Module 3 BBB Practice Questions Flashcards
What reasonable diagnosis may be considered for a positive pregnancy test and spotting?
Implantation bleeding
Miscarriage/threatened abortion
False positive pregnancy test-period bleeding
Cervical Irritation/polyps/STI
Molar pregnancy
Ectopic pregnancy
Subchorionic hemorrhage
Uterine fibroids
What question would be most helpful in ruling in or out implantation bleeding with c/o positive pregnancy test and spotting?
Pregnancy dates/times since fertilization and implantation?
What question would be most helpful in ruling in or out cervical irritation with c/o positive pregnancy test and spotting?
Timing of recent intercourse?
What question would be most helpful in ruling in or out uterine fibroids with c/o positive pregnancy test and spotting?
History of fibroids?
What question would be most helpful in ruling in or out subchorionic hemorrhage with c/o positive pregnancy test and spotting?
Pregnancy dates/times since fertilization and implantation?
We don’t typically see bleeding until 6+ weeks after the placenta begins to develop
What question would be most helpful in ruling in or out spontaneous pregnancy loss with c/o positive pregnancy test and spotting?
Cramping?
Mild cramping can be normal in first trimester
What question would be most helpful in ruling in or out ectopic pregnancy with c/o positive pregnancy test and spotting?
Unilateral pelvic pain?
What question would be most helpful in ruling in or out molar pregnancy with c/o positive pregnancy test and spotting?
What color is the bleeding? Classically has darker brown bleeding and high levels of HCG.
What symptoms would lead us to NEED to rule out ectopic pregnancy?
A positive pregnancy test with bleeding and/or pain.
What should the provider do if an ectopic pregnancy is suspected?
Provide precautions, consult, and follow up until IUP is confirmed.
Would a serum quantitative beta hCG be helpful in a patient with a positive pregnancy test and spotting?
It could help use determine if we should order an U/S. hCG level of 1,000=we should be able to see a gestational sac. >10,800=we should see cardiac activity.
What could a low or high hCG indicate?
Low: unhealthy pregnancy or inaccurate pregnancy dates
High: multiple pregnancies, molar pregnancy, or inaccurate pregnancy dates
What benefit could a serum quantitative beta hCG provide in a patient with a positive pregnancy test and spotting?
If levels double every 2-3 days, it can provide some reassurance of a healthy baby. It does not guarantee a healthy pregnancy
What are the two main uses of a serum quantitative beta hCG?
1) As a single value: to signify what structures might be seen on ultrasound
2) In serial values: to determine if levels are doubling every 2-3 days from about 0-10 weeks
What are the two main uses of a serum quantitative beta hCG?
1) As a single value: to signify what structures might be seen on ultrasound
2) In serial values: to determine if levels are doubling every 2-3 days from about 0-10 weeks
What are the criteria required for Naegele’s Rule to be accurate?
-Known LMP
-Regular cycles
-Did not conceive with on hormonal contraception or BF
-Clinical picture fits
If a patient in week 7w+?d and the EDC is Jan 8 by Naegele’s rule. U/S gives an EDC of Jan 5. Which EDC should be used?
Jan 8.
If the patient is less than 9 weeks gestation, should use U/S only if the difference between US and menstrual dates is >5days
A patient in their first trimester of pregnancy reports awful nausea and vomiting for the last couple of weeks. What questions should we ask to assess this Issue fully?
-How much time during the day are you nauseated?
-How often are you vomiting?
-Have you lost weight?
-Have your symptoms affected your ability to work or carry out other activities?