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Sophia's Additions > ER Exam 1 > Flashcards

ER Exam 1 Flashcards

1
Q

What is a nabothian cyst and its significance in a colposcopy?

A

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

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2
Q

When do you do a cervical exisional procedure?

A

If an endocervical curretage/bx is positive

or

unsatisfactory colposcopy performed (can’t see SCJ)

or

substantial difference btw pap and biopsy

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3
Q

When is the estimated date of confinement (delivery)?

A

40 weeks after first day of last menstrual period (FDLMP)

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4
Q

Why do up to 40% of women have some vaginal bleeding during early pregnancy?

A

implantation bleeding

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5
Q

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?

A

menses = 100

negative < 5

preg test = 25

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6
Q

What is the definition of a biochemical pregnancy?

A

presence of hCG 7-10 d after ovulation in a woman w/ regular cycles

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7
Q

When is the risk of fetal loss decreased to 2%?

A

if US reveals a live appropriately grow fetus at 8 weeks w/ + cardiac activity

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8
Q

What is an abortus?

A

fetus lost before 20 weeks

less than 500 g

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9
Q

How many threatened abortions eventually result in loss of pregnancy?

A

25-50%

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10
Q

Is the cervix closed or open in a complete abortion?

A

closed

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11
Q

What is the tx for a septic abortion?

A

ampicillin

gentamycin

clindamycin

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12
Q

How large is a blighted ovum?

A

> 25 mm

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13
Q

What is asherman syndrome?

A

rare acquired syndrome where scarring and adhesions form in the uterus due to trauma

often due to aggressive abortions –> destroys basalis layer

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14
Q

when does cervical incompetence typically cuase loss of pregnancy?

A

second trimester

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15
Q

What is the leading cause of maternal death in the first trimester?

A

ectopic pregnancy

(trophoblasts implant into mucosa of fallopian tube and rapidly erode through to the underlying blood vessels)

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16
Q

What is the difference in ectopic locations in natural conception vs assisted conception?

A

in natural, >95% are tubal

after ART, 92.7% are ampullary

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17
Q

What is the arias-Stella reaction?

A

thickened endometrial stripe seen in an ectopic pregnancy

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18
Q

When do you check hCG after giving a methotrexate dose for ectopic pregnancy?

A

day 4 and 7

will initially increase on day 4

if no decrease on day 7, give another dose

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19
Q

What are relative contraindications of methotrexate use for ectopic pregnancy?

A

gestational sac 3.5 cm or greater

embryonic cardiac motion

hCG levels > 6000

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20
Q

When do most ectopics resolve spontaneously?

A

80% will with hCG levels < 1000

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21
Q

What is a salpingostomy?

A

cut into tube to remove ectopic –> don’t sew it up, let it heal by secondary intention

(vs salpingotomy = sew it up)

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22
Q

What ethnic group has the most RhD negative people?

A

15%

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23
Q

How much fetal blood is needed to cause isoimmunization?

When does this blood transfer typically occur?

A

0.1 ml or less

usually during routine vaginal deliveries

1-2% occur in antipartum period

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24
Q

When do you administer rhoGam?

A

28 weeks

within 72 hrs after delivery of Rh D positive infant

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25
Q

When is the risk of intrauterine transfusion for an anemic baby greater than the risk of delivery?

A

at 35 weeks –> consider delivery and transfusing the neonate

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26
Q

What are normal cardiac sounds heard during pregnancy?

A

systolic murmurs

exaggerated splitting and S3

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27
Q

What is chadwick’s sign?

A

bluish discoloration of cirvix, vagina, and labia from increased blood flow

normal during pregnancy

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28
Q

What infections are screened for at a first prenatal visit?

A

rubella (vaccinate postpartum if not immune)

syphilis

Hep B surface Ag

HIV

gonorrhea and chlamydia

DM

Urine culture

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29
Q

When is a fetal pole seen?

A

6 weeks

when mean hCG is 5200

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30
Q

What measurements determine due date btw 6-11 weeks?

What about 12-20 weeks?

A

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

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31
Q

How is fetal demise diagnosed in first trimester (based on CRL)?

A

if CRL > 5 mm w/ absence of fetal cardiac activity

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32
Q

What is the incidence for trisomy in women under 35, 35-39, 40-45, and >45?

A

< 35 –> 1 in 800

35-39 –> 1 in 300

40-45 –> 1 in 80

>45 –> 1 in 35

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33
Q

What are aminopterin and methotrexate?

A

both folic acid antagonists (chemo drugs)

exposure before 40 days is lethal

later exposure causes other se

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34
Q

How does valproid acid affect a fetus?

A

(anticonvulsant med)

1-2% risk of open spina bifida

some assoc w/ heart, skeletal, and craniofacial defects

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35
Q

What is carbamazepine and its assoc w/ pregnancy?

A

anticonvulsant

increased risk for spina bifida and other minor defects

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36
Q

What defects can retinoids cause?

A

CNS

cardiovascular

craniofacial (microcephaly w/ severe ear abn, microtia and cleft palate)

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37
Q

How often should moms have prenatal visits?

A

every 4 weeks until 28 weeks

every 2 weeks from 28-36 weeks

weekly until delivery

38
Q

What is the weight gain recommendation for moms w/ BMI <19?

19-25?

>25?

A

<19 = 28-40

19-25 = 25-35

> 25 = 15-25

39
Q

What is the technical definition of labor contractions?

A

at least every 5 minutes

last 30-60 seconds

40
Q

What are the shapes of the anterior and posterior fontanelles?

A

anterior = diamond shaped, larger

posterior = Y or triangle shaped

41
Q

What is the smallest and most common head diameter?

A

suboccipitobregmatic (9.5 cm)

when head is well flexed and OA

42
Q

When does the occipitofrontal diameter pass through the pelvis?

How wide is it?

A

when the head is deflexed and is in the occiput posterior position

11 cm

43
Q

When does the supraoccipitomental diameter present and what is its measurement?

A

brow presentation(from chin to occiput)

largest = 13.5 cm

44
Q

When does the submentobregmatic diameter present and what is its measurement?

A

face presentation

9.5 cm

45
Q

What characterizes the gynecoid pelvis?

A

classic female type

round at inlet

wide transverse diameter and wide suprapubic arch

good prognosis for delivery

46
Q

What characterizes the android pelvis?

A

classic male type

widest transverse diameter closer to the sacrum

prominent ischial spines

narrow pubic arch

fetal head is forced to OP –> poor prognosis

47
Q

What characterizes the anthropoid pelvis?

A

like an ape’s

much larger AP than transverse diameter

narrow pubic arch

baby engages only in AP diameter, usually OP

good prognosis

48
Q

What characterizes the platypelloid pelvis?

A

flattened gynecoid (3% of females)

short AP and wide transverse

*fetal head has to engage in transverse diameter –> poor prognosis

49
Q

What are the two pelvis shapes with a poor prognosis?

A

android

platypelloid

50
Q

What are the diagonal and obstetric conjugate measurements?

A

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

51
Q

What is the pelvic outlet measurement?

A

measure ischial tuberosities and pubic arch

tuberosities at least 8.5 cm is good

infrapubic angle > 90 is good

52
Q

What are the cardinal movements of labor?

A

Every Decent Family In England Eats Eggs

Engagement

Descent

Flexion

Internal rotation

Extension

External rotation

Expulsion

53
Q

What maneuver is often performed to deliver a head in a normal delivery?

A

modified Ritgen maneuver

extend the head by pulling up on chin

counterpressure on occiput

54
Q

What spinal levels innervate the uterus?

pelvic floor, vagina, and perineum?

A

Uterus = T10-L1

lower down = S2-S4 (pudendal nerve)

55
Q

How can pitocin affect fetal heart rate?

A

can cause bradycardia or tachycardia if too much

56
Q

How do chemoreceptors and baroreceptors affect fetal HR respectively?

A

chemo –> produce tachycardia in response to hypoxia

baro –> decrease HR via vagus n

57
Q

What is a “shoulder” in a fetal HR diagram?

A

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

58
Q

When do you see a sinusoidal pattern on FHR monitor?

A

fetal anemia

59
Q

What is class B diabetes?

A

onset at age 20 or older w/ duration < 10 yrs

60
Q

What is class c diabetes?

A

onset at age 10-19 or duration of 10-19 yrs

61
Q

What is class D diabetes?

A

onset before age 10 or duration greater than 20 yrs

62
Q

What are class F, R, RF, H, and T diabetes?

A

F: diabetic nephropathy

R: retinopathy

RF: retinopathy and nephropathy

H: ischemic heart dz

T: prior kidney Transplant

63
Q

How often should to evaluate a fetus in a mom w/ preexisting DM?

A

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

64
Q

How do insulin requirements for the mother change after delivery?

A

drop significantly after delivery of the placenta

insulin-dependent pts typically require 2/3 of pregnancy dose after

65
Q

What thyroid meds do you use for hyperthyroidism in pregnancy?

A

1st trimester - PTU

2nd and 3rd - methimazole

66
Q

How should post-renal transplant pts manage pregnancy?

A

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

67
Q

What can maternal steroid tx do to a fetus?

A

induce adrenal and hepatic insufficiency

68
Q

What complications can maternal pyelonephritis cause?

A

increased uterine activity and preterm labor

ARDS

69
Q

What are initial txs for N/V of pregnancy?

A

Vit B6

doxylamine

promethazine

70
Q

Who more often gets hyperemesis gravidarum?

A

first pregnancies

multiple pregnancies

trophoblastic dz

71
Q

What GI dz may improve in pregnancy?

A

peptic ulcer

72
Q

What GI dz can increase risk of miscarriage?

A

IBD

(if active at time of conception)

73
Q

What is a potential cause of acute fatty liver dz of pregnancy?

A

LCHAD deficiency

74
Q

When is the risk of venous thrombosis highest for a mother?

A

first 5 weeks postpartum

75
Q

What heart sound can you hear in a maternal PE?

A

accentuated pulmonic valve second heart sound

76
Q

What are the treatments for asthma in pregnancy based on severity?

A

mild intermittent = SABA

mild persistent = low dose inhaled steroid

mod persistent = daily ICS + LABA

severe persistent = add systemic steroids

77
Q

How is MS affected by pregnancy?

A

usually experience fewer and less severe episodes

may exacerbate postpartum

incr risk of lower birth weight baby and c-section

78
Q

What supplement is increased in women on anti-epileptic drugs in pregnancy?

A

folic acid

need 1 mg to 4 mg

79
Q

What is considered mild chronic htn in pregnancy?

how to manage?

A

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

80
Q

What htn meds must you never use in pregnancy?!

A

ACE Inhibitors

ARBs

81
Q

When should you deliver a baby in a mom w/ severe chronic htn?

A

after 38 weeks

82
Q

What is significant about herpes presentation (males vs females)?

A

ALL Males are symptomatic

but females are more susceptible to getting it

83
Q

where does herpes stay latent?

A

lumbosacral ganglia

84
Q

What ages are more likely to get preeclampsia?

A

<20 and >35

85
Q

What happens to the heart and lungs in preeclampsia?

A

heart: edema, absence of normal intravascular vol expansion bc of 3rd spacing, reduction in circulating blood volume
lungs: noncardiogenic pulmonary edema

86
Q

What labs are increased in preeclampsia?

A

hematocrit (bc third spacing)

LDH

AST, ALT

uric acid

87
Q

How many units of blood do you type and cross match for transfusion?

A

4 units

88
Q

What is the mean gestational age for bleeding in placenta previa?

A

30 weeks

89
Q

Most common risk factor for placental abruption?

A

maternal HTN

90
Q

What is the most common cause of maternal DIC in pregnancy?

A

placental abruption

91
Q
A

Sophia's Additions (4 decks)

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