Exam 4

Question 1

5 examples of women who would benefit from genetic counseling

Answer 1

Maternal age >35
Family history of genetic disorder
History of multiple spontaneous abortions
Unexplained stillbirth
Exposure to teratogens

Question 2

4 risks for the occurrence of a multi factorial disorder

Answer 2

Close relatives with the disorder
Close relative(s) with a severe form of the disorder
The defect occurs in a female
Geographic location where the disorder is more likely to occur

Question 3

Examples of 2 multi factorial disorders and why they may have happened

Answer 3

Spina bifida: genetic predisposition and mother who took a folic acid antagonist while pregnant

Pyloric stenosis: genetic predisposition and a mother who had an infection while pregnant that she took antibiotics for

Question 4

Environmental factors that could contribute to multifactorial disorders

Answer 4

Alcohol
Teratogens
Tobacco
Drug use
Folic acid antagonists
Infection
Mercury
Metals

Question 5

Calories needed by breastfed infants
Calories needed by formula fed infants

Answer 5

85-100 cal/kg of body weight
100-110 cal/kg of body weight

Question 6

How can parents determine if infant is eating enough?

Answer 6

3 wet diapers and 3 stools by the 3rd day
At least 6 wet diapers by day 4
Weight gain

Question 7

What is the milk like during Lactogenesis I?

Answer 7

Begins during pregnancy to early days after giving birth
Colostrum - thick, yellow, high in protein and vitamins/minerals

Question 8

What is the milk like during lactogenesis II?

Answer 8

Begins 2-3 days after birth
Transitional milk - gradually changes from colostrum to mature milk for about 10 days
Amount increases, immunoglobulins and proteins decrease, lactose, fat, calories increase

Question 9

What is the milk like during lactogenesis III?

Answer 9

Mature milk - bluish, not as thick

Question 10

Which vitamins is Breastmilk high in?

Answer 10

A, E, and C
Low in vitamin D

Question 11

Which immunoglobulin does breast milk contain?

Answer 11

IgA, which helps prevent viral or bacterial invasion of intestinal mucosa

Question 12

What are the main differences between Breastmilk and formula?

Answer 12

Breastmilk contains immunologic components
Formula contains more casein which is harder to digest, causing larger stools and more protein to go undigested
Less iron absorbed with formula
Formula has higher calorie content

Question 13

Risks to the infant by not breastfeeding

Answer 13

More likely to develop allergies
Increased risk for infection
Increased risk of SIDS
Nutrients not absorbed as well
Can be improperly and potentially dangerously diluted

Question 14

Risks to the mother by not breastfeeding

Answer 14

Does not release oxytocin, which enhances uterine involution
Resumes ovulation earlier
Balanced maternal diet that improves healing is less likely
Less frequent skin to skin which can be detrimental to bonding
Expensive

Question 15

Where is Breastmilk made in the breast?

Answer 15

Alveoli

Question 16

What causes the release of Breastmilk?

Answer 16

Loss of placental hormones at birth (estrogen and progesterone) increasing prolactin, and the release of oxytocin which causes the milk to let down

Question 17

What things are scored when determining the latch score?

Answer 17

Latch
Audible swallowing
Type of nipple
Comfort (breast or nipple)
Hold (positioning)

Question 18

What should be heard when the infant is latched?

Answer 18

Swallow, but not other noises

Question 19

Good hold during breastfeeding for c/s patients

Answer 19

Football hold

Question 20

Patient teaching for breastfeeding

Answer 20

• Cradle, football, or cross-cradle holds
  -vInfants mouth fully open, aim at roof of mouth, nipple drawn to back of mouth
• Tongue should be forward, under breast and over lower gums, lips flared out

Question 21

Reasons a male may have infertility

Answer 21

Abnormal sperm
Fluid doesn’t have proper nourishment to keep sperm going
Past chemo or radiation

Question 22

Reasons a female may have infertility

Answer 22

Not ovulating
PCOS (egg doesn’t pop out of ovary wall)
Fallopian tube disorder (chronic STD causing scarring)
Endometriosis causing abnormal bleeding or extra endometrium that does not slough off
Abnormalities of cervix due to surgeries or incompetent cervix

Question 23

Egg white consistency cervical mucous

Answer 23

Spinnbarkeit

Question 24

What should you teach patients who are undergoing infertility evaluation and treatment?

Answer 24

Simple therapies done before more costly and complex ones
Evaluations and therapy done more quickly if woman is >35
Typically require more time, energy, discomfort and risk for the woman than the man

Question 25

What does clomid do?

Answer 25

Stimulate follicle development leading to ovulation

Question 26

What does hCG medication do?

Answer 26

Induce release of several ova

Question 27

What occurs with IVF?

Answer 27

Ova removed by U/S, mixed with sperm
Life starts in Petri dish
Fertilized oocytes returned to uterus (or can wait until embryo develops and then is returned to uterus)

Question 28

Example of health people 2020 goals for women’s health

Answer 28

Lower breast cancer deaths
Reduce cervical cancer deaths
Increase cervical cancer screening
Increase proportion of adults who receive a colorectal screening
Reduce hip fracture hospitalizations amount women 65 and older

Question 29

When should mammograms begin and how often?

Answer 29

As needed for women 40-45
Yearly at 45
Every other year at 55

Question 30

Drug treatment for endometriosis

Answer 30

Lupron - creates pseudo menopause

Question 31

Name of HRT (estrogen and progesterone)

Answer 31

Prevarin

Question 32

Pt teaching for menopause

Answer 32

Average age is 51.5
Whole time period for the climacteric phase is 3-5 yr
Symptoms (hair loss, fatigue, pelvic floor disorders, vaginal atrophy)

Question 33

Management for menopause

Answer 33

HRT (progesterone and estrogen): inc risk of breast cancer and heart disease
ERT increases risk of stroke (only ok for pts without uterus)
Water soluble lube
Botanical preparations to replace estrogen
Kegels
Drink at least 8 glasses of water per day

Question 34

Anterior vaginal wall prolapse

Answer 34

Cystocele

Question 35

Prolapse of upper posterior vaginal wall between vagina and rectum

Answer 35

Enterocele

Question 36

Prolapse of posterior vaginal wall, rectum protrudes into vagina

Answer 36

Rectocele