Family Med SG11 Flashcards
The pneumococcal vaccine is required for high risk patients, like whom?
cochlear implants or asplenia
Folic acid requirement for all women capable of getting pregnant, those with DM or epilepsy, and those with a previous child with NTD
All women- 800 micrograms; those with DM or epilepsy get 1 g; those with a previous child with NTD get 4g
Preconception counseling involves what?
Folic acid recommendations, carrier screening, infectious disease screening, and environmental toxin discussion
What carrier screening is recommended?
Sickle cell, Thalasemmia, Tay Sachs, CF, and Non-syndromic hearing loss (Connexin-26)
Which infectious diseases should be screened for at the preconception visit and which immunizations should be given?
Screen for HIV, syphilis, Hep B immunity. Immunizations should be given for rubella and varicella. You should also counsel about CMV, B19, and Toxo
What environmental toxins should pregnant women avoid?
Paint thinners, pesticides, smoking
What drugs to get off when you are pregnant?
ACE/ARB, thiazide diuretics, warfarin, benzos
What lifestyle suggestions should you give your pregnant patients?
Regular moderate exercise, avoid hyperthermia (like hot tubs), avoid overuse of Vit A or Vit D, limit caffeine to 2 cups of coffee per day
Gestational development 5 weeks
Embryo is 1/8 of an inch in size and has a heart beat. Her brain and spinal cord are developing
Gestational development 8 weeks
Enlargement of the uterus is detectable on bimanual exam
Gestational development 10-12 weeks
Fetal heart beat is elicited on doppler and by 12 weeks the uterine fundus can be palpated above the symphisis pubis
Gestational developmen 18-20 weeks
Fetal movement is detected by mom
Gestational development 20-36 weeks
Size of the uterus corresponds to the weeks
Calculating due date by Naegele’s Rule
Start on first day of LNMP add 1 years subtract 3 mos add 1 week
Does stress or physical or sexual actvity cause miscarriage?
No
Most common cause of miscarriage in the first trimester?
Chromosomal abnormalities
If you have first trimester bleeding, what is your chance of miscarriage?
25-50%
Pregnancy physical exam- Goodell’s sign, Hegar’s sign, and Chadwick’s sign
Goodell’s sign is softening of the cervix. Hegar’s sign is softening of the uterus. Chadwick’s sign is blue hue of the cervix and vaginal walls caused by hyperemia
What is the clinical significance of ectropion (when central part of the cervix looks red)
There is none. It is common in women on OCPs
When urine HCG is positive, there is no need for a serum HCG
Because the level to detect HCG in the urine is actually higher
Initial pregnancy evaluation tests
Serum Hcg (if not pos by urine); CBC to look for nutritional and congenital anemias as well as platelet disorders; Rubella IgG antibodies (if patient is not immune, they need postpartum immunization); Hep B surface antigen; Blood type (Rh neg get Rhogam 50 micrograms); RPR; HIV
Tests to order for first trimester bleeding
CBC, wet mount prep for g/c and trich, type and screen, quant B-HCG, progesterone, transab and transvag u/s
Why order wet mount prep for g/c and trich in pregnant patients who are bleeding?
All STIs can cuase vaginal bleeding. But no need for cultures. That’s expensive
What is Kleihauer-Betke testing used for?
Estimating the amount of fetal hemoglobin in the maternal circulation to determine the dosing for Rhogam
