1
Q
PRESUMPTIVE signs of preganancy
A
Subjective symptoms reported by the patient
- amenorrhea
- breast tenderness, tingling, or enlargement
- areolar color changes
- fatigue
- urinary frequency
- n/v
- maternal perception of fetal movement
- skin changes such as linea nigra and straie
2
Q
PROBABLE signs of pregnancy
A
Objective signs observed by the provider
- positive pregnancy test
- palpation of Braxton Hicks contractions
- increase in uterine size
- increase in abdominal
circumference - Hegar’s sign
- Goodell’s sign
- Chadwick’s sign
3
Q
Hegar’s sign
A
softening of the lower uterine segment and cervical isthmus
4
Q
Goodell’s sign
A
softening of the cervix
5
Q
Chadwick’s sign
A
blue discoloration of the cervix and vagina
6
Q
What are Braxton-Hick’s contractions
A
painless irregular contractions that do not cause cervical dilation
7
Q
POSITIVE signs of pregnancy
A
those that confirm a pregnancy
- auscultation of fetal heart tones
- palpation of the ENTIRE fetal body by a healthcare provider
- palpation of fetal movements by the healthcare provider
- visualization on US of the gestational sac, embryo/fetus
8
Q
____ sign of pregnancy: palpation of the ENTIRE fetal body by a healthcare provider
A
positive
9
Q
Average length of gestation per Nagele’s rule
A
280 days
= 9 calendar months
10
Q
____ sign of pregnancy: provider palpation of fetal movement
A
positive
11
Q
Nagele’s rule
A
utilizing LMP
subtract 3 months
add 7 days
add 1 year
12
Q
____ sign of pregnancy: patient perception of fetal movement
A
presumptive
13
Q
____ sign of pregnancy: auscultation of fetal heart tones
A
positive
14
Q
____ sign of pregnancy: amenorrhea
A
presumptive
15
Q
____ sign of pregnancy: positive pregnancy test
A
probable
16
Q
____ sign of pregnancy: provider palpation of increased uterine size
A
probable
17
Q
____ sign of pregnancy: provider palpation of Braxton Hick’s contractions
A
probable
18
Q
Between _____ to ____ weeks, the gestational age correlates with the measurement of fundal height in centimeters, within + or - _____cm
A
16-38 weeks
+ or - 3cm
19
Q
Fetal heart sounds can be detected as early as _____ using a handheld doppler
A
10 weeks
20
Q
Initial maternal perception of fetal movement within the uterus usually occurs between _____ weeks (quickening)
A
16-22 weeks
typically earlier for those who have been pregnant before
21
Q
GTPAL: Gravida
A
number of pregnancies, regardless of outcome
if a woman is pregnant for the first time but carrying twins, she is still G1 because there are 2 fetuses but it is only 1 pregnancy
22
Q
GTPAL: Term
A
number of pregnancies delivered at term > or = 37 weeks or weighing > or = 2500g
23
Q
GTPAL: Preterm
A
number of pregnancies prematurely born between 20-36 weeks or weighing between 500-2499g
24
Q
GTPAL: Abortion
A
number of spontaneous abortions, miscarriages, or terminations at <20 weeks or <500g
25
GTPAL: Living
number of current living children
26
GP: Gravidity
The total number of times a woman has been pregnant (including the current one), same as for GTPAL
27
GP: Parity
the number of pregnancies carried to the 20th week gestation or the delivery of an infant weighing >500g regardless of the outcome of the pregnancy
28
Nulligravida
never been pregnant
29
Nullipara
never carried a pregnancy past 20 weeks or delivered a baby >500g
30
Primigravida
first pregnancy
31
Primipara
has been or is currently pregnant for the first time past 20 weeks gestation
32
Multigravida
has been pregnant 2 or more times
33
Multipara
has carried 2 or more pregnancies past 20 weeks gestation or delivered an infant >500g more than once
34
Grand multipara
give birth five or more times
35
_____ sign of pregnancy: Hegar's, Chadwick's, and Goodell's signs
probable
36
_____ sign of pregnancy: palpation of fetal movements by the healthcare provider
positive
37
Multiple gestations (e.g., twins) only counts as 1 in every GTPAL category except....
LIVING
38
Fertilization occurs in the fallopian tubes during the first _____ after release of the egg from the ovary
12 hours
39
Result of zygote mitotic division
blastomere
40
A 16-cell ball of blastomeres
morula
41
Morula travels into the uterus ____ after conception
3 days
42
Inner cell mass of the blastocyst becomes the....
embryo
43
Outer cell mass of the blastocyst becomes the....
trophoblast
44
The ____ attaches the blastocyst to the uterine wall and differentiates into two layers
trophoblast
45
The trophoblast, once implanted in the uterine wall, differentiates into these (2) layers which later develop into the placenta
1. cytotrophoblast (inner layer)
| 2. synctiotrophoblast (outer layer)
46
The developing conceptus before the end of the ____ week after conception is referred to as an EMBRYO
8 weeks post-conception (10 weeks LMP)
47
Implantation occurs when after conception/fertilization
6-7 days after conception
48
Main function of the placenta
support normal growth of the fetus by facilitating exchange of nutrients and waste products between the fetal and maternal circulatory systems
49
Typical size and weight dimensions of a mature placenta
weighs 500g
2-3cm thick
20cm in diameter
50
the placenta and the chorion are both derived from the
trophoblast
51
the _____ establishes connection with the uterine lining, which gives rise to the placenta
chorionic villi
52
decidual tissue that surrounds the chorionic sac
decidua capsularis
53
fetal part of the placenta
chorion frondosum
54
maternal part of the placenta
decidua basalis
55
beta hCG is produced mainly by the ....
placenta
56
beta hCG may be detectable in the plasma as early as ___ days after conception
7 days
57
beta hCG's main function
to maintain the corpus luteum and thus progesterone production
58
hPL is detectable as early as....
2-3 weeks after conception
59
hPL's main function
acts as a diabetogenic that inhibits maternal insulin activity, influences carbohydrate metabolism, both of which increase maternal sugars for fetal nutrients
60
(8) placental hormones
- beta hCG
- hPL
- ACTH
- relaxin
- human placental growth hormone
- estradiol 17-beta
- estriol
- progesterone
61
ACTH (placental hormone)'s main function
may have an impact on fetal lung maturation
62
relaxin's main function
thought to maintain quietude of the uterus early in pregnancy, and is also secreted by the corpus luteum during this stage
63
functions of estrogen during pregnancy (3)
- stimulate growth of the endometrium
- increase blood flow between uterus and placenta
- prepare breasts for lactation
64
when does placenta take over progesterone production from the corpus luteum
around the 9-10th week
65
(2) functions of progesterone in pregnancy
- prepares uterus for implantation
| - essential hormone for maintaining pregnancy, quietude of the uterus
66
Maximum amniotic fluid volume occurs at
34 weeks
67
Polyhydramnios AFI
24cm or more
68
Polyhydramnios DVP
8cm or more
69
50% of polyhydramnios etiology
ideopathic
70
Oligohydramnios AFI
<5 cm
71
Oligohydramnios DVP
<2cm
72
Organogenesis weeks
weeks 3-8 after conception (5-10w LMP)
73
Frequency of prenatal visits
Q4 weeks until 28w, Q2-3 weeks until 36 weeks, weekly until birth
(7-11 visits total)
74
First prenatal visit typically occurs at ___ weeks
8-12 weeks
75
What is Tay-Sachs disease
Rare autosomal recessive disease caused by a deficiency in beta-hexosaminidase A. Leads to progressive neurodegeneration due to intracellular accumulation of GM2 gangliosides. Symptoms include developmental delay, "cherry-red" spot on macula, seizures, and hearing impairment. Patients usually die around the age of 4. More prevalent in the Ashkenazi Jewish population.
76
Piskacek's sign
uterus enlarges asymmetrically usually over the site of the implantation (~6 weeks)
77
Anthropod pelvis
adequate for vaginal birth due to large size
78
Android pelvic
"male pelvis"
| heart shaped and may lead to more dystocia and operative births
79
Gynecoid pelvis
"female pelvis"
| best suited for childbirth
80
Platypelloid pelvis
rare, <3%
| poor prognosis for vaginal birth
81
Ptyalism
increased salivation
82
Etiology for physiologic dyspnea in pregnancy
increased tidal volume and lower PCO2
83
Pituitary enlargement by ___% in pregnnacy
>100%
84
Supplements for leg cramps in pregnancy
calcium and/or magnesium tablets
85
The uterus is back to pre-pregnancy size by ____ weeks post partum
6 weeks
86
lochia rubra days
delivery - 3 or 4 days
87
lochia serosa
3-4 days until 2 weeks
88
lochia alba
2 weeks until 6 weeks
89
By ___ weeks post partum, the cervix is almost closed and is about back to normal size and shape
6 weeks
90
By ____ weeks postpartum, the vagina is expected to be healed and tone close to pre-pregnancy
6 weeks
91
average time to ovulation for lactating women
6 months
92
average time to ovulation for non-lactating women
70% by 12 weeks
| 2.5-3 months
93
GFR returns to normal by ____ weeks postpartum
8 weeks (2 months)
94
Each nipple contains ____ lactiferous ducts
14-18
95
Sebaceous glands that lubricate the nipple and areaola
montgomery's tubercles/glands
96
Lactogenesis I
mid-pregnancy to 2nd day postpartum
alveolar cells differentiate into secretory cells
97
Lactogenesis II
"milk coming in", pp day 3-8 triggered by decreasing progesterone (10-fold decline)
characterized by copious milk production
98
Lactogenesis III
established mature milk supply, >8 days postpartum
99
Amount of milk typically made on Day 1 post partum
100mL
100
Sensitive period for bonding post-partum
30-60 minutes after birth
101
Bonding is ___directional
unidirectional (mother to infant)
102
Attachment is ___directional
bidirectional (interactive)
103
Under the influence of estrogen during pregnancy, thyroid function changes include an increase in:
thyroxine binding globulin
104
Lab test used to diagnose rubella
HAI titer
1:10 - 1:64 is immunity
>1:64 is active infection
105
HAI titer 1:6 for rubella indicates...
not immune
106
HAI titer 1:10 for rubella indicates....
immune
107
HAI titer 1:65 for rubella indicates....
active infection
108
effect of pregnancy on cholesterol and triglcyeride levels
may increase
109
What happens to treponemal and non-treponemal tests after infection with, and then treatment for, syphilis
non-treponemal (RPR, VDRL) should become nonreactive after treatment
treponemal tests (FTA-ABS, TPI) usually remain positive indefinitely after treatment
110
Heart sound best heard at the BASE of the heart
S2
| base = top
111
What are somatic mutations
can occur any time in one's life after conception, acquired
112
Renal function tests should be completed every _____ for someone on PrEP
q6 months
113
Most opportunistic infections occur in folks with HIV and a CD4+ count less than....
<200 cells/mm3
114
Classic triad for mono
- fever
- sore throat
- swollen lymph nodes
115
most common reason for painless BRBPR
internal hemorrhoids
116
First line treatment for otherwise healthy <65yo with CAP
azithromycin (advanced gen macrolide)
117
First line treatment for >65yo and/or comorbidities with CAP
levofloxacin (respiratory fluoroquinolones)
118
Expected findings in IDA: ferritin
low ferritin <10 mg/L
119
How is estrone made after menopause
estrone is converted from androstenedione from the ovarian stroma and adrenal gland
120
What is a benefit of continuous-combined HT over cyclic-combined HT
there is overall less progesterone in continuous-combined
continuous-cyclic is every day estrogen with only some days progesterone
121
Considerations for choosing DMPA injection site in someone who is obese
IM injection requires deep muscle penetration, deltoid may be a better site than the glutes
122
major MOA of POP pills
thickening cervical mucus
123
If you are more than _____ late taking a POP pill, use backup for _____
>3 hours, use backup for 48 hours
124
Does pre-ejaculatory semen contain sperm?
No
125
(2) risk factors for nonpuerperal mastitis
smoking, nipple piercing
126
First leopold's maneuver
determine fetal lie (relationship of long axis of the fetus to long axis of the mother - spines)
127
Second leopold's maneuver
determine fetal presentation (presenting part - part of the fetus in the pelvic inlet)
128
Third leopold's maneuver
determine fetal position
129
Fourth leopold's maneuver
determine fetal attitude (flexion of the head if in vertex/cephalic)
130
the fetal system most commonly associated with oligohydramnios
fetal kidneys
131
Peak HR increase in pregnancy occurs when
10-15 bpm which occurs by 28 weeks (end of second trimester)
132
Peak cardiac volume increase in pregnancy occurs when
10% volume increase which occurs by 20 weeks (midpregnancy)
133
Preventing infections in pregnancy include heating meat up to at least _____
145F (63C) and 160F if poultry (71C)
134
CMV is usually asymptomatic, but if symptoms they usual resemble what other illness?
mono (EBV)
135
ASYMMETRICAL growth restriction is caused by (2) main factors
- uteroplacental perfusion abnormalities
| - reduced nutrition to fetus
136
Can you use metronidazole to treat BV in pregnancy
Yes, all trimesters ok
metronidazole 500mg PO BID x7 days
metronidazole 250mg PO TID x7 days
clindamycin 300mg PO BID x7 days
137
BV treatment in pregnancy?
if asymptomatic and no risk for preterm delivery, dont treat
if asymptomatic and at risk for preterm delivery, treat
if symptomatic, treat
138
Trich treatment regimen in pregnancy
metronidazole 2g PO x1 at any time in pregnancy
139
SYMMETRIC growth restriction usually becomes apparent when
18-20 weeks EGA
140
(3) causes of symmetric growth restriction
- chromosomal abnormalities
- maternal drug use
- congenital infections
141
average Hgb in pregnancy
12.5
142
% prevalence of UTIs in pregnancy
2-7% of pregnancies
143
% of UTIs in pregnancy that progress to pyelonephritis if untreated
25-30%
144
(3) criteria for very high risk for TB (>5mm induration is positive)
- recent contact with known infected person
- abnormal chest radiograph
- HIV positive
145
% prevalence of breech
14% before 32 weeks, and only 3.5% by term
146
Inflammation of PUPPP is characterized by
perivasculitis (inflammation)
147
Normal postpartum involution takes ____ to complete
6 weeks
148
max dose acetaminophen per day
4g (4000mg)
149
max dose ibuprofen per day
3.2g (3200mg)
150
Mife-Miso medical abortion can be safely used up to ______ weeks gestation
10 weeks (70 days)
151
What is DIRECT bilirubin
conjugated
152
What is INDIRECT bilirubin
unconjugated
153
What would you expect in terms of cervical dilation on day 2 pp?
normal for the cervix to remain 2-3 cm dilated on pp days 2-3
154
How does a claims made NP insurance policy work?
the incident must occur AND be reported when the policy is in effect, i.e., they won't continue to cover you in the future once you have a different policy for something that occurred during that time
155
most common cause of pathologic nipple discharge in peri-menopause
intraductal papilloma (commonly found in perimenopausal 30-50yo age group)
156
Which androgen can be aromatized into ESTRADIOL
testosterone
157
Which androgen can be converted into ESTRONE
androstenedione
