exam 1

Question 1

o Gestation age

Answer 1

• Full-term ≥ 37 weeks gestational age

* Premature < 37 weeks gestational age

Question 2

o Trimester of pregnancy

Answer 2

• 1st trimester: week 1-12
• Organogenesis in first 8 weeks
• After 1st 8 weeks, most teratogenic effects are related to fetal growth retardation
• 2nd trimester: week 13-27
• 3rd trimester: week 28-birth

Question 3

o Prenatal Care Visits

Answer 3

• Every 4 weeks until 28 weeks gestation
• Every 2 weeks at 26-36 weeks gestation
• Every weekly from 36 weeks onward until delivery
• More frequent for high-risk pregnancy

Question 4

• Birth weight

Answer 4

o Low Birth Weight (LBW) = 1,500 g – 2,500g
o Very Low Birth Infant (VLBW) = 1,000 g – 1,500 g
o Extreme Low Birth Weight (ELBW) = < 1,000 g

Question 5

o Category-A

Answer 5

o Adequate well-controlled studies, no increased fetal risk

Question 6

Category
o B
o (Australia: B1, B2, B3)

Answer 6

o Animal studies show no harm to the fetus but no adequate well-controlled studies in pregnant women, or animal studies have shown an adverse effect but well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus

Question 7

Category-C

Answer 7

o Animal studies have shown an adverse effect and no adequate well controlled studies in pregnant women, or no animal studies have been conducted and there are no adequate and well controlled studies in pregnant women

Question 8

Category-D

Answer 8

o Studies well controlled or observational, in pregnant women have demonstrated a risk to the fetus. However benefits may outweigh the risks.

Question 9

Category-X

Answer 9

product is contradicted in women who are or may become pregnant.

Question 10

• Pregnancy Visit 1 Labs

Answer 10

o Pregnancy confirmation (hCG level)
• blood or urine
o Rhesus type (Rh type) and antibody screen
o Genetics testing
o Screening for anemia
• Complete blood count, iron deficiency
o Urinalysis
o Rubella and varicella immunity
• Don’t vaccinate while pregnant. Must already be immune before being pregnant
o STI- HIV, syphilis, Hep B, chlamydia, gonorrhea on 1st visit and 3rd trimester
o Precautions to prevent other infections
• Example: toxoplasmosis- a possible source is cat litter
o Thyroid function -TSH, T3, T4
o Type 2 diabetes

Question 11

• 1st trimester visit

Answer 11

o Physical exam, updated histories, and education (nutrition, medication, warning signs)

Question 12

• 2nd trimester visit

Answer 12

o	15-24 weeks gestation
      •	Ultrasound and blood tests 
o	24-28 weeks gestation
      •	gestational diabetes
      •	recheck Rhesus type (Rh) and antibody screen
      •	CBC (screen for anemia)

Question 13

• 3rd trimester visit

Answer 13

o 28-36 weeks
• Tdap Vaccine
• STI screening
• Group B beta-hemolytic streptococcus screening
• Fetal assessment
o 36 week onward
• Education on preparation for labor, delivery, postpartum issues, etc.

Question 14

• Failure to Thrive

Answer 14

o Inadequate physical growth diagnosed by observation of growth over time using a standard growth chart (WHO, CDC)
o Weight falls below 5th percentile or drops in crossing 2+ major percentile lines

Question 15

• How to use growth chart

Answer 15

o WHO charts for patient < 2 years
o CDC charts for patient 2-20 years
o Make sure you have the correct chart for age and gender
o Make sure you have the correct chart of the measurement you wish to plot

Question 16

• Antibody and Vaccine

Answer 16

o Live vaccine 1st => wait 2 weeks before give antibody
o Antibody 1st => wait 3 months+ before give vaccine
o Exception = monoclonal antibodies and red blood cells
o Polysaccharide vaccines are not consistently immunogenic in children < 2 years. Give conjugated form.

Question 17

• Hepatitis B

Answer 17

o 3 doses = 0, 1-2, 6-18 months
• 1st dose after birth before hospital discharge
• If baby’s mom is positive for antibody or weigh less 2,000 g then give HepB vaccine and HBIG within 12 hours of birth

Question 18

• Rotavirus

Answer 18

o	LIVE ORAL VACCINE
o	1st dose given before 15 weeks of age and all doses administered by 8 months of age
o	RV5 (RotaTeq) = 3 dose series at 2, 4, and 6 months of age
o	RV1 (Rotarix) = 2 dose series at 2, 4 months of age

Question 19

• Haemophilus influenzae type b (Hib)

Answer 19

o Earlier the dose if given, the more in a series they are needed

Question 20

Urinalysis

Answer 20

Urinalysis
• Protein, culture
• Sign and symptoms of urinary tract infection
• Treat UTI even when asymptomatic

Question 21

Type 2 diabetes

Answer 21

• Fasting plasma glucose >125 mg/dL
  * A1C > 6.5%
  * Random plasma glucose > 200 mg/dL, confirm by elevated fasting or A1C

Question 22

• Diphtheria/ Tetanus/ Pertussis

o If doses given at 2 months of age, 4-5 doses are required

Answer 22

• DTaP = 1st 3 doses separated by 4 weeks and 4th dose at least 6 months from last dose
• 2 months of age, 3 months of age, 6 months of age, and 15 months of age
• Booster dose of DTaP at 4-6 years of age if all four doses given before 4th birthday

Question 23

• Diphtheria/ Tetanus/ Pertussis

o If dose began at 12 months of age

Answer 23

o If dose began at 12 months of age, then only 3 doses required

Question 24

• Diphtheria/ Tetanus/ Pertussis

basics

Answer 24

o Tdap boost 11-12 years age
o Tdap for 27-36 weeks of each pregnancy
o Tdap for anyone who have never received it