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Family Medicine > Family Medicine 2 > Flashcards

Family Medicine 2 Flashcards

1
Q

tf

valvular heart disease can cause palpitations

A

t

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2
Q

tf

palpitations can be atypical presentation of CHD

A

t

coronary heart disease

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3
Q

palpitations affecting sleep or work inc likelihood that they are caused by __

A

arrhythmia

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4
Q

proportion of palpitations caused by

A

190 pt univ hops study
43% cardiac
31% anxiety/panic
6% prescription or recreational drug

another study found 19% no specific cause

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5
Q

another name for menopause

A

climacteric

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6
Q

climacteric means

A

menopause

vs critical

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7
Q

some drugs that cause palpitations

A

caffeine alc tobac cocaine
sympathomimmetics, vasodilators, anticholinergics
BB withdrawal

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8
Q

tf

Cushings presents with palpitations

A

f

it does not

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9
Q

DSM-V for panic attack

A 
abrupt surge in fear or discomfort w/in mins
4+ of
palps
sweats
shakes
sob
chokes
chest pain/discomfort
nausea ab discomf
dizzy
chills/heats
paresthesias
derealization depersonalization
fear of losing control / "going crazy"
fear of dying
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10
Q

DSM-V for panic disorder

A

recurrent panic attacks
1+ month of fear of attacks +/- maladaptation

not attributable to drug or another disease

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11
Q

most common structural heart abnorm presenting w palpitations
and PE finding

A

MVP

mid-systolic click w murmur

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12
Q

LVH

Q waves in I AVL V456 suggests

A

HOCM

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13
Q

workup palpitation

A 
ekg (dysrrhyth)
24-48hr holter monitor
week-months loop recorder
echo (structural)
cbc (anemia)
tsh (hyperthy)
urine drug screen
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14
Q

tf

LDL-c targets dictate statin therapy in 2016

A

f

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15
Q

statin therapy targets what diseases to prevent

A

stroke

MI

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16
Q

what pharmacologic agents are recommended for lowering cholesterol 2016

A

statins only

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17
Q

4 indications for statin

A 
ASCVD (stroke MI UA TIA PVD)
-high intensity statin
40-75y w DM (also consider outside this age)
-Mod intense high if ASCVD risk ^7.5%
^21 w LDL-c ^190 (often genetic)
-high intensity
40-75y w ASCVD risk ^7.5%
-mod or high
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18
Q

high intensity statins

A

Atorvastatin 40-80mg

Rosuvastatin 20-40mg

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19
Q

tf

count risk factors to select cholesterol mgmt plan

A

f
not anymore 2016
based on calculated ASCVD risk

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20
Q

tf

angina presentation in women is more likely to be atypical

A

t
95% F MI report prodrome
only 30% report chest discomfort

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21
Q

some characteristics of pain less likely angina

A

pleuritic - PE PNA pneumothorax pleurisy pleuropericarditis
pulsating
positional - pericarditis pleuritic msk
palpation reproduced - msk

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22
Q

prodromal sx of ACS in F

A 
fatigue
dyspnea
neck jaw pain
palps
cough
n/v
indigestion
back pain
dizzy
numb
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23
Q

Erikson’s stages of human dev

A 
infant - trust / mistrust
toddler - autonomy / shame doubt
preschooler - initiative / guilt
school age - industry / inferiority
adolescent - identity / role confusion
young adult - intimacy / isolation
middle age - generatively / stagnation
elderly - integrity / dispair
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24
Q

sandwich generation

A

caring for children and elderly parents

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25
Q

tf

normal keg rules out CAD

A

f
spec if not symptomatic at exam
may be anginal but not infarct

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26
Q

neuro dysreg from stress

A

noradrenergic

serotonergic probably too

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27
Q

when to give baby asa for primary prevention of CAD

A

50-59y w 10%+ ASCVD risk
not bleed risk
10 year life expectancy
willing to take dose for at least 10 years

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28
Q

exercise recommendation for adult

A

moderate-vigorous 3-4x/wk 40min

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29
Q

when is age a risk factor for CAD

A

45+ men

55+ women

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30
Q

when is FH a risk factor for CAD

A

1st deg relative w CHD
male v55
femal v65

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31
Q

35 yo women in good health should be screened for

A

htn

not CBC TSH CHO HBA1C at this age healthy

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32
Q

tf

asa dec risk of ischemic stroke in men

A

f

ASA prev MI in men, ischemic stroke in women

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33
Q

how long does it take for most low back pain to resolve

A

2-4 weeks

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34
Q

low back pain ranks __ for volume of outpatient visits

A

5th

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35
Q

broad differential for low back pain

A

CT MIIND VV
congenital - scholi kypho spondy
traumatic - strain compress fx
metabolic - OP hyperthy peget osteomalac
infectious - osteomy pyelo discitis herpzos abscess
inflammatory - ank spond sacroiliitis RA
neoplastic - MM mets lymphom leuke osteosarc
degenerative - disc hern OA facet arth spin stenos
vascular - aortic aneur diabetic neurop
visceral - prostatit PID ov cys endometrios kid ston cholecystit pancreatit

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36
Q

3 most common causes of low back pain

A

lumbar strain
disc hern
degenerative joint dz

(all mechanical (97%))
vs far fewer visceral or non-mechanical

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37
Q

tf

kidney stones and pyelo are common causes of low back pain

A

f
most commonly mechanical (strain, disc hern, degen joint)
not visceral

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38
Q

red flags for serious low back pain (illness vs neuro compromise)

A 
fever
weight loss
pain at night
bowel bladder incont
neuro sx
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39
Q

valsalva can increase low back pain caused by…

A

herniated disc

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40
Q

low back pain improved in supine position suggests

A

spinal stenosis

disc herniation

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41
Q

cauda equina syndrome

A 
always consider in low back pain because perm neuro def possible
large mass effect (disc hern, tumor)
compress cauda equina
pain/numbess radiate down leg
bowblad incont (low on ddx without)

emergent decompression within 72 hours

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42
Q

low back pain from mets inc or dec w recumbency?

A

inc w recumbency

and cough

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43
Q

ank spondy location

A

spine and sacroiliiac

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44
Q

most common causes of referred lumbar pain men vs women

A

prostatitis

PID endometriosis

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45
Q

order of position for back exam

A

standing
sitting
supine

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46
Q

standing back exam

A

inspect curvature
check flexion 90, extension 15, side hand to fib
palpate paraspinals
walk heel (L5 disc hern) toe (S1 disc hern)
squat (relieves spinal stenosis)

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47
Q

heel walk is difficult with what cause of low back pain

A

L5 disc hern

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48
Q

toe walk is difficult with what cause of low back pain

A

S1 disk hern

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49
Q

squatting relieves back pain assoc w

A

spinal stenosis

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50
Q

side-bend low back pain on same vs opposite side of bend suggests

A

same side - bone oa or neural compression

op side - muscle strain

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51
Q

low back pain w flexion suggest

A

herniation
oa
muscle spasm

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52
Q

low back pain w extension suggest

A

degen dz

spinal sten

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53
Q

seated back exam

A 
CVA tenderness
leg raise
tripod sign
reflexes
motor
sensory
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54
Q

grade deep tendon reflexes

A 
0 none
1+ hyporeflexic
2+ normal
3+ hyperreflexic
4+ clonus repeat shortening w one stim
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55
Q

nerves of patellar reflex

A

L3 L4

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56
Q

nerves of achilles reflex

A

L5 S1

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57
Q

grade muscle strength

A 
0/5 none
1 flicker not movement
2 movement not antigravity
3 antigravity not resistance
4 overcome some resistance
5/5 normal strength
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58
Q

spinal nerves of hip flexion

A

L234

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59
Q

spinal nerves of hip abduction

A

L45 S1

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60
Q

spinal nerves of hip adduction

A

L234

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61
Q

spinal nerves of knee extension

A

L234

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62
Q

spinal nerves of knee flexion

A

L5 S12

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63
Q

spinal nerves of ankle dorsiflexion

A

L45

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64
Q

spinal nerves of ankle plantar flexion

A

S12

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65
Q 
spinal nerves of
hip flexion
hip adduction
knee extension
ankle dorsiflexion
hip abduction
knee flexion
ankle plantarflexion
A 
hip flexion L234
hip adduction L234
knee extension L234
ankle dorsiflexion L34
hip abduction L45 S1
knee flexion L5 S12
ankle plantar flexion S12
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66
Q

spinal nerve of
great toe sensation
lateral malleolus
posteriolateral foot

A

great toe sensation L5
lateral malleolus S1
posteriolateral foot S1

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67
Q

supine back exam

A 
auscultate bruit AAA
palpate ab/pelv tenderness
rectal exam ONLY in red flags
-masses bleeding (mets) abnorm tone (disc hern cauda equina)
passive SLR
FABER
pelvic compression
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68
Q

specify tight hamstrings on SLR

A

can’t SLR to 80 deg
lower slightly, dorsiflex foot - no pain = hamstrings tight
(nerve pain if radiating pain - L5 S1 espec)

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69
Q

pain v30deg on SLR suggests

A

malingering

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70
Q

pain opposite of SLR suggests

A

root compression from central disc hern

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71
Q

SLR sn sp compared to MRI

A

36% sn

74% sp

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72
Q

what is “crossed leg raise” pe maneuver

A

SLR of asymptomatic leg
+ suggests central disc hern
(not sn 25% but highly sp 90% so neg does not rule out but pos virtually diagnostic of disc hern)

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73
Q

FABER test

A

flexion abduction external rotation
(pressure on flexed knee while stabilizing op hip)
hip or si path

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74
Q

pelvic compression test

A

forcibly press hips together

+ causes si pain

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75
Q

disc hern pain
exacerbated w
relieved w

A

inc w sitting or bending
coughing sneezing

dec w lying or standing

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76
Q

tf

disc hern can cause foot drop

A

t

muscle weakeness

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77
Q

tf

urinary retention assoc w disc hern

A

f

cauda equina syndrome

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78
Q

pretty comprehensive red flags for low back pain

A 
hx ca
ue wl ^10kg 6 mos
^50 v17 age
persists more than 4-6 wks
night pain rest pain
persistent fever (100.4)
IVDU
UTI PNA cellulitis recently
immunocompromise (DM steroids HIV)
U incont or retent
saddle anesth
anal tone dec fecal incont
bilat le weak numb
progressive FNDs
3/5 muscle weakeness (antigrav not resist)
foot drop
prolongued corticosteroids
mild trauma 50y+, major trauma any age
70y+
OP
prev vert fx
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79
Q

cauda equina syndrome red flags

A 
u incont renent
fecal incont dec anal tone
saddle anesth
bilat le numb weak
FNDs progressing
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80
Q

cancer low back pain red flags

A 
hx ca
ue wl ^10kg 6 mos
^50 v17 age
persists more than 4-6 wks
night pain rest pain
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81
Q

infection low back pain red flags

A 
persistent fever (100.4)
IVDU
UTI PNA cellulitis recently
immunocompromise (DM steroids HIV)
U incont or retent
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82
Q

disc hern low back pain red flags

A

major 3-/5 muscle weakness (not resisted)

foot drop

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83
Q

vertebral fx low back pain red flags

A 
prolonged corticosteroids
OP
mild trauma 50y+
major trauma any age
70y+
prev vertebral fx
84
Q

when to get CBC for low back pain

A

tumor or infection suspected

get ESR too

85
Q

guidelines for low back pain xr

A 
hx trauma
strenuous lifting w OP
prolongued corticosteroids
OP
v20y ^70
hx ca
fever chills wl
pain worse supine night
fx tumor infection suspected
86
Q

MRI indications for low back pain

A 
FND
radiculopathy... not if prob disc hern not progressing?
progressive major motor weakness 3-/5
bowel/bladder cauda equina
suspect mets or infection systemic
failed 6 wks conservative care
87
Q

% hern discs improve w/in 6 wks conservative

A

75%

88
Q

tf

early MRI assoc w improved outcomes ni pts w acute back pain or radiculopathy

A

f

89
Q

how to id lumbar vertebra on xr

A

not rib bearing

90
Q

approach to AP spine xr

A 
count lumbar verts
-non-rib bearing, typically 5 but variable
2 eyes and nose per vert
-pedicles and spinous process
alignment
disc space uniformity
si joint margins
ab/pelv path - kid calcs, vasc calcs, foreign bodies
91
Q

approach to lat spine xr

A

vert body height uniformity
disk space uniformity (diminish gradually down)
alignment
osteophytes
ab/pelv path - kid calcs, vasc calcs, foreign bodies

92
Q

particular concern in spine xrs

A

for women ovarian radiation risk equivalent to daily CXR for one year

93
Q

conservative therapy for low back pain

A

NSAIDs acetaminophen muscle relaxants

moist heat

94
Q

tf

strict bed rest for low back pain

A

f

encourage to resume normal activities as soon as able

95
Q

tf

physical therapy and spinal manipulation for low back pain

A

tish
some evidence
safe
but staying active (but avoiding strain) almost as effective

96
Q

manage pt expectation for low back pain treated conservatively

A

most improve 2-6 wks
(90% resolved 1 mo only 5% persist 3 mo)
recurrence 35-75%
longer recovery time older you get (^45y)
out of work ^6mos only 50% return to work
……..^2y ~0% return to work

97
Q

reasonable mgmt options for

low back pain radiculopathy from hern disc progressing slightly after 5 wk conservative mgmt

A
  • refer to surgeon
  • continue NSAIDs acetaminophen muscle relaxants moist heat activity not strenuous
  • epidural steroid injection
98
Q

lifetime prevalence of low back pain

A

60-80%

99
Q 
L3
reflex
sensation
motor
function
A

patellar tendon reflex
lateral thigh medial femoral condyle sensation
extend quads
squat/rise

100
Q 
L4
reflex
sensation
motor
function
A

patellar tendon reflex
medial leg and medial ankle sensation
dorsiflex ankle
heel walk

101
Q 
L5
reflex
sensation
motor
function
A

medial hamstring reflex
lateral leg dorsum foot sensation
dorsiflex great toe
heel walk

102
Q 
S1
reflex
sensation
motor
function
A

achilles reflex
post calf foot sole lat ankle sensation
plantarflex ankle
walk on toes

103
Q

point tenderness on spinous process in context of low back pain suggests

A

vertebral origin

OP fx, malignancy, etc

104
Q 
male low back pain
malaise chills hesitancy and pain with urination
fever
suggests..
what PE to corroborate
A

prostatitis

DRE for tenderness over prostate

105
Q

negatively birefringent rods aspirated from joint in

A

gout

106
Q

positively birefringent rhomboids aspirated from joint in

A

pseudogout

107
Q

baker’s cyst aka

A

popliteal cyst

108
Q

knee exam
palpate locations
for

A 
patella
quad tendon
patellar tendon
tib tubercle
joint line all around
109
Q

normal knee rom

A

135 degrees

110
Q

lachman vs ant drawer sign

which tests acl?

A

both

111
Q

mcmurray test

A

for meniscal tears (though sn sp questionable)

apply rotation and var/valgus stress while extending knee for pain clunking clicking

112
Q

3 top ddx for peds w knee pain

A 
patellar sublux
tibial apophysitis (osgood schlatter)
patellar tendonitis
113
Q

tf

psoriatic plaques must be present to dx psoriatic arthritis

A

t

BUT in ~15% cases arthritis appears first so can keep on ddx

114
Q

define oligoarthritis

A

2-4 joints

5+ = polyarthritis

115
Q

synovial wbc in
septic arthritis
vs
gout pseudogout

A

15k - 200k
vs
3k - 50k

116
Q

popliteal baker cysts often arise in association with

A

underlying disease such as ra oa

117
Q

ankylosing spondylitis
genotype assoc
joints affected

A

HLA-B27

lumbar spine, si, hips sometimes

118
Q

accompanying sx to look for in suspected SLE arthritis

A 
fev
rash
raynaud
pleuritis
chest pain
119
Q

to look for in suspected lyme arthritis

A

prior rash, fever, migratory arthralgia

120
Q

workup of suspected
septic arthritis or
acute inflammatory arthropathy

A

cbc w diff
ESR
arthrocentesis w cell count diff glue protein cx sns
…polarized light microscopy for crystals

121
Q

ddx arthrocentesis
transudative
hemarthrosis
hemarthrosis w fat globules

A

transudative - oa degenerative miniscal inj
hemarthrosis - lig ten tear fx
hemarthrosis w fat globules - osteochondral fx

122
Q

ottowa knee rules

A 
xr any of
55y+
isolated patellar tenderness
fibular head tenderness
can't flex 90
can't bear weight immed or ed (4 steps limp ok)
123
Q

when to consider knee MRI

A

locking popping instability
(cartilage miniscal ligament damage)
but if xr and hx clear oa w js narrowing… can opt out of MRI

124
Q

% US w dxd arthritis

A

22%

125
Q

tf

exercise improves function and dec pain in OA

A

t

126
Q

paracetamol generic

A

acetaminophen

aka tylenol in the UK

127
Q

best 1st choice for short-term mild-mod oa pain

A

acetaminophen
(tylenol, paracetamol in UK)

toleratbility, low se profile (hepatotox rare if taken approp – 4gm max/day)

128
Q

intraarticular corticosteroid inj

A 
for inflamed joint (swelling pain)
1/mo max, 3/yr max
long-acting triamcinolone preferred to methylprednisolone
combo 1ml w 3-4ml local anesthetic
rest 24 hr not more
fewer se than nsaids or opiates
129
Q

toradol vs tramadol

A 
toradol = ketorolac = nsaid
tramadol = opioid
130
Q

acupuncture benefit arthritis?

A

maybe some

131
Q

glucosamine
chondroiotin sulfate
benefit arthritis?

A

maybe some combined

132
Q

tramadol for joint pain?

A

opioid
limited by se
modest benefit in older pts moderate-severe pain

133
Q

NSAID cream for joint pain?

A

better than nothing

134
Q

tf

arthroscopic debridement improves OA pain and function

A

f

not proven

135
Q

phalen test

A

press dorsum of hands together 30-60 sec

136
Q

atrophy of thenar eminence in…

A

long standing untreated carpal tunnel

137
Q

how useful are tinel and phalen when testing for carpal tunnel

A

somewhat useful
lower sn
high sp
(so will not catch all ct, but if positive likely ct)
nerve conduction velocity study is dx test of choice

138
Q

diagnostic test of choice for carpal tunnel

when to get

A

nerve conduction velocity study

  • expensive uncomfortable
  • only do if sx fail conservative tx, motor dysfunction, thenar atrophy
139
Q

PHQ-2
sn
sp

A

bothered feelling down dep hopeless
bothered little interest or pleasure
+1 = positive
sn 87% sp 78%

f/u w PHQ-9 or other to dx and severity

140
Q

most common se of long acting opioids

A

constipation

tx w bowel reg lax softeners exercise water fiber

141
Q

what assoc of TCAs makes them CI in pts w CV dz or nerve conduction problems

A 
anticholinergic side effects
dry mouth
urinary reten
constipation
blurred vision

tachyarrhythmias bp changes heart block mi

142
Q

long or short acting opioids higher risk of dependence

A

short acting

143
Q

tf

anticonvulstants for chronic pain syndromes

A

f
for trigeminal neuralgia
not other chronic pain evidence lacking

144
Q

what to watch for carbamazepine in young woman

A

cyp p 450 inducer

OCPs less effective

145
Q

NSAID se’s
acute
chronic

A

GI upset
dec effectiveness of antihtns
inc effect of sulfonylureas

GI ulcers
ESRD
hepatotox, coagulopathy

146
Q

tramadol moa
use
se

A

centrally acting mu opioid analgesic
stim serotonin release
inhib ne reuptake

control mod severe pain
lower abuse potential than more potent opiods
but still abuse potential

seizures serotonin syndrome resp dep angioedema bronchospasm dependence
constipation nausea dizziness pruritus

147
Q

age range for colorectal cancer screening

A

50-75

148
Q

stop screening for colorectal cancer at

A

75

149
Q

age range for screening mammography

A

50-74 biennially

150
Q

AAA screen recs

A

men 65-75 smoking hx

151
Q

AAA screening recs in women

A

none

USPSTF recommend against

152
Q

USPSTF carotid artery stenosis screening in asymptomatic pts

A

don’t screen carotids in asymptomatic pts

153
Q

lipid screening in women

A

45+ at inc risk for lipid CAD

154
Q

routine thyroid screening?

A

insuffic ev for or against

155
Q

when to stop cervical cancer screening

A

65

if adequate screening negative prior

156
Q

best confirmatory test for lyme after joint aspiration

A

synovial fluid PCR

not cx, less sensitive for lyme

157
Q

tf

caution w nsaid use pt on warfarin

A

t

nsaids can inc effect of anticoagulants

158
Q

tf

caution w nsaid use pt hx h.pylori infection

A

f

not a CI

159
Q

pt w gout has ci to said and colchicine

next question to guide tx?

A

number joints involved
1-2 jionts arthrocentesis w intra-articular glucocort inj
polyarticular oral glucocorticoids

160
Q

routine prenatal folic acid dose

A

400-800mcg
.4-.8mg

1mg DM or epilepsy
4mg prior child w neural tube defect

161
Q

prenatal genetic screen

A 
sickle cell
thalassemia
tay-sachs
cystic fibrosis
non syndromic hearing loss (connexin-26)
162
Q

prenatal ID screen

A

HIV
syphilis
Hep B immunization
rubella varicella immunization
toxoplasmosis - avoid cat litter, garden soil, raw meat
CMV parvovirus B19 (fifth dz) - hand washing

163
Q

environmental toxins to avoid prenatally

A

paint thinners pesticides
tobacco smoke
alcoholism drugs

164
Q

medical adjustments prenatally

A 
DM - control, folic acid 1mg, stop ACEI
HTN - avoid ACEI ARB thiazide dour
Epilepsy - control, folic acid 1mg
DVT - switch warfarin to heparin
Depression/Anxiety - avoid BZD
165
Q

lifestyle mod prenatally

A 
regular moderate exercise
avoid hot tubs hyperthermia
caution obesity underweight
screen domestic violence
assess nutritional risk
-- vegan pica milk intol ca fe deficiency
avoid Vit A overuse (2500 - 10000 IU)
avoid Vit D overuse(600 - 4000 IU)
limit caffeine 2 cups coffee
166
Q

goodell’s sign

A

softening of cervix in pregnancy

167
Q

hegar’s sign

A

softening of uterus in pregnancy

168
Q

Chadwick’s sign

A

purpling of cervix and vaginal walls in pregnancy

-hyperemia

169
Q

when is enlarged uterus first palpable by experienced examiner

A

8 wks gestation on bimanual exam

170
Q

when is uterine funds palpable above pubis symphysis

A

12 wks gestation

171
Q

when is uterine measurement used to approximate gestational age

A

20-36wks

172
Q

quickening

A

fetal movement

detected by mother 18-20wks gestation

173
Q

when are fetal heart tones elicited

A

hand-held doppler 10-12 wks gestation

174
Q

what is a medical abortion process like

A

two-step
first pill in office, not usually noticeable
second pill at home 2-3 days later, cramping and heavy bleeding within hours
f/u one week later

175
Q

Naegele’s Rule for calculating estimated due date

A

first day of LNMP
add 1 year
subtract 3 mos
add 1 wk

176
Q

early in prey, which is higher, urine or serum hCG?

A

serum hCG

177
Q

when to give RhoGAM (RhoD Immune Globulin)

A

RH- mother any bleeding episode during pregnancy, regardless of gestational age

178
Q

ectropion

A

turned out

eg eyelid or cervix

179
Q

how many pregnant pts experience vaginal bleeding in first trimester

A

1/4

180
Q

chance of miscarriage when significantly bleeding in first trimester

A

25-50%

181
Q

tf

most pregnant pts have mild leukocytosis

A

t

182
Q

when is progesterone level useful to get in preg

A

ectopic v5
sustainable intrauterine preg ^25
between not too helpful

so extreme values useful

183
Q

when is hCG secreted by trophoblastic cells

A

day 7 post ovulation

early embryonic life

184
Q

ddx higher than normal vs lower than normal hCG

A

higher mole multiple test

lower ectopic spontaneous abortion

185
Q

most definitive pregnancy diagnosis

A

hCG quant

pelvic us

186
Q

3 most common causes of bleeding early in preg

A

spontaneous abort
ectopic
idiopathic in viable pregnancy

187
Q

cervical os dilated w obvious bleeding early in prey suggests

A

spontaneous abortion

188
Q

distended acute abdomen w vaginal bleeding early in pregnancy suggests

A

ruptured ectopic

189
Q

at what b-hCG level can US detect intrauterine pregnancy reliably?

A

b-hCG ^1500

190
Q

patient becomes unstable w
unstable spontaneous abortion
ruptured ectopic

mgmt

A

unstable spont abort - d&c

ruptured ectopic - laparoscopy or laparotomy

191
Q

gestational trophoblastic dz aka

A

molar pregnancy

aka placenta acts like a tumor

192
Q

change EGA or EDD based on LNMP if US findings differ?

A

1st and 2nd trimester, yes.

3rd trimester, fetal size cannot be used to accurately estimate, do not change due date.

193
Q

accuracy of fetal US in predicting EDD

A

1st tri +/- 1wk
2nd tri +/- 2wk
3rd tri +/- 3 wk

194
Q

define spontaneous abortion

A

loss of preg w/o outside intervention v20wk gestation

195
Q

define threatened abortion

A

bleeding before 20wks gestation

196
Q

define inevitable abortion

A

dilated cervical os….

as compared to threatened abortion or missed abortion (no dilation)

197
Q

define missed abortion

A

fetal demise w/o cervical dilation and/or uterine activity (often found incidentally on US w/o presentation of bleeding).

198
Q

what to expect w expectant management of inevitable abortion

A
  • watchful waiting w precautions regarding unusual amounts of bleeding or pain fever
  • 75% effective
  • can take up to 1mo for complete expulsion
  • can delay emotional closure
  • give RhoGam (rhesus immune globulin) for Rh-
199
Q

mgmt options for inevitable abortion

A

-expectant: 75% effective, can take 2-6 wks
-surgical D&C vs vacuum for pt pref or heavy bleeding
CI pelvic infection
-medical: off-label vaginal misoprostol 95% effective 3-4 days to 2 wks

RhoGam always for Rh- in all cases!

200
Q

some miscarriage stats

A

about 1/3 pregnancies end in miscarriage

1/2 of 1st tri miscarriages due to chromosomal abnorm

201
Q

tf

miscarriage indicates fertility problem

A

fish
not necessarily
many successful pregs after miscarriage

87% miscarriages have subseq normal births

202
Q

tf
stress
physical activity
sex

can cause miscarriage

A

f

no evidence supporting this

203
Q

labs for initial preg eval

A

CBC RPR HIV Rub type/scren HepB

204
Q

purpose of CBC in initial pregnancy eval

A

nutritional anemia
congenital anemia
plt disorders

205
Q

tf

CMP routine initial pregnancy eval

A

f

only ordered as indicated

206
Q

rate of b-hcg increase

A

doubles q48hr in first 6-7wks gestation if intrauterine preg

less if ectopic

207
Q

how does b-hcg correspond to ability to detect preg on us?

A

transvag us detects intrauterine preg w b-hcg 1500-1800

transab w b-hcg ^5000

Family Medicine (2 decks)

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