Family Med SG11

Question 1

The pneumococcal vaccine is required for high risk patients, like whom?

Answer 1

cochlear implants or asplenia

Question 2

Folic acid requirement for all women capable of getting pregnant, those with DM or epilepsy, and those with a previous child with NTD

Answer 2

All women- 800 micrograms; those with DM or epilepsy get 1 g; those with a previous child with NTD get 4g

Question 3

Preconception counseling involves what?

Answer 3

Folic acid recommendations, carrier screening, infectious disease screening, and environmental toxin discussion

Question 4

What carrier screening is recommended?

Answer 4

Sickle cell, Thalasemmia, Tay Sachs, CF, and Non-syndromic hearing loss (Connexin-26)

Question 5

Which infectious diseases should be screened for at the preconception visit and which immunizations should be given?

Answer 5

Screen for HIV, syphilis, Hep B immunity. Immunizations should be given for rubella and varicella. You should also counsel about CMV, B19, and Toxo

Question 6

What environmental toxins should pregnant women avoid?

Answer 6

Paint thinners, pesticides, smoking

Question 7

What drugs to get off when you are pregnant?

Answer 7

ACE/ARB, thiazide diuretics, warfarin, benzos

Question 8

What lifestyle suggestions should you give your pregnant patients?

Answer 8

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

Question 9

Gestational development 5 weeks

Answer 9

Embryo is 1/8 of an inch in size and has a heart beat. Her brain and spinal cord are developing

Question 10

Gestational development 8 weeks

Answer 10

Enlargement of the uterus is detectable on bimanual exam

Question 11

Gestational development 10-12 weeks

Answer 11

Fetal heart beat is elicited on doppler and by 12 weeks the uterine fundus can be palpated above the symphisis pubis

Question 12

Gestational developmen 18-20 weeks

Answer 12

Fetal movement is detected by mom

Question 13

Gestational development 20-36 weeks

Answer 13

Size of the uterus corresponds to the weeks

Question 14

Calculating due date by Naegele’s Rule

Answer 14

Start on first day of LNMP add 1 years subtract 3 mos add 1 week

Question 15

Does stress or physical or sexual actvity cause miscarriage?

Answer 15

No

Question 16

Most common cause of miscarriage in the first trimester?

Answer 16

Chromosomal abnormalities

Question 17

If you have first trimester bleeding, what is your chance of miscarriage?

Answer 17

25-50%

Question 18

Pregnancy physical exam- Goodell’s sign, Hegar’s sign, and Chadwick’s sign

Answer 18

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

Question 19

What is the clinical significance of ectropion (when central part of the cervix looks red)

Answer 19

There is none. It is common in women on OCPs

Question 20

When urine HCG is positive, there is no need for a serum HCG

Answer 20

Because the level to detect HCG in the urine is actually higher

Question 21

Initial pregnancy evaluation tests

Answer 21

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

Question 22

Tests to order for first trimester bleeding

Answer 22

CBC, wet mount prep for g/c and trich, type and screen, quant B-HCG, progesterone, transab and transvag u/s

Question 23

Why order wet mount prep for g/c and trich in pregnant patients who are bleeding?

Answer 23

All STIs can cuase vaginal bleeding. But no need for cultures. That’s expensive

Question 24

What is Kleihauer-Betke testing used for?

Answer 24

Estimating the amount of fetal hemoglobin in the maternal circulation to determine the dosing for Rhogam

Question 25

When does b-HCG start being secreted?

Answer 25

7 days post-ovulation

Question 26

Threshold b-HCG for vaginal and transabdominal ultrasound?

Answer 26

Vaginal is 1500; Transabdominal is over 5000