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Life Stages > Physiology - clinical > Flashcards

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
Q

Recommended weight gain during pregnancy by BMI

A

Underweight (<18.5): 28-40 pounds
Normal (18.5 - 24.9): 25-35 pounds
Obese (>30): 11-20 pounds

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26
Q

Parity and gravidity nomenclature

TPAL

A

Parity: # of births >20 weeks
Gravidity: # of times pregnant, including current pregnancy (including miscarriages, stillborns, multiple gestation = 1)

Term, Premature, Abortion, Living

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27
Q

Spontaneous abortion: time indication

A

<20 weeks

28
Q

Schedule of prenatal visits

A

4-28 wks: every 4 wks
28-36 wks: every 2 wks
36-birth: every week

29
Q

Fetal heart monitoring: what do accelerations and decelerations mean?

A

VEAL CHOP

  • variable decels | cord compression
  • early decels | head compression
  • accelerations | okay
  • late decels | placental insufficiency
30
Q

Normal fetal heart rate? HR for fetal tachycardia/bradycardia?

A

Nl: 110-160
Fetal tachycardia: >160 for >10 mins
Fetal bradycardia: <110 for >10 mins

31
Q

How are fetal heart tracings categorized?

A

Category I: reassuring
Category III: immediate intervention needed
Category II = everything in between

32
Q

Physiologic hematologic changes during pregnancy: hemoglobin, coagulability

A

Dilutional anemia:

  • plasma volume increases faster than RBC mass
  • purpose: minimize RBC loss during delivery

Hypercoagulability: estrogen increases clotting factor production

33
Q

Physiologic cardiovascular changes during pregnancy: cardiac output, blood pressure changes, PE

A

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
Q

Physiologic pulmonary changes during pregnancy: ventilation

A

Increased minute ventilation

- mom is trying to decrease PaCO2 so baby’s CO2 can more easily diffuse to mom)

35
Q

Physiologic acid-base changes during pregnancy

A

Respiratory alkalosis due to increased minute ventilation

Kidneys compensate by excreting more bicarbonate

36
Q

Physiologic urinary tract changes during pregnancy

A

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
Q

Physiologic renal changes during pregnancy: GFR, serum creatinine, glucosuria

A

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
Q

Top complications of pregnancy

A

Thromboembolism
Diabetes
Preeclampsia

Iron deficiency anemia
Morning sickness

39
Q

Preterm labor: time frame

A

Prior to 37 weeks

40
Q

Braxton-Hicks contractions

A

Contractions without cervical change

41
Q

Stages of Labor

A

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
Q

Fetal orientation (4)

A
  1. Lie - longitudinal vs transverse
  2. Presentation - cephalic or breech
  3. Position - occiput anterior or posterior
  4. Station
43
Q

What triggers neonatal transition?

A

First breath

44
Q

Neonatal routine care immediately after delivery

A

Hep B vaccination: 1 dose

Vitamin K injection to prevent hemorrhagic disease

Erythromycin eye ointment to prevent gonorrhea infection

45
Q

Breastfeeding: recommendations for newborns

A

Every 2-3 hours, 15-20 minutes on each breast

46
Q

Newborn screening: pulse oximetry - how to test, and what do results mean?

A

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
Q

Normal bilirubin peak level in neonates?

A

5-6 mg/dL at day 3 or 4

48
Q

Physiologic causes of hyperbilirubinemia in neonates

A
  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
Q

How does progesterone interact with prolactin?

A

Progesterone inhibits prolactin activity

50
Q

How does progesterone interact with prolactin?

A

Progesterone inhibits prolactin activity

51
Q

Adrenarche

A

HPA axis maturation; growth of pubic hair

52
Q

Tanner Staging: females

A 
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
Q

Tanner Staging: testes

A

1: prepubescent
2: testes >2.5 cm
3. penis lengthens, scrotum enlarges
4: penis widens, scrotum darkens
5: adult

54
Q

Tanner Staging: pubic hair

A

1: prepubescent
2: straight hairs
3: curly hairs with pigmentation
4: coarsening of hair, adult distribution
5: hair to inner thighs

55
Q

Progression of puberty in males

A 
Testicular development
Pubic hair, axillary hair
Growth spurt
First ejaculation
Facial hair
Adult height
56
Q

Progression of puberty in females

A 
Breast bud development
Pubic hair
Growth spurt
Axillary hair
Physiologic leukorrhea (white vaginal discharge)
First menses (2 years after breast bud)
Adult height
57
Q

How do adrenarche and puberty track together?

A

Track closer together in males, less so in females

58
Q

Zones of prostate and associated diseases

A

Transition zone - BPH
Peripheral zone - cancers
Central zone - contains ejaculatory ducts

59
Q

Common genetic mutation in prostate cancer

A

TMPRSS2/ERG fusion (50% of cases)

60
Q

Where are most breast cancers located in the breast?

A

Upper outer quadrant (45%) - most glandular tissue

61
Q

Breast cancer: risk factors

A
  • smoking
  • alcohol
  • obesity
  • family history, esp cancer at younger age
  • denser breast tissue
62
Q

PALM-COEIN classification system: what for? what does it stand for?

A

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
Q

Creatinine as a measure of kidney function in older adults - useful?

A

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
Q

What are ADL’s?

A 
Bathing
Dressing
Toileting
Eating
Transferring
65
Q

Prostate: testosterone signaling pathway

A

5-alpha-reductase converts testosterone to DHT, whicih promotes growth and survival of benign prostatic cells and prostatic adenocarcinoma cells

Life Stages (10 decks)

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