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?
A patient in the first trimester with nausea and vomiting reports she is nauseated most of the day, every day, and vomits once each day. She’s able to work but feels miserable. She has lost 1-2 lbs. Is It appropriate to suggest ginger ale, crackers, a bland diet, and eating early in the morning?
NO! It is better to ask the patient what she has tried and her experience before beginning to educate
How should we assess FHR on a nine weeks patient who had a U/S 2 weeks ago that showed normal size embryo and normal cardiac activity.
Assume fetal well-being as long as Angie doesn’t report bleeding or other concerns
What new OB labs are usually done?
CBC, Type and Screen, RPR/VDRL, HepB, HepC, HIV, Rubella titer, Urine culture, Hgb electrophoresis
What education can be provided to someone in the first trimester?
-Next appointment
-N/V: when it will improve
-What to expect at the next appointment, uterus sizing and doppler
-Lab results and how they will find out if they are abnormal
-How to reach out for concerns
What does the evidence say about the traditional prenatal visit schedule?
It is lacking evidence to support its use.
A patient we met at a GYN visit a while ago called to say they now want to get pregnant. Thier cycles are 30 days and generally regular. They’re asking about their most fertile time. What should we tell them?
Days 13-18
What preconception counseling should be reviewed with a patient who has a history of Spina bifida with their first baby?
Take 4 mg/day of folic acid
A patient did not indicate their race or ethnicity on their intake forms, how should we approach offering carrier screening?
Carrier screening should be offered to all patients regardless of race, ethnicity, or any other preconceived notions. We can assess if a patient identifies as a part of a group with a higher prevalence of certain conditions and provide that information while informing them about genetic screening.
A patient was screened for DM at 11 weeks with a result of 142. What should be done?
This is an abnormal result so we should order a diagnostic test as a workup for undiagnosed DM II.
As we review the results of prenatal labs for a 9 week pt, we do not see an antibody screen result. What should we conclude?
The antibody screen was probably inadvertently omitted
Results come back for cfDNA testing on a patient, and results are low risk. How should we tell the patient?
The results of your screen show that there is a very low change that your baby has a chromosomal difference such as Down Syndrome
A patient has a positive pregnancy test at home, in office, and urine is collected upon her arrival to the office for a new OB visit. What is appropriate at this point concerning additional pregnancy testing needed?
We’‘ll need more information before we decide
Ex. bleeding, cramping, pain, pregnancy symptoms, etc.
If a patient is unsure about her LMP, how should we respond?
“I have a series of questions I’d like to ask to possibly jog your memory about when your last period started. Is it OK if we go through those questions?”
On May 6 you see a patient with the LMP of March 18. She has regular cycles 26-27 days long, her last period was normal, and she has not been using contraception. Is it appropriate to use Naegele’s Rule?
Yes
On May 6 you see a patient with the LMP of March 18. She has regular cycles 26-27 days long. According to Naegele’s rule, what is her EDC?
December 24th
Describe Naegele’s rule.
LMP-3 months=X
X+7 days=Y
Y+a year=EDC (EDC based on a 28d cycle)
EDC +/- days based on cycle length=adjusted EDC based on cycle length
Using a pregnancy wheel (https://www.prokerala.com/health/pregnancy/pregnancy-wheel/), What is your patient’s gestation age if today is May 6 and their EDC is December 24th?
About 7 weeks
Your patient is 7 weeks gestation, what would we expect to find for uterine size?
Slightly larger than her non-pregnant uterus size
Based on Naegele’s rule, our patient is given a due date of 12/24. She has an early ultrasound that gives an EDC of 12/21 with a crown-rump length of 7weeks 5 days and present cardiac activity. What EDC should we use?
12/24 based on LMP
-Patient is less than 9 weeks and it is less than 5 day difference
What options for genetic screenings are available in the first trimester?
1) First trimester screen- U/S that measures nuchal translucency + maternal blood for serum markers
2) Chorionic Villus sampling (CVS)
3) Cell-free DNA (cfDNA)- also called noninvasive prenatal testing (NIPT) or noninvasive prenatal screening (NIPS)
Your pregnant patient is 32 years old. Does her age affect the genetic screening testing options we will offer?
No, we offer all screening and diagnostic tests to all pregnant patients, regardless of age
You are discussing genetic testing for your first-trimester patient. She is interested in testing for “something like down syndrome”, and is interesting in knowing the sex of the baby but does not want to do any tests that may harm the baby. What test would best align with her wishes?
Cell-free DNA
This would give us the sex of the baby
When can a cfDNA test be done?
10 weeks to term
Some clinicians recommend after 10 weeks on patients with a larger BMI due to change for a inconclusive/false positive
Your new OB patient was 182 prior to pregnancy with a BMI of 30.3 and her current weight at 7 weeks is 181. What is your assessment of her weight?
Her weight is clinical within normal limits
BMI >30; recommended weight+ in 1st trim is 0-1lbs, it is not unusual to loose a few lbs in early pregnancy
What is the IOM/NAM’s recommendation for total weight gain in pregnancy for a BMI categorized as obese?
11-20lbs in entire pregnancy
Your patient’s pre-pregnancy BP was 128/74, and at her new OB visit today it is 120/64. Should we be concerned?
This is an expected change, consistent with cardiovascular physiology in pregnancy
What should we tell our patient about fetal heart rate monitoring at her 11 week appointment?
At your next visit, the top of your uterus should be almost at the level of your pubic bone. We will try to listen to your baby’s heartbeat with a doppler, although sometimes it can be challenging to hear before 12 weeks
