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Family Medicine Cases > Vaginal Bleeding and UCG > Flashcards

Vaginal Bleeding and UCG Flashcards

1
Q

Who get’s screened for chlamydia

A

Sexually active or pregnant women 24 and younger
High risk women 25+ (Regardless of pregnancy)
No good evidence of men to get screened

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2
Q

Risk factors fo chlamydia

A

Past infection (any STD counts)
Multiple sex partners
Poor condom use
Sex for things

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3
Q

Folic acid recommendations

  • Normal
  • Diabetic or epileptic
  • Hx of child with NT defect
A

400 to 800 mcg
1 mg
4 mg

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4
Q

Carrier screening (ethinic)

A

Sickle cell
Thalassemia
Tay-sachs

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5
Q

Carrier screening (family hx)

A

Cystic fibrosis
Nonsyndromic hearing loss
- Connexin-26

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6
Q

Infectinous disease screening

A 
HIV
Syphilis
Hep B (vaccine)
Rubella & Varicella (Vaccines)
Toxo (cat litter, dirt, and raw meat)
CMV
Parvo B19
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7
Q

Environmental toxins

A

Paint thinners, strippers, solvents, and pesticides
Smoking cessation
EtOH and Drug use

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8
Q 
Medical assessment
Diabetes
HTN
Epilepsy
DVT
Deprssion/Anxiety
A 
Optimize control, Folic acid, and DC ACEI
DC ACEI, ARBS, and Thiazides
Optimize control & Folic acid
Switch to heparin 
Avoid benzos
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9
Q

Lifestyle

A 
Avoid hot tubes
Good weight management
Domestic violence
Nutritional deficiencies 
Avoid Vitamin A overuse (750 to 3000 mcg)
Vitamin D
Limit caffine to two cups perday
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10
Q 
Amenorrhea
Fatigue
Nausea
Vomiting
Breast changes (Tenderness)
A

Suprise!!!!

You’re pregnant

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11
Q

Goodell’s sign

A

Soft cervix

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12
Q

Hergar sign

A

Soft uterus

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13
Q

Chadwick’s sign

A

Bluish-purple hue in cervix and vaginia

- Hyperemia

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14
Q

Enlargement of the uterus on exam

A

8 weeks bimanual
12 weeks above pubic symphysis
20 to 36 wks can estimate age

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15
Q

Fetal heart tones

A

10 to 12 weeks

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16
Q

Fetal movement

A

18 to 20 weeks

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17
Q

Estimated due date

- Naegele’s rule

A

1st day of LNMP + 1 yr - 3 months + 1 week

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18
Q

Last week abortion is legal

A

22 weeks

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19
Q

Who gets Rhogam?

A

Rh negative moms

- Give at 28 weeks & within 72 hrs of delivery

20
Q

What vital sign will change first in significant blood loss?

A

HR will increase

- Then BP will drop

21
Q

Red cervix produced by mucous-producing endocervical epithelium protruding through the cervical os

A

Ectropion

- No clinical significance

22
Q

Chance of miscarriage with significant bleed in first trimester bleeding

A

25 to 50%

23
Q

EGA
First trimester
Second trimester
Third trimester

A

Crown-rump length
- Change EGA and EDD if > 1 week difference from LMP
Biparietal diameter, head circumference, abdomen circumference, and femur length
- Change dates if > 2 week difference from LMP
Do not use 3rd trimester dates

24
Q

Most common cause of abortion

A

Chromosomal abnormalities

25
Q

Recurrence of abortion

A

87%

26
Q

HEEADSSS

A 
Home
Education/Employment
Eating
Activites
Drugs
Sex
Suicide
Safety
27
Q

Most common cause of first trimester bleeding

A

Spontaneous abortion
Ectopic pregnancy
idiopathic bleeding of viable pregnancy

28
Q

Open cervical os with obvious bleeding

A

Spontaneous abortion

29
Q

Acute distended abdomen

A

Ruptured ectopic

30
Q

When can’t an US be used to evaluate an IUP

A

Quants

31
Q

Caution about using US

A

Do not assume ectopic pregnancy if patient is in stable condition.

  • Best to do quants
  • Then serial US looking for IUP (48 to 72 hrs)
32
Q

Less likely cause of 1st trimester bleeding

A

Gestational trophoblastic disease
- Quants will be > 100,000
Vaginal trauma or cervical pathology
- Chlamydia or gonorrhea

33
Q

Initial pregnancy labs

A 
CBC
Rubella titer
Hep B surface antigen
Blood type
RPR
HIV
34
Q

Where will hCG be highest?

A

In the serum

- Not necessary to do serum hCG

35
Q

First trimester bleeding labs

A

CBC
Wet mount perp
Progesterone
- > 25 good;

36
Q

How high does hCG need to be to see IUP with ultrasound

A

> 5000

37
Q

How do quants present in ectopics or abortions

A

Lower and would not double by 48 hrs

38
Q

Bleeding at

A

Threatened abortion

39
Q

Dilated cervical os

A

Inevitable abortion

40
Q

Some products of conception have been expelled

A

Incomplete abortion

41
Q

Fetal demise w/o cervical dilation or uterine activity

A

Missed abortion

42
Q

Wit intrauterine infection

A

Septic abortion

43
Q

Produce of conception have completely passed

A

Complete abortion

44
Q

Management of an inevitable abortion

A 
Expectant management
- 75% success; can take up to a month
Surgical
- Choice if bleeding is heavy
Medical 
- 95% success
- 800 mcg misoprostol
- 3 to 4 days is typical, may take 2 weeks
45
Q

Should Rhogam be given to an Rh- mom who went through an abortion

A

Yes!

Family Medicine Cases (13 decks)

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