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Physiology - clinical Flashcards

1
Q

Estrogen potency ranking

A

Estradiol > estrONE (E1, menopause) > estriol (pregnancy)

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2
Q

When is the “fertile period?”

A

1-2 days prior to ovulation

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3
Q

Surfactant: # wks GA first produced? secreted?

A

24 wks: first produced
28-32 wks: first secreted
35 wks: enough to prevent alveolar collapse after birth

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4
Q

How long does increased thromboembolic stroke risk in women last for after pregnancy?

A

6 weeks, especially in first 3 weeks

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5
Q

What contraceptive options do breastfeeding women have?

A
  • Lactation (up to 6 wks) if exclusively breastfeeding
  • Progestin-only methods (Nexplanon, IUD)
  • Avoid estrogen-containing methods for 6 weeks; estrogen may decrease quality of milk and milk volume
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6
Q

When to place IUD after pregnancy?

A

Immediately after delivery OR at 6 wks postpartum visit

Note: +20% risk of expulsion

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7
Q

When to place Nexplanon after pregnancy?

A

Couple of days after delivery

Slight delay b/c need progesterone to drop for lactogenesis to occur

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8
Q

How long should women wait before next pregnancy?

A

18 months recommended

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9
Q

When do most teratogens act during development?

A

First 8-12 weeks, during organogenesis

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10
Q

How to calculate gestational age?

A

Gestational age = embryonic age + 2 weeks

[2 weeks between last menstrual period and fertilization]

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11
Q

Prenatal screening tests: first trimester (11-14 wks)

A
  1. Maternal serum analytes (PAPP-A, hCG for T21, T18)
  2. Ultrasound (nuchal translucency - increased fluid under neck suggestive for chromosomal abnormalities, heart defects)

[Cell free DNA after 10 wks for T13, T18, T21]

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12
Q

Prenatal screening tests: second trimester (15-20 wks)

A
  1. Ultrasound
  2. Quad screening for neural tube defects, T18, T21: AFP (elevated - neural tube defects), hCG, UE3 (unconjugated estriol), inhibin

All low: T18

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13
Q

Chorionic villus sampling: timeline? indication? compare to amnio?

A

10-14 wks
Diagnostic test for karyotyping
Know results earlier than amnio (15-20 wks) but slightly higher chance of miscarriage

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14
Q

Amniocentesis: timeline? indication?

A

15-20 wks

Diagnostic test for karyotyping

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15
Q

Why take folic acid before conception? When should you take it?

A

Helps to prevent neural tube defects

Take 1 mo before conception through 12 weeks of pregnancy

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16
Q

Best way to date a pregnancy?

A

Transvaginal ultrasound - measure crown rump length

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17
Q

What to screen for every month in pregnancy?

A

IPV, especially as GA increases

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18
Q

RhoGAM: when to administer?

A

28 wks if mom is Rh-

Earlier if first trimester bleeding occurred (opportunity for blood mixing)

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19
Q

Maternal prenatal screening: first trimester

A 
BP
BMI
Blood type for Rh status
Diabetes screen if high risk (e.g. FH)
Check for immunity: VZV, rubella, Hep B
STI testing: HIV, gonorrhea/chlamydia, PPD
UA and culture

Fetal heart sounds (Doppler)

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20
Q

Vaccines contraindicated in pregnancy

A

VZV, MMR, HPV

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21
Q

What to do if mom is Hep B+?

A

Vaccinate her

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22
Q

Maternal prenatal screening: second trimester

A

BP
Weight
Gestational diabetes screen
Fundal height

Fetal heart sounds
U/S for placental location

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23
Q

Maternal prenatal screening: third trimester

A

BP (for preeclampsia)
Weight
Fundal height
Group B strep screen (neonate at risk for meningitis)

Fetal heart sounds
U/S for fetal presentation

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24
Q

When is full term?

A

37-42 weeks

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25
Recommended weight gain during pregnancy by BMI
Underweight (<18.5): 28-40 pounds Normal (18.5 - 24.9): 25-35 pounds Obese (>30): 11-20 pounds
26
Parity and gravidity nomenclature | TPAL
Parity: # of births >20 weeks Gravidity: # of times pregnant, including current pregnancy (including miscarriages, stillborns, multiple gestation = 1) Term, Premature, Abortion, Living
27
Spontaneous abortion: time indication
<20 weeks
28
Schedule of prenatal visits
4-28 wks: every 4 wks 28-36 wks: every 2 wks 36-birth: every week
29
Fetal heart monitoring: what do accelerations and decelerations mean?
VEAL CHOP - variable decels | cord compression - early decels | head compression - accelerations | okay - late decels | placental insufficiency
30
Normal fetal heart rate? HR for fetal tachycardia/bradycardia?
Nl: 110-160 Fetal tachycardia: >160 for >10 mins Fetal bradycardia: <110 for >10 mins
31
How are fetal heart tracings categorized?
Category I: reassuring Category III: immediate intervention needed Category II = everything in between
32
Physiologic hematologic changes during pregnancy: hemoglobin, coagulability
Dilutional anemia: - plasma volume increases faster than RBC mass - purpose: minimize RBC loss during delivery Hypercoagulability: estrogen increases clotting factor production
33
Physiologic cardiovascular changes during pregnancy: cardiac output, blood pressure changes, PE
Increased cardiac output (first increased SV then increased HR) Blood pressure decreases in first half of pregnancy due to prostaglandin, increases later possibly due to preeclampsia Supine hypotension: - weight of uterus compresses IVC, decreasing preload Benign flow murmur
34
Physiologic pulmonary changes during pregnancy: ventilation
Increased minute ventilation | - mom is trying to decrease PaCO2 so baby's CO2 can more easily diffuse to mom)
35
Physiologic acid-base changes during pregnancy
Respiratory alkalosis due to increased minute ventilation Kidneys compensate by excreting more bicarbonate
36
Physiologic urinary tract changes during pregnancy
Hydronephrosis: obstruction of ureters due to mass effect, usually more on right side (left ureter may be more protected by colon) Increased risk of UTI's due to urinary stasis (progesterone decreases bladder tone)
37
Physiologic renal changes during pregnancy: GFR, serum creatinine, glucosuria
Increased GFR and renal plasma flow due to larger cardiac output Decreased serum creatinine due to increased blood filtration --> thus, "high normal" creatinine is worrying Glucosuria is not uncommon
38
Top complications of pregnancy
Thromboembolism Diabetes Preeclampsia Iron deficiency anemia Morning sickness
39
Preterm labor: time frame
Prior to 37 weeks
40
Braxton-Hicks contractions
Contractions without cervical change
41
Stages of Labor
Stage 1: - Latent: dilation <6 cm, up to 20 hours - Active: dilation 6-10 cm, 6-10 hours Stage 2: - "Pushing stage," ending with delivery Stage 3: - delivery of placenta
42
Fetal orientation (4)
1. Lie - longitudinal vs transverse 2. Presentation - cephalic or breech 3. Position - occiput anterior or posterior 4. Station
43
What triggers neonatal transition?
First breath
44
Neonatal routine care immediately after delivery
Hep B vaccination: 1 dose Vitamin K injection to prevent hemorrhagic disease Erythromycin eye ointment to prevent gonorrhea infection
45
Breastfeeding: recommendations for newborns
Every 2-3 hours, 15-20 minutes on each breast
46
Newborn screening: pulse oximetry - how to test, and what do results mean?
Measure O2 sat at 2 sites: right hand and right/left foot If >3% differential: patent ductus arteriosus If both low: patent foramen ovale or other defect
47
Normal bilirubin peak level in neonates?
5-6 mg/dL at day 3 or 4
48
Physiologic causes of hyperbilirubinemia in neonates
1. Increased production (shorter RBC life span, increased hematocrit in newborns) 2. Decreased conjugation ability (liver not yet mature - UGT1A1/UDPGT not yet working at target levels) 3. Increased enterohepatic circulation (gut motility decreased --> conjugated bilirubin taken up by beta-glucoronidases in liver and unconjugated again)
49
How does progesterone interact with prolactin?
Progesterone inhibits prolactin activity
50
How does progesterone interact with prolactin?
Progesterone inhibits prolactin activity
51
Adrenarche
HPA axis maturation; growth of pubic hair
52
Tanner Staging: females
``` Stage 1: prepubescent Stage 2: breast buds Stage 3: enlargement Stage 4: areola and papilla elevate to form secondary mound Stage 5: Secondary mound recedes ```
53
Tanner Staging: testes
1: prepubescent 2: testes >2.5 cm 3. penis lengthens, scrotum enlarges 4: penis widens, scrotum darkens 5: adult
54
Tanner Staging: pubic hair
1: prepubescent 2: straight hairs 3: curly hairs with pigmentation 4: coarsening of hair, adult distribution 5: hair to inner thighs
55
Progression of puberty in males
``` Testicular development Pubic hair, axillary hair Growth spurt First ejaculation Facial hair Adult height ```
56
Progression of puberty in females
``` Breast bud development Pubic hair Growth spurt Axillary hair Physiologic leukorrhea (white vaginal discharge) First menses (2 years after breast bud) Adult height ```
57
How do adrenarche and puberty track together?
Track closer together in males, less so in females
58
Zones of prostate and associated diseases
Transition zone - BPH Peripheral zone - cancers Central zone - contains ejaculatory ducts
59
Common genetic mutation in prostate cancer
TMPRSS2/ERG fusion (50% of cases)
60
Where are most breast cancers located in the breast?
Upper outer quadrant (45%) - most glandular tissue
61
Breast cancer: risk factors
- smoking - alcohol - obesity - family history, esp cancer at younger age - denser breast tissue
62
PALM-COEIN classification system: what for? what does it stand for?
Abnormal uterine bleeding Structural: Polyps, Adenomyosis, Leiomyomas, Malignancy Non-structural: Coagulopathy, Ovulatory, Endometrial (diagnosis of exclusion), Iatrogenic/infection, Not yet classified [E and N can be lumped together]
63
Creatinine as a measure of kidney function in older adults - useful?
Creatinine production decreases with age --> there's less in the plasma to start In older patients: kidney function can be very impaired, but b/c there's less to start, the final creatinine value can still be within normal Instead, use Cockcroft Gault formula or CKD-Epi equation
64
What are ADL's?
``` Bathing Dressing Toileting Eating Transferring ```
65
Prostate: testosterone signaling pathway
5-alpha-reductase converts testosterone to DHT, whicih promotes growth and survival of benign prostatic cells and prostatic adenocarcinoma cells

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