Module 2 BBB Practice Questions Flashcards
What are some of the specific clinical situations in which we might provide preconception care?
-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
For a patient who presents for a GYN visit, what question is most appropriate to ask concerning preconception care?
Is pregnancy in the next year or so a possibility for you? Would you like to talk more about preconception health?
Why may the question “Is pregnancy in the next year a possibility for you” be the best way to approach preconception care?
The patient may not plan ever to have children.
Why do we ask patients about the length of their cycle in regards to preconception?
Because regular cycles are often ovulatory cycles
What cycle length indicates probable ovulation cycles?
28-30 days. 1-2 day variation in range indicates probable ovulation.
What symptoms are an indication of regular cycles?
PMS and uterine cramping
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?
Ectopic pregnancy and infertility. Chlamydia can result in scarring of the uterine tubes.
What vaccinations should we review with patients in the preconception period? What are the recommendations if the patient is unvaccinated?
**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
If a patient comes to us for a preconception visit, when should a physical exam be performed?
-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
What assessments should be done if a full physical exam is not required for a preconception visit?
BP and weight
What patients are considered high risk for neural tube defects? How much folic acid is recommended for this category?
History of NTD or previous child with NTD
Recommend 4.0mg/day (4,000 mcg/day)
What is the recommended folic acid dose for patients that are low risk for neural tube defects?
0.4mg/day (I.e 400 mcg/day)
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?
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
What is the difference between folate and folic acid?
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
Would we be more concerned about the folic acid consumption in a patient who is vegan or keto?
Keto because the vegan is more likely to be eating greens. Liver is not commonly eaten. Enriched foods are often carb based.
Is folate or folic acid absorbed better?
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
Should every patient be taking specific PRENATAL vitamins?
Patients don’t necessarily need to take vitamins specifically labeled as prenatal. Many multivitamins include all the necessary vitamins.
What aspects of Motivational Interviewing can help when addressing sensitive topics?
Engaging: establishing a relationship and listening
Focusing: asking what is important to the patient
If a patient’s cycles are 28-29 days long, when does she likely ovulate?
Day 14 or 15
Ovulation usually occurs 14 days before the end of the cycle. cycle-13
If a patients cycle is 28-29 days long, what is her expected fertile window?
Days 11-18
Include the 3 days before and 3 days after ovulation
How should we recommend a patient to approach having sex during their fertile window?
It is ideal to have sex every 1-2 days based off comfort level
What are some options for fertility indicators?
-Cervical mucus monitoring
-Ovulation testing
-BBT testing
-Cervix checking
-Fertility tracking apps
-Monitoring symptoms
What is the source of progesterone?
The corpus luteum
What are the three phases of the normal menstrual cycle?
Follicular
Ovulatory
Luteal
Which hormone stimulates the follicles in the ovaries to develop?
Follicle-stimulating Hormone (FSH)
In the hormone graph, estrogen rises quite a bit during days 7-12. What is the source of that estrogen?
Follicles in the ovaries-they are estrogen “factories”
Which hormone triggers ovulation?
Luteinizing hormone (LH)
Which hormone do ovulation predictor kits detect?
Luteinizing hormone (LH)
Some extensive ovulation kits detect LH and another hormone. What hormone is it?
Estrogen, the rise in estrogen give a few more days notice before ovulation.
Which phase of the cycle is the corpus LUTEUM involved in?
Luteal (corpus luteum produces progesterone)
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?
Rise in human chorionic gonadotropin (hCG)
Describe the length of time involved in fertilization and implantation.
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.
Describe the stages of fertilization/implantation. Where do they occur and when?
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)
The blastocyst is completely implanted in the endometrium at how many days after fertilization?
10-12 days
What period is a pregnancy most susceptible to teratogens?
Weeks 1-2 after fertilization: all or nothing period
Embryonic Period Weeks 3-7 after fertilization: Most susceptible to deformities.
Which structures are developing when a person may not know they are pregnant?
Primarily the neural tube/brain, the heart
Which structures are developing over a very long period during pregnancy?
**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)
Which embryonic structures develop around the time of the expected next menstrual bleed?
Heart and central nervous system
Which structure can be affected at ANY point in pregnancy because it develops over a long period of time?
Brain
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?
The BBT would remain elevated well into what would have been the next cycle
What triggers the menstrual cycle if a person is not pregnant?
The corpus luteum dies and that hormone withdrawal is part of what triggers bleeding.
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?
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.
Why do we produce slippery cervical mucus mid-cycle?
This type of mucus helps transport sperm
If a patient is having unprotected sex with multiple partners. What STD testing should be offered/encouraged?
G/C, HIV, Syphilis, Hep. B
What are some sources of reliable information about alcohol and cannabis/substance use in pregnancy?
OTIS, ACOG, CDC, March of Dimes, SAMHSA
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?
“A good place to start is by asking your employer for the material safety data sheets for the chemicals in your workplace”
Your patient has a BMI of 30.3. What menstrual issue may we be more likely to see with this BMI?
Ovulating less frequently or not at all (anovulation/oligo-ovulation)
Once a patient receives carrier screening, would they ever need to be re-screened?
No, baring any major changes in carrier screening testing.
