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FM cases 2 Flashcards

1
Q

What is the size of a patch?

A

Greater than 1 cm

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2
Q

What is the size of a papule?

A

Less than 1 cm

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3
Q

What is the size of a plaque?

A

Greater than 1 cm

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4
Q

What is the size of a tumor?

A

Larger than a nodule

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5
Q

What is the size of a vesicle?

A

Less than 1 cm

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6
Q

What is the size of a bulla?

A

Greater than 1 cm

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7
Q

What grade recommendation is a full skin exam during a routine physical?

A

Insufficient evidence for or against (Grade I)

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8
Q

Which gender is more predisposed to develop skin cancer?

A

Males

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9
Q

What is the typical presentation of lichen planus/?

A

Lichen planus typically presents as 2-10 mm flat-topped papules with an irregular, angulated border (polygonal papules) that are commonly located on the flexor surface of wrists and and on the legs immediately above the ankles.

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10
Q

What is the treatment for eczema?

A

Steroid cream

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11
Q

What is an ointment?

A

greases, jellies, with little to no water. Good for drier skin.

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12
Q

What are the two fungal infections that necessitate systemic treatment?

A

Tinea unguium

Tinea capitis

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13
Q

What are the systemic antifungals that are used to treat tinea capitis and tinea unguium? (3)

A

Griseofulvin (tinea capitis)
Terbinafine (both)
Itraconazole (unguium)

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14
Q

What is Bowen’s disease?

A

SCC in situ

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15
Q

Well defined, small (< 2 centimeters) SCC lacking any high-risk features requires a (___) margin of normal tissue around the visible tumor to result in 95% histologic cure rate.

A

Well defined, small (< 2 centimeters) SCC lacking any high-risk features requires a four millimeter margin of normal tissue around the visible tumor to result in 95% histologic cure rate.

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16
Q

When if 5FU appropriate in the treatment of SCC?

A

If excision not an option

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17
Q

When is cryotherapy indicated in the treatment of SCC?

A

Small, well defined, low risk lesions

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18
Q

When is radiation therapy indicated in the treatment of SCC?

A

An option for the initial management of small, well-defined, primary SCCs, especially older patients and those who are not surgical candidates.

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19
Q

What is the usual cause of blood in semen?

A

BPH

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20
Q

What are the tests to perform in cases of suspected prostate cancer?

A

DRE
UA
Serum PSA
Serum BUN and Cr.

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21
Q

What drugs are first line in treating BPH?

A

Alpha adrenergic antagonists

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22
Q

What are the behavior modifications to reduce the s/sx of BPH? (4)

A
  • Avoiding fluids prior to bedtime
  • Reducing diuretics
  • Limiting salts
  • Maintaining voiding schedules
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23
Q

What are the two 5-alpha-reductase inhibitors used in the treatment of BPH?

A

Finasteride

Dutasteride

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24
Q

What are the four major alpha adrenergic antagonists used in the treatment of BPH?

A

Tamsulosin
Alfuzosin
Terazosin
Doxazosin

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25
Q

What drugs should be avoided in pts with BPH?

A

Antihistamines and decongestants (alpha agonists)

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26
Q

What is acral lentiginous melanoma?

A

Acral lentiginous melanoma is seen more often in dark-skinned people, and typically appears on the palms and soles of feet, including under the nails.

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27
Q

What is the technical definition of menopause?

A

anovulatory for 12 months

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28
Q

True or false: CA-125 is used as a screening tool for ovarian CA

A

False.

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29
Q

What is the age range that should have a biennial mammogram?

A

50-74

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30
Q

What are the recommendations regarding pap smears?

A

Start at age 21, q3 years until age 30.

From 30-65, HPV testing with pap q5 years OR q3 years if pap alone

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31
Q

Bleeding after how many months of hormone replacement indicates a need for further work up?

A

More than 12 months without bleeding

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32
Q

What are common diseases that are risk factors for the development of endometrial cancer? (4)

A

HTN
DM
h/o colon or breast CA
Obesity

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33
Q

What causes the increased FSH and LH in menopause?

A

Decreased inhibin and estrogen

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34
Q

If a TVUS shows endometrial thickness less than how many mm, is the risk for endometrial cancer very low?

A

4 mm

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35
Q

What is the tool that is used to screen for osteoporosis in women under 65 who have not had a DEXA scan?

A

FRAX

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36
Q

What is the recommended vit D intake in women over 50?

A

1200 mg of CA and 800-1000 IU of vit D QD

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37
Q

What are the four bones that are most commonly fractured in osteoporotic women?

A

Vertebrae
Hip
Radius
proximal humerus

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38
Q

What are the three major bisphosphonates used to prevent osteoporosis?

A

Alendronate
Ibandronate
Zoledronic acid

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39
Q

What is the brand name of synthetic PTH?

A

Forteo

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40
Q

What is the MOA and use of raloxifene?

A

Selective estrogen receptor modulator (SERM)

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41
Q

True or false: exogenous calcitonin has been shown to reduce the incidence of hip and vertebral fractures

A

Partially false–not hip or other fractures, just vertebral

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42
Q

Besides hormone replacement therapy, what can be used to reduce the s/sx of menopause? (3)

A

SSRIs
Clonidine
gabapentin

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43
Q

What herbal BS might be helpful in the treatment of hot flashes?

A

Black cohosh

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44
Q

What is the effect of smoking on the incidence of endometrial cancer?

A

Decreases, I guess

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45
Q

How many episodes of HAs are needed to diagnose:

  • Migraines
  • Tension
  • Cluster
A
  • Migraines = 5
  • Tension = 10
  • Cluster = 5
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46
Q

Which type of HA is classically worse with activity?

A

Migraines

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47
Q

What is the duration of:

  • Migraines
  • Tension
  • Cluster
A
  • Migraines = 4-72 hours
  • Tension = 30 mins-7 days
  • Cluster = 15-180 mins
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48
Q

New onset of headache in a person age (__) or over may indicate the need for imaging

A

35

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49
Q

HAs that worsen with what exam maneuver indicate the need for imaging?

A

Valsalva

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50
Q

How often must one use analgesics for a medication overuse HA to develop?

A

at least 15 times per month for 3 months

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51
Q

True or false: aspartame may increase the incidence of HAs

A

True

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52
Q

True or false: intense exercise may increase the incidence of HAs

A

True

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53
Q

What are the drugs that are contraindications to the use of triptans?

A

SSRIs (possibly)

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54
Q

What are the two antiepileptic drugs that can be used as migraine prophylaxis?

A

Valproate

Topiramate

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55
Q

What are the antidepressant class that can be used to prevent migraines?

A

TCAs

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56
Q

What are the anti-HTN class of meds that can be used as migraine prophylaxis?

A

beta blockers

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57
Q

Which herbal med supposedly helps with migraines?

A

Butterbur

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58
Q

When should migraine prophylaxis be started?

A
  • At least six headache days per month
  • At least four headache days with at least some impairment
  • At least three headache days with severe impairment or requiring bed rest.
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59
Q

What are the goals of treatment for migraine HAs? (4)

A

(1) decrease attack frequency by 50% and decrease intensity and duration;
(2) improve responsiveness to acute therapy;
(3) improve function and decrease disability; and
(4) prevent the occurrence of a medication overuse headache (MOH) and chronic daily headache.

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60
Q

True or false: stress can lead to stomach ulcers

A

False

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61
Q

True or false: caffeine intake has been associated with PUD development

A

False

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62
Q

True or false: pts with GERD report lower quality of life as compared to pts with DM or an MI

A

True

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63
Q

What is the first line test to detect H. Pylori?

A

IgG titers for it, but note that this will remain elevated for years after the infection

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64
Q

What is the best treatment for nonfunctional dyspepsia?

A

TCAs

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65
Q

What percent of pts with duodenal ulcers and infected with H. pylori?

A

90%

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66
Q

What is the strongest evidence to support the idea that h.pylori causes PUD?

A

PUDs resolve with eradication

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67
Q

What is happening to the incidence of H.pylori infection worldwide?

A

Decreasing

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68
Q

What are the two treatment regimens for h.pylori?

A

PPI + amox 1 gram + Clarithromycin 500mg BID for 10 days

PPI+metronidazole 250 mg+tetracycline 500 mg + bismuth subsalicylate 525 mg QID for 10 days

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69
Q

What tests are appropriate to test for elimination of h.pylori after therapy?

A

Urea breath test or fecal antigen test

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70
Q

When is it appropriate to test someone for H.pylori after they have been treated for it? (4)

A

If continued s/sx
MALT lymphoma
H/o gastric CA
Pts planning to resume chronic NSAID therapy

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71
Q

What are important questions to ask about intimate partner abuse? (4)

A

Guns in the house
Threatened or hurt you?
Drug use by perpetrator
Suicidal/homicidal suggestions

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72
Q

How does a person carry their arm when that have a posterior dislocation of their shoulder?

A

Adducted and internally rotated

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73
Q

How does a person carry their arm when that have a an impingement of their shoulder?

A

Poor posture with scapulae protracted

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74
Q

How does a person present when that have a fracture of their clavicle or sprain of the AC joint of their shoulder?

A

Bony deformity in the area of the AC joint

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75
Q

How does a person carry their arm when that have a anterior dislocation of their shoulder?

A

Fullness of the anterior shoulder with a large dimple in the posterior shoulder

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76
Q

How does a person carry their arm when that have a a frozen shoulder?

A

Atrophy of the larger muscles of the shoulder girdle, like the deltoid or pectoralis major

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77
Q

How does a person carry their arm when that have a torn rotator cuff?

A

Atrophy of smaller muscles such as the supraspinatus or infraspinatus

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78
Q

Does a rotator cuff tear present with restricted PROM and AROM of the shoulder?

A

Not PROM

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79
Q

A patient with loss of active and passive ROM is more likely to have (___) disease; whereas a patient with loss of only active ROM is more likely to have an issue with (___).

A

A patient with loss of active and passive ROM is more likely to have joint disease; whereas a patient with loss of only active ROM is more likely to have an issue with muscle tissue.

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80
Q

What is adhesive capsulitis?

A

Adhesive capsulitis, a condition common in patients with metabolic diseases such as diabetes and hypothyroidism in which there is contracture of the joint capsule

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81
Q

When testing the shoulder, resisting internal rotation with the patient’s elbow at his side tests which muscle?

A

Subscapularis

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82
Q

When testing the shoulder, resisting external rotation with the patient’s elbow at his side tests which muscle?

A

Infraspinatus

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83
Q

Winging of the scapulae when pushing against a wall indicated what pathology?

A

Damage to the long thoracic nerve

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84
Q

Asymmetric movement of one scapula usually indicates what?

A

weakness or dyskinesis in the scapular stabilizers.

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85
Q

What does the Neer’s test assess for?

A

Impingement–As you reach the end of this range of motion, several structures are pinched between the humerus and the arch formed by the acromion and the ligament that attaches it to the coracoid process. You may remember that the structures in that space include the supraspinatus tendon, the long head of the biceps muscle, and the subacromial bursa.

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86
Q

What does the Hawkins-Kennedy test assess for?

A

As you reach the end of this range of motion, several structures are pinched between the humerus and the arch formed by the acromion and the ligament that attaches it to the coracoid process. You may remember that the structures in that space include the supraspinatus tendon, the long head of the biceps muscle, and the subacromial bursa.

87
Q

What is the sulcus sign, and what does it assess?

A

The Sulcus sign is an orthopedic evaluation test for glenohumeral instability of the shoulder. With the arm straight and relaxed to the side of the patient, the elbow is grasped and traction is applied in an inferior direction. With excessive inferior translation, a depression occurs just below the acromion. The appearance of this sulcus is a positive sign.

88
Q

What does the apprehension test assess for?

A

Shoulder instability/dislocation

89
Q

What are the three major components of the shoulder stabilizers?

A

Labrum
Rotator cuff muscle group
Glenohumeral ligaments

90
Q

What does speeds test assess for?

A

Biceps tendinopathy

91
Q

What is the clunk test of the shoulder, and what does it assess for?

A

With the patient supine, the examiner rotates the patient’s arm and loads (force applied) from extension through to forward flexion. The examiner is checking for a “clunk” sound or clicking sensation arising from the glenoid labrum that can indicate a labral tear even without instability.

92
Q

What is SLAP testing?

A

Shoulder and elbow are flexed. Dr push down on pronated and supinated forearm in this position. Pain = Superior labral tear

93
Q

What is the difference between rotator cuff tendinopathy vs tear?

A

Tendinopathy is just painful movement, whereas a tear implies weakness

94
Q

What are the two major tests to assess for shoulder impingement?

A

Apley’s scratch test with limited ROM

Neer and Hawkins-Kennedy +

95
Q

What are the tests to assess for shoulder labral tears?

A

Clunk and O’brien’s test

96
Q

What is O’brien’s test?

A

Like empty can test, but with slight adduction of the shoulder, and resistance applied with forearm in supination and pronation

97
Q

What is the max dose of acetaminophen?

A

1000mg QID

98
Q

What are the indications for an arm sling in shoulder injuries?

A

Only needed for humeral fractures or shoulder dislocations

99
Q

What are the four responses to the PHQ-2 test, and their respective point values?

A
  • “not at all” (0 points)
  • “several days” (1 point)
  • “more than half the days” (2 points),
  • “nearly every day” (3 points).
100
Q

What are the four major preventative screening tests that the USPSTF recommends?

A

Breast
Lung
Colon
Cervical

101
Q

When does breast CA screening begin, end, and how often?

A

50-74 years

Biennially

102
Q

What is the USPSTF recommendation regarding self breast exam screening?

A

Teaching self-breast examination (SBE) is not recommended (Grade D recommendation) as it has shown only to increase rates of biopsy without improving cancer detection or treatment.

103
Q

What is the USPSTF recommendation regarding colon cancer screening?

A

Once every 10 years after age 50

104
Q

What is the USPSTF recommendation regarding prostate CA screening?

A

Due to findings that “many men are harmed as a result of prostate cancer screening and few, if any, benefit,” prostate specific antigen (PSA) testing for prostate cancer is given a D rating (it is recommended against).

105
Q

What is the USPSTF recommendation regarding testicular cancer screening?

A

Testicular cancer screening gets a Grade D rating from the USPSTF. In this case, the low incidence of disease and the favorable outcomes of treatment at any stage make screening unlikely to improve outcomes beyond what they are now.

106
Q

What are the two most common causes of Fe deficiency anemia in men and postmenopausal women?

A

Colorectal CA or adenomatous colonic polyps

107
Q

Is there any relationship between red meat consumption and colorectal CA?

A

No

108
Q

What is the dosing for Fe supplementation? What is a common adverse effect of this?

A

ferrous sulfate 325 mg three times daily

docusate sodium 100 mg twice daily as needed for constipation

109
Q

What are the three major ways to screen for colon cancer?

A

FOBT collected annually + sigmoid every 5 years
CT of the colon every 5 years
FIT testing every annually

110
Q

What are the components of the SPIKES mnemonic for delivering bad news

A
  • Set up
  • Perception
  • Invitation
  • Knowledge
  • Emotions
  • Strategy/summary
111
Q

What are the components of the HEEADSSS mnemonic for interviewing adolescents?

A 
Home
Education/employment
Eating
Activities
Drugs
Sex
Suicide
Safety
112
Q

Which testicle tends to sit lower in the scrotum?

A

Left

113
Q

What are the four major risk/precipitating factors for testicular torsion?

A

Exercise
Trauma
Undescended testes
Congenital anomaly

114
Q

How does testicular torsion present on US?

A

Decreased echogenicity 2/2 decreased blood flow

115
Q

What is the gold standard imaging test for testicular torsion?

A

Radionuclide scintigraphy

116
Q

What are the chances of a testicle surviving torsion at the 2, 12, and 24 hour mark?

A

6 hours 90%
more than 12 hours 50%
more than 24 hours 10%

117
Q

What are the four components of patient centered medical home?

A
  1. Personal physician
  2. Physician directed medical practice
  3. Whole person oriented
  4. Care is coordinated
118
Q

What are the skin manifestations of dermatomyositis?

A
  • Heliotrope rash (violaceous periorbital rash)
  • Shawl sign (rash involving the shoulders, upper chest, and back)
  • Gottron’s papules (papular rash with scales located on the dorsum of the hands, elbows, and knees)
119
Q

What is the initial treatment for dermatomyositis?

A

Corticosteroids

120
Q

What is the MOA and use of rituximab?

A

anti-CD20 antibody for use in dermatomyositis

121
Q

What is the translocation the produces mantle cell lymphoma?

A

t(11:14)

122
Q

What is the translocation the produces Burkitt lymphoma? What is the molecule that is upregulated in this? What is the GI side effect of this?

A

t(8;14)
c-Myc
Intussusception

123
Q

What is alopecia areata, and what is the treatment?

A

Autoimmune, non scarring hair loss that occurs on the scalp, without associated erythema, and “exclamation point hairs” along the periphery. The hair loss is sudden in onset, usually before the age of 30.

Treatment is with intralesional triamcinolone injections q2-6 weeks PRN

124
Q

What is subclinical hypothyroidism, and what is the most common cause?

A

Elevated TSH without decrease in T4 levels

Hashimoto’s thyroiditis

125
Q

What two lab values should be assessed in all pts with new onset dementia?

A

B12

TSH

126
Q

Which diuretic is first line in the treatment of meniere’s disease?

A

HCTZ

127
Q

What are the CSF findings of MS?

A

Mononuclear pleocytosis with oligoclonal bands

128
Q

What is the role of abx in the treatment of crohn’s disease?

A

May be used as a second line agent, and have good efficacy.

129
Q

What is the difference in duration of acute vs chronic bronchitis?

A

Acute - 1-3 weeks

Chronic - at least three months the past two years

130
Q

What happens to the laryngeal height at full expiration with COPD?

A

Decreases

distance from the suprasternal notch to the top of the thyroid cartilage

131
Q

Over what age does COPD usually begin?

A

45

132
Q

What is the role of a CXR in the diagnosis of COPD?

A

Rules out other causes

133
Q

What are the FEV1 values for mild, moderate, severe, and very severe COPD?

A

Over 80% - Mild
50-79% - Moderate
30-49% - Severe
Less than 30% - Very severe

134
Q

What is the cutoff for significant reversibility on a PFT?

A

FEV1 increase of over 12%

135
Q

True or false: Macrophages and T killer cells play a role in COPD.

A

True

136
Q

True or false: FVC is normal to decreased in COPD, but always decreased in asthma.

A

True

137
Q

What is the therapy for moderate COPD?

A

albuterol PRN and long acting anticholinergic / beta agonist

138
Q

What is the therapy for severe COPD?

A

Inhaler glucocorticoids with a LABA

139
Q

What three vaccinations are indicated for COPD pts?

A

Flu
Pneumovax
TdaP

140
Q

Over what age is the flu vaccine given?

A

6 months

141
Q

Who is the pneumovax recommended for?

A

Recommended for all adults 65 years old and older; also for adults aged 19 through 64 years with chronic medical conditions (this includes those with lung disease such as COPD or asthma).

142
Q

How often should PFTs be obtained in a pt with COPD?

A

q6 months to 1 year

143
Q

What is the recommended screening for COPD in smokers?

A

There is none–recommended against

144
Q

When should ABx be given to COPD patients?

A

-Patients with exacerbations of COPD with the following three cardinal symptoms: increased dyspnea, increased sputum volume, and increased sputum purulence

145
Q

What are the six areas of functioning that are used to diagnose dementia?

A 
Learning and memory
Attention (complex)
Perceptual-motor
Executive function
Language
Social cognition

(LAPELS)

146
Q

What is the clinical dementia rating scale components?

A 
0	No cognitive impairment
0.5	Very mild dementia
1	Mild dementia
2	Moderate dementia
3	Severe dementia
147
Q

What are the top three causes of dementia?

A
  • Alzheimer’s
  • Vascular dementia
  • Dementia with Lewy bodies
148
Q

What is the best bedside assessment tool to diagnose delirium?

A

Confusion assessment method (CAM)

149
Q

What are the 6 ADLs?

A 
Bathing
Dressing
Transferring
Continence
Toileting
Feeding
150
Q

What are the 6 IADLs?

A 
shopping
preparing meal
using the telephone
managing transportation needs
managing medications
managing finances
151
Q

What are the two components of the mini-cog?

A

Name three objects and draw a clock

152
Q

What are the 10 points of the orientation part of the mini-mental status exam?

A

What is the (year) (season) (date) (day) (month)?

Where are we (state) (country) (town) (hospital) (floor)?

153
Q

What are the components of the registration part of the mini-mental status exam?

A

Name 3 objects: 1 second to say each. Then ask the patient all 3 after you have said them. Give 1 point for each correct answer.

154
Q

What is the attention and calculation part of the mini-mental status exam?

A

Serial 7’s. 1 point for each correct answer. Stop after 5 answers

155
Q

What is the recall part of the mini mental status exam?

A

Ask for the 3 objects repeated above. Give 1 point for each correct answer

156
Q

What are the components of the language part of the mini-mental status exam, and their point values? (6)

A

-Name a pencil and watch (2)
-Repeat the following “No ifs, ands, or buts” (1)
-Follow a 3-stage command:
“Take a paper in your hand, fold it in half, and put it on the floor.” (3)
-Read and obey the following: CLOSE YOUR EYES
-Write a sentence (1)
-Copy the intersecting pentagons

157
Q

What are the amounts of a post void residual the is normal, equivocal, and suggestive of retention?

A
  • 50 mL of residual urine = normal
  • 50-200 mL of residual urine = equivocal
  • over 200 mL of residual urine = abnormal
158
Q

What is the drug of choice for treating acute delirium in elderly pts with dementia?

A

Haldol

159
Q

What are four major hospital interventions to minimize delirium?

A
  • 1-1 sitter
  • Repeated reorientation
  • Avoid sedative and anticholinergic meds
  • ROM exercises
160
Q

Why are foley caths avoided as much as possible in the treatment of a delirious pt?

A

Caths are agitating

161
Q

What is the role of frequent stimulation in the treatment of delirious pts?

A

Improves clinical outcomes as opposed to a quiety environment

162
Q

What are the four major drugs to treat symptoms of dementia?

A
  • Cholinesterase inhibitors
  • Memantine
  • Atypical antipsychotics for behavioral disturbances
  • Vitamin E
163
Q

True or false: Cognitive rehabilitation therapy has been demonstrated to be helpful in slowing the progression of Alzheimer’s dementia

A

False–has NOT

164
Q

What happens to the primitive reflexes in dementia?

A

Come back as dementia progresses

165
Q

What is the glabellar tap reflex?

A

Primitive reflex where tapping the forehead elicits blinking

166
Q

When are women screened for GBS?

A

35-37 weeks gestation

167
Q

What is the goal abx administration time for GBS?

A

PCN within 4 hours of delivery

168
Q

What are the odd advantages of group prenatal care?

A
  • Decrease in preterms in AA
  • Increased birth weight if preterm
  • More personalized care
169
Q

What is a normal fetal heart rate in a non-stress test?

A

110-160 bpm

170
Q

What determines whether or not a fetal stress test is “reactive” or not?

A

A neurologically intact and healthy fetus should have two heart rate accelerations of at least 15 beats per minute over at least 15 seconds in a 20-minute period

171
Q

What are the components of a reassuring fetal stress test?

A
  • Moderate variability (6 to 20 beats per minute).
  • A subjective report of active fetal movement.
  • A “reactive” strip showing two heart rate accelerations (of at least 15 seconds with a peak of at least 15 beats per minute above the baseline) in a 20-minute period.
172
Q

What are concerning signs for a neonatal non-stress test?

A
  • A baseline fetal heart rate of 170 beats per minute is defined as tachycardia, and would be cause for concern.
  • Minimal (5 or less beats per minute), absent, or marked (greater than 20 beats per minute) variability of the fetal heart rate.
173
Q

Cervical dilation of more than how many cm is indicative of labor?

A

6 cm

174
Q

How many contractions are indicative of labor?

A

Once every 3-5 minutes

175
Q

True or false: the fetal heart tracing does not impact the diagnosis of active labor

A

True

176
Q

When is the best time to do a vaginal exam during labor?

A

Between contractions

177
Q

What is the normal thickness of a cervix (not pregnant)?

A

3 cm

178
Q

What are the absolute contraindications to performing a digital vaginal exam during labor?

A
  • Vaginal bleeding with an undocumented placental location (or placenta previa)–worsens bleeding
  • PPROM (infection)
179
Q

What are the steps to decrease maternal blood loss in the third stage of labor?

A
  • Give oxytocin
  • Pull on the cord gently
  • Massage the uterus
180
Q

When should the umbilical cord be clamped in labor?

A

Two minutes after delivery

181
Q

What are the two phases of the first stage of labor?

A
  • latent phase: regular contractions have started, but the cervix is less than 6 cm dilated
  • active phase: begins when 6 cm dilated; ends when fully dilated
182
Q

When does the second stage of labor begin and end?

A

begins at full dilation; ends when the baby is delivered

183
Q

When does the third stage of labor begin and end?

A

begins with birth of the baby; ends with delivery of the placenta

184
Q

What are the criteria for preeclampsia?

A
  • BP over 140/90 (either part) on at least two readings greater than 6 hours apart (ideally)
  • Proteinuria-at least 300 mg on a 24 hour urine collection or at least 1+ or 30 mg/dL 6 hours apart (ideally)
185
Q

Which ethnicity is more and less likely to develop preeclampsia?

A

african american

186
Q

Any one of four criteria will diagnose preeclampsia with severe features. What are these four criteria?

A
  • severe hypertension of at least 160 mmHg systolic or 110 mmHg diastolic
  • right-upper-quadrant pain or a doubling of serum transaminases
  • platelet count < 100 > 1.1 mg/dL
  • pulmonary edema
187
Q

What sort of edema is suggestive of preeclampsia?

A

Non-dependent

188
Q

What are late decelerations? What can these indicate?

A

Late decelerations are decelerations in the fetal heart rate that begin after a contraction begins, with the nadir after the peak of the contraction

They can be an indication of utero-placental insufficiency,

189
Q

What are the components (generally) of the categories of fetal heart tracings (I, II, III)?

A 
I = normal (or early decelerations)
II = anything not I and not III
III= no variability + bradycardia, or late decelerations
190
Q

What are the four components of management of late decelerations?

A
  1. Continuous fetal monitoring.
  2. Position the patient on her side to decrease pressure on her vena cava, and increase blood return to the heart, in order to maximize cardiac output and blood flow to the uterus.
  3. Monitor blood pressure. If her blood pressure is low, she may benefit from a fluid bolus to further increase blood flow to the uterus.
  4. Oxygen by face mask, to maximize placental oxygen delivery.
191
Q

What is the average speed of cervical dilation?

A

2 cm /hr for nulliparous women

1cm/ hr for primiparous women

192
Q

What is the definition of failure to progress in labor?

A

there is no cervical change for two hours in the active phase of labor.

193
Q

What is the name of the curve to plot cervical dilation to see how labor progresses?

A

Friedman curve

194
Q

What are the seven stages of labor?

A
  1. engagement
  2. Descent
    3, Flexion
  3. Internal rotation
  4. Extension
  5. External rotation
  6. Expulsion
195
Q

What is the engagement part of labor?

A

The presenting part of the fetus has entered the pelvic inlet.

196
Q

What is the descent part of labor?

A

Described by the “station” on cervical exam. The fetus is at 0 station when the widest part of the presenting part is between the ischial spines.

197
Q

What are the components of the APGAR score?

A 
Appearance
Pulse
Grimace
Activity
Respirations
198
Q

What are 0, 1, and 2 for the appearance part of the APGAR score?

A 
0 = pale blue color
1 = central pink, peripheral blue
2 =  fully pink
199
Q

What are 0, 1, and 2 for the pulse part of the APGAR score?

A 
0 = No pulse
1 = below 100 bpm
2 =  above 100 bpm
200
Q

What are 0, 1, and 2 for the Grimace part of the APGAR score?

A 
0 = no reaction
1 = only grimacing
2 =  grimacing and a cough, sneeze or vigorous cry
201
Q

What are 0, 1, and 2 for the activity part of the APGAR score?

A 
0 = loose and floppy extremities
1 = some tone
2 =  active motion
202
Q

What are 0, 1, and 2 for the respirations part of the APGAR score?

A 
0 = no breathing
1 = slow or irregular
2 =  cries well
203
Q

What are the four T’s of postpartum hemorrhage?

A
  • Tone (uterine atony leading to continued bleeding)
  • Trauma (perineal or cervical lacerations, uterine inversion)
  • Tissue (retained or invasive placental tissue in the uterus)
  • Thrombin (a bleeding disorder-much less common that the other three causes)
204
Q

How long should pacifiers be avoided in babies to encourage breast feeding?

A

first few weeks

205
Q

How often should a baby be fed?

A

On demand

206
Q

When should the first newborn exam take place?

A

Within 24 hours of delivery, but not too soon as to interfere with bonding

207
Q

How long does it take for milk production to begin in new mothers?

A

2-3 days sometimes

208
Q

How much weight should an infant gain in the peripartum period?

A

In the newborn period, expect to see a weight gain of about an ounce per day once the maternal milk is in.

209
Q

Early decelerations are associated with what neonatal problem?

A

Head compression

210
Q

How does uterine insufficiency manifest on a NST?

A

Late decelerations (decrease in FHR after the peak of a contraction)

211
Q

Fetal bradycardia is a baseline fetal heart rate of less than what?

A

120 bpm

212
Q

Severe prolonged fetal bradycardia of less than 80 bpm that lasts for three minutes or longer indicates what?

A

Impending fetal death

213
Q

Fetal tachycardia is a baseline fetal heart rate over how many BPM?

A

160

214
Q

When is bed rest appropriate treatment for preeclampsia?

A

If BP is able to be controlled

A2 (26 decks)

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