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Patient History and Physical Exam > Pregnant Patient PE Quiz > Flashcards

Pregnant Patient PE Quiz Flashcards

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1
Q

What should be addressed at the initial prenatal care visit?

A
  1. confirm pregnancy with lab tests (urine or blood)
  2. assess health status of the mother
  3. counsel mother to ensure a healthy pregnancy
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2
Q

How to confirm pregnancy at initial prenatal care visit?

A

lab tests ( urine or blood)

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3
Q

What should be addressed at subsequent prenatal care visits (NOT initial)

A
  1. assess health of mother
  2. assess fetus
  3. educate to ensure a healthy pregnancy
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4
Q

During weeks 4-28 a woman should get a prenatal checkup every [] weeks

A

4/ once a month

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5
Q

During weeks 28-36 a woman should get a prenatal check up every [] weeks

A

2/ twice a month

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6
Q

during weeks 36-birth a woman should get a prenatal check up every [] weeks

A

once a week until baby is born

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7
Q

When is it best to do genetic screening?

A

15-18 weeks

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8
Q

when it is best to do in depth US

A

20 weeks

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9
Q

when is it best to screen for gestational diabetes

A

24-28 weeks

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10
Q

[] is the number one cause of neonatal meningitis

A

group B strep

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11
Q

when should group B testing be done

A

36-39 weeks

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12
Q

What initial labs should you draw on your pregnant patient

A
  1. CBC
  2. blood type
  3. hepatitis panel
  4. HIV testing
  5. syphilis testing
  6. UA and culture
  7. pap smear
  8. chalmydia
  9. gonorrhea cultures
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13
Q

What subsequent lab tests should be ran on your pregnant patient

A
  1. urine for glucose (GDM)
  2. protein in urine (preeclampsia)
  3. WBC (infection)
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14
Q

glucose in urine can be indicative of []

A

gestational diabetes

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15
Q

protein in urine can be indicative of

A

preeclampsia

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16
Q

WBC in urine can be indicative of

A

infection

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17
Q

hormonal changes lead to extensive [1] and [2] changes in [3]

A
  1. anatomical
  2. physiological
  3. every major body system
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18
Q

what hormones are most responsible for pregnancy related endocrine and metabolic changes

A
  1. estradiol
  2. progesterone
  3. pregnancy hormones (HCG)
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19
Q

erythrocyte mass and plasma volume [] during pregnancy

A

increase

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20
Q

cardiac output [] during pregnancy

A

increase

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21
Q

system vascular resistance and pressure [] during pregnancy

A

fall

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22
Q

musculoskeletal changes occur from [] and []

A
  1. weight gain

2. relaxin hormone

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23
Q

what happens to the spine during pregnancy?

A

lumbar lordosis

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24
Q

[] and [] ligaments relax during pregnancy

A
  1. SI joints

2. pubic symphyses

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25
Q

Describe some breast changes in pregnancy

A
  1. enlarge moderately
  2. become more nodular by 3rd month of pregnancy
  3. clostridium expression
  4. areolae darken
  5. venous pattern becomes more visible
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26
Q

what causes breasts to enlarge moderately during pregnancy

A
  1. hormone secretion
  2. increased vascularity
  3. hyperplasia of glandular tissue
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27
Q

what 4 breast changes occur in late pregnancy

A
  1. colostrum may be expressed
  2. areolae darken
  3. montgomery’s glands are more pronounced
  4. venous pattern increasingly visible
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28
Q

when is the uterus most easily palpable

A

12-14 weeks as it straightens from anteverted position and rises up out of pelvis

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29
Q

as uterus enlarges is rotates to the [] to accommodate for []

A
  1. right

2. rectosigmoid structures on the left side of pelvis

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30
Q

describe changes to the vaginal during pregnancy

A
  1. walls appear thicker and deeply rugated

2. vaginal secretions are thick, white, and more profuse

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31
Q

describe Chadwick’s sign

A

bluish discoloration of the cervix, vagina and labia from increased blood flow

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32
Q

[] is a bluish discoloration of cervix, vagina, and labia from increased blood flow

A

Chadwick’s sign

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33
Q

describe cervical changes during pregnancy

A
  1. Chadwick’s sign

2. mucous plug

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34
Q

describe changes to ovaries during PE

A

cadges generally not noticeable on PE

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35
Q

What symptoms of pregnancy should you address with your patients

A
  1. absence of menses
  2. breast tenderness
  3. N/V
  4. fatigue
  5. increased frequency urination
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36
Q

what are 6 important history taking points to talk about with your pregnant patient

A
  1. symptoms pregnancy
  2. maternal concerns/attitude about pregnancy
  3. current state of health
  4. obstetrical hx
  5. past medical hx
  6. family hx congenital disease
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37
Q

how should you assess maternal concerns and attitude about pregnancy with your patient

A
  1. how does she feel?
  2. was is planned?
  3. is it desired?
  4. does she plan to continue to term?
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38
Q

how should you asses the current state of health of the patient

A
  1. review nutrition and exercise
  2. obtain smoking/alochol/and drug hx
  3. obtain occupational hx, look for workplace hazards
  4. assess social support and finances
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39
Q

what symptoms of pregnancy typically only occur in the 1st trimester

A
  1. nausea
  2. breast tenderness
  3. weight loss
  4. edema
40
Q

How would you assess past obstetrical history with your patient?

A
  1. past pregnancy
    - prenatal/labor issues
  2. review birth weight of prior pregnancies
  3. review any miscarriages and fetal demise
41
Q

how would you asses past medical history

A

review for any systemic diseases that would affect pregnancy

42
Q

how would you assess family hx of congenital disease

A

investigate for sickle cell/cystic fibrosis/etc.

43
Q

every exam during prenatal time is an excellent opportunity for []

A

emphasizing healthy habits

  • nutrition
  • weight gain
  • exercise
  • smoking/alcohol/illicit drug use
  • screen for DV
  • immunization
44
Q

How you do establish estimated date of delivery

A

Naegle’s Rule

first date of LMP + 1 week - 3 months + 1 year

45
Q

Describe Neaegle’s Rule

A

way to determine EDD

first date of LMP + 1 week -3 months + 1 year

46
Q

how can you verify the EDD?

A
  1. doptone (+ 10-12 weeks)
  2. fetoscope (heard at 18 weeks)
  3. fetal movement (18-24 weeks)
  4. US
47
Q

a doptone might be positive at [] week

A

10-12

48
Q

a fetoscope can be heard at []

A

18 weeks

49
Q

fetal movement may occur at [] weeks

A

18-24 weeks

50
Q

General inspection of pregnant patient should include

A
  1. overall health status
  2. emotional state
  3. nutritional status
51
Q

[] is very important in establishing if a patient becomes hypertensive during pregnancy

A

BP

52
Q

What vital sign is especially important to asses in pregnancy women and why?

A

BP

to monitor hypertension during pregnancy

53
Q

> 140/90 before 20 weeks indicates []

A

chronic hypertension

54
Q

what value would point to chronic hypertension in pregnancy

A

> 140/90 before 20 weeks

55
Q

> 140/90 after 20 weeks indicates []

A

gestational hypertension

56
Q

what indicates gestational hypertension

A

> 140/90 after 20 weeks

57
Q

> 140/90 after 20 weeks with protein in urine indicates

A

preeclampsia

58
Q

what BP state indicates preeclampsia

A

> 140/90 after 20 weeks with protein in urine

59
Q

why is weight and BMP important to discuss with patients

A

important to educate patient on proper weight gain and nutrition

60
Q

for a low BMI of [] a [] lb gain is recommended

A
  1. > 19.8

2. 28-40 pound weigh gain

61
Q

for a normal BMI of [], a [] lb gain is recommended

A
  1. 19.9-26

2. 25-35 lb gain

62
Q

for a high BMI of [] and [] lb weight gain is recommended

A
  1. 26.1-29

2. 15-25 lb gain

63
Q

for an obese bmi [] a [] weight gain

A
  1. > 29

2. <15 lb

64
Q

what signs on patient’s head are common in pregnancy

A
  1. mask of pregnancy/cholasma

2. edema

65
Q

what signs on patients hair indicate pregnancy

A

often dry and thinning

66
Q

what signs on eyes indicate pregnancy

A
  1. pallor of conjunctiva can mean anema
67
Q

what signs on nose indicate pregnancy

A

edema with congestion normal

68
Q

what should you note on inspecting patients mouth

A

note gums and teeth, periodontal disease common

69
Q

patients often complain of [] in thorax during pregnancy

A

shortness of breath

70
Q

[] are common in pregnancy when listening to heart

A

venous hums

71
Q

what should you be inspecting in patients breasts

A
  1. symmetry
  2. color
  3. veins often prominent
72
Q

describe chloasma

A

melanoma of pregnancy, dark, blotchy, brown, confetti-like patches of skin on forehead, upper lip, cheeks

73
Q

What should you inspect on you pregnant patient’s abdominal exam

A
  1. scars from earlier c section
  2. striae
  3. linea nigra
  4. palpate abdominal organs for masses
  5. palpate uterus
  • fetal movement at 24 weeks
  • contractions can be felts
74
Q

[] can be palpated at 24 weeks on patients abdomen

A

fetal movement

75
Q

[] dark vertical line that appears on the abdomen

A

linea nigra

76
Q

[] a gap of roughly 1 inch or greater between 2 sides of rectus abdominis muscle

A

diastasic recti

77
Q

describe distasis recti

A

a gap of roughly 1 niche or greater between 2 sides of rectus abdominis mucle

78
Q

describe striae

A

stretch marks

79
Q

fundal height is measured from the [] to the []

A
  1. superior portion of pubic symphysis

2. top of fundus

80
Q

superior portion of pubic symphyses -> top of fundus

A

fundal height

81
Q

from [] gestation, the fundal height in cm should approximate the number of weeks gestation

A

20-32 weeks

82
Q

at 20-32 weeks gestation, fundal height in cm should approximate []

A

number of weeks gestation

83
Q

how can fetal heart rate be assessed

A
  1. doptone (10 weeks)

2. fetoscope (18 weeks)

84
Q

fetal heart rate should be [] in the first weeks for pregnancy

A

150s - 160s

85
Q

fetal heart rate should be [] by term

A

120s - 140s

86
Q

if the fetal heart rate is around 150-160 BPM what can you conclude?

A

the woman is a few weeks along

87
Q

if the fetal heart rate is 120-140 what can you conclude?

A

the pregnancy is almost to term/to term

88
Q

what should you assess on your pregnancy patient’s genitals

A
  1. episiotomy scars

2. perineal lacerations from prior delivery

89
Q

what should you asses on your patients anus

A
  1. hemorrhoids
  2. fissures
  3. warts

*have patient bear down to rectoceles or cystoceles

90
Q

gravid cervix appears [] on speculum exam

A

bluish (chadwick’s sign)

91
Q

the cervix appears soft on speculum exam, this is know as [] sign

A

Hegar’s

92
Q

describe Hegar’s sign

A

soft cervix on speculum exam

93
Q

What 3 things should you note on your pregnancy patient’s speculum exam regarding the cervix

A
  1. color (bluish)
  2. consistency/soft
  3. shape

*obtain pap and std culture

94
Q

Desicribe bimanual exam

A
  1. with 2 fingers in vagina palpate cervix, uterus, and adnexal areas
  2. assess length of cervix
  3. assess if externa/internal os is open or closed
  4. if term, assess station of presenting part
95
Q

why is it important to asses the length of the cervix on bimanual exam

A

so thinning of cervix can be estimated during delivery

96
Q

what is important to note on bimanual exam of a patient at term

A

station of presenting part

-i.e. how inferior presenting part is to ischial spine

97
Q

what should you note on your pregnancy patient’s extremities

A
  1. varicose veins
  2. edema
  3. reflexes

Patient History and Physical Exam (2 decks)

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