Blueprints 1, 3, 12, 22, 28

Question 1

when will a urine preg test be positive

Answer 1

at the time of a missed period

Question 2

from what organ do they hormones of pregnancy that affect every organ come from

Answer 2

the placenta

Question 3

what CV changes occur in pregnancy?

Answer 3

increase CO, 
decrease SVR (progesterone-> SM relaxation), 
decrease BP ( but return to normal by 24 weeks)

Question 4

3 common screening tests for fetal abnormalities

Answer 4

MS-AFP (maternal serum AFP) : 15-18 weeks
and triple screen( AFP, hCG, and estriol)
quad: add on inhibin

Question 5

3 diagnostic tests for screening abnormalities

Answer 5

amniocentesis, CVS, ultrasound

Question 6

tests for fetal status antepartum

Answer 6

BPP= U/S and NST (fetal nonstress test- activity over 30 minutes- good if 2 accelerations 15 beats above for 15 sec). BPP>10 is reassuring.
OCT (oxytocin challenge test- goal is 3 contractions every 10 minutes)

Question 7

how early can you see gestational sac on transvag US

Answer 7

5 weeks, fetal heart at 6 weeks

Question 8

chadwick sign

Answer 8

blueish color or vagina and cervix during prgenancy

Question 9

NAAGELS rule for EDD. US estimation?

Answer 9

subtract 3 months from LMP and add 7 days. U/S should be within 1 weeks first TM, 2 weeks second TM, 3 weeks third trimester

Question 10

lung changes in pregnancy

Answer 10

TLC decreased 5% but tidal volume increases 30-40% which causes decrease in expiratory respiratory reserve 20%

Question 11

paco2 in pregnancy

Answer 11

decreases to 30 mmHg from 40 mmHg likely caused by progesterone. gradient increases oxygen delivery and CO2 removal from fetus

Question 12

kidney in pregnancy

Answer 12

GFR increases 50%, BUN and creatinine decrease by 25%. even though increased aldo and increased NA reabsorption, plasma levels of sodium stay the same

Question 13

heme in preg

Answer 13

dilutional anemia, incresed WBC, hypercoagulable

Question 14

hPL

Answer 14

produced in placenta for ensuring constant nutrient supply to fetus-> lipolysis with increase in circulating FA. HPL is insulin antagonist=diabetogenic.

Question 15

preg and thyroid

Answer 15

increased TBG so slight increase in total T3 and T4 but same level of free T3/4 and stimulates TSH a little. overall euthyroid.

Question 16

third trimester screening tests

Answer 16

hematocrit (iron supplement), RPR/VDRL, glucose loading test

Question 17

when do most fetal congenital abnormalities occur

Answer 17

embryogenesis

Question 18

what chromosomes are most common inherited aneuoploidies

Answer 18

of sex chromosomes- usually less severe

Question 19

what types of cells do you need for karyotype and DNA tests

Answer 19

fetal or trophoblastic cells

Question 20

what can you use to screen for downs

Answer 20

quad screen- AFP, bHCG, estriol, inhibit- sn=80% in second trimester

Question 21

when do neural tube defects occur

Answer 21

defective closure of neural tube at week 4 of development (6 weeks by gestational aging)

Question 22

nuchal transluscency

Answer 22

a way to test for downs and chromosomal abnormalities in the first trimester

Question 23

dangerous HPV strains for cancer

Answer 23

16, 18, 31, 45

Question 24

what PAP results should get a colposcopy?

Answer 24

ASC-H (atypical squamous cells), LSIL, and HSIL

Question 25

someone gets a pap of CINI...next steps?

Answer 25

repeat pap smears every 6 months x2 OR HPV testing in 12 months

Question 26

what to do with adult women result of CINII or III

Answer 26

treatment with surgical excision, typically with loop/LEEP/Lletz

Question 27

tx of stage 0, 1a-1, 1a-2

Answer 27

0 and 1a-1: cone biopsy, ia-2: radical hysterectomy

Question 28

5 year survival for cervical cancer for stage I, stage IV

Answer 28

stage 1: 85-90%, stage 2: 15-20%

Question 29

how to make the diagnosis of PMS and PMDD

Answer 29

sxs must be in the second half of the menstrual cycle with at least a 7 day sx free interval in the first half of the menstrual cycle. sxs must occur in at least two cycles

Question 30

menorrhagia, metrorrhagia, menometrorrhagia

Answer 30

menorhhagia: regular bleeding that is heavy or prolonged. metrorrhagia: bleeding between periods. menometrorrhagia: heavy or prolonged irregular bleeding.

Question 31

causes of menometrorrhagia

Answer 31

polyps, fibroids, adenymyosis, cancer, pregnancy complications

Question 32

most common causes of oligomenorrhea (35 days apart)

Answer 32

PCOS, chronic ovulation, pregnancy

Question 33

acute hemorrhage- drugs

Answer 33

IV estrogen and high dose oral estrogen. not responsive to medicine-> D&C, endometrial ablation, hysterectomy

Question 34

most common cause of postmenopausal bleeding

Answer 34

atrophy. other causes= cancer, endometrial polyps, exogenous hormonal stimulation. rule out cancer with CDC, TSH, PRL, FSH, endometrial biopsy, pelvic U/S

Question 35

two central issues in immediate postpartum period

Answer 35

pain management and wound care

Question 36

which birth control can you use postpartum

Answer 36

depo-provera, norplant, poregesterone only minipill- dont decrease milk production

Question 37

endomyometritis

Answer 37

dx is clinical: fever, elevated WBC, uterine tenderness. tx: broad sprectum antibx and D&C for retained POCs

Question 38

peak of bHCG and when

Answer 38

10 weeks= 100,000

Question 39

how early can you see pregnancy on US. bhcg?

Answer 39

5 weeks on TVUS. should have bchg of 1500-2000.heart motion at 6 weeks.

Question 40

embryo vs fetus

Answer 40

embryo= 8 weeks. fetus>8 weeks

Question 41

at what age can you auscultate fetal heart

Answer 41

20 weeks by nonelectric fetoscope and 10 weeks by doppler US

Question 42

cardiac output in pregnancy

Answer 42

increases by 30-50%. mostly in first TM max in 20-24 weeks gestation

Question 43

what causes fall in SVR in preg

Answer 43

most likely increase in progesterone

Question 44

hyperemesis gravidarum definition

Answer 44

morning sickness with wt loss >5% of pre pregnancy wt AND ketosis