1
Q
If a patient has sex with 2 different men 3 days apart can you tell who the father is?
A
No its too close together with too much variablility, will need genetic testing upon birth
2
Q
Goals of prenatal care
A
To have all patients receive some form, and preferably in the first trimester
3
Q
4 stages of prenatal care
A
- Preconception care (basic medical care esp. for those with chronic medical conditions and staying up to date on vaccines)
- prompt diagnosis of pregnancy (confirm they didn’t read an at home test wrong)
- initial presentation for pregnancy care (initial pelvic exam, height of fundus, etc)
- followup prenatal visits
4
Q
Supplementing with folic acid prior to conception (typically done in all bread purchased) has allowed for a decrease in…
A
….neural tube defects (spinal bifida)
5
Q
1 and #2 structural birth defects
A
congenital heart anomalies, neural tube defects
6
Q
Tdap in pregnancy
A
Used in every pregnant woman for every pregnancy to help lower prevalence of whooping cough in infants as infants don’t receive Dtap until 6 months of age, given at 27-36 weeks to promote passive antibody transfer
7
Q
Signs and symptoms of pregnancy (4)
A
- cessation of menses (not as reliable now due to obesity and birth control)
- changes in cervical mucus and softening
- breast tenderness
- urine or serum pregnancy tests gold standard
8
Q
Parturient definition
A
Meaning just having delivered
9
Q
Estimation of duration of pregnancy
A
Mean is 266 days from conception, 279-282 from first day of last menstrual period
Neagle rule
Estimated date of delivery = 1st day of last menstrual period + 7 days, - 3 months + 1 year
10
Q
If the uterus fails to grow as expected, what should be considered?
A
Intrauterine growth restriction (IUGR)
11
Q
1st trimester ultrasound
A
Best method possible to predict due date by measuring crown rump length, when done earlier in pregnancy more accurately predicts due date*** (further in gestation more biological variation we get)
12
Q
Pelvimetry
A
Measurement of the diagonal conjugate from posterior inferior edge of symphysis pubis to sacral promontory to estimate the inlet of the pelvis, normally >12.5cm, can determine if a lady can deliver a baby at term without complication
13
Q
Lab tests in prenatal care (11)
A
- pap smear (not before 21 regardless of pregnancy status)
- GC and chlamydia screen (regardless if monogomous)
- HIV screen
- syphilis screening
- hepatitis screening
- rubella antibody titer (congenital rubella syndrome)
- ABO and antibody screen
- urinalysis and culture
- cystic fibrosis screen
- fifth disease (in high risk populations, mother can get it from being around kids)
- glucose tolerance tests (determine diabetes)
- thyroid studies
- Quad screen (oh lawdy)
14
Q
Signs of fetal life (3)
A
- Transvaginal ultrasound 6-8 weeks gestation
- doppler ultrasound 10-12 weeks gestation
- palpation of fetal movements
15
Q
Diagnosis of fetal death (5)
A
- more common early in pregnancy (1/6 ends in miscarriage)
- regression of signs of pregnancy despite hCG remaining high for weeks after
- failure of uterine growth
- ultrasound primary method**
- failure to feel fetal movement after having felt it before
16
Q
Scheduling of routine prenatal visits
A
Every 4 weeks thru week 28, every 2 weeks weeks 28-36, every week from 36 to delivery, 2x per week for postdates >42 weeks
17
Q
12, 14-16, 20, 24, 28, 32-36, 36-40, 40+ week visits
A
- 12 (review prenatal lab tests, assess fetal heart beat with doppler)
- 14-16 (assess growth, order some genetic tests and order amniocentesis)
- 20 (auscultate fetal heart with fetoscope (old school) ultrasound for fetal anatomy)
- 24 (maternal education and review signs and symptoms for preterm labor)
- 28 (repeat antibody screens, administer Rh immune globulin, perform glucose screen, perform cervical assessment, TDaP administration)
- 32-36 (assess the cervix, GBS culture)
- 36-40 (assess fetal position, cervical exam for dilation each visit)
- 40+ (perform cervical assessment, institute fetal surveillance, typically WILL induce by end of 41 weeks)
18
Q
Weight gain during pregnancy
A
a woman at ideal body weight requires total 24-28 lb weight gain, less for those over or more for those under ideal weight to meet goal requirements (might have to modify diet)
19
Q
Weight loss during pregnancy is not advised except in those with…
A
…very high BMI
20
Q
Weight retention after pregnancy
A
Average retained pregnancy weight of 3 lbs, see loss over 6 months progressively due to natural diuresis of excess volume
21
Q
Smoking and pregnancy complications (6)
A
- bleeding
- premature birth
- low birth weight
- neonatal absence syndrome
- congenital anomalies
- low IQ of childhood
22
Q
Alcohol and pregnancy complications (2)
A
- low birth weight
- fetal alcohol syndrome
23
Q
Best advice regarding alcohol and pregnancy
A
Complete abstience
24
Q
Fetal alcohol syndrome features (6)
A
- growth restriction
- behavioral disturbances
- brain defects
- cardiac defects
- spinal defects
- broad upper lip, facial distortions
25
Caffeine in pregnancy
Ideally none, but risks not as obvious as smoking and alcohol
26
Cell free fetal DNA (cffDNA)
A maternal phlebotomy study that is often done on screening in the first trimester to determine sex of child and test for aneuploidy, these DNA fragments increase in conc. in bloodstream thruout pregnancy and quickly diminishes upon delivery
27
Nucchal fold translucency
Ultrasound screen done most often in the first trimester to visualize fetus, can be found alone in 62% of down syndromes and 30% of spontaneous abortions
28
AFP testing
Alpha fetoprotein, a sometimes recommended 2nd trimester screen that finds 20% of down syndrome patients and neural tube defects
29
Pregnancy associated protein A (PAPPA)
Screening done during first trimester alongside nucchal fold translucency on ultrasound to increase rate of determining presence of down syndrome (positive in both up to 73% certainty)
30
Amniocentesis
a relatively low risk .5% of fetal loss test done during 2nd trimester for chromosome analysis, AFP, DNA markers, etc, not done as screening but for diagnosis and evaluation
31
Work conditions which increase risk of low birth weight, preterm labor, and delivery (4)
- physically intensive employment
- standing for long periods of time
- increased pulling, pushing, or lifting
- decreased rest periods
32
Recommended favorable working conditions for pregnant women (4)
- only 8 hour shifts
- no more than 48 hrs a week
- limit work between 6am and midnight
- avoid jobs that require good sense of balance
33
Saunas, hot tubs, and whirlpools use while pregnant
Advise not to use while pregnant, temp already elevated by the baby
34
Travel while pregnant
Best taken during 2nd trimester, many airlines have regulations
35
Common pregnancy complaints and how are they treated? (8)
- nausea and vomiting (first trimester usually resolves 16 weeks, morning sickness), treated with zofran
- constipation, treated with bulking agents (mirilax)
- hemorrhoids, treated with prevention or topical anesthetic
- fatigue (particularly early on), supplemental iron if anemic
- urinary frequency or incontinence (differentiate from rupture of amnion also known as water breaking), treated with kegals
- headaches, treated with acetaminophen
- syncope (due to blood flow to fetus does see drastic drop in blood pressure), treated with resting in lateral recumbent position, change position gradually, hydrate
- edema (common, as long as bilateral can be physiologic and not concern for DVT or heart failure and is relieved by raising legs)
36
Live vaccines and pregnancy
Contraindicated (MMR, V, and live influenza!)
37
Nulligravida
Never having been pregnant
38
Nullipara
Never having given birth
39
In measuring the fundus, if smaller than expected may be due to these 2 conditions. If larger, than these 3
- earlier gestation
- oligohydraminos
- later gestation
- polyhydramnios
- twins
40
Intrauterine growth restriction
When the unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb, putting it at risk of certain health problems and complications during pregnancy (potentially even death), delivery, and after birth
41
Quad screen
One lab test performed in patients prenatal care based on history at 15-19 weeks, includes AFP, hCG, estriol, and inhibin A to assess neural tube defects and genetic defects
42
Group B infection in neonates vs 1 month old
Because it is ubiquitous and commensal with mother not generating antibodies, the 1 month old is too often colonized and asymptomatic but neonates do not have immune function and can get septic from infection
43
Standard of care for screening in first trimester (2)
- ultrasound
- blood test for pregnancy associated protein A
44
Chorionic villous sampling
Removal of part of the placenta to take for chromosomal testing either abdominally or vaginally, NOT often utilized because of high risk of fetal loss and is pretty much obsolete
45
Exercise while pregnant
Good 3-4x a week but not starting anything new they haven't already been doing, should avoid hot humid conditions or when febrile, sports injuries much higher due to ligmaent tissue loosening due to circulating relaxin levels
46
Round ligament pain in pregnancy
Prior to 28 weeks can have a lot of pain especially on the right side as it is pulled and hurts with activity but subsides with rest differentiating it from acute appendicitis
47
15% (1/6) of all pregnancies end in...
...miscarriage
48
Implantation bleeding definition
A source of first trimester bleeding that may be mistaken as presence of the period, is common and usually lighter than menses and benign
49
Bleeding in the first trimester will lead to loss of pregnancy __% of the time
50%
50
Causes of early abortion (3)
- most often chromosomal abnormality*** (aneuploidy or triploidy are most common or inversions or deletions)
- infection
- environmental factors (smoking, diabetes, aging gametes, incompetent cervix)
51
Asherman syndrome
Intrauterine adhesions that prevent the opening of the uterus often becoming a source of miscarriage
52
Spontaneous abortion definition
Abortion without medical or mechanical means to empty the uterus (empties on own without coaching), more than 80% occur before 13 weeks, increased with parity and with increased maternal and paternal age
53
Threatened abortion definition
Cramping and bleeding without passage of tissue, os remains closed
54
Inevitable abortion definition
Threatned abortion with more severe cramping and opened os
55
Mifepristone mech of action and use
Antiprogesterone that binds antagonistically progesterone receptors that is used for elective abortion, ineffective in low progesterone spontaneous abortions in helping them pass, causes less bleeding than surgical intervention
56
What other condition is mifepristone used treatment for
cushing's syndrome through binding antagonistically to glucocorticoid receptors thus reducing impact of the high cortisol
57
Gold standard for treatment of ectopic pregnancy and more commonly used treatment
surgery, but most often non gold standard and more commonly used is medical management because it is less invasive
58
Ectopic pregnancy definition
Implantation anywhere other than endometrial lining of uterine cavity, ***most often fallopian tubal in origin, has increased risk of death due to hemorrhage than vaginal delivery
59
Risk factors for ectopic pregnancy (4)
- tubal corrective surgery
- previous ectopic pregnancy
- IUD
- previous STD
60
Criteria for medical treatment of ectopic pregnancy (4)
- has to be smaller than 3.5cm on ultrasound (too much fetal tissue)
- no cardiac activity present on fetus (too much fetal tissue)
- no signs of intra abdominal bleeding
- liver functioning (for methotrexate)
61
Required studies to treat an ectopic pregnancy (2)
- ultrasound with empty uterus
- - 2 hCG levels that aren't progressing properly
62
Drug of choice for ectopic pregnancy
Methotrexate 50mg/meter square of body surface
63
Preterm labor isn't a miscarriage or an ectopic pregnancy in that...
....it is common 10-11% in the population and that these infants are able to be self sustained
64
Complications of prematurity are responsible for over half of...
...perinatal morbidity and mortality
65
No induction of labor or c section should occur sooner than __ weeks to prevent prematurity
39
66
Aneuploid abortions peak at ___ weeks, euploid at ___
8 weeks, 13 (later)
67
Incomplete abortion definition
Bleeding and passage of tissue but some is retained
68
Complete abortion definition
Abortion has passed tissue and os is now closed
69
Missed abortion definition
Retention of dead products of conception for several weeks
70
Discriminatory zone
Refers to how hCG must exceed 1500 units before an intrauterine pregnancy can typically be detected on transvaginal ultrasound exam, if above threshold but not see on ultrasound may have aborted or have ectopic
71
Misoprostol functions (2) and MOA
Drug used to induce abortion in mothers with dead fetus syndrome or empty fetal sac that have low progesterone levels and thus do not respond to elective abortion medication
Also used to stimulate prostaglandin receptors that bind the sotmach's parietal cells preventing gastric acid release
synthetic prostoglandin analog
72
Treatment for incomplete or missed abortion
D&C
73
Prior preterm birth is a large predictive factor for...
....future preterm births
74
Criteria that determine labor commencement
- 4 contractions over 20 minutes or 8 over 60 + cervical changes
- cervical dilation >1cm
- cervical effacement (thinning) >80%
75
Fetal fibronectin
Vaginal swab test to determine fake labor, negative has high predictive value for remaining pregnant for 3 more weeks while positive 50% chance of remaining pregnant for 2 more weeks
76
Inhibition of labor (tocolysis) and its contraindications (4)
Medications that can stop the uterus from contracting, contraindicated in fetal distress, pre/eclampsia, hydramnionos, infection
77
Tocolytic drugs (3)
- terbutaline (B2 adrenergic blockers)
- magnesium sulfate
- ca2+ channel blockers
78
Drug for prevention of preterm delivery (1)
-17 a hydroxyprogesterone IM injection in those that have previous preterm birth
79
Cervix length and indication
Normal is 36mm at 22 weeks,
<10mm can put at risk for 32 weeks delivery, and shorter the cervix, earlier risk of delivery
80
2 methods to monitor the fetal heart rate
- auscultation
- electronically (nowadays this is the most common obstetrical procedure reviewed frequently thru the first and 2nd stages of delivery)
81
Methods of external fetal heart rate monitoring electronically (2)
- ultrasound doppler with gel held in position by belt (not as strong)
- internal FHR monitoring, a bipolar electrode attached to fetal scalp with a wire penetrating the scalp (membranes are ruptured) where a 2nd pole is the metal base of the electrode and vaginal fluid creates saline electric bridge (requires intact maternal physiology, functional placenta, and fetus)
82
Insufficient o2 or nutrition (chronic, long term malnutrition) in the mother can cause these things (5)
- intrauterine growth restriction
- hypoxia
- metabolic acidosis
- acute aspyxia
- fetal death
83
Placenta function can be acutely impaired by these things (3)
- placental separation
- placental infarct
- maternal or fetal hypotension
84
Tachysystole (uterine activity)
More than 5 contractions in 10 min averaged over 30 minutes, should always be qualified as to the presence or absence of fetal heart rate abnormality
85
Basic warning signs in labor (4)
- contractions lasting longer than 90 seconds (starve fetus of oxygen and nutrients)
- relaxation between contractions of less than 60 seconds (if not at rest for long enough, not enough time to wash out co2 and gain o2 and nutrients)
- resting uterine tone above 20mmhg (normal is 5-10 mmHg, during labor may be 10-15)
- peak pressure of contractions above 90 mmHg
86
Normal fetal heart rate during development and at term
110-160bpm, until week 26 heart rate controlled by sympathetic NS, as matures parasympathetic increases in control slowing the heart to 110-120bpm
87
Tachycardia of fetal heart rate
Greater than 160bpm
88
Factors associated with fetal tachycardia (6)
- fetal/maternal temp elevation
- medication side effects
- acidosis
- arrhythmia
- hypovolemia
- hyperthyroidism
89
Factors associated with fetal bradycardia (4)
- post term fetus (mature parasympathetic system)
- hypoxia
- B blockers
- damage to fetal heart
90
Head compression of fetus by uterine tissue fetal heart monitoring
Predictable event as uterus compresses engaged head causing vagal slowing causing early decelaration of fetal heart rate and ends with same time as uterine contraction, NOT considered a sign of distress
91
Uteroplacental insufficiency
Predictable event as uterus compresses engaged head causing vagal slowing causing LATE decelaration of fetal heart rate in comparison to uterine contraction,
92
Response to uteroplacental insufficiency (late decelerations)
- change maternal position to side (prevent positional compression)
- stop oxytocin
- increase IV fluids
- o2 for mom up to 100%
93
Cord compression
Predictable event as uterus comresses the umbilical cord causing VARIABLE decelerations of fetal heart rate, most common, if prolonged causes hypoxia
94
Response to cord compression (variable decelerations) (4)
- change maternal position to right or left side
- 100% o2
- stop oxytocin
- deliver via forceps or c-section
95
Brain damage in labor determining factors (did it happen during labor and not beforehand?) (4)
- profound umbilical artery acidemia (pH <7)
- apgar score 0-3 for longer than 5 min
- neonatal neurological sequelae (seizures, coma, hypotonia)
- multiorgan system dysfunction
96
Amaurosis fugax definition
Transient, acute onset monocular blindness, often described as a "curtain" coming down over eye, high 80% risk of stroke occurring within next 72 hours and thus requires urgent treatment
97
Scintillating scotoma definition
Classically associated symptom where patient experiences bilateral flashing visual disturbances seen with migraines due to chemical or vascular interruption of signals (often a migraine causes vasospasm and occlusion of blood flow to the visual cortex causing them)
98
Arcus abnormality (arcus senilus)
Condition causing white ring appearance around iris associated with old age very common in patients of asian heritage, despite unclear association with cardiovascular disease it is linked to deposition of lipids and thus warrants a lipid panel to assess hypercholesterolemia (esp. in patients under 50)
99
Kayser fleischer rings/Wilson's disease
Copper deposition in a ring around the iris often associated with resting tremors referred for chelation to remove, autosomal recessive disease mapped to chromosome 13 autosomal recessive
100
Pterygium definition
Nicknamed surfers eye, a condition that causes noncancerous growth of the conjunctiva in a wedge shape that will eventually cover the pupil, common in people who spend time outdoors and requires surgical removal
101
Pinguecula definition
Yellowish patch or growth on the conjunctiva over the sclera that is a deposit of fat, protein, or calcium, can be associated with pterygium but does not occlude vision and is completely benign.
102
Xanthelasma definition
Cholesterol buildup causing a plaque or growth that occurs on the eyelid or extensor surfaces of extremities that upon observation indicates a lipid panel for monitoring
103
Ectropion vs Entropion
Entropion eye lid is rolled inward, ectropion is an eyelid rolled outward
104
Exophthalmos definition
Condition often due to hyperthyroidism (often brought on by graves disease) causing bulging of eyes bilaterally
105
Chalazion
small painless blockage of meibomian gland
106
Dacroadenitis and what 2 big organisms can be a source of this
lacrimal gland infection by bacterial (most often, typically staph), fungal, or viral (MUMPS is big one for this)
107
Differentiating between conjunctivitis and Uveitis (3 ways)
- Conjunctivits has preserved visual acuity, and uveitis causes loss of visual acuity
- Conjunctivitis is usually infectious in origin while uveitis is often autoimmune
- Uveitis is more diffuse redness while conjunctivitis affects both bulbar and palpebral conjunctiva
108
Glaucoma definition
Second most common cause of blindness from damage to optic nerve due to increased pressure in eye's anterior chamber, either near-sighteded (open angle) or farsighted (closed angle)
109
Acute closed angle glaucoma (and 2 ways its treated)
Emergency form of glaucoma requiring pharmacologic treatment or laser trabeculoplasty, presents with acute onset pain, blurred vision, nausea and vomiting, halos, and elevated intraocular pressure
110
A normal cup to disk ratio
.3, 1:2
111
Subconjunctival hemorrhage
Often spontaneous precipitated by cough or sneeze that results in blood accumulation beneath the conjunctiva, is asymptomatic and heals on own as long as patient's coaguability and BP are normal
112
Hyphema definition
blood accumulation in anterior chamber usually due to trauma requiring coag studies and referral to ophthalmology
113
Amblyopia definition
Monocular blindness due to failure of visual cortex to develop due to lack of visual input stimulation derived from children with defect in lens left uncorrected requiring patching of the good eye
114
Ishihara test
Color vision test of all colors using 38 plates used in military/industry/professions when slight variations in shade make a difference
115
Bitemporal hemianopia
Caused by a lesion at the optic chiasm (both temporal visual fields of the patient are located more medially, and cross at the optic chiasm)
116
Ipsalateral nasal hemianoptia
A lesion at the uncrossed optic nerve fibers causing nasal visual field half blindness in one eye due to light entering to the lateral retina and traveling without crossing down the optic nerve, tract, and chiasm but getting cut off somewhere in there
117
Contralateral homonymous hemianoptia
Lesion at optic tract bisecting it completely, removing the nasal view of one eye and temporal view of the other with the lesion being on the side of the tract in the body that can still see
118
Contralateral homonymous hemianoptia with macular sparing
Lesion at the optic tract bisecting it (typically deeper in the lateral geniculate nuclei) causing lack of nasal view of one eye and temporal view of other eye with lesion being on side of the tract in the body that can still see while the macula is spared
119
Ipsalateral central scotoma
Lesion at the eye at a fixed point creating a blind spot
120
Ipsalateral horizontal defect
Vascular occlusion of part of the eye resulting in 1 sided blindness either superiorally or inferiorally, with the occlusion being located at the point that is preserved in visual field
121
Any condition that is monocular in nature indicates...
Binocular indicates...
...condition is anterior to the optic chiasm (anterior circulation)
...condition is posterior to the optic chiasm and much deeper in the brain (geniculate nuclei or visual cortex) (posterior circulation)
122
Proptosis and what causes monocular proptosis
Bulging out of eye, exophthalmos typically refers to bilateral proptosis brought on by Graves disease
Monocular proptosis could occur due to tumor or infection
123
Open angle glaucoma
Occurs when drainage canals of schlemm become plugged in the anterior chamber that has insidious onset typically after 50 with visual symptoms only in late disease, avoided by avid screening of patients
124
Cup to disk ratio
A measure of % of optic disk (the exit point of all vessels and nerves in the retina from the eye) covered by cup (white center of the disk)
Professional Development
flashcards
Decks in class (62)
# Cards
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Part 1122
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Part 2123
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Part 3120
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Part 4150
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Part 5124
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Part 6125
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Part 7148
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Part 8160
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Part 9198
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Part 10119
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Part 11131
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Part 12119
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Part 13126
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Part 14123
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Part 15133
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Part 16142
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Part 17124
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Part 18135
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Part 19127
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Part 20108
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Part 21160
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Part 22125
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Part 23145
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Part 24160
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Part 25170
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Part 26120
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Part 27130
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Part 28153
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Part 29124
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Part 30144
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Part 31181
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Part 32121
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Part 33165
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Part 34133
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Part 35116
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Part 36175
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Part 37170
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Part 38191
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Part 39222
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Part 40150
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Part 41124
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Part 42154
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Part 43183
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Part 44132
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Part 45103
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Part 46125
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Part 47165
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Part 48126
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Part 49114
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Part 50155
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Part 51151
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Part 52101
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Part 53128
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Part 54151
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Part 55130
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Part 56132
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Part 57149
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Part 58131
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Part 59151
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Part 60151
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Part 61136
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Part 62111
