Peds & OB Review Flashcards
Where is estrogen produced during pregnancy what is it responsible for?
Ovaries & placenta produce causes enlargement of uterus, breasts and genitals
What is progesterone during pregnancy responsible for?
Maintains endometrium for implantation
Inhibits uterine contractions- prevents abortion
Promotes secretory ducts of breasts for lactation
Thyroxine (T4) elevates during pregnancy, what does it produce?
Increased BMR by 23%, elevated HR
What hormone stimulates progesterone and estrogen by the corpus luteinizing to maintain pregnancy until uterus takes over?
HCG (human chorionic gonadotropin)
This hormone is responsible to increase in glucose and protein metabolism and is produced by the placenta?
Human placental lactogen (hPL)
This hormone produced by the anterior pituitary is responsible for the darkening of skin found in pregnancy?
Melanocyte stimulating hormone (MSH)
Relaxin is produced where and responsible for what?
By the corpus luteum and inhibits uterine activity
What hormone prepares breasts for lactation?
Prolactin
Oxytocin is produced where and responsible for what during pregnancy?
Posterior pituitary
Stimulates uterine contraction
—after birth contractions reduce bleeding
Stimulates mild ejection reflex (let-down)
T/F cortisol is 2-3 times higher during pregnancy and helps to developer fetuses neurological system including mental development and temperament?
True
What are the presumptive signs of pregnancy?
Subjective: Amenorrhea, nausea, breast tenderness, fatigue, increased urination
What are the probably signs of pregnancy?
Objective: softening and darkening of the cervix, uterine softening and enlargement, positive pregnancy test, ballottement.
What are the positive signs of pregnancy?
Diagnostic: Fetal heart sounds, fetal outline and movements
What happens to the alveoli during pregnancy?
They become increasingly distended
What 2 hormones cause the proliferation in duct and grandular tissue that produces an average 12-ounce increase in breast weight?
Estrogen and progesterone
What is uterine soufflé?
Maternal arterial blood flow
What happens to the walls of the uterus during pregnancy?
They thicken from 10-25mm in first 16 weeks, then thin to 5-10 mm by term
What is Hegar’s sign?
Uterine softening, lengthening and bending anteriorly
What is Chadwick’s sign
Bluish, darkening of the vagina, vulva & cervix
What is Goodell’s sign?
Softening of the cervix
What is the average increase in fundus after 20 weeks?
1cm per week
What is the fundal height at 20 weeks?
20cm or at umbilicus
What is the fundal height at 12 weeks?
12cm or just at symphysis pubis
What is the fundal height at 16 weeks?
Halfway between symphysis pubis and umbillicus
What happens to the vaginal pH during pregnancy?
It decreases
T/F it is expected to hear hyperactive bowel sounds during all stages of pregnancy?
False- usually tend to be more hypoactive due to the normal decrease in peristalsis
How much is the cardiac output usually increased in pregnancy?
30-50%
At 30-34 weeks, blood volume increases by how much?
30-50% (1110-1600ml)
What is the normal increase in oxygen consumption during pregnancy?
30%
What hormone very active during pregnancy decreases bladder tone further increasing risk for incontinence?
Progesterone
T/F the pituitary gland increased to 3x it’s normal size during pregnancy?
True
What labs are routinely ordered at during early pregnancy?
H&H, Rh factor, Type & Screen, antibody screen, varicella, and rubella and TSH (if indicated)
urine culture
STI screen for chlamydia & gonorrhea, Hep B & C, syphilis, and trachomatis
Maternal genetic testing
When is rhogam shot given to pregnant Rh negative mom?
28 weeks and within 72 hours of delivery (or abortion)
What are the two most critical elements to prenatal supplementation?
Folate & Iron
When does the extreme fatigue of pregnancy usually peak?
9-12 weeks
What are the common genetic and fetal screening tests often in first trimester?
CF, Sickle cell, autosomal recessive disorders (screen both parents)
Fetal screenings: Down syndrome, aneuploiudies, chromosomal number abnormalities
What is the most common STI?
HPV
T/F removal HPV wart cures infection?
False
What is the most commonly reported STI?
Chlamydia
A major complication of PID is what condition?
Fitz-Hugh-Curtis syndrome
HIV affects CD4 cells in what manner?
Decreasing number AND function
What is considered the perimenopausal period?
2-8 years prior to cessation of menses
What is considered the early post-menopausal period?
First 5 years after cessation
What is considered the late perimenopausal period?
6+ year after onset of symptoms
What is necessary to diagnose menopause?
Complete essation of menses for 1 continuous year
What test might be used to aide in the diagnosis of or predict menopause?
Anti-Mullerian hormone reflects the number of follicles
When should patients be screened for thyroid dysfunction?
Every 5 years starting at 35 years olf
What is the leading cancer cause of death?
Lung, followed by breast, then colon
T/F women are more likely to experience depression but men are more likely to die from it?
True
What is are helpful diagnostic tools when evaluating urinary incontinence (UI) in a woman?
3-day voiding diary
Filling Cystometogram
Urethral pressure profile
MRI, 3-D US
What are lifestyle interventions that should be utilized with urge incontinence?
Beverage management: avoid caffeine, artificial sweeteners and alcohol
Bladder training
Knack skill
Kegel exercises
Weight management
Pessary
What drugs can help with urge-type incontinence?
Anticholinergics: oxybutynin (ditropan), tolterodine (Detrol), fesoterodin (Toviaz), solinenacin (Vesicare), and dirifenacin (Enalblex).
Also- SSIRs duloxetine
TCA- imipramine (tofranil) and mirabegron
Post menopausal women- vaginal estrogen
What may be secondary causes of scrotal swelling?
CHF, trauma, and hernia
What are primary causes of scrotal swelling?
Testicular cancer, inflammation (orchitis), hydrocele, variocele, hernia, and epidymitis
T/F hydrocele is common in newborns?
True
What are two major causes of orchitis?
STI, mumps
T/F variocele usually reduces in size when laying down?
True
T/F BPH is often a warning sign for impending prostate cancer
False
Alpha blockers relax the prostate and neck of bladder, what are some examples?
Doxazosin (cardura)
Tasulosin (Flomax)
Terazosin (Hytrin)
Prazosin (minipress)
Siodosin (Rapaflo)
These drugs shrink the prostate and prevent hypertrophy, dutasteride (avodart) and finasteride (Proscar), what class do they belong to and who should never handle them?
5-alpha reductase inhibitors - pregnant or potentially pregnant woman should never handle
What additional drugs have been show to reduce prostate symptoms and increase flow rate?
Phophodiesterase 5 inhibitors (PDE5): Sildenafil (viagra), garden AFib (Levitra) and tadalafil (Cialis)
What is the most important finding on the growth chart?
What is the pattern, is there a change? Falling <25 or >95 are usually concerning
What is considered newborn age?
0-28 days
What is considered infant age?
1-12 months
What is the average birth weight and what is expected in the first few days then 2 weeks?
Average 7.5lb, can expect to lose 5-8% first week
Gains back by 10-14 days
What is the expected weight increase at mile markers?
Birth weight doubled 4-6 months
Tripled at 12 months
Anterior Fontanels close at what age?
Around 18 months
Posterior fontanels close at what age?
2-3 months
What is the normal pulse and RR for newborns?
HR 120-170
RR 30-80
What is the normal pulse and RR for 3 year old? What would be considered hypertensive?
HR 80-120, RR 20-30
>116/76
What is the normal pulse and RR for 1 year old? What would be considered hypertensive?
HR 80-160, RR 20-40
>112/74
What is the normal pulse and RR for 6 year old? What would be considered hypertensive?
HR 75-115, RR 16-20
>122/78
What is the normal pulse and RR for 10 year old? What would be considered hypertensive?
HR 70-110, RR 16-20
>126/82
What BP would be considered elevated for 13-15 year old?
> 136/86
What should be considered in a child with a low HGB? And a high HGB?
Low= anemia, thalassemia or SCD
High= dehyrdation
What should be considered in a child with a low HCT? And a high HCT
High- dehyrdation, polycythemia-usually response to chronic respiratory issues
Low- anemia, hyperthyroidism, leukemia
What should be considered in a child with a low WBC? And a high WBC?
Low- bone marrow suppression, viral infection, hypersplenia, leukemia and some drugs
High- acute bacterial infection, hemolysis, steroid use
Newborn screening is required usually 24-48 hours of life includes what disorders?
Hypothyroidism
PKU
Galactosemia
Hemoglobinopathies
Maples syringe disease
CF
How does colic present differently from reflux regurgitation?
Colic appears in pain, just ting out or in of legs, persistent crying. Will eat normally when not crying.
Reflux- Eats normal, no fussing, but ejects undigested food after eating
What are concerning signs suggestive of cystic fibrosis?
Newborn failure to pass meconium (meconium ileus)
Extremely thick, tenacious, and copious respiratory secretions
Salty tasting skin
Poor growth trajectory
Children and adults with cystic fibrosis also frequently have problems what additional problems?
Pancreatic insufficiency
What is the gene is responsible for CF?
CFTR gene
What is the average age CF is diagnoses in a child where prenatal genetic testing or newborn screening was not done?
6-8 months
CFTR gene causes impaired mucous clearance, leads to bacterial infections and chronic neutrophilic inflammation. This results in what lung pathology?
Bronchiectasis
What are the treatments for CF?
High calorie and protein diet
Chest physiotherapy
Breathing exercises
Aerosol therapy (bronchodilators)
Mucolytics
Pancreatic enzymes
What are the symptoms often found in CF?
Fatigue
Chronic cough
Recurrent URI and infections
Thick, sticky mucous
Clubbing of nails, barrel chest due to hypoxia
Abdominal distention (poor digestion r/t lack of digestive enzymes)(
Fatty, stinky stools (steatorrhea)
Child is consistently failing milestones such as sitting up at 6 months and talking at 12 months with social interaction issues, what disorder should they be evaluated for?
Autism spectrum disorder
This is defined at child who demonstrates in attention, impulsivity, and motor hyperactivity more so than peers at same developmental level?
Attention deficit hyperactivity disorder
With autosomal dominant disorders, how many parents need to have the gene to pass on to the child?
Only 1- the trait is dominant, 50% chance to pass on
With autosomal recessive disorders, how many parents need to have the gene to pass on to the child?
Both, 25% chance of passing on to children if heterozygous (Dd)(Dd)
Unless, both are homozygous (meaning 2 pairs of recessive genes), then all of their offspring will be affected (dd) (dd)
With x-linked disorders, who is it passed and to whom?
If carried by unaffected mothers:
50% of passing on to sons
50% of daughters will be carriers
If carried by father- 100% of daughters will be carriers
What is aneuploidy and what are some examples
Wrong number of chromosomes such as trisomy 13, 18, and 21
Turner syndrome where X chromosome is missing
First trimester genetic screening includes what tests and are they conclusive?
Nuchal translucency (US measurement of fluid around fetuses neck) and maternal blood draw for woman at risk of Down’s syndrome or tiresomy 18. Usually done 15-21 weeks
Triple screen or AFP 3- usually 15-18 weeks detects genetic disorders such as downs, trisomy, and neural tide defects.
Positives means need to investigate further with US or amnio
Chorionic villus sampling is an invasive procedure, when is it performed and what can it indicate?
Samples the placental cells which share some genetics as fetus, generally done 10-12 weeks and tests for chromosomal abnormalities
With trisomy 18, what is often found en urtero and postnatal?
Uterine growth restriction, cardiac defects, club feet, wide posterior head and narrow frontal region.
50% of babies die within 1 week
What is another name for trisomy 21?
Downs syndrome
Trisomy 13 infants usually present with what findings and what is the prognosis?
Cerebral defects- two hemispheres are fused, mass CNS abnormalities, abnormal mid face developing (cleft face), and heart defects.
50-80% die within 1 month, the vast majority die before 6 months
Which is the most common inherited form of mental retardation?
Fragile X syndrome- males are more likely to be affected because they only have one X chromosome
But woman are frequently carriers
PKU is an autosomal recessive disorder that affects what?
Ability to metabolized phenylalanine- causing the resulting protein to build up in the blood stream causing metal retardation.
Diet is the treatment
This condition produces an extra X chromosome in males and produces what outcome?
Klinefelter syndrome- boys are taller but have developmental issues and are infertile
