Ob Exam 3

Front 1

Necrotizing enterocolitis

Back 1

Risk for babies born preterm. Their GI tract is not developed enough, and the lining is still porous. Particles become lodged and decompose, causing gas accumulation in the intestines.

Front 2

Is the risk for necrotizing enterocolitis greater for babies fed with formula, or beast fed?

Back 2

Formula fed

Front 3

Treatment for necrotizing enterocolitis

Back 3

- Putting baby NPO to let gut recover.

- Breastmilk instead of formula when they do eat again.

- Potentially surgery, small bowel resection.

- Probiotics to stimulate good flora.

- Betamethasone in premies to mature gut.

Front 4

What is the concern with the ocular nerve of a preterm infant?

Back 4

The ocular nerve may not be developed enough yet to handle the bright lights of the outside world. Risk for blindness. This is why the NICU should be relatively dark and quiet.

A high O2 level also harms a premature ocular nerve.

Front 5

Will infants of insulin-dependent diabetic mothers typically be large or small?

Back 5

They can be either

Front 6

The critical blood glucose level we want to keep infants above is

Back 6

40 mg/dL

Front 7

Best location for a heel stick on a baby

Back 7

on the outside edges of the heel. The inside has blood vessels and nerves

Front 8

Bilirubin becomes _________ when it binds with ___________, and can then be excreted in the stool

Back 8

conjugated; albumin

Front 9

Why are babies not given ASA for pain?

Back 9

Because it can affect albumin levels

Front 10

What is the preferred analgesic for infants?

Back 10

Tylenol. Not ASA.

Front 11

What drugs can affect albumin levels in the baby

Back 11

ASA, oxytocin, sulfa drugs

Front 12

What can cause a baby to be born with too many RBCs

Back 12

Chronic hypoxia while a fetus, or delayed cord clamping.

Front 13

4 types of jaundice

Back 13

- Physiologic.

- Pathologic.

- Breastfeeding.

- Dehydration/starvation.

Front 14

Bilirubin levels usually peak around _____________

Back 14

2-4 days

Front 15

What racial groups typically tolerate hyperbilirubinemia better?

Back 15

Asians and Native American

Front 16

Phototherapy is indicated if the baby's bilirubin is above

Back 16

15

Front 17

Transfusion is indicated if the baby's bilirubin is above

Back 17

20

Front 18

When does pathologic hyperbilirubinemia occur, compared to breastfeeding hyperbilirubinemia?

Back 18

Pathologic - Onset first day, gets worse.

Breastfeeding - Onset 5 days, peaks around 10-15 days.

Front 19

How is breastfeeding hyperbilirubinemia diagnosed?

Back 19

By briefly stopping breastfeeding and measuring bilirubin. If it's breastfeeding in etiology, the levels will quickly drop after cessation.

Front 20

Why can breastfeeding cause hyperbilirubinemia

Back 20

The lipids in the breastmilk can increase re-absorption of conjugated bilirubin

Front 21

How does phototherapy affect bilirubin levels

Back 21

The light causes conjugation of bilirubin in the capillaries near the skin

Front 22

A baby should be progressing from meconium stools to yellow stools by ____ days

Back 22

5

Front 23

Kernicterus

Back 23

Elevated bilirubin causing neurologic damage

Front 24

Early warning signs of kernicterus

Back 24

Lethargy, poor tone, poor feeding, high pitched cry, jaundice

Front 25

Stages of kernicteurs

Back 25

- Phase 1: first few days of life. Treatable.

- Phase 2: 4-7 days. May still be treatable.

- Phase 3: >1 week. Likely not treatable.

Front 26

Jaundice from hyperbilirubinemia typically starts where

Back 26

High, like in the head, and moves down.

Front 27

Neural tube defects can be prevented by taking what

Back 27

Folic acid/Vitamin B12

Front 28

Effects of increased estrogen early in pregnancy

Back 28

- Softens ligaments and cartilage.

- Increases vascularity of respiratory tract (can cause stuffiness).

- Causes changes in uterus and breast tissues (often making them tender).

Front 29

Effects of increased progesterone early in pregnancy

Back 29

- Softens joints.

- Causes thickening of mucous.

Front 30

Hydroxyprogesterone caproate

Back 30

Used to stop preterm labor and help prevent preterm birth.

Front 31

It is technically possible to excrete colostrum by ___ weeks

Back 31

12

Front 32

Estrogen has what effect on lactogenesis

Back 32

duct proliferation

Front 33

Progesterone has what effect on lactogenesis

Back 33

Develops alveoli, but suppresses milk production

Front 34

During pregnancy, the mother's tidal volume ___________

Back 34

increases

Front 35

During pregnancy, the mother's respiratory rate ______________

Back 35

increases

Front 36

Effect of progesterone in the airway

Back 36

Progesterone relaxes smooth muscle, opening airways

Front 37

What happens to the diaphragm during pregnancy

Back 37

It elevates

Front 38

Anatomic respiratory system changes during pregnancy

Back 38

Diaphragm elevates, causing shortness of breath. A/P diameter increases to compensate for this.

Nasal congestion also occurs from the swelling and enlargement of the mucous membranes from estrogen.

Front 39

Blood volume increases by _____% by the third trimester

Back 39

45

Front 40

BP is lowest during the ________ trimester

Back 40

second

Front 41

Does pregnancy generally cause vasodilation or vasoconstriction?

Back 41

Vasodilation. Progesterone relaxes smooth muscle.

Front 42

Is anemia during pregnancy normal?

Back 42

Yes, it can be. It's easier for the body to increase plasma volume than make new RBCs, so there may be a time as the mother's body is trying to increase blood volume that she's physiologically anemic.

Front 43

Does coagulability increase or decrease during pregnancy?

Back 43

Increase

Front 44

What Hgb level is considered severe anemia

Back 44

< 6.8

Front 45

How does anemia increase risk of cardiac problems during pregnancy?

Back 45

Less oxygen-carrying capacity > increased cardiac output to make up for it > heart working harder, more stress

Front 46

Progesterone has what effect on GI motility?

Back 46

Decreases it. Progesterone decreases peristalsis.

Front 47

Is glycosuria normal in pregnancy?

Back 47

Yes, it can be. Tubular reabsorption is impaired.

Front 48

Why are UTIs more common during pregnancy?

Back 48

Anatomic changes make the urethra more straight, making it easier for bacteria to move up it.

Front 49

Recommended weight gain for a mother starting out at a normal bodyweight

Back 49

25-35 lbs

Front 50

Recommended weight gain for a mother who is already overweight starting out

Back 50

15-25 lbs

Unless they're not just overweight but obese, and then it's <15 lbs.

Front 51

Recommended weight gain for a mother who is starting out underweight

Back 51

28-40 lbs

Front 52

What type of particles are most likely to cause problems causing necrotizing enterocolitis

Back 52

Small, high-osmolarity molecules

Front 53

If an early delivery is anticipated, what can be given before birth to help reduce risk for necrotizing enterocolitis?

Back 53

Betamethasone

Front 54

What kind of environment do you want for a preterm infant?

Back 54

Dark, quiet, similar to that of the womb.

Front 55

What effect can maternal diabetes have on the infant following delivery?

Back 55

Hypoglycemia. Baby might be making a lot of insulin during pregnancy to compensate for high circulating levels of glucose. After cord is cut > lots of excess insulin > blood sugar drops sharply.

Front 56

Bilirubin binds to ___________ in order to be excreted

Back 56

albumin

Front 57

What drugs can interfere with bilirubin binding to albumin?

Back 57

Sulfas, aspirin, and oxytocin.

Front 58

What percentage of Kernicterus is preventable?

Back 58

100% of it

Front 59

Increased estrogen will _________ levels of cortisol

Back 59

Increase

Front 60

Couvade syndrome

Back 60

Also called sympathetic pregnancy. Where the partner of the pregnant mother experiences some of the same symptoms as her.

Front 61

How do physical risks in pregnancy compare between a 20-year-old, and a 16-year-old, assuming good prenatal care for both?

Back 61

It's about the same

Front 62

Increased maternal age is associated with __________ rate of chromosomal abnormalities

Back 62

increased

Front 63

An ultrasound can judge gestational age to within _____________ if done in the first trimester

Back 63

2 days

Front 64

An ultrasound can judge gestational age to within _____________ if done in the second trimester

Back 64

1 week

Front 65

An ultrasound can judge gestational age to within _____________ if done in the third trimester

Back 65

2+ weeks

Front 66

"Nagel's rule" to estimate gestational age

Back 66

[Date of last menstrual period] - 3 months + 7 days

Front 67

Fundal height at 20 weeks

Back 67

at umbilicus

Front 68

The top of the fundus should be at the umbilicus by ___ weeks

Back 68

20

Front 69

Past 20 weeks, how quickly will the top of the fundus rise

Back 69

1 cm per week (or 1 finger-breadth per week)

Front 70

erythroblastosis fetalis

Back 70

disorder where mother's immune system kills the fetus's RBCs, resulting in fetal anemia

Front 71

Most common cause of admissions in first trimester pregnancies

Back 71

hyperemesis gravidarum

Front 72

Most common cause of maternal mortality in first trimester

Back 72

ectopic pregnancy

Front 73

Ectopic pregnancy

Back 73

implantation outside of the uterus

Front 74

What diagnostic tests could be used to determine ectopic pregnancy in a patient presenting with abdominal pain?

Back 74

hCG, plus an ultrasound to determine location

Front 75

What drug is often used for ectopic pregnancies?

Back 75

methotrexate

Front 76

Salpingectomy

Back 76

surgical removal of fallopian tubes

Front 77

Gestational trophoblastic disease (GTD)

Back 77

Also called molar pregnancy. Occurs when tissue that would normally become a fetus, instead develops into a growth in the uterus.

Front 78

Molar pregnancy.

Back 78

Caused by an abnormal proliferation of trophoblastic tissue. Instead of forming an embryo, placenta develops growth of grape-like clusters that fill the uterus

Front 79

Partial molar pregnancy

Back 79

Embryo develops, has 69 chromosomes, and lives 8-9 weeks

Front 80

Complete molar pregnancy

Back 80

Ovum has no genetic material. No embryo develops.

Front 81

Signs/symptoms of GTD

Back 81

- Spotty bleeding.

- Passing of hydropic vesicles.

- No FHT.

- High hCG, hyperemesis.

- Elevated BP.

- Very rapid fundal growth.

Front 82

How is a molar pregnancy diagnosed

Back 82

ultrasound

Front 83

Following a molar pregnancy, contraception will be taken for how long?

Back 83

6 months - 1 year

Front 84

Three types of abnormally implanted placentas

Back 84

- Placenta Accreta - slight penetration into myometrium.

- Placenta Increnta - deep penetration into myometrium.

- Placenta percreta - perforation of the uterine wall, potentially into other organs.

Front 85

Type of abnormal placenta implantation characterized by slight penetration into myometrium.

Back 85

Placenta Accreta

Front 86

Type of abnormal placenta implantation characterized by deep penetration into myometrium.

Back 86

Placenta Increnta

Front 87

Type of abnormal placenta implantation characterized by perforation of the uterine wall, potentially into other organs.

Back 87

Placenta percreta

Front 88

Amniocentesis

Back 88

Sampling of a small amount of amniotic fluid from the amniotic sac. This will contain small amounts of fetal tissues, and the fetal DNA can be examined. Often used to look for abnormalities.

Front 89

Maternal Serum alpha-fetoprotein

Back 89

A screening test that examines levels of alpha-fetoprotein in the mother's blood. Used to determine when further testing is necessary. Often done between 15-22 weeks.

Front 90

Mnemonic for potential effects of pre-eclampsia

Back 90

HELLP.

- Hemolysis.

- Elevated LFTs.

- Low platelets.

Front 91

Symptoms of pre-eclampsia

Back 91

- Hyperactive reflexes.

- Headache, often with visual disturbances.

- RUQ pain.

- Seizure.

Front 92

What is used to treat pre-eclampsia

Back 92

Magnesium sulfate by IV to decrease chance of seizure

Front 93

What is used to counteract overdose of magnesium sulfate

Back 93

calcium gluconate

Front 94

Signs of infection in a neonate

Back 94

Lethargy, and hypothermia

Front 95

Nonstress test (NST)

Back 95

Test used to evaluate baby's health in utero. A fetal heart monitor is applied and changes are noted during movement of the baby or during any contractions that occur.

Front 96

How can maternal diabetes affect the amount of amniotic fluid?

Back 96

Polyhydramnios

Front 97

Cold stress leads to

Back 97

hyperbilirubinemia and hypoglycemia

Front 98

Risks of diabetes on neonate

Back 98

RDS, due to decreased surfactant, and hypoglycemia

Front 99

"Honeymoon phase" in a diabetic mother

Back 99

Period of 24-36 hours after delivery where the mother may not require insulin. She will eventually return to her approximate pre-pregnancy baseline.

Front 100

With a T1DM mother, early delivery can result in ________________, while late delivery can result in ___________________

Back 100

RDS/breathing problems, placental issues

Front 101

How would insulin be administered to a T1DM mother during labor?

Back 101

Mom is hooked up to two IVs, one with glucose, one with insulin. Hourly blood glucose checks, with both titrated appropriately.

Front 102

Are oral antihyperglycemic drugs indicated in babies of T1DM mothers?

Back 102

No

Front 103

Are oral antihyperglycemic drugs indicated in babies of T2DM mothers?

Back 103

Yes

Front 104

High blood sugar levels during the first 8 weeks of pregnancy are more likely to result in ___________

Back 104

birth defects

Front 105

Bacterial vaginosis

Back 105

Condition where the normal Lactobacillus flora of the vagina are replaced by other organisms which cause vaginitis

Front 106

What are two drugs often used to treat bacterial vaginosis

Back 106

Azithromycin (single dose, expensive).

Doxycycline (less expensive, but 7 day course).

Front 107

Bacterial vaginosis that is not diagnosed and treated early can lead to what

Back 107

PID

Front 108

Most common organism involved in a yeast infection

Back 108

Candida albicans

Front 109

Only oral agent available for yeast infections

Back 109

Fluconazole

Front 110

A pregnant mother who is hypertensive and has T2DM develops a yeast infection. The doctor plans to treat this with Fluconazole. What is he overlooking?

Back 110

Fluconazole is a pregnancy category C drug, and may cause birth defects. Typically only topical antifungals are used in pregnant women.

Front 111

Most common curable STI in young, sexually-active women

Back 111

Trichomoniasis

Front 112

Newborn risks from trichomoniasis

Back 112

- PROM.

- Pre-term birth.

- Low birth-weight.

Front 113

What percentage of women, and what percentage of men, who have chlamydia are asymptomatic?

Back 113

Women - 3/4.

Men - 1/2.

Front 114

Transplacental inoculation

Back 114

When the fetus can become infected with a pathogen that the mother has. Ex: syphilis.

Front 115

Treatment for syphilis

Back 115

If caught early, often just a single dose of penicillin. If the patient has had it > year, may require IM penicillin once a week for 3 weeks.

Front 116

What are the types of herpes virus, and which is the most common cause of genital herpes?

Back 116

Two types: HSV-1 and HSV-2.

HSV-2 is the most common cause of genital herpes.

Front 117

What does a positive HBsAg test indicate?

Back 117

Acute or chronic Hepatitis B infection.

HBsAg is the surface antigen of the Hep B virus. Means there are virus actively circulating.

Front 118

What does a positive HBsAb test indicate?

Back 118

It means that Hep B antibodies are present, meaning the individual has had prior infection and now has some immunity (or they've received an immunization)

Front 119

Treatment for Hepatitis B

Back 119

No treatment exists for Acute HBV. Antivirals are used for chronic infections.

Front 120

In addition to the Hep B vaccine, newborns born to mothers who have positive HBsAg should receive what?

Back 120

HBIG.

Immunoglobulin.

Front 121

How many total doses of Hep B vaccine should be given?

Back 121

4

Front 122

Chance of a mother giving her baby HIV/AIDS without any treatment to prevent it

Back 122

28%

Front 123

Chance of a mother giving her baby HIV/AIDS with ZDV and a c-section

Back 123

2%

Front 124

Pelvic Inflammatory Disease

Back 124

general term that refers to an infection of the uterus, Fallopian tubes, and other reproductive organs. Ascending infection.

Front 125

PID often begins as

Back 125

an STI

Front 126

At what point during pregnancy do neural tube defects occur?

Back 126

First few weeks

Front 127

Spina bifida

Back 127

Incomplete closing of the backbones and membranes around the spinal cord. Most common site is the lower back.

Front 128

Spina bifida occulta

Back 128

Type of spina bifida with no or only mild signs. Only visible evidence may be swelling, a dimple, or patch of hair on the area.

Front 129

Gastroschisis

Back 129

Condition where the intestines are outside of the abdomen, with no membrane covering them.

Front 130

Oomphalocele

Back 130

Condition where the intestines and/or liver herniate outside of the abdomen. Membrane still covering them.

Front 131

Which type of condition is characterized by the intestines protruding outside of the abdomen, without a membrane covering them?

Back 131

Gastroschisis

Front 132

Which type of condition is characterized by the intestines protruding outside of the abdomen, but with a membrane covering them?

Back 132

Oomphalocele

Front 133

How does circumcision affect rates of UTIs?

Back 133

A historical study showed UTI rates are 12x higher in uncircumcised males. Subsequent study has shown no difference.

Up for debate.

Front 134

Zygote

Back 134

fertilized ovum; single diploid cell

Front 135

What part of the blastocyst will form the placenta

Back 135

trophoblast

Front 136

What part of the blastocyst will form the embryo

Back 136

Inner mass

Front 137

What is the most likely site of fertilization?

Back 137

Ampulla of the fallopian tube

Front 138

Dizygotic twins

Back 138

Result from 2 eggs and 2 ova.

Fraternal twins.

Forms two placentas.

Front 139

Which type of twins has a likelihood component related to family, nutrition, etc?

Back 139

Dizygotic twins

Front 140

Monozygotic twins

Back 140

Results from one ova.

Identical twins.

Division time affects number of placentas and membranes

Front 141

Dichorionic

Back 141

Two placentas

Front 142

Monochorionic

Back 142

One placenta

Front 143

Diamniotic

Back 143

Two amniotic sacs

Front 144

The placenta develops in week ____

Back 144

3

Front 145

Embryonic stage

Back 145

2-8 weeks.

Tissues differentiating.

Most vulnerable to teratogens.

Front 146

All of the fetal organs are formed by ____ weeks

Back 146

8

Front 147

The fetus will likely be able to move by ____ weeks

Back 147

12

Front 148

WHO recommendations for breastfeeding

Back 148

Breastfeed exclusively for the first 6 months. Then at 6 months begin introducing complementary foods. Breastfeed for up to 2 years and beyond. No cow's milk before 1 year.

Front 149

In younger mothers, which race tends to breastfeed the most? Which tends to breastfeed the least?

Back 149

Most: Hispanic americans.

Least: African americans.

Front 150

What drugs should be avoided while breastfeeding?

Back 150

- ASA.

- Pseudoephedrine.

- Stimulants.

- Chronic pain meds.

Front 151

What cultures may sometimes believe that the baby should not drink the colostrum?

Back 151

- Hispanics.

- Native Americans.

- Eastern Europeans.