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Exam 3 Flashcards

1
Q

Ectopic Rupture

A

Medical Emergency

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2
Q

Intense Pelvic and Lower Abd Pain
50% report shoulder pain
Leads to shock (Drop in BP, Spike in HR)

A

Ectopic Rupture

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3
Q

Dx Studies: Ectopic Pregnancy

A

Bimanual Exam
Serial B-hCG Levels (Slower rise than norm preg)
Transvaginal Ultrasound= Best Dx Tool
H&H
Culdocentesis
Laparoscopy (may also treat)

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4
Q

Most common site of Ectopic Pregnancy

A

Fallopian Tube

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5
Q

Implantation at any site other than endometrium

A

Ectopic Pregnancy

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6
Q

Risk Factors for Ectopic Pregnancy

A 
Endometriosis 
PID (Pelvic Inflammatory Disease = key)
Previous Ectopic (10% More likely)
Increased Progesterone 
Assisted Reproduction 
Tube  Abnormality (Sx, Birth, Sterilization)
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7
Q

Molar Pregnancy
46 Paternal Chromosomes
No Embryo
No Fetal Tissue

A

Complete Molar Pregnancy

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8
Q

2 Tx of Ectopic Pregnancy

A

Laparoscopy

Methrotrexate (Chemo–>destroys preg)

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9
Q

S/S Choriocarcinoma

A

Bloody, Brown Discharge

Elevated hCG

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10
Q

CA arose in placenta during pregnancy
Rare
Can Metastasize

A

Choriocarcinoma

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11
Q

Percentage of Females with molar pregnancy that develop Choriocarcinoma

A

20%

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12
Q

Important Teaching For Molar Pregnancy

A

STRESS: F/U hCG (Weekly then Monthly)
NO Pregnancy for at least 6 mo (Can Hide S/S)
Provide Support

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13
Q

Cure Rate for Choriocarcinoma

A

100% IF still in uterus w/ normal Subsequent Pregnancy

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14
Q

Termination of Pregnancy before viability

before 20 weeks

A

Abortion

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15
Q

Medical Termination of Pregnancy

A

Induced Abortion (Elective/ Therapeutic)

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16
Q

Miscarriage

A

Spontaneous Abortion

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17
Q

Roe v Wade 1973

A

Any woman may have an abortion within the first 12 wks of pregnancy

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18
Q

Abortion @>20 weeks of gestation

A

Illegal unless to save the life of mom

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19
Q

Abortion Method (12-20 weeks) 2nd Trimester

A

D&E (suction and evacuation)

Mifepristone w/ misopristol

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20
Q

80% of Spontaneous Abortions Occur w/in

A

The First Trimester

Before mom knows she is pregnancy–think heavy menses

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21
Q

Responsible for 50% of early spontaneous abortions

A

Fetal Chromosomal Abnormalities

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22
Q

Responsible for Late Spontaneous Abortion

A

weak cervix or maternal illness

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23
Q

Greatest Risk Factor for Spontaneous Abortion

A

AMA

> 35 years old

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24
Q

10% of birth defects are caused by

A

medications (OTC, Herbal, Street)

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25
60% of woman use at least...
One Rx in pregnancy
26
FDA Maternal Medication Use | Category A
failed to show fetal risk - best choice
27
FDA Maternal Medication Use | Category B
animal studies failed to show fetal risk
28
FDA Maternal Medication Use | Category C
animal studies | show fetal risk
29
FDA Maternal Medication Use | Category D
evidence of human fetal risk
30
FDA Maternal Medication Use | Category X
studies have shown fetal abnormalities | DO NOT USE
31
Preferred Anticoagulant
Heparin
32
Leading cause of mental retardation
Alcohol During Pregnancy
33
Most Common teratogen
Alcohol During Pregnancy
34
Accutane
increase risk of spontaneous abortion & congenital deformity
35
Anticonvulsants-Valproic Acid, Carbamezapine
Increase risk of cognitive abnormality, neural tube defects, cleft pallet, and IUGR
36
Inhibits prostanglandin synthesis --> premature ductus arteriosis constriction
Salycilates (NSAIDS, ibuprofen, aspirin, motrin, advil)
37
List Salycilates
``` NSAIDS ibuprofen aspirin Motrin Advil ```
38
Salycilates Asc Pregnancy
Do NOT use in late pregnancy >20 wks Increases Birth Defects Prolonged/ Inhib Labor
39
Premature Ductus Arteriosis Constriction
Allows fetal circulation to bypass lungs
40
Tetracycline
-->yellow teeth & depresses skeleton growth
41
ACE Inhibitors
Risk birth defects IUGR Fetal Death
42
Warafin
Risk of spontaneous abortion Fetal demise Fetal & NB Hemorrhage CNS defects
43
Contraindicated Vaccines
``` Measles Mumps Rubella Varicella Activated (Nasal) Flu ```
44
Pregnant Nurses
Discuss w/ MD & inform work Use universal precautions Leave during X-rays
45
Pregnant Nurses use caution with patient assignments including:
Radioactive implants Nuclear procedures (Dx using radionucleides, antineoplastics, chemicals, anesthetic gases, sterilizing agents)
46
Caffeine
Increases risk of spontaneous abortion
47
Safe Amt of Caffeine
300mg daily | 3 average sized cups of coffee
48
5A's
``` Ask - About Advise- to quit smoking Assess- willingness to quit Assist- to quit Arrange- for follow up care * majority resume smoking w/in 1+ yo after birth ```
49
Smoking
significant modifiable cause of poor pregnant outcomes d/t hypoxemia & chemicals Nicotine--> decreased uterine blood flow
50
Smoking increases the risk of
``` Low-birth wt & IUGR Preterm delivery Fetal death SIDS Asthma Childhood CA Learning disabilities Infant ear & respiratory infections ```
51
Alcohol stopped mid pregnancy-->
inhibits protein synthesis | alters embryonic organization of cells - can not be fixed
52
Alcohol increases the risk of
miscarriage, stillbirth,and death
53
Congenital anomalies of eyes d/t alcohol
``` Palpebral fissures (sm eye opening) Strabismus (crosses) Ptosis (saggy) Myopia Widest ```
54
Congenital anomalies of nose d/t alcohol
Shortened, upturned, broad bridge
55
Congenital anomalies of mouth d/t alcohol
Mircognathia Smooth philtrum sm chin/ smooth upper lip
56
Midface of Fetal Alcohol Baby
Flattened
57
Cardiac defects (alcohol)
murmurs atrial-septal defects ventricular septal defects
58
FELOP
``` FSH Estrogen LH (Surge) Ovulation Progesterone *menstrual cycle order* ```
59
3 phases of Ovarian Cycle
Follicular Phase Ovulatory Phase Luteal Phase
60
Variable Phase of Ovarian Cycle
Follicular Phase | Days 1-14
61
Primary follicles=Immature, FSH --> growth into oocyte | Graafian follicle= small ovum, secrets EST
Follicular Phase of Ovarian Cycle
62
Days 15-28 of Ovarian Cycle | Fixed Time Frame
Luteal Phase
63
Upsurge of LH-->Ovulation -Follicle ruptures, ovum free -->travels to Fallopian tube Corpus luteum develops -- remain follicle fills w/ fluid high in PRO
Luteal Phase
64
Fertilized Ovum -->
egg secrets HCG--> maintains Corpus Luteum (secretes PRO-->maintains pregnancy)
65
Ovum not fertilized-->
corpus luteum regresses--> Follicle atresia
66
Hormone that controls secondary female sex characteristics
Estrogen
67
Tattle tales w/ sense of justice
7 yo
68
Keep promises
7 yo
69
Will cheat to win
6 yo
70
Most important socializing agent is the peer group
6-12 yo
71
Marijuana -->
LBW IUGR Preterm Birth Behavior Problems
72
Methamphetamine
SIDS IUGR Reduced brain growth Development effects
73
Amniocentesis
``` 14-16wk gestation High risk pregnancy US->local pocket of amniotic fluid 15-20 mL amniotic fluid aspirated, result in 2 wks <1% risk ```
74
Post Amniocentesis
Monitor FHR RhoGam in Rh- Minimal activity 24h -->decrease uterine irritability
75
Begins when estrogen levels peak & ends with the release of the oocyte
Ovulatory phase
76
3 phases of endometrial cycle
Proliferative Secretory Menstrual
77
Implantation
7-10d after fertilization | Depends on vascular changes of endometrium
78
genotype
persons genetic makeup
79
genome
organisms complete set of DNA
80
Key S/S of SBS (Shaken Baby Syndrome)
``` Subdural Hemorrhages (80%) Retinal Hemorrhage (50-100%) ```
81
Most likely perpetrator in SBS
Father (44%) | Mother's BF (23%)
82
Least likely perpetrator in SBS
Mother is least likely
83
Highest form of Child Maltreatment
Neglect (63%) of Child Abuse Cases
84
Key in Child Maltreatment/ Abuse Cases
GOOD DOCUMENTATION
85
A report of child abuse is made...
q 10 secs
86
of children that die q day in the US from child abuse
5+ | US= WORST industrialized nation
87
% of abused & neglected children that abuse their own children
30% of abused and neglected children later abuse their own children
88
Characteristics of Abusive Parents
``` Majority were abused Difficulty coping Younger Drug, Alcohol, and decreased support network Lack of education ```
89
Emotional/ Verbal Abuse Froms
``` belittling favoritism Corrupting Over-pressuring Isolation Ignoring ```
90
Deliberate attempt to destroy/ impair a child's self-esteem or competence
Emotional/ verbal abuse
91
S/S of SBS (ICP)
``` Sleepy Irritable Vomiting = RED FLAG Respiratory Compromise Coma/ Death (Not Imminent) ```
92
Health Risk of Childhood Obesity
``` Cardiovascular Hyerinsulineamia Type II DM CA Sleep Apnea Orthopedic Problems Adult Obesity Social Discrimination ```
93
BMI
WT/HT | (LBS/IN)*703
94
Normal %tile range for wt
5-85
95
5-2-1-almost none
5 fruits/ veggies 2 hours screen time 1 hour of activity Almost no soda etc
96
Tx Threatened Abortion
``` Limit Activity (1st 12-24h) No stress, sex, or fatigue Be honest (may/ may not loose baby) ```
97
S/S of Threatened Abortion
Cervix = Closed Days of unexplained bleeding/ cramping Risk of Expulsion
98
Complications of Elective Abortions
``` Hemorrhage Infection Uterine Perforation Cervical Laceration Retained products of conception ```
99
Immunological reactions against the sperm that causes a decreases in sperm motility
Sperm Antibodies | mainly w/ vasectomy reversal/ testicular trauma
100
Seaman Analysis
Abstains 2-3d before sample(s)
101
Ovarian Reserve Testing
day 3 of menses -->serum FSH and estradiol test | FSH>10 IU/l-->specialist
102
BBT
Basal Body Testing | +0.4* F x3days = ovulation
103
Detecting LH Surge
Surge in LH 36h before ovulation Tested w/ Urine or Serum -Ideal time for Sex if want Prego
104
Endometrial Biopsy
Outpatient Assess Response of Uterus to hormonal signals Performed at end of menses
105
Hysterosalpingogram
Radiological exam w/ dye | Info about endocervical canal, uterine cavity, and tubes
106
Myomectomy
Sx removal of uterine fibroids

N201 (21 decks)

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