Pregnancy

Question 1

Hegar sign

Answer 1

Softening of the cervix. Occurs around 6-8 weeks.

Question 2

Chadwick sign

Answer 2

Bluish-discoloration of cervix, vagina, and vulva caused in increased vascularity and venous congestion. Occurs around 6-8 weeks of gestation.

Question 3

What changes occur due to alcohol consumption during pregnancy?

Answer 3

Facial changes:
- smooth philtrum
- thin upper lip
- small eye openings
- flat midface
Microcephaly
Lots of cognitive issues

Question 4

Treatment for mild preeclampsia?

Answer 4

Bed rest except for the bathroom

Close monitoring of weight and blood pressure

Close following of urinary protein, creatinine, and platelet count

Question 5

Low alpha fetoprotein and high human chorionic gonadotropin in pregnancy

Answer 5

Down syndrome

Fetal demise

Question 6

Preferred treatment of VTE during pregnancy?

Answer 6

Low molecular weight heparin:
- dalteparin (fragmin)
- enoxaprin (lovenox)

Does not cross the placenta. Safe. Warfarin DOES cross the placenta and is teratogenic. Apixaban (eliquis) is not recommended.

Question 7

How much does a 3 month old baby eat and how often?

Answer 7

3-4 month old babies eat 3-4 ounces every 3-4 hours. This age can go longer between feedings at night.

Question 8

Venlafaxine (Effexor)
- Side effects?
- How is this medication viewed during pregnancy in the perinatal period? 4

Answer 8

An SNRI that is used to treat depression, anxiety, social anxiety, and panic disorders.
- Side effects - reuptake of norepinephrine and serotonin can result in HTN. Nausea. Headache. Dry mouth. Dizzy. Insomnia. Increased risk for suicide.

• Effexor can increase the risk for HTN which can increase the risk for preeclampsia during pregnancy. This medication should be avoided in pregnant patients who are at risk for HTN.
• There is some research showing there is a low risk for birth defects while taking Effexor.
• Risk for neonatal adaptation syndrome (withdrawal) - seen as agitation, irritability, hypoglycemia, hypothermia, and resp distress.
• Some evidence showing that there is an increased risk for spontaneous abortion and postpartum hemorrhage.

Question 9

Facts:

Pregnancy and depression
- Monotherapy is preferred over combinations due to fetal exposure.
- Some medications may need to be increased to account for pharmacokinetic changes.
- Psychotherapy should be offered and is first line treatment for patients with depression during pregnancy due to the lowest risk of fetal harm. Pharmacotherapy should be implemented if additional help is needed.

Question 10

At what age can infants start eating solid food? At what age is it recommended to stop breast feeding and get all nutrient from solid foods?

Answer 10

Infants can start eating solid foods at 6 months old. Breast feeding or bottle feeding should be continued months past this start, slowly increasing solid food intake. Breast feeding or bottle feeding is recommended to continue until the infant is 12 months old.

Question 11

Treating asymptomatic bacteriuria in pregnancy
- Why?
- With what?
- What to avoid?

Answer 11

Asymptomatic bacteriuria should be treated in pregnancy to avoid adverse outcomes such as preterm birth and low birth weight.

• Fosfomycin (monurol), Amoxicillin-clavulanate (Augmentin), and Cephalexin (Keflex) are all pregnancy safe antibiotics that can be used to treat UTI (E.Coli), even if asymptomatic.
• Nitrofurantoin (Macrobid), Trimethoprim-Sulfamethoxazole (Bactrim), and Doxycycline (Vibramycin) are all antibiotics that can be used in uncomplicated UTIs in patients that are not pregnant. They have teratogenic properties if taken during pregnancy.

Question 12

What is Wilm’s Tumor?
Who is it most commonly found in?
What are the presenting signs and symptoms?
Treatment and prognosis?

Answer 12

Wilm’s Tumor the most common renal tumor in young patients presenting with:
- abdominal mass and swelling - the mass extends from the flank toward the midline
- constitutional symptoms - nausea and vomiting
- abdominal pain
- Hematuria
- 25% of cases include HTN - increased renin secretion

Treatment: surgery, chemotherapy, radiation
90% 5 year survival rate. The younger the patient is when found, the better the prognosis.

Question 13

Strawberry tongue

Answer 13

Kawasaki disease

Question 14

When are children expected to be able to copy basic shape drawings?

Know colors?

Answer 14

Drawings - 5 years old

Colors - 4 years old

Question 15

Symptoms of pre-eclampsia?

Answer 15

Elevated blood pressure after 20 weeks of pregnancy with signs of organ dysfunction.
BP - systolic of 140+/90

Organ dysfunction:
+ proteinuria (>300mg in 24 hours)
+ low platelets (<100,000)
+ increased LFTse
+ Pulmonary edema

Question 16

Normal estradiol levels?
FSH?
Anti-Mullerian Hormone?

Answer 16

Ovulatory: 15-350
Postmenopausal: <30

3.5-21.5 - FSH

AMH: decline as a person ages - less than .5 indicates perimenopause

Question 17

What is anti-mullerian hormone?

Answer 17

A predictor of menopause. A measurement that is a predictive ovarian reserve. Decreases throughout life as the number of eggs decreases.

Question 18

What hormone is increased during ovulation and can be tested for to determine the best time for intercourse in order to conceive?

Answer 18

Luteinizing hormone

Question 19

Pap-smears
- What is being tested for?
- Guidelines

Answer 19

HPV - cervical cancer

Guidelines - start testing at age 21 (every 3 to 5 years)
Stop testing after age 65 in low risk populations.

Question 20

How to measure fundal height during pregnancy?

Answer 20

Measure from the top of the pubic bone to the top of the uterus. Helps estimate fetal growth and gestational age. Most accurate between 20 and 36 weeks.

12 weeks - at pubic bone
16 weeks midway between pubic bone and umbilicus
20 weeks - at navel
24-36 weeks - fundal height = gestational age (+/- 1cm)

Question 21

PURPLE crying

Answer 21

A acronym used to explain the patterns of normal infant crying
- P - peak of crying (around 2 months)
- U - Unexpected (can happen for no reason)
- R - Resists soothing
- P - Pain-like face
- L - long-lasting
- E - Evening, when the crying typically is the worst

Question 22

What are the classic signs of fetal alcohol syndrome?

Answer 22

• Microcephaly
• Narrow eyes
• Thin lips
• Smooth philtrum
• Intellectual disabilities
• ADHD

Question 23

What is the only supplement recommended for the first few days of life for an infant?

Answer 23

Vitamin D drops

Question 24

When does an infant double and triple their birth weight?

Answer 24

Double - 6 month
Triple - 12 months

Question 25

At what age does separation anxiety typically begin?

Answer 25

Separation anxiety typically begins around 8-12 months of age and begins to diminish around 18 months.

Question 26

What is a diaphragm? - What must it be used with?

Answer 26

A form of contraception inserted into the female's vagina and aims to cover the cervix. A type of barrier protection with 88% success rate. It requires a prescription for use. A Diaphragm must be used with a spermicides for maximum effectiveness.

Question 27

What is the moro reflex?

Answer 27

The startle reflex - assess upon birth by holding the infant secure and then suddenly tipping the infants head backwards to mimic falling. A normal infant response is to extend bilateral arms reaching upwards. A unilateral response can indicate injury to the nonparticipating side, often a clavicle fracture from the birthing process.

Question 28

When is Pertussis vaccination recommended for pregnant women?

Answer 28

Recommended between 27-36 weeks gestation which allows time for the antibodies to be transferred to the infant.

Question 29

What are the go-to antihistamines for pregnancy? Why are these chosen? What about Benadryl?

Answer 29

Go-to antihistamines for pregnancy are 2nd generation anti-histamines. These cause less sedation, less anticholinergic effects. Cetirizine (Zyrtec) and Loratadine (Claritin) are first choice. They do not cross the placenta. Benadryl crosses the placenta and can negatively effect baby.

Question 30

Newborn is dx with brachial plexus injury, what is the best step in initial treatment?

Answer 30

PT evaluation

Question 31

At what age should toliet training begin?

Answer 31

Ages 18-24 months. 1.5 to 2 years old.