ER Exam 1 Flashcards
What is a nabothian cyst and its significance in a colposcopy?
mucus-filled cyst on the surface of the cervix occurs when columnar epithelium is engulfed and covered by squamous
can look abnormal because always covered with vasculature - can be mistaken for abnormal vessels but it doesn’t suggest CA
When do you do a cervical exisional procedure?
If an endocervical curretage/bx is positive
or
unsatisfactory colposcopy performed (can’t see SCJ)
or
substantial difference btw pap and biopsy
When is the estimated date of confinement (delivery)?
40 weeks after first day of last menstrual period (FDLMP)
Why do up to 40% of women have some vaginal bleeding during early pregnancy?
implantation bleeding
What level of hCG is reached about the time of expected menstruation?
What level of hCG is considered negative?
What level can a pregnancy test detect?
menses = 100
negative < 5
preg test = 25
What is the definition of a biochemical pregnancy?
presence of hCG 7-10 d after ovulation in a woman w/ regular cycles
When is the risk of fetal loss decreased to 2%?
if US reveals a live appropriately grow fetus at 8 weeks w/ + cardiac activity
What is an abortus?
fetus lost before 20 weeks
less than 500 g
How many threatened abortions eventually result in loss of pregnancy?
25-50%
Is the cervix closed or open in a complete abortion?
closed
What is the tx for a septic abortion?
ampicillin
gentamycin
clindamycin
How large is a blighted ovum?
> 25 mm
What is asherman syndrome?
rare acquired syndrome where scarring and adhesions form in the uterus due to trauma
often due to aggressive abortions –> destroys basalis layer
when does cervical incompetence typically cuase loss of pregnancy?
second trimester
What is the leading cause of maternal death in the first trimester?
ectopic pregnancy
(trophoblasts implant into mucosa of fallopian tube and rapidly erode through to the underlying blood vessels)
What is the difference in ectopic locations in natural conception vs assisted conception?
in natural, >95% are tubal
after ART, 92.7% are ampullary
What is the arias-Stella reaction?
thickened endometrial stripe seen in an ectopic pregnancy
When do you check hCG after giving a methotrexate dose for ectopic pregnancy?
day 4 and 7
will initially increase on day 4
if no decrease on day 7, give another dose
What are relative contraindications of methotrexate use for ectopic pregnancy?
gestational sac 3.5 cm or greater
embryonic cardiac motion
hCG levels > 6000
When do most ectopics resolve spontaneously?
80% will with hCG levels < 1000
What is a salpingostomy?
cut into tube to remove ectopic –> don’t sew it up, let it heal by secondary intention
(vs salpingotomy = sew it up)
What ethnic group has the most RhD negative people?
15%
How much fetal blood is needed to cause isoimmunization?
When does this blood transfer typically occur?
0.1 ml or less
usually during routine vaginal deliveries
1-2% occur in antipartum period
When do you administer rhoGam?
28 weeks
within 72 hrs after delivery of Rh D positive infant
When is the risk of intrauterine transfusion for an anemic baby greater than the risk of delivery?
at 35 weeks –> consider delivery and transfusing the neonate
What are normal cardiac sounds heard during pregnancy?
systolic murmurs
exaggerated splitting and S3
What is chadwick’s sign?
bluish discoloration of cirvix, vagina, and labia from increased blood flow
normal during pregnancy
What infections are screened for at a first prenatal visit?
rubella (vaccinate postpartum if not immune)
syphilis
Hep B surface Ag
HIV
gonorrhea and chlamydia
DM
Urine culture
When is a fetal pole seen?
6 weeks
when mean hCG is 5200
What measurements determine due date btw 6-11 weeks?
What about 12-20 weeks?
6-11 weeks –> crown rump length can det due date w/in 7 days
12-20 weeks –> femur length, biparietal diameter, and abdominal circumference can est w/in 10 days
How is fetal demise diagnosed in first trimester (based on CRL)?
if CRL > 5 mm w/ absence of fetal cardiac activity
What is the incidence for trisomy in women under 35, 35-39, 40-45, and >45?
< 35 –> 1 in 800
35-39 –> 1 in 300
40-45 –> 1 in 80
>45 –> 1 in 35
What are aminopterin and methotrexate?
both folic acid antagonists (chemo drugs)
exposure before 40 days is lethal
later exposure causes other se
How does valproid acid affect a fetus?
(anticonvulsant med)
1-2% risk of open spina bifida
some assoc w/ heart, skeletal, and craniofacial defects
What is carbamazepine and its assoc w/ pregnancy?
anticonvulsant
increased risk for spina bifida and other minor defects
What defects can retinoids cause?
CNS
cardiovascular
craniofacial (microcephaly w/ severe ear abn, microtia and cleft palate)
How often should moms have prenatal visits?
every 4 weeks until 28 weeks
every 2 weeks from 28-36 weeks
weekly until delivery
What is the weight gain recommendation for moms w/ BMI <19?
19-25?
>25?
<19 = 28-40
19-25 = 25-35
> 25 = 15-25
What is the technical definition of labor contractions?
at least every 5 minutes
last 30-60 seconds
What are the shapes of the anterior and posterior fontanelles?
anterior = diamond shaped, larger
posterior = Y or triangle shaped
What is the smallest and most common head diameter?
suboccipitobregmatic (9.5 cm)
when head is well flexed and OA
When does the occipitofrontal diameter pass through the pelvis?
How wide is it?
when the head is deflexed and is in the occiput posterior position
11 cm
When does the supraoccipitomental diameter present and what is its measurement?
brow presentation(from chin to occiput)
largest = 13.5 cm
When does the submentobregmatic diameter present and what is its measurement?
face presentation
9.5 cm
What characterizes the gynecoid pelvis?
classic female type
round at inlet
wide transverse diameter and wide suprapubic arch
good prognosis for delivery
What characterizes the android pelvis?
classic male type
widest transverse diameter closer to the sacrum
prominent ischial spines
narrow pubic arch
fetal head is forced to OP –> poor prognosis
What characterizes the anthropoid pelvis?
like an ape’s
much larger AP than transverse diameter
narrow pubic arch
baby engages only in AP diameter, usually OP
good prognosis
What characterizes the platypelloid pelvis?
flattened gynecoid (3% of females)
short AP and wide transverse
*fetal head has to engage in transverse diameter –> poor prognosis
What are the two pelvis shapes with a poor prognosis?
android
platypelloid
What are the diagonal and obstetric conjugate measurements?
diagonal: inf portion of pubic symphysis to sacral promontory; if > 11.5 cm the AP diameter is adequate
obstetric: estimated by subtracting 2 cm from the diagonal conjugate = narrowest fixed distance thru which the fetal head must pass
What is the pelvic outlet measurement?
measure ischial tuberosities and pubic arch
tuberosities at least 8.5 cm is good
infrapubic angle > 90 is good
What are the cardinal movements of labor?
Every Decent Family In England Eats Eggs
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion
What maneuver is often performed to deliver a head in a normal delivery?
modified Ritgen maneuver
extend the head by pulling up on chin
counterpressure on occiput
What spinal levels innervate the uterus?
pelvic floor, vagina, and perineum?
Uterus = T10-L1
lower down = S2-S4 (pudendal nerve)
How can pitocin affect fetal heart rate?
can cause bradycardia or tachycardia if too much
How do chemoreceptors and baroreceptors affect fetal HR respectively?
chemo –> produce tachycardia in response to hypoxia
baro –> decrease HR via vagus n
What is a “shoulder” in a fetal HR diagram?
when umbilical cord is only slightly compressed, umbilical V is obstructed
initial response is a slight increase to compensate for lack of blood return
slight increase –> followed by major drop = shoulder
When do you see a sinusoidal pattern on FHR monitor?
fetal anemia
What is class B diabetes?
onset at age 20 or older w/ duration < 10 yrs
What is class c diabetes?
onset at age 10-19 or duration of 10-19 yrs
What is class D diabetes?
onset before age 10 or duration greater than 20 yrs
What are class F, R, RF, H, and T diabetes?
F: diabetic nephropathy
R: retinopathy
RF: retinopathy and nephropathy
H: ischemic heart dz
T: prior kidney Transplant
How often should to evaluate a fetus in a mom w/ preexisting DM?
look for malformations at 11-13 weeks
quad screen 16-21 weeks
fetal growth US every 2-4 weeks
fetal testing (NST/BPP) every week starting at 32 weeks
How do insulin requirements for the mother change after delivery?
drop significantly after delivery of the placenta
insulin-dependent pts typically require 2/3 of pregnancy dose after
What thyroid meds do you use for hyperthyroidism in pregnancy?
1st trimester - PTU
2nd and 3rd - methimazole
How should post-renal transplant pts manage pregnancy?
not recommended bc may lose graft fxn or experience rejection
best candidates are 1-2 yrs post-transplant w/ stable Cr and proteinuria w/out severe htn
What can maternal steroid tx do to a fetus?
induce adrenal and hepatic insufficiency
What complications can maternal pyelonephritis cause?
increased uterine activity and preterm labor
ARDS
What are initial txs for N/V of pregnancy?
Vit B6
doxylamine
promethazine
Who more often gets hyperemesis gravidarum?
first pregnancies
multiple pregnancies
trophoblastic dz
What GI dz may improve in pregnancy?
peptic ulcer
What GI dz can increase risk of miscarriage?
IBD
(if active at time of conception)
What is a potential cause of acute fatty liver dz of pregnancy?
LCHAD deficiency
When is the risk of venous thrombosis highest for a mother?
first 5 weeks postpartum
What heart sound can you hear in a maternal PE?
accentuated pulmonic valve second heart sound
What are the treatments for asthma in pregnancy based on severity?
mild intermittent = SABA
mild persistent = low dose inhaled steroid
mod persistent = daily ICS + LABA
severe persistent = add systemic steroids
How is MS affected by pregnancy?
usually experience fewer and less severe episodes
may exacerbate postpartum
incr risk of lower birth weight baby and c-section
What supplement is increased in women on anti-epileptic drugs in pregnancy?
folic acid
need 1 mg to 4 mg
What is considered mild chronic htn in pregnancy?
how to manage?
BP less than 160/110
baby aspirin at 12 weeks
meds if reach threshold
prenatal visits every 2-4 weeks and then weekly at 34 weeks
What htn meds must you never use in pregnancy?!
ACE Inhibitors
ARBs
When should you deliver a baby in a mom w/ severe chronic htn?
after 38 weeks
What is significant about herpes presentation (males vs females)?
ALL Males are symptomatic
but females are more susceptible to getting it
where does herpes stay latent?
lumbosacral ganglia
What ages are more likely to get preeclampsia?
<20 and >35
What happens to the heart and lungs in preeclampsia?
heart: edema, absence of normal intravascular vol expansion bc of 3rd spacing, reduction in circulating blood volume
lungs: noncardiogenic pulmonary edema
What labs are increased in preeclampsia?
hematocrit (bc third spacing)
LDH
AST, ALT
uric acid
How many units of blood do you type and cross match for transfusion?
4 units
What is the mean gestational age for bleeding in placenta previa?
30 weeks
Most common risk factor for placental abruption?
maternal HTN
What is the most common cause of maternal DIC in pregnancy?
placental abruption
