Clinical Medicine - TW: intimate partner violence, sexual violence Flashcards Preview

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Flashcards in Clinical Medicine - TW: intimate partner violence, sexual violence Deck (17)
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1

What is the differential if the fundal height is lower than expected?

Height (cm)

  • Wrong dates
  • Intrauterine growth restriction
  • Oligohydraminos

 

2

Which patients should be screened for intimate partner violence?

ALL patients

  • Every new patient
  • Any patient with signs of trauma
  • Any patient with conditions associated with IPV
    • Extensive, can affect many organ systems: GI, Repro, Psych, behaviorla signs

 

 

3

G_P_ _ _ _

What does each blank stand for?

GaPb c d e

  • a = Number of pregnancies
  • b = Number of term births
  • c = Number of preterm births
  • d = Number of abortions (spontaneous or otherwise)
  • e = Number of living children

 

4

When should intimate partner violence be documented in a patient's chart?

ONLY if the patient says it's okay

 

5

What is the differential if the fundal height is higher than expected?

Height (cm) > (#weeks gestation = 3) 

  • Wrong dates
  • Multiples (twins, triplets)
  • Fibroids
  • Macrosomia
  • Hydraminos

 

6

List and describe the 3 components of the cycle of abuse

  • Intimidation
    • Threats, abuse (physical, emotional, sexual)
  • Violence escalation
    • This is often when pts will present to the ER or engage with healthcare providers
  • Honeymoon phase
    • Abuser shows remorse
    • Vicitm may blame themselves

 

7

After 20 weeks gestation, blood pressures above ____ would raise concern for pre-eclampsia or gestational HTN?

140/90

8

How do you calculate the estimated date of delivery (EDD) for a pregnant patient?

From the first day of the last menstrual period (LMP)

EDD = LMP + one year - 3 months + 7 days

9

When is it mandatory to report intimate partner violence?

When a patient presents with injuries from a firearm

If children are involved

 

 

Otherwise, not necessary to document/report - ALWAYS ask pt before documenting in their chart

10

When during gestation does fetal movement begin?

When should there be a expected pattern?

Begins at 20 weeks

At 26 weeks, there is an expected pattern; deviations need to be evaluated for fetal well-being

11

What is considered normal for fundal height?

At 20 weeks: 

Beyond:

  • At 20 weeks: 
    • At umbilicus
       
  • > 20 weeks: 
    • #cm above pubic symphysis should be equal to weeks of gestation +/-3
    • Ex: 26 weeks => fundal height should be 23-29 cm above the pubic symphysis

 

12

What tissue does Non-invasive prenatal screening (NIPS) look at to analyze the fetal genome?

Cell free DNA

 

Based on the assumption that the total number of fragments of any one chromosome is proportional to the size of the chromosome

13

List 4 factors that will affect the fetal fraction of cell free DNA in maternal blood

  • Gestational age
    • Slightly increases 10-21 weeks
    • Significant increase >21 weeks
  • Maternal BMI
    • Higher BMI = lower Fetal fraction
  • Small placenta
  • Aneuploidy
    • Increased in Trisomy 21, decreased in Trisomy 18 and 13
    • This is what we're actually looking for

 

Normally, fetal cell-free DNA is 10% of the total circulating cell-free DNA

 

14

What is the earliest gestational age at which NIPS can be performed?

Any time after 10 weeks

15

List 4 limitations of NIPS

  • False positives
  • Failed results
  • Re-draw also has potential to fail
    • Delayed results delay time-sensitive decision making
  • Results take 1-2 weeks
    • Especially important if close to 24 weeks 

 

16

What is the appropriate next test if NIPS is positive for a fetal aneuploidy?

Diagnostic testing

(Invasive method, ex: amniocentesis)

17

Who should be offered prenatal genetic screening?

All pregnant patients

Offer either standard screening of cell free DNA