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Clinical Medicine > Exam #5: History & Exam of the Pregnant Female > Flashcards

Exam #5: History & Exam of the Pregnant Female Flashcards

1
Q

Why should you ask the pregnant patient about her past menstrual cycles?

A

Regularity or irregularity can effect due date

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2
Q

When should a woman start taking folic acid if she has a history of a prior infant with a NTD?

A

Prior to attempting subsequent pregnancy

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3
Q

What immunizations can be given during pregnancy?

A

tDAP

Influenza

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4
Q

What is Naegele’s Rule?

A

Method of estimating date of delivery (EDD)

“Day 1 of the LMP - 3 months + 7 days”

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5
Q

When is US most accurate?

A

Early–it is INVERSELY related to the length of gestation

- Accurate within 5 days if within the first 7 weeks

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6
Q

What are the two questions you need to ask when a woman presents with an early pregnancy?

A

1) Where is it i.e. is it an ectopic pregnancy?

2) Is the fetus viable?

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7
Q

How do you determine viability & location of a pregnancy?

A
  • Dates
  • Doppler for fetal heart tones
  • bHCG
  • Ultrasound
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8
Q

What is a molar pregnancy?

A

This is a “fetus” that does NOT have a viable number of chromosomes

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9
Q

When can you first hear fetal heart tones?

A

9-10 weeks

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10
Q

Why aren’t Pap smears done in 17 year olds?

A
  • Lesions found
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11
Q

What can pyelonephritis cause in the pregnant female?

A

Pre-term labor

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12
Q

What is the most important thing to know when a women presents in labor?

A

Need to know when fluid leak started–> has implications for when labor needs to happen for prevention of infection

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13
Q

What are leopold manuvers used to determine?

A

Fetal lie or fetal presentation i.e. relation of the fetus to the maternal spine

  • Transverse
  • Oblique
  • Longitudinal
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14
Q

How does the fetal position differ from the fetal lie?

A

Fetal position describes the presenting part in relation to the pelvis
- Determined with the occiput–“Occiput Posterior vs. Occiput Anterior” & variations of that

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15
Q

What is the difference between effacement & dilation?

A 
Effacement= thinning
Dilation= open
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16
Q

What are the different stages of labor and how long do they last?

A

1= Onset of labor to complete dilation of cervix
8-20 hours

2= Complete dilation of cervix to delivery of the baby
3-4 min

3= Delivery of the baby to delivery of the placenta
30 min

17
Q

How does the time of labor differ for women that have and have not had a prior pregnancy?

A

Longer labor time (curve) is normal for 1st pregnancy

18
Q

What are labor curves used to determine?

A

Need for:

1) Oxytocin
2) C-section

19
Q

When dating a history on a pregnant woman, what do you need to know?

A

1) Risk factors that may affect pregnancy

2) Due date & fetal growth

20
Q

What are special things that you will focus on in terms of history on a pregnant woman?

A

1) Diet
2) Prior surgery
3) OB/GYN history
- Menses, STD, Pap smear, Infertility
- G/P, C-section, Complications
4) Family history
- Inherited disorders, birth defects
5) Social history–drugs & alcohol/ abuse

21
Q

What do G, P, T, P, A, & L mean in an OB/GYN history?

A 
G= # pregnancies 
P= # w/ birth beyond 20 weeks 
T= # term pregnancies 
P= # preterm pregnancies 
A= # abortions/ miscarriages/ ectopic pregnancies 
L= # of living children
22
Q

During your first physical of a gravid female, what are special things that you will need to take into account?

A

1) Height/ weight
2) Uterine size & shape
3) Pelvis size & shape
4) Blood pressure baseline

23
Q

What labs should you get on your gravid patient?

A
  • Prenatal screen for genetic abnormalities
  • STD
  • Cervical cytology (after age 21)
  • Blood group
  • Urine culture
24
Q

How often should you be seeing your gravid patient in the office?

A

36 weeks= weekly

25
Q

What is done at each gravid patient visit?

A
  • Fetal heart determination
  • Weight
  • BP
  • Urine for glucose/ protein/ nitrites
26
Q

When is fetal activity perceived by the mother?

A

18-20 weeks

27
Q

When do you need to start measuring the fundal height?

28
Q

What is the rule of thumb regarding fundal height?

A

Weeks of gestation= cm from symphysis pubis to top of fundal +/- 2cm

29
Q

What are the common physical changes that happen in pregnancy?

A
  • N/V & dehydration
  • Constipation
  • GERD
  • Hemorrhoids
  • Pica
  • Varicose veins
  • Hemorrhoids
  • Urinary frequency
  • Larger breasts
  • Dyspnea
30
Q

What are the later physical changes of pregnancy?

A
  • Contractions
  • Edema
  • Excessive weight gain
  • Skin pigmentation changes–“cholasma” & “spider hemangiomas”
  • MSK changes
  • Carpal Tunnel Syndrome
31
Q

What are the cardiovascular changes that occur in pregnancy?

A

1) Increased blood volume
2) Increased cardiac output
3) Decreased systemic vascular resistance

Clinical Medicine (27 decks)

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