Module 2 BBB Practice Questions

Question 1

What are some of the specific clinical situations in which we might provide preconception care?

Answer 1

-Annual GYN Appointment
-Preconception Appointment
-Primary Care Visits
-Contraception Visits
-Any patient who wants to get pregnant/may become pregnant in the next year or so

Question 2

For a patient who presents for a GYN visit, what question is most appropriate to ask concerning preconception care?

Answer 2

Is pregnancy in the next year or so a possibility for you? Would you like to talk more about preconception health?

Question 3

Why may the question “Is pregnancy in the next year a possibility for you” be the best way to approach preconception care?

Answer 3

The patient may not plan ever to have children.

Question 4

Why do we ask patients about the length of their cycle in regards to preconception?

Answer 4

Because regular cycles are often ovulatory cycles

Question 5

What cycle length indicates probable ovulation cycles?

Answer 5

28-30 days. 1-2 day variation in range indicates probable ovulation.

Question 6

What symptoms are an indication of regular cycles?

Answer 6

PMS and uterine cramping

Question 7

Our patient has a history of chlamydia that was treated years ago, and she has been negative since. What is she at higher risk for?

Answer 7

Ectopic pregnancy and infertility. Chlamydia can result in scarring of the uterine tubes.

Question 8

What vaccinations should we review with patients in the preconception period? What are the recommendations if the patient is unvaccinated?

Answer 8

**Rubella (MMR): If unvaccinated, a titer can be drawn, or the patient can be vaccinated when not pregnant. If vaccinated before pregnancy, the patient should wait one month before pregnancy.

Hep B: If the patient is unvaccinated, it is recommended. It can be given during pregnancy but is recommended only for patients at high risk (ex. IV drug users, multiple sex partners)

TDAP: recommend every pregnancy (typically 26-34w)

HPV: not recommended in pregnancy

Flu: recommended every flu season

Question 9

If a patient comes to us for a preconception visit, when should a physical exam be performed?

Answer 9

-If one has not been done within the last year
-If the patient has new complaints or symptoms
-If there is a new medical or family history
-If the exam would benefit the patient

Question 10

What assessments should be done if a full physical exam is not required for a preconception visit?

Answer 10

BP and weight

Question 11

What patients are considered high risk for neural tube defects? How much folic acid is recommended for this category?

Answer 11

History of NTD or previous child with NTD

Recommend 4.0mg/day (4,000 mcg/day)

Question 12

What is the recommended folic acid dose for patients that are low risk for neural tube defects?

Answer 12

0.4mg/day (I.e 400 mcg/day)

Question 13

Your patient does not like to take pills and asks what food she could eat instead of taking folic acid. What should you tell her?

Answer 13

Folate can be found in beef liver, green vegetables (asparagus, Brussels, spinach), fruits and veg (esp. oranges), nuts, beans, and peas.

Folic acid: enriched bread, flour, cornmeal, pasta, and rice, fortified cereal and tortillas

Question 14

What is the difference between folate and folic acid?

Answer 14

Folate is a water-soluble vitamin found naturally in foods.

Folic acid is a form of folate that is used in fortified foods and vitamins

Question 15

Would we be more concerned about the folic acid consumption in a patient who is vegan or keto?

Answer 15

Keto because the vegan is more likely to be eating greens. Liver is not commonly eaten. Enriched foods are often carb based.

Question 16

Is folate or folic acid absorbed better?

Answer 16

Folic acid!! We need less folic acid to get the recommended amounts.

240 mcg folic acid= 400 mcg DFE
400 mcg folate= 400 mcg DFE

DFE=dietary folate equivalent

Question 17

Should every patient be taking specific PRENATAL vitamins?

Answer 17

Patients don’t necessarily need to take vitamins specifically labeled as prenatal. Many multivitamins include all the necessary vitamins.

Question 18

What aspects of Motivational Interviewing can help when addressing sensitive topics?

Answer 18

Engaging: establishing a relationship and listening

Focusing: asking what is important to the patient

Question 19

If a patient’s cycles are 28-29 days long, when does she likely ovulate?

Answer 19

Day 14 or 15

Ovulation usually occurs 14 days before the end of the cycle. cycle-13

Question 20

If a patients cycle is 28-29 days long, what is her expected fertile window?

Answer 20

Days 11-18

Include the 3 days before and 3 days after ovulation

Question 21

How should we recommend a patient to approach having sex during their fertile window?

Answer 21

It is ideal to have sex every 1-2 days based off comfort level

Question 22

What are some options for fertility indicators?

Answer 22

-Cervical mucus monitoring
-Ovulation testing
-BBT testing
-Cervix checking
-Fertility tracking apps
-Monitoring symptoms

Question 23

What is the source of progesterone?

Answer 23

The corpus luteum

Question 24

What are the three phases of the normal menstrual cycle?

Answer 24

Follicular
Ovulatory
Luteal

Question 25

Which hormone stimulates the follicles in the ovaries to develop?

Answer 25

Follicle-stimulating Hormone (FSH)

Question 26

In the hormone graph, estrogen rises quite a bit during days 7-12. What is the source of that estrogen?

Answer 26

Follicles in the ovaries-they are estrogen “factories”

Question 27

Which hormone triggers ovulation?

Answer 27

Luteinizing hormone (LH)

Question 28

Which hormone do ovulation predictor kits detect?

Answer 28

Luteinizing hormone (LH)

Question 29

Some extensive ovulation kits detect LH and another hormone. What hormone is it?

Answer 29

Estrogen, the rise in estrogen give a few more days notice before ovulation.

Question 30

Which phase of the cycle is the corpus LUTEUM involved in?

Answer 30

Luteal (corpus luteum produces progesterone)

Question 31

If a person does NOT get pregnant during a cycle, the corpus luteum is not needed and goes away. If a person DOES get pregnant during a cycle, the corpus luteum sticks around. What causes this?

Answer 31

Rise in human chorionic gonadotropin (hCG)

Question 32

Describe the length of time involved in fertilization and implantation.

Answer 32

Fertilization occurs within 12-24 hours in the uterine tube.

Implantation occurs over a 6 to 10/12 day period, starting with the blastocyst formation and ending with implantation of the blastocyst.

Question 33

Describe the stages of fertilization/implantation. Where do they occur and when?

Answer 33

1) Fertilization (12-24 hours after ovulation in the uterine tube)
2) Cleavage (a series of mitotic divisions)
3) Morula (3-4 days after fertilization-still in the uterine tube)
4) Blastocyst (4-5 days after fertilization-in the uterus, this begins implantation)
5) Implantation (Complete by 10-12 days after fertilization-in the uterus)

Question 34

The blastocyst is completely implanted in the endometrium at how many days after fertilization?

Answer 34

10-12 days

Question 35

What period is a pregnancy most susceptible to teratogens?

Answer 35

Weeks 1-2 after fertilization: all or nothing period

Embryonic Period Weeks 3-7 after fertilization: Most susceptible to deformities.

Question 36

Which structures are developing when a person may not know they are pregnant?

Answer 36

Primarily the neural tube/brain, the heart

Question 37

Which structures are developing over a very long period during pregnancy?

Answer 37

**The Brain/Central Nervous System-whole pregnancy

-Heart, Arms/Legs-embryonic period (Heart takes the longest of this group)
-Ears, Eyes, Teeth, Palpate, and External genitals- embryonic and fetal periods (Eyes take the longest of this group)

Question 38

Which embryonic structures develop around the time of the expected next menstrual bleed?

Answer 38

Heart and central nervous system

Question 39

Which structure can be affected at ANY point in pregnancy because it develops over a long period of time?

Answer 39

Brain

Question 40

Given that progesterone is the cause for a BBT rise, what would you expect on a temperature chart if the person using BBTs became pregnant?

Answer 40

The BBT would remain elevated well into what would have been the next cycle

Question 41

What triggers the menstrual cycle if a person is not pregnant?

Answer 41

The corpus luteum dies and that hormone withdrawal is part of what triggers bleeding.

Question 42

You have a patient with a 27-28 day cycle who wants to know when she should have intercourse during her fertile window. What can you tell her?

Answer 42

Counting your first day of bleeding as day 1, your fertile window is day 13-14 which means it would be best to have sex every 1-2 days on days 10-17, you will have the greatest likelihood of pregnancy.

Question 43

Why do we produce slippery cervical mucus mid-cycle?

Answer 43

This type of mucus helps transport sperm

Question 44

If a patient is having unprotected sex with multiple partners. What STD testing should be offered/encouraged?

Answer 44

G/C, HIV, Syphilis, Hep. B

Question 45

What are some sources of reliable information about alcohol and cannabis/substance use in pregnancy?

Answer 45

OTIS, ACOG, CDC, March of Dimes, SAMHSA

Question 46

You’r patient works in a body shop and is concerned about her exposure to paint and chemicals at work affecting a pregnancy. What should you advise?

Answer 46

“A good place to start is by asking your employer for the material safety data sheets for the chemicals in your workplace”

Question 47

Your patient has a BMI of 30.3. What menstrual issue may we be more likely to see with this BMI?

Answer 47

Ovulating less frequently or not at all (anovulation/oligo-ovulation)

Question 48

Once a patient receives carrier screening, would they ever need to be re-screened?

Answer 48

No, baring any major changes in carrier screening testing.