Clinical Medicine - TW: intimate partner violence, sexual violence Flashcards

1
Q

What is the differential if the fundal height is lower than expected?

Height (cm)

A
  • Wrong dates
  • Intrauterine growth restriction
  • Oligohydraminos
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2
Q

Which patients should be screened for intimate partner violence?

A

ALL patients

  • Every new patient
  • Any patient with signs of trauma
  • Any patient with conditions associated with IPV
    • Extensive, can affect many organ systems: GI, Repro, Psych, behaviorla signs
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3
Q

G_P_ _ _ _

What does each blank stand for?

A

GaPb c d e

  • a = Number of pregnancies
  • b = Number of term births
  • c = Number of preterm births
  • d = Number of abortions (spontaneous or otherwise)
  • e = Number of living children
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4
Q

When should intimate partner violence be documented in a patient’s chart?

A

ONLY if the patient says it’s okay

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5
Q

What is the differential if the fundal height is higher than expected?

Height (cm) > (#weeks gestation = 3)

A
  • Wrong dates
  • Multiples (twins, triplets)
  • Fibroids
  • Macrosomia
  • Hydraminos
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6
Q

List and describe the 3 components of the cycle of abuse

A
  • Intimidation
    • Threats, abuse (physical, emotional, sexual)
  • Violence escalation
    • This is often when pts will present to the ER or engage with healthcare providers
  • Honeymoon phase
    • Abuser shows remorse
    • Vicitm may blame themselves
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7
Q

After 20 weeks gestation, blood pressures above ____ would raise concern for pre-eclampsia or gestational HTN?

A

140/90

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8
Q

How do you calculate the estimated date of delivery (EDD) for a pregnant patient?

A

From the first day of the last menstrual period (LMP)

EDD = LMP + one year - 3 months + 7 days

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9
Q

When is it mandatory to report intimate partner violence?

A

When a patient presents with injuries from a firearm

If children are involved

Otherwise, not necessary to document/report - ALWAYS ask pt before documenting in their chart

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10
Q

When during gestation does fetal movement begin?

When should there be a expected pattern?

A

Begins at 20 weeks

At 26 weeks, there is an expected pattern; deviations need to be evaluated for fetal well-being

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11
Q

What is considered normal for fundal height?

At 20 weeks:

Beyond:

A
  • At 20 weeks:
    • At umbilicus
  • > 20 weeks:
    • #cm above pubic symphysis should be equal to weeks of gestation +/-3
    • Ex: 26 weeks => fundal height should be 23-29 cm above the pubic symphysis
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12
Q

What tissue does Non-invasive prenatal screening (NIPS) look at to analyze the fetal genome?

A

Cell free DNA

Based on the assumption that the total number of fragments of any one chromosome is proportional to the size of the chromosome

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13
Q

List 4 factors that will affect the fetal fraction of cell free DNA in maternal blood

A
  • Gestational age
    • Slightly increases 10-21 weeks
    • Significant increase >21 weeks
  • Maternal BMI
    • Higher BMI = lower Fetal fraction
  • Small placenta
  • Aneuploidy
    • Increased in Trisomy 21, decreased in Trisomy 18 and 13
    • This is what we’re actually looking for

Normally, fetal cell-free DNA is 10% of the total circulating cell-free DNA

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14
Q

What is the earliest gestational age at which NIPS can be performed?

A

Any time after 10 weeks

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15
Q

List 4 limitations of NIPS

A
  • False positives
  • Failed results
  • Re-draw also has potential to fail
    • Delayed results delay time-sensitive decision making
  • Results take 1-2 weeks
    • Especially important if close to 24 weeks
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16
Q

What is the appropriate next test if NIPS is positive for a fetal aneuploidy?

A

Diagnostic testing

(Invasive method, ex: amniocentesis)

17
Q

Who should be offered prenatal genetic screening?

A

All pregnant patients

Offer either standard screening of cell free DNA