Pregnancy

Question 1

why should you avoid asking pregnant women to spend long periods of lying on her back?

Answer 1

Supine Hypotensive Syndrome = Compression from this position interferes with venous return from lower extremities & pelvic vessels, causing patient to feel dizzy & faint.

Question 2

During majority of pregnancy exam, patient should be in what positions?

Answer 2

sitting up or left-side lying position (exception - during pelvic exam)

Question 3

Tolerance of 1st trimester wt. loss due to N/V depends on

Answer 3

pre-pregnancy BMI

Question 4

Weight loss of 5% of pre-pregnancy weight

Answer 4

Hyperemesis Gravidarum - may lead to adverse pregnancy outcomes

Question 5

Chronic HTN during pregnancy is

Answer 5

> 140/>90 documented before pregnancy, before 20 wks, & after 12 wks postpartum

Question 6

Gestational HTN

Answer 6

> 140/>90 first documented after 20 weeks without proteinuria

Question 7

Preeclampsia

Answer 7

> 140/>90 after 20 weeks with proteinuria

Question 8

Facial edema after 20 gestational weeks may reflect

Answer 8

Preeclampsia

Question 9

Localized patches of hair loss

Answer 9

should NOT be attributed to pregnancy (though postpartum hair loss is common)

Question 10

Anemia may cause

Answer 10

conjunctival pallor

Question 11

Erosions & perforations of nasal septum are seen in

Answer 11

intranasal cocaine use

Question 12

Dental problems are associated with

Answer 12

poor pregnancy outcomes - so refer for tot & gum pain or infections

Question 13

Dyspnea accompanied by increased respiratory rate, cough, rales, or respiratory distress raises concern of

Answer 13

possible infection, asthma, pulmonary embolus, or peripartum cardiomyopathy

Question 14

Murmurs may signal

Answer 14

anemia

Question 15

dypnea & signs of heart failure

Answer 15

peripartum cardiomyopathy (particularly in late stages of pregnancy)

Question 16

Severe focal tenderness of breast with erythema

Answer 16

mastitis

Question 17

Do cesarean scars always match the orientation of the scar on uterus?

Answer 17

no

Question 18

Confirm fetal health & gestational age via

Answer 18

formal ultrasound

Question 19

If fetal movement can’t be felt after 24 weeks

Answer 19

error in calculating gestational age; fetal death or severe morbidity; false pregnancy

Question 20

Before 37 weeks, regular uterine contractions with or without pain & bleeding

Answer 20

suggests preterm labor

Question 21

If fundal height is 4 cm larger than expected consider:

Answer 21

multiple gestation; large fetus; extra amniotic fluid; uterine leiomyoma (investigate via ultrasound)

Question 22

If fundal height is 4 cm smaller than expected consider:

Answer 22

low level of amniotic fluid; missed abortion; intrauterine growth retardation; fetal anomaly (investigate via ultrasound)

Question 23

Lack of audible fetal heart tones may indicate

Answer 23

fewer wks gestation than expected; fetal demise; false pregnancy; observer error (Always investigate via ultrasound)

Question 24

After 24 weeks, auscultation of more than one FHR in different locations with varying rates suggests

Answer 24

multiple gestation

Question 25

These may be pronounced from the muscle relaxation of pregnancy

Answer 25

Cystoceles & rectoceles

Question 26

A pink cervix suggests

Answer 26

non-pregnant state

Question 27

Cervical erosion, erythema, discharge, or irritation

Answer 27

cervicitis

Question 28

Abnormal vaginal discharge

Answer 28

possible candida or bacterial vaginosis (these can affect pregnancy outcome)

Question 29

Cervical opening or shortening (effacement) prior to 37 weeks

Answer 29

may indicate preterm labor

Question 30

Irregular shaped uterus suggests

Answer 30

uterine leiomyomata, fibroids, or bicornuate uterus (uterus with 2 distinct cavities separated by a septum)

Question 31

Adnexal (uterine appendages) tenderness or masses early in gestation

Answer 31

require ultrasound to rule out ectopic pregnancy

Question 32

why is acute pelvic inflammatory disease rare in pregnancy, especially after 1st trimester?

Answer 32

because adnexae are sealed by gravid uterus & mucous plug

Question 33

______ often engorge during late pregnancy; they may be painful, bleed, or thrombose

Answer 33

Hemorrhoids

Question 34

Unilateral severe edema with calf tenderness suggests

Answer 34

deep vein thrombosis

Question 35

Hand or fascial edema after 20 gestational weeks should be investigated for

Answer 35

preeclampsia

Question 36

Hyperreflexia may signal

Answer 36

preeclampsia – BUT this must be compared to patients baseline reflexes

Question 37

______ are used to determine fetal position within maternal abdomen in 2nd trimester

Answer 37

Leopold Maneuvers

Question 38

Breech presentation during Leopold Maneuver exam

Answer 38

when parts other than head, such as butt or foot present at the maternal pelvis

Question 39

Fetal buttocks are usually at

Answer 39

upper fetal pole — should feel firm but irregular, & less globular than head

Question 40

Fetal head should feel

Answer 40

firm, round, & smooth