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Clin Med 2 > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Basic metabolic rate increase

A

15%

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2
Q

Cardiac output increase

A

30-50%

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3
Q

Blood volume increase

A

35%

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4
Q

Oxygen utilization increase

A

20%

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5
Q

GFR increase

A

50%

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6
Q

Average total weight gain

A

24 pounds

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7
Q

Pregnancy is high….

A

Progesterone and estrogen

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8
Q

Placenta takes over PR production by…

A

Week 7-8

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9
Q

Estrogen produced by…

A

The placenta

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10
Q

CV changes

A

Heart displaced upward and left

Ventricular muscle mass increase

LV and LA increase in size

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11
Q

Heart rate increase by…

A

10-20 bpm

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12
Q

BP is the lowest…

A

Week 24

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13
Q

Systemic vascular resistance…

A

Decreases

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14
Q

Heart sounds in pregnancy that are normal

A

Increased 2nd heart sound intensity, splits with inspiration

S3 gallop, 3rd heart sound

Low grade SEM

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15
Q

Abnormal heart findings in pregnancy

A

Diastolic murmur

Hypertension

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16
Q

Supine hypotension syndrome

A

Increase in maternal HR
Dizziness
Light headedness
Syncope

Relived by lying on left side when supine

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17
Q

EKG changes in pregnancy

A

Slight left axis deviation

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18
Q

Tidal volume…

A

Increases 30-40% and minute ventilation increases

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19
Q

Total lung capacity and CO2 levels…

A

Decrease

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20
Q

Bohr effect

A

Compensated respiratory alkalosis

Hyperventilation to create a gradient facilitating o2 delivery to the fetus and removing co2 delivery from the fetus

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21
Q

Clotting changes in pregnancy

A

Increase fibrinogen, factors VII-X

Decrease in proteins C and S

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22
Q

Physiologic anemia in pregnancy

A

Dilutional

Decrease in Hb and Hct

If it is less than 11 Hb, then usually due to iron deficiency

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23
Q

Gallbladder in pregnancy

A

Impaired gallbladder contractility

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24
Q

GI manifestations in pregnancy

A 
NV
Cravings, aversions
Increase caloric intake
GERD
Constitution
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25
Q

Labs in pregnancy for GI

A

Increased total serum alk phos, bile is not moving

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26
Q

Renal anatomical changes

A

Kidneys lengthen

Ureters dilate, right usually more than the left

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27
Q

Functional increases in the renal system

A

Increased renal plasma flow

Increased DFR

Increased RAA system activity

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28
Q

Clinical renal manifestations

A

Frequency, dysuria, urgency

Stress incontinence

Pyelonephritis is increased incidence

Edema

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29
Q

Thyroid and pregnancy

A

Euthyroid state

HCG is a weak stimulating effect on the thyroid, so may enlarge and have rise of FT4

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30
Q

Random endocrine increases

A

Cortisol
ACTH
Aldosterone

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31
Q

Glucose in pregnancy

A

Increase in insulin sensitivity followed by progressive insulin resistance

Type 2 diabetic state

Glucose is primary fuel for placenta and fetus

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32
Q

Lipids in pregnancy

A

Increase in all lipids, lipoproteins and apolipoproteins

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33
Q

Pubic symphisis separates at…

A

28-30 weeks

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34
Q

Hair loss in pregnancy

A

2-4 months post partum

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35
Q

Most rapid changes of breast size

A

In first 8-10 weeks of pregnancy

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36
Q

Eyes in pregnancy

A

Blurred vision

Decreased intraocular pressure and increased thickness of the cornea

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37
Q

Placenta and immunology

A

Keeps fetus from direct contact with maternal immune system

6 weeks lymphocyte production happens

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38
Q

In the fetus, well oxygenated blood enters…

A

The left ventricle

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39
Q

In a fetus, less oxygenated blood enters…

A

The right ventricle

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40
Q

How does the fetus maintain adequate tissue oxygenation?

A

Fetal hemoglobin

Decreased fetal o2 consumption

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41
Q

Kidney in utero

A

Functional in second trimester

Source of amniotic fluid

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42
Q

Liver in utero

A

Slow to mature

Vitamin K deficiency

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43
Q

Thyroid in utero

A

Functional at the end of T1

Mother is the primary source of thyroid hormone prior to 24-28 weeks

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44
Q

Differentiation into testes occurs…

A

6 weeks after conception

Testosterone and mullerian inhibitory factor inhibit development of female external genitalia

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45
Q

Development of fetal ovary begins…

A

At 7 weeks

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46
Q

Gestational age

A

Time of pregnancy counting from the first day of the LMP

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47
Q

Developmental age

A

The time of pregnancy counting from fertilization (2 weeks less than GA)

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48
Q

EDD

A

Estimated date of delivery

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49
Q

First trimester

A

Up for 14 weeks (GA)

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50
Q

Second trimester

A

14-28 weeks

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51
Q

Third trimester

A

28 weeks- deliver

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52
Q

Embryo

A

Fertilization - 8 weeks

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53
Q

Fetus

A

9 weeks to birth

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54
Q

Previable

A

<24 weeks

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55
Q

Preterm

A

20-36 weeks

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56
Q

Term

A

37-42 weeks

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57
Q

Gravidarity

A

Total number of pregnancies

Including ectopic and molar

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58
Q

Parity

A

Number of deliveries >20 weeks gestation, stillborn or alive

If twins, P1

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59
Q

Abortus

A

Number of pregnancies lost before the 20th gestational week

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60
Q

TPAL

A

Term deliveries
Preterm deliveries
Abortions
Living children

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61
Q

Elderly primagravida

A

At least 35

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62
Q

Clinical presentation of pregnancy

A 
Amenorrhea
Fatigue
NV
Breast changes
Urinary frequency
Chadwick sign
Hegars sign
Leukorrhea
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63
Q

Chadwick sign

A

Early pregnancy sign

Blue discoloration of cervix

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64
Q

Hegar’s sign

A

Softening of junction between the uterus and the cervix

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65
Q

Quickening

A

16-20 weeks GA, feeling the baby move

Could be week 14 if many pregnancies

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66
Q

Urine pregnancy test

A

Can be positive 4 weeks after the 1st day of LMP

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67
Q

Serum pregnancy test

A

Positive before missed period

Quantitative helpful when monitoring problems

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68
Q

TA UA

A

5-6 weeks GA

5000-6000

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69
Q

TV US

A

3-4 weeks GA

1000-2000

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70
Q

Fetal heart tones doppler

A

12 weeks

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71
Q

Naegele’s rule

A

Add 9 months and 7 days to day of LMP

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72
Q

Fundal height measurement

A

20-36 weeks, the fundal heigh in centimeters should about match the weeks GA

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73
Q

HIV screening

A

Opt out approach

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74
Q

Panorama test

A

Early as 9 weeks

Screens for trisomy 13, 18 and 21

Determines sex of baby

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75
Q

Less than 28 weeks, see OB

A

Every 4 weeks

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76
Q

28-36 weeks pregnant, see OB

A

Every 2 weeks

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77
Q

> 36 weeks pregnant, see OB

A

Every week until delivery

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78
Q

False labor

A

Irregular intervals

Same intensity

Relieved by meds

No cervical change

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79
Q

True labor

A

Regular intervals that shorten

Increase in intensity

Back discomfort

Cervix dilates

Not relieved by meds

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80
Q

High BMI and low BMI weight gain expectations

A

<19: 28-40 pounds

> 26: no more than 20 pounds

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81
Q

GA HTN

A

BP >140/90 on at least 2 occasions 20 weeks or later GA and no proteinuria

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82
Q

Fundal heigh discrepancy

A

> 3cm, or progressive decrease, need to do US

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83
Q

Normal FHT

A

110-160, maybe higher in early PG

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84
Q

GDM

A

Screened 24-28 weeks

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85
Q

28 weeks, screen…

A

Ab and consider RhoGAM if RH-

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86
Q

Activity during PG

A

30 minutes of moderate exercise per day if accustomed to this already

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87
Q

Can fly safely up to…

A

36 weeks GA unless complications

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88
Q

Contacting doc about labor

A

Contractions every 5 minutes for an hour

Sudden gush of fluid or constant leakage

Significant vaginal bleeding

Decrease in fetal movement

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89
Q

Pooling

A

ROM

Fluid collection in posterior fornix

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90
Q

Valsalva

A

ROM

Fluid comes thru cervical os during valsalva

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91
Q

Ferning

A

ROM

Presence of ferning pattern on microscope of dried fluid

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92
Q

Nitrazine

A

ROM

Positive if nitrazine paper turns blue, indicating basic pH

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93
Q

Amnisure test

A

ROM

Detects amniotic fluid protein

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94
Q

Effacement

A

Shortening of cervical canal from 2cm to a paper thin circular orifice , expressed in %

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95
Q

Fetal station

A

Identifying the level of the fetal presenting part in the birth canal in relation to ischial spines

Zero station is a crucial functional landmark in the labor path

96
Q

Modified ritgen maneuver

A

Pushing the babies chin upward during birth

97
Q

Three signs of placental separation

A

Uterus rises in the abdomen and becomes globular

Gush of blood

Lengthening of umbilical cord

98
Q

Inspect umbilical cord for…

A

2 arteries and 1 vein

99
Q

After delivery of placenta, …

A

Palpate uterus to rule out uterine atony

Should be reduced in size and firmly contracted

100
Q

4th degre laceration

A

Extends into rectal mucosa

101
Q

3rd degree

A

Extends into sphincter, but not rectal mucosa

102
Q

Postpartum complications biggest risk is…

A

1st hour after delivery

103
Q

Nonstress test

A

Measures fetal heart rate acceleration in response to fetal movement

104
Q

Contraction stress test

A

Measures the response of the fetal heart to the stress of uterine contractions

105
Q

Biophysical profile

A

Series of 5 assessments to predict risk of anatenatal fetal death

106
Q

Doppler US of umbilical artery

A

Suspected intrauterine growth restriction

107
Q

NST acceleration

A

15 beats/min above the baseline for 15 seconds in a 20 min period

108
Q

Non reactive NST

A

Baby may be asleep, retest after mom eats or drinks

109
Q

Reactive NST

A

2 or more accelerations over 20 minutes

110
Q

Variability NST

A

Beat to beat irregularity and waviness of the FHR; reflects in tact and mature brain stem

111
Q

Early deceleration NST

A

Normal!!

112
Q

Variable deceleration NST

A

Caused by cord compression

113
Q

Late deceleration NST

A

Hypoexmia, abnormal!

114
Q

CST

A

Performed if NST is non reactive

Stimulated by pitocin or nipple stimulation

If positive, late deceleration found following 50% or more contractions

115
Q

Late deceleration during labor STOP

A

Sterile vaginal exam

Turn patient on her left side

Give patient oxygen

Turn off the pitocin

116
Q

BPP aspects

A 
NST
Breathing
Movement
Muscle tone
Determination of amniotic fluid
117
Q

AFI values

A

> 5 cm: adequate
<5 cm: abnormal, oligohydramnios
25 cm: abnormal, polyhydramnios

118
Q

Normal BPP values

A

8-10

119
Q

Equivocal BPP values

A

6

120
Q

Abnormal BPP values

A

<4

121
Q

Small for gestational age

A

Estimated fetal weight <10th%

122
Q

Large for gestational age

A

Estimated fetal weight >90th %

123
Q

<20 weeks, hyperplastic

A

Symmetric growth restriction

124
Q

> 20 weeks,hypertrophic

A

Asymmetrical growth restriction, intrauterine growth restriction

125
Q

Decreased growth potential

A

Starts small, stays small

126
Q

IUGR

A

Progressively falls off the growth curve

127
Q

Macrosomia

A

BW >4500 g (9.92 pounds)

128
Q

LGA prevention

A

Tight control of diabetes

Weight loss before conception

129
Q

Leading cause of maternal death

A

Obstetric hemorrhage

130
Q

T3 causes of hemorrhage

A

Placenta previa and placental abruption

131
Q

Pregnant woman plus vaginal bleeding plus pain

A

Placental abruption until proven otherwise!

132
Q

Painless bleeding in T3, transverse lie fetus

A

Placenta previa

133
Q

Placental abruption

A

Bleeding at placental interface that causes partial or total detachment prior to delivery

Non often seen on ultrasound

134
Q

Risk factors for placental abruption

A

Abdominal trauma/accidents
Cocaine/other drugs
Eclampsia
Previous abruption

135
Q

Placenta previa

A

Abnormal implantation of the placenta over the internal cervical os

Often detected via US

136
Q

Different types of previa

A

Complete- completely covers internal os

Partial- covers portion of internal os

Marginal- edge of placenta reaches the margin of internal os

137
Q

Vasa previa

A

Unprotected fetal vessels lying over the cervix

Can rupture, shear, lacerated or be compressed

Large bleeds

Can be detected with US

138
Q

Placenta accreta

A

Attaches to myometrium

139
Q

Placenta increta

A

Invades the myometrium

140
Q

Placenta percreta

A

Penetrates through the myometrium

141
Q

Uterine rupture prsentation

A

FHR declarations during labor

Popping sensation, sudden pain

Palpate fetus in extrauterine space

Bleeding

142
Q

Never do a digital vaginal exam in the 3rd trimester…

A

Bleeding until placenta previa is ruled out

143
Q

Apt test

A

Dilute blood with water, combine with sodium hydroxide

Brown is maternal blood, pink is fetal

144
Q

Kleihauer betke test

A

Measures fetal RBC percentage in maternal circulation

If >1%, fetal bleeding

145
Q

Wrights stain

A

Nucleated RBCs in vaginal blood indicate fetal bleed

146
Q

Three p’s responsible for vaginal delivery

A

Pelvis

Passenger

Power

147
Q

Cephalopelvic disproportion

A

One of the most common indications of failure to progress and getting C section

148
Q

Presentation of baby

A

Vertex is the most common. (Head down)

149
Q

Breech

A

Butt first

Prolapsed cord and entrapment of head

150
Q

External version

A

Don’t perform before 36-37 weeks

Initially w/o anesthesia

Can revert back

Do when in breech position

151
Q

Preterm ROM

A

Before 37 weeks GA

152
Q

Premature ROM

A

Occurs before onset of labor

153
Q

Born at 24 weeks gestation

A

> 50% mortality rate

154
Q

Preterm labor definition

A

GA <37 weeks with regular uterine contractions plus one of the following:

Progressive cervix changes
2cm dilated cervix
80% effaced
Ruptured membranes

155
Q

<25mm transvaginal cervical length measurement

A

High risk of preterm labor

156
Q

> 35 mm transvaginal cervical length measurement

A

Low risk of preterm labor

157
Q

Fetal fibronectin assay

A

Vaginal swab of posterior fornix prior to digital exam

If negative, 99% predictability for no preterm delivery within 1 week

158
Q

Preterm labor treatment

A

Hydration
Bed rest
Antibiotics in PPROM
Tocolytics

159
Q

CI in tocolytic therapy

A 
Bleeding 
Placental abruption
Fetal death
Chorioamnionitis
Severe PIH(ypertension)
Unstable maternal hemodynamics

BAD CHU

160
Q

Cervical incompetence

A

Painless dilation and effacement of the cervix

2nd trimester losses

161
Q

Cerclage

A

Suture placed to close the cervix

Can be emergent or elective

162
Q

McDonald cerclage

A

Suture placed at cervical vaginal junction

163
Q

Shirodkar cerclage

A

Suture placed at internal os

164
Q

Post term pregnancy

A

PG that goes beyond 42 weeks

Innaccurate dating most common cause

165
Q

Bishop score

A

If the score is greater than 6, inducing will be similar to a spontaneous vaginal delivery

If less than 6, don’t induce

166
Q

Agents for induction

A

Oxytocin

Prostaglandins

Foley balloon or laminaria

167
Q

APGAR components

A 
Activity 
Pulse
Grimace
Appearance
Respiration
168
Q

APGAR scores

A

7-10 is excellent

0-3 is severely depressed

169
Q

1 minute

A

APGAR score reflects intrauterine environment

170
Q

5 minutes

A

APGAR reflected the transition to extrauterine environment

171
Q

New Ballard score

A

Used to determine infants GA after delivery, in infants 20-44 weeks GA

172
Q

Typical stay after birth

A

2 days after vaginal

3-4 days after C section

173
Q

Puerperium

A

Period between childbirth and 6 weeks after delivery

Uterine size is normal 6 weeks later

174
Q

Lochia

A

Decidual tissue that sloughs off as vaginal discharge days after delivery

175
Q

Onset of lactation

A

24-72 hours postpartum

176
Q

4 t’s of postpartum hemorrhage

A

Tissue: retained placenta
Trauma: episiotomy
Tone: uterine atony
Thrombin: coagulation defects, DIC

177
Q

Endometriosis

A

10x more frequent after C section
GBS colonization big risk factor
2-3 days postpartum

178
Q

5 w’s and B for post delivery fever

A 
Wind
Water
Walking
Wound
Wonder drugs
Breast
179
Q

Postpartum contraception

A

Typically oculate 6-8 weeks after delivery

Lactational amenorrhea with exclusive breast feeding prevents ovulation

180
Q

Pills choice for post partum moms

A

Progestin only because of the way that estrogen inhibits breast milk production

181
Q

Chronic hypertension

A

Before PH, before the 20th week of PG, or persists >12 weeks postpartum

182
Q

If mom doesn’t have proteinuria with new onset HTN, preeclampsia if she has one of these:

A 
Platelet count <100,000
SCr >1.1 or doubling of SCr
Liver enzymes twice normal concentrations
Pulmonary edema
Cerebral or visual symptoms
183
Q

Preeclampsia risk factors

A

Previous preeclampsia
APA or inherited thrombophilia
DM
>BMI

184
Q

Preeclampsia presentation

A 
HA
Visual changes
Pain
NV
Dyspnea, fluid retention, edema

Hyperreflexia, clonus

185
Q

Mild preeclampsia management

A

Rest and frequent monitoring as outpatient

186
Q

Worsening or severe management of preeclampsia

A

Delivery is the ultimate treatment

Hospitalize and monitor

187
Q

HELLP

A

Hemolysis
Eleveated Liver enzymes
Low platelets

Can lead to serious maternal morbidity

Usually t3

188
Q

HELLP diagnostics

A 
Schistocytes on peripheral smear
Elevated LDH
Elevated bilirubin
Platelets <100,000
Elevated AST and ALT
189
Q

Platelet transfusion for HELLP if…

A

<20,000 before or after vaginal delivery

<50,000 before c section

190
Q

Only…of twins in T1 result in viable twins

A

50%

191
Q

Monochorionic/diamnionic

A

Twinto twin transfusion syndrome risk

One placenta, two sacs

192
Q

Monochorionic/monoamnionic

A

High mortality rates from cord accidents

193
Q

Ectopic pregnancy

A

Blastocyst becomes implanted at a site other than endometrium of uterine cavity

Hemorrhage is the most major complication

194
Q

Risk factors for ectopic pregnancy

A 
Previous ectopic pregnancy
Previous tubal surgery
Tubal ligation
Hx of PID
Smoking
195
Q

Clinical presentation of ectopic pregnancy

A

Normal pregnancy symptoms
Abdominal or pelvic pain
Vaginal bleeding
Amenorrhea

196
Q

Ectopic physical exam

A

Tenderness of abdomen

Adnexal mass

Orthostatic changes

Peritoneal signs, abdominal distension

197
Q

Diagnosing an ectopic pregnancy

A

HCG quantitative

In viable PG, should double every 48 hours

Falling or slow to rise is most consistent with failed IUP

198
Q

Medical management of ectopic PG

A

Methotrexate

Best for asymptomatic and hemodynamically stable pt

199
Q

Abortion

A

Termination of PG by removal or expulsion from uterus prior to viability

Usually in T1

200
Q

Induced abortion methods

A

Dilation and evacuation: manually open uterine cervix, evac the contents

Vacuum aspiration for T1

Suction or extraction for T2

201
Q

Nonsurgical induced abortion

A

<49 days GA

Mifepristone, methotrexate, misoprostol

202
Q

Threatened Ab

A

Bleeding through the cervical os in the first half of PG

203
Q

Inevitable Ab

A

Gross rupture of the membranes in the presence of cervical dilation

204
Q

Incomplete Ab

A

Internal cervical os opens and allows passage of blood

205
Q

Complete Ab

A

PH that spontaneously passes all of the products of conception

206
Q

Missed Ab

A

Retention of a failed IUP for an extended period, usually defined as >2 menstrual cycles

207
Q

Isoimmunization

A

Fetal maternal blood exchange occurs

Maternal antibodies are formed to the baby

Can cross the placenta and enter fetal circulation, creating a hemolytic disease in the fetus or newborn in subsequent pregnancies

208
Q

What does mom have to have in order to create isoimmunization?

A

RH negative!! With a fetus who is Rh positive

209
Q

Screening for isoimmunization

A

1st prenatal visit, again at 28 weeks GA, then again for any “event” during pregnancy or delivery

210
Q

Positive screen for antibody…

A

Further measures:

Indirect Coombs test for mother

Direct Coombs test for neonate after birth

211
Q

Eval for possible fetal anemia

A

T2

Amniotic fluid assessment for bilirubin level

Us to look for erythroblastosis fetalis

212
Q

Preventing isoimmunization

A

Anti D immune globulin administered to RH negative women at 28 weeks

Moms that deliver rh positive infants after delivery

Any time a fetematernal hemorrhage may have occured

213
Q

Most common cause of PPH

A

Uterine atony

214
Q

Uterine atony management

A

Uterine massage
Immediate breastfeeding
Uterotonic agents
Surgery

215
Q

Postpartum endometritis

A

Infection of decides

> 100.4 temp on any 2 of the first 10 days post partum, except 1st day

216
Q

Postpartum endometritis clinically

A

Fever
Tracy
Midline lower abdominal pain
Uterine tenderness

Purulent lochia, chills, malaise, anorexia, HA

Uterus slightly soft

217
Q

Anemia is pregnancy is when…

A

Hbg <11 and HCT <33%

218
Q

Fe deficiency anemia in PG

A

Women should be prescribed Fe in T2 and T3, 30 mg

60-100 mg for treating anemia

Take with vitamin C

219
Q

Folic acid deficiency anemia in PG

A

.4 mg daily before conception

Lactating women need extra folic acid

1 mg daily to treat folic acid

220
Q

Sickle cell anemia in PG

A

Preconceptional assesment and counseling, high risk of complications

African descent women need to be screened

221
Q

Suspect APS when..

A

Thromboembolism episode

3 consecutive abortions before 10 weeks

Hx of preterm delivery <34 weeks due to preeclampsia

222
Q

APS treatment in PG

A

Heparin and ASA

223
Q

Hyperthyroid in PG

A

Radioactive Iodine is CI

Fetal goiter potentially

224
Q

HPL

A

Human placental lactogen, causes insulin resistance state in pregnancy

225
Q

High insulin levels cause…

A

Excessive fetal growth

226
Q

Screen pregnant women for DM at

A

24-28 weeks gestation

227
Q

White classifications A1 and A2

A

A1- controlled with diet

A2- requires insulin

228
Q

Pre pregnant diabetes

A

Increases fetal loss risk and fetal malformations

Need to get HbA1C under control!!

229
Q

Epilepsy in PG

A

Increases risk of fetal malformations, from drugs too!

If 2-5 years seizure free, consider off trial meds

230
Q

UTI’s in PG

A

All women need US and Cx at first prenatal visit, treat those with positive culture

Admit all PG patients with pyelonephritis

231
Q

GBS

A

All women screened between 35-37 weeks, need to treat during labor

232
Q

Hep B

A

Screen at 1st visit

Breast feeding big for neonatal infection

Vaccine can be given during pregnancy

Babies get HBIG and HBV vaccine immediately after birth

233
Q

Varicella

A

Transplacental transmission, can cause congenital malformations

Microcephalic, microphthalmus

Vaccinate BEFORE PG

234
Q

Herpes

A

History of HSV, low risk for baby
Contracted during PG, high risk for baby

Prophylactic acyclovir around delivery

235
Q

Cyst can safely be removed…

A

In the 2nd trimester of PG

Clin Med 2 (8 decks)

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