Beckman MF Phys

Question 1

Earliest changes in maternal phys

Answer 1

Cardiovascular

Question 2

Heart is displaced during pregnancy:

Answer 2

Up and left. From diaphragmatic elevation by displacement of abdominal viscera by enlarging uterus

Question 3

Primary CV change

Answer 3

Increased CO by 30-50%

Question 4

Why does systemic vascular resistance decrease

Answer 4

Smooth muscle relaxing effect of progesterone, increased vasodilatory substances, AV shunting to the uteroplacental circ

Question 5

_____% of the CO goes through uterus at term, increasing the risk of

Answer 5

20%; post partum hemorrhage

Question 6

How much does CO increase during labor

Answer 6

40%

Question 7

Why does CO increase significantly after delivery?

Answer 7

Venous return is no longer blocked by the gravid uterus impinging on the vena cava

Question 8

Increased S2 split with inspiration, distended neck veins, and low grade systolic ejection murmurs characterize:

Answer 8

Normal CV physical exam findings during pregnancy (note: diastolic murmurs are NOT normal)

Question 9

most notable changes to coagulation system

Answer 9

increased fibrinogen conc.

Question 10

Primary anatomic change of renal system

Answer 10

enlargement and dilation of the kidneys and urinary collecting system

Question 11

RPF changes and RAAS

Answer 11

at term, can be up to 75% greater than normal. RAAS system also increases (substrates)

Question 12

changes in lung function

Answer 12

20% decrease in RV and FRC, 5% decrease in Total Lung Volume

40% increase in TV and minute ventilation = Respiratory alkalosis (but also inc. inspiratory capacity)

(maternal respiratory rate will be unchanged)

Question 13

acid-base changes due to increase in minute ventilation

Answer 13

Progesterone =
increased central chemo-R sensitivity to CO2 = increased ventilation and decreased arterial pCO2 = RESPIRATORY ALKALOSIS =
compensation by increased renal excretion of bicarb

Question 14

changes to maternal hematoligc system (anatomic)

Answer 14

increase in plasma volume, red cell volume, and coagulation factors

Question 15

Does supplemental iron use prevent IDA in mother or fetus?

Answer 15

Prevent in the mother. (Fe is actively transported to the fetus, so fetal hemoglobin (Hgb) are maintained regardless of maternal stores)

Question 16

Pregnant women should receive how much iron supplementation?

Answer 16

60 mg daily (in a women who is not naturally anemic). Recommend 27mg of this comes from iron supplement (present in most prenatal vitamins)

Question 17

Changes in clotting factors

Answer 17

Fibrinogen (factor 1) increases as well as VII, VIII, IX, X

Prothrombin (II) and V and XII do not change

Protein C and S (inhibitors of coag) decrease

Question 18

functional pulm changes

Answer 18

1. increase in total oxygen carrying capacity
2. increased Hg affinity for oxygen in maternal lungs
3. increased CO2 gradient btwn fetus and mother in the placenta

Question 19

risk for thromboembolism in pregnancy

Answer 19

pregnancy = hypercoagulable state = 2x risk of thromboembolism

Question 20

change to creatinine and BUN during normal pregnancy

Answer 20

decrease. Note that creatinine clearance actually increases

Question 21

Imagining of renal system during preg would show:

Answer 21

Normal dilation of the collection system resembling hydronephrosis

Question 22

which of the following changes in size: stomach, intestines, liver, biliary tract, portal veins

Answer 22

portal veins (increased blood flow)

Question 23

2 mot notable GI pregnancy-related physical findings

Answer 23

Gingival disease and hemorrhoids

Question 24

hCG effect on T4

Answer 24

in 1st trimester, hCG’s thyrotropin-like activity produces transient rise in free t4. placental hCG decreases after 1st tri = normalization of free t4

Question 25

estrogen effect on T4

Answer 25

Estrogen induces Thyroxine-binding globulin = increase in total t4 and t3. Free levels are unchanged

Question 26

estrogen effect on adrenal proudction

Answer 26

doesn’t change size of gland, but increase hepatic cortisol-binding globulin = increasedcortisol. Aldosterone synthesis increases. Deoxycorticosterone increases.

Question 27

causes of pulm edema in preg

Answer 27

tocolytic use
fluid overload
preeclampsia
cardiac disease

Question 28

Is the renal pelvis/ureter dilation equal on each side?

Answer 28

No, R>L due to cushioning from sigmoid colon to left ureter and greater compression by uterus on right side

Question 29

How much weight are mothers recommended to gain (underwt; normal;overweight;obese)?

Answer 29

BMI: 
<18.5 = 28-40lbs
18.5-25= 25-30lbs
25-30= 15-25lbs
>30= 11-20lbs

so even if morbidly obese, still want them to gain some weight

Question 30

most common form of inherited mental retardation

Answer 30

Fragile X