Labs - 28 weeks
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A316. Rhogam (if needed)
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Q317. Prenatal Labs - 32-36 weeks
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A317. HCT; screen for GBS - if positive - PCN during labor; cervical chlamydia and gonorrhea cultures if need
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Q318. AFP - How to measure
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A318. MSAFP at 15-20 weeks; results reported as - MoMs (multiples of the median)
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Q319. AFP - What does elevated MSAFP mean
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A319. > 2.5 MoMs: gastroschisis, omphalocele, multiple gestation, incorrect gestational dating, fetal death, placental abnorm – abruptio, open neural tube defects – anencephaly, spina bifida; MCC of high - date is wrong, if high - get US (check date); if true age more than thought - why "high" value, if still 15- 20 weeks, repeat MS-AFP; if date is right and no explanation on US - amnio for AF-AFP & acetylcholinesterase; high levels - open NTD; normal levels - still at risk for: IUGR, stillbirth, preeclampsia
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Q320. AFP - Abnormally low MSAFP means
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A320. < 0.85 MoM; MCC of low - date is wrong, check date - get triple marker screen; if not available - then get US; if true age less than thought - why "low" value, if still 15-20 weeks, repeat MS-AFP; if date is right and no explanation on US - amnio for karyotype; sensitivity to detect chromosome abnorm increased by triple screen; trisomy 18 - all 3 are low; trisomy 21 - AFP and estriol low, B-hCG high
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Q321. Amniocentesis - When done; Risks; Why done
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A321. 15-17 weeks; US-guided needle; risks - fetal-maternal hemorrhage; fetal loss; why done - > 35 y/o at time of delivery; Rh-sensitized pregnancy; evaluate fetal lung maturity in conjunction with abnorm triple screen
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Q322. Chorionic Villus Sampling - What is it; Advantages; Risks
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A322. Transvaginal or transabdom aspiration; advantages - as accurate as amniocentesis; available 10-12 weeks (amniocentesis - 15-17 weeks) Risks; fetal loss 1%; can't Dx neural tube defects; if do < 9 weeks - association with limb defects
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Q323. Percutaneous Umbilical; Blood Sampling (PUBS) - What is it
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A323. Done in 2nd & 3rd trimesters; fetal karyotyping; fetal infection; evaluate genetic diseases; evaluate fetal acid-base status; assess & Tx Rh isoimmunization; erythroblastosis fetalis
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Q324. Labor - First Stage
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A324. Latent - from onset of labor to 3-4 cm dilation; active - from 4 cm to complete cervical dilation (10 cm); prolonged with cephalopelvic disproportion
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Q325. Labor - Second Stage
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A325. From complete cervical dilation to delivery
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Q326. Labor - Third Stage
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A326. From delivery of infant to delivery of placenta; uterus contracts to establish hemostasis
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Q327. Nonstress Test (NST) - What is it
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A327. Left lateral supine, FHR - monitored by Doppler, correlate with spontaneous fetal movement as reported by mom, unrelated to contractions; normal - accelerate 15 bpm above baseline for 15 seconds; reactive test - 2 accelerations in 20 mins. repeat weekly; nonreactive - 80% false positive, do vibroacoustic stimulation. if persistently nonreactive, do BPP; no accelerations can be due to: GA < 30 weeks, fetal sleeping, fetal CNS anomalies, moms' sedative admin, fetal hypoxia
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Q328. Contraction Stress Test (CST)- What is it
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A328. Used in high-risk pregnancies; assess uteroplacental dysfunction; monitor FHR during contraction; positive - repetitive late decelerations during at least 3 contractions in 10 mins. > 36 weeks - deliver; < 36 weeks - do BPP, negative - no late decelerations, fetus well, repeat weekly
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Q329. Vasa Previa - What is it; Risk Factors
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A329. Fetal vessels cross internal os; if they rupture - exsanguinate very fast => fetal death Risk factors:; accessory placental lobes; multiple gestation; velamentous insertion of umbilical cord
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Q330. Vasa Previa - History/PE
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A330. Classic triad - ROM; painless vaginal bleeding, then fetal bradycardia
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Q331. Vasa Previa - Dx
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A331. Antenatal US with color Doppler; confirm - after delivery; exam of placenta & fetal vessels; rarely confirm before delivery
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Q332. Vasa Previa - Tx
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A332. Immediate C-section
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Q333. Uterine Rupture - What is it; Risk Factors
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A333. Complete separation of wall of uterus with or without expulsion of fetus; complete or incomplete rupture before or during labor Risk factors:; previous classic uterine incision; myomectomy; excessive oxytocin stimulation; grand multiparity; marked uterine distention
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Q334. Uterine Rupture - History/PE
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A334. Nonreassuring fetal monitoring; vaginal bleeding; abdom pain; change in uterine contractility
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Q335. Uterine Rupture - Dx
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A335. Surgical exploration of uterus
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Q336. Uterine Rupture - Tx
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A336. Immediate C-section; uterine repair - stable, young; hysterectomy - unstable or no desire for more kids
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Q337. Multiple Gestation - Complications
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A337. Nutritional anemia; preeclampsia; preterm labor; malpresentation; C-section; postpartum hemorrhage
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Q338. Multiple Gestation - History/PE
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A338. Hyperemesis gravidarum - more common; from high levels of B-hCG; uterus larger than dates; MS-AFP very high
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Q339. Multiple Gestation - Tx:; Antepartum; Intrapartum; Postpartum
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A339. Antepartum - iron and folate, monitor BP, serial US; intrapartum - vaginal - if both cephalic, C-section - if 1st noncephalic, controversial - if 1st cephalic and 2nd not; postpartum - watch for postpartum hemorrhage from uterine atony (due to overextended uterus)
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Q340. A pt on birth control has amenorrhea, what is the most common cause?
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A340. Pregnancy, no contraception is 100%
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Q341. Si/sx of pregnancy
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A341. amenorrhea,; morning sickness,; weight gain,; linea nigra,; melasma,; fetal heart tones,
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Q342. Hegar's sign
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A342. softening and compressibility of the lower uterine segment
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Q343. Chadwick's sign
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A343. dark discoloration of the vulva and vaginal walls
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Q344. Define macrosomia
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A344. a newborn that weighs more than 4 kg (9 lbs), usually because of maternal diabetes
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Q345. It's the first prenatal visit. What do you order?
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A345. Pap smear,; UA,; CBC,; type and screen,; syphilis,; rubella,; glucose if risk factors present,; GC and chlamydia for every teenager and patient with risk factors
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Q346. When do you screen for maternal diabetes?
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A346. At the first visit if risk factors present. If not, screen at 24-28 weeks.
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Q347. How do you screen for maternal diabetes?
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A347. Get a fasting serum glucose and glucose levels 1-2 hours after an oral glucose load.
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Q348. When do you do a triple screen?
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A348. 16-20 weeks
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Q349. How does Down Syndrome present on triple screen?
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A349. low AFP,; low estriol,; high hCG
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Q350. When can fetal heart tones be picked up by doppler?
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A350. 10-12 weeks
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