Embarazo Flashcards
A 36-year-old woman, gravida 3, para 2, at 31 weeks’ gestation comes to the emergency department because of painless, bright red vaginal bleeding for one day. She has not felt any contractions. She did not receive routine prenatal care. Her other children were delivered by Cesarean section because of breech position. She has no history of serious illness and takes no medication. Vital signs are within normal limits. Examination shows a soft, nontender abdomen; no contractions are felt. Fetal heart rate is reactive with no decelerations. Which of the following findings is most likely on ultrasound?
Placenta over the cervical os
Which is the most appropriate action to reverse the symptoms a patient with supine hypotensive syndrome?
Lying in the left lateral decubitus position is generally recommended for pregnant women when lying down, especially in the third trimester, because this position shifts the uterus away from and thus avoids compression of the inferior vena cava.
Lactation failure and new-onset hypotension in a postpartum patient with a history of severe antepartum hemorrhage indicate _____ caused by pituitary infarction (Sheehan syndrome).
hypopituitarism
A 15-day-old female newborn is brought to the physician for evaluation of red eyes with discharge for 3 days. She was born at 37 weeks’ gestation to a 26-year-old woman. Pregnancy and delivery were uncomplicated. The mother received irregular prenatal care during the 3rd trimester of pregnancy. Examination of the newborn shows watery discharge in both eyes and mild eyelid swelling. Which of the following is the most likely cause of this patient’s presentation?
Chlamydia trachomatis
Neisseria gonorrhoeae
Chlamydia trachomatis
A 32-year-old primigravid woman with a history of seizures comes to the physician because she had a positive pregnancy test at home. Medications include valproic acid and a multivitamin. Physical examination shows no abnormalities. A urine pregnancy test is positive. Her baby is at increased risk for requiring which of the following interventions?
Lower spinal surgery
Valproic acid intake is known to inhibit folate absorption in the mother.
It may also cause cognitive impairment, facial, cardiovascular (e.g., ASD), and skeletal abnormalities (e.g., polydactyly), fetal hydantoin syndrome.
During 3rd-8th week
Ebstein anomaly
A congenital heart defect characterized by caudal displacement of a tricuspid valve leaflet that results in atrialization of the right ventricle, tricuspid regurgitation, and right atrial enlargement. Classically associated with fetal lithium exposure
This newborn’s head tilt, limited passive range of motion of the neck, and palpable lower neck mass are consistent with a diagnosis of _____
Congenital torticollis.
Decreased intrauterine space during pregnancy (e.g., due to fetal macrosomia, multiple gestation, oligohydramnios) is a risk factor
In addition, fetal macrosomia, breech presentation, and assisted vaginal delivery can cause perinatal trauma to the sternocleidomastoid muscles,
This newborn presents with low-set ears, flat nose, micrognathia, foot clubbing, and respiratory distress, which suggests _____
Potter sequence.
Etiology for Potter sequence
Compression of growing fetal tissue in utero due to oligohydramnios
Common causes of oligohydramnios include chronic placental insufficiency, chronic amniotic fluid leakage, and decreased fetal renal output.
A 30-year-old woman comes to the physician for evaluation of successful conception. She and her husband are trying to conceive, and they have had frequent sexual intercourse over the past month. Her menstrual cycles occur at regular 28-day intervals, and her last menstrual period began 25 days ago. Which of the following is the most sensitive test for diagnosing pregnancy at this time?
Serum testing
Serum β-hCG testing is the most sensitive test for detecting early pregnancy. β-hCG is produced by the syncytiotrophoblast to preserve the corpus luteum and can be detected in serum as early as 6–9 days after fertilization.
This woman’s significantly elevated blood pressure (> 160 mm Hg systolic) after 20 weeks’ gestation in the context of new-onset headaches and visual disturbances indicates preeclampsia with severe features. What is the pathogenesis?
Abnormal remodeling of the spiral arteries creates narrow vessels instead of large, high-capacity vessels, which leads to placental hypoperfusion. This causes the release of vasoactive substances by the placenta into the maternal bloodstream that alter systemic endothelial cell function. Increased vascular tone (systemic vasoconstriction) raises maternal blood pressure to ensure sufficient blood supply to the fetus, and endothelial lesions and release of procoagulants result in microthrombi. These factors lead to organ ischemia and damage, which can manifest with headaches and visual disturbances as seen in this patient due to vasospasms in the CNS.
A previously healthy 18-year-old woman comes to the emergency department for evaluation of intractable vomiting and uterine cramping. Her last menstrual period was 7 weeks ago. Serum β-human chorionic gonadotropin concentration is 170,000 mIU/mL. A transvaginal ultrasound shows a complex intrauterine mass with numerous anechoic spaces and multiple ovarian cysts. The patient undergoes dilation and curettage, which shows hydropic villi with diffuse, circumferential trophoblastic proliferation. Karyotype analysis of the specimen is most likely to show which of the following?
A complete hydatidiform mole results from the fertilization of an “empty” oocyte (i.e., one that does not carry any chromosomes) by a sperm. The haploid set of chromosomes from the sperm then doubles (paternal disomy) to yield a karyotype of either 46,XX (∼ 90% of cases) or 46,XY (∼ 10% of cases).
A 2500-g (5-lb 8-oz) female newborn delivered at 38 weeks’ gestation develops rapid breathing, grunting, and subcostal retractions shortly after birth. Despite appropriate lifesaving measures, the newborn dies 2 hours later. Autopsy shows bilateral renal agenesis. Which of the following is the most likely underlying cause of this newborn’s respiratory distress?
Decreased amniotic fluid aspiration into the lungs > pulmonary hypoplasia
This newborn has evidence of the Potter sequence: bilateral renal agenesis and features of respiratory distress (e.g., tachypnea, subcostal retractions, grunting).
A 3-month-old male infant with HIV infection is brought to the physician for evaluation. The physician recommends monthly intramuscular injections of a monoclonal antibody (pavlizumab) to protect against infection caused by an enveloped virus with a helical capsid and negative-sense, single-stranded RNA. The causal pathogen (paromyxovirus) for this infection is most likely transmitted by which of the following routes?
Droplet transmission
A 35-year-old woman, gravida 2, para 1, at 16 weeks’ gestation comes to the office for a prenatal visit. She reports increased urinary frequency but otherwise feels well. Pregnancy and delivery of her first child were uncomplicated. Her vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 16-week gestation. Urinalysis shows mild glucosuria. Laboratory studies show a non-fasting serum glucose concentration of 100 mg/dL. Which of the following is the most likely explanation for this patient’s glucosuria?
Increased glomerular filtration rate is normal during pregnancy and leads to mild glucosuria even in patients with normal serum blood glucose concentrations
