Flashcards in CNM Varney's Review Book Part A Deck (117):
1
Cycle history last 12 months: shortest 26 days, longest 30 days. According to calendar method, what is the fertile period for this person?
Days 6-20 of her cycle.
Subtract 20 days from the shortest cycle,
subtract 10 days from longest cycle.
2
Who CANNOT use rhythm/calendar method?
menstrual cycle <25 days
irregular cycles
cycles that vary in length by 8 days or more
postpartum women
lactating women
perimenopausal women
3
In order to avoid pregnancy, the woman using the cervical mucus method of family planning should avoid intercourse for a minimum of how many days following the peak day of her cyce?
3 days
4
What is nonoxynol-9 and how is it beneficial?
Is the active ingredient in most spermicidal preparations and is available without rx.
In the laboratory, is lethal to agents that cause GC, CT. trich, syphilis, and AIDS
Lowers the chance of becoming infected with a bacterial STI/STD
5
Timing of spermicide use
If you do not have sex within 1 hour of inserting the spermicide, need to reapply it
6
What lubricants are safe to use with polyurethane condoms?
Safe to use with any lubricant, including oil-based
7
What is the minimum amount of time after the last act of intercourse that a woman must leave a diaphragm in position in order to maximize contraceptive effectiveness?
6 hours
8
If a diaphragm is properly fit and cared for, how long is it good for?
2 years
9
Diaphragm facts
With typical use, failure rate ~18%
Frequency of intercourse significantly affects effectiveness among women who are consistent diaphragm users.
Use of spermicide significantly increases effectiveness of diaphragm.
10
32 yr old G2P1 successfully used a coil-spring diaphragm prior to birth of her child. Wishes to resume use. PE: uterus retroverted, arch behind symphysis pubis average, first-degree cystocele. Which method birth control to use?
A method other than a diaphragm
C/I in severe cystocele
severe uterine prolapse
severe anteversion or retroversion of uters
fistulas
known allergy to the rubber of the diaphragm or to the accompanying spermicidal preparation
11
Cervical cap/spermicide in relation to inertcourse
with the cervical cap, additional spermicide is not needed for repeated acts of intercourse
12
Absolute contraindications for insertion of IUD
recurrent PID
pregnancy
cervical or uterine carcinoma
unexplained or abnormal uterine bleeding
hx or presence of valvular heart disease
Wilson's dz or allergy to copper
uterine sound measurement outside 6-9 cm
genital actinomycosis
cervical mycosis
...
13
prerequisites to insertion of IUD
informed consent form
pregnancy test
GC/CT cultures
14
woman with IUD and +Uhcg is at increased risk for
sepsis
placenta previa
ectopic pregnancy
15
Which progestin is used as the index progestin in order to compare the biological potency of the various progestins used in oral conntraceptives?
Norethindrone
16
Why should you delay the initiation of COCP in pp woman who is not breastfeeding?
because earlier initiation of COCP can increase risk of thromboembolism
17
How soon after a first-term abortion can a woman safely start taking COCP?
immediately
18
what is the main mechanism of action of COCP to prevent pregnancy?
suppression of ovulation by suppression of FSH and LH
19
which sx should be reported immediately by a woman who is taking OCP?
hemoptysis (expectoration of blood-tinged mucous)
20
To ensure maximal contraceptive effectiveness and minimize chances of breakthrough bleeding, when in cycle should OCP be started?
within the first five days of the cycle
21
for at least how long shoudl a woman use back-up contraception if she has issed two of her COCPs?
7 days
22
Woman started COCP 2 months ago, is having breakthrough bleeding with each cycle. What do you do?
recommend that she use a back-up method until the bleeding has stopped, and reassure her that in most cases btb will remit by her fourth pill cycle
23
spotting and btb in early half of cycle (days 1-9), it is most likely due to ...
estrogen deficiency
24
what contraceptives can be used as emergency contraception?
COCP, progestin-only pills, IUDs
25
what is the maximum amount of time after an unprotected act of intercourse that the Yupze regimen of oral contraceptive pills is considred to be effecdtive as a method of EC?
72 hours
26
maximum amount of time after unprotected intercourse that a copper IUD is considreed to be effective as method of EC?
5-7 days
27
What is Depo-Provera's main mechanism of action?
suppression of ovulation by suppression of FSH and LH
28
most common side effect of Depo-Provera
menstrual changes
29
is depo protective against PID?
yes
30
how soon after birth can a woman who is breastfeeding initiate Depo?
6 weeks pp
31
When does Depo become effective if received within 5 days of beginning of her menstruation?
immediately
32
How soon after insertion does Norplant become effective in preventing pregnancy?
24-48 hours
33
Most commonly cited reason for discontinuing IUD
menstrual changes
34
Most popular method of birth control in US
sterilization
35
35 yr with G4P3013, smokes 1/2 pack/day, desires highly effective birth control for 3 months until husband our of military. does not desire any more children
depo
36
25 yr old G2P2 pp visit, plans to bf 6+ months. Has used COCs and condoms plus spermicide but found it irritating and caused yeast infections. Best bc method?
IUD
37
27 yr old G3P1111 has 11 mo child, wishes another in 1-2 yrs, hx of DVT during first pregnancy. Best bc method?
Diaphragm
38
amenorrhea workup
results: UHCG: neg
TSH: wnl
Prolactin: wnl
progestational challenge test: positive withdrawal bleed followin g10 days of 10 mg of provera
What is the dx?
chronic anovulation
39
You would expect levels of all the following to be elevated during the ovulatory phase of the menstrual cycle EXCEPT:
FSH, LH, estrogen, progesterone
progesterone
40
What is the predominant hormone of the luteal phase of the menstrual cycle?
progesterone
41
relationship of HPV and cervical cancer
it is believed that HPV alone does not result in neoplastic changes and that cofactors to HPV infection are necessary for the development of cervical cancer.
42
What is the rx of choice for tx of BV in pregnancy?
metronidazole PO
43
adverse pregnancy outcomes associated with trich
PROM, PTB, LBW
44
chlamydia infection increases preg risk for
PROM, infertility, ectopic pregnancy
45
approx what % of women with untreated syphilis infxn experirence fetal or neonatal loss?
40%
46
what test is dx for syphilis?
postiive darkfield microscopic examinatino of exudate from chancre
47
appropriate agents in emergency tx of anaphylactic shock
corticosteroids
epinephrine
oxygen
48
lower abdominal pain, positive abdominal guarding, +CMT, +bilateral adnexal tenderness, +mucopurulent d/c, increased leukocytes on wet mount
PID
49
average age of menopause in women in US
51
50
what is the characteristic hormonal change of perimneopause (6-7 years before menopause)?
increased FSH levels
51
physiological changes seen in menopausal women r/t decreased estrogen
thinning of vaginal epithelium
atrophic endometrium
loss of bone density
52
benign skin changes
seborrheic keratosis
cherry angioma
fibroepithelioma
53
the most common symptom associated with menopause
hot flashes
54
connection between EPT and breast cancer
Women who take EPT daily have increased risk of breast cancer due to the progestin
Risk decreases to normal level after being off HRT for 3 years
Lean women or those with dense breasts may be at increased risk
55
EPT/HRT is prescribed for which women?
women who still have a uterus;
the progesterone protects the lining of the uterus
56
estrogen is prescribed alone for which women
those who have had a hysterectomy
57
relation of EPT/HRT and endometrial cancer
it is not increased in women with a uterus bc it is EPT, not ET
58
connection bt ET and BRCA
women without a uterus who were taking ET have slightly decreased risk for breast cancer, according to WHI study. British Million women study found 1-3% increase in risk
59
HRT and ovarian cancer
EPT not a link for sure
ET - risk associated with duration of use; with 5+ years of use, increased risk up to 50%
60
Estrogen/Progesterone Therapy/HRT and colorectal cancer
during tx, EPT seemed to show 40% decrease in risk, which was back to normal when checked 2 yrs after tx stopped
ET seemed to show no difference in risk
61
leading cause of death in postmenopausal women in US
cardiovascular dz
62
estrogen therapy decreases the risk of fractures by how much?
50% (but this is not a first-line tx for osteoporosis)
63
what therapeutic measure has not been demonstrated to decrease the risk of bone fracture in postmenopausal women?
addition of vitamin D to the diet
(ok, this is tricksy. USPS says don't supplement with calcium/D with the intent to prevent fractures. National Osteoporosis Foundation says aim to get the recommended amounts through food, and supplement the rest.)
64
what therapeutic measures have been demonstrated to decrease the risk of bone fracture in postmenopausal women?
addition of calcium to the diet
weight-bearing exercises
estrogen replacement therapy (although again, this is not a first-line tx anymore with the intent of bone density improvement)
(ok, this is tricksy. USPS says don't supplement with calcium/D with the intent to prevent fractures. National Osteoporosis Foundation says aim to get the recommended amounts through food, and supplement the rest.)
65
What is the minimum daily dose of conjugated estrogen that is effective in maintaining bone mass?
0.625 mg
66
what procedure would be indicated:
60 yo woman who has been on continuous HRT Prempro for 2 years and is experiencing uterine bleeding
endometrial biopsy
67
what is the standard dose for continuous HRT?
0.625 mg conjugated estrogens (Premarin) daily
2.5 mg medroxyprogesterone (Provera) daily
68
menorrhagia
abnormally heavy and prolonged menstrual period at regular intervals (>80 ml/>7 days)
also called hypermenorrhea
69
causes of menorrhagia
abnormal clotting
disruption of normal hormonal regulation of periods
disorders of endometrial lining of the uterus
70
dysmenorrhea
abnormally painful periods
71
length of normal menstrual cycle
25-35 days
72
average blood flow in normal cycle
25-80 ml
73
menometrorrhagia
heavy bleeding which occurs frequently at irregular intervals
74
a regular tampon fully soaked will hold about how much blood?
about 5 ml
75
endometriosis r/t pain & blood loss
is a cause of pain (dysmenorrhea) but not usually alteration in menstrual blood loss
76
polymenorrhea
epimenorrhea
short cycles <21 days with normal menses
always anovulatory due to hormonal disorders
77
epimenorrhagia
short cycle with excessive bleeding
due to ovarian dysfunction
78
excessive menses and long intervals
anovular ovarian disorder d/t prolonged estrogen production
May occur after extended COC use
79
metrorrhagia
irregular or frequent flow, non-cyclic
80
dysfunctional uterine bleeding
abnormal endometrial bleeding of hormonal cause and related to anovulation
81
Which is a CNS depressant:
marijuana, alcohol, cocaine, amphetamines
alcohol
82
what is the approximate risk of perinatal HIV transmission without antiretroviral tx?
25%
83
During initial PE on woman who has just tested positive for HIV, a Mantoux test was performed. 48 hours later, woman returns to have Mantous test read. There is not an induration. What is the best interpretation of this?
the negative test could be due to anergy, therefore an anergy panel is indicated to verify the negative result.
Anergy is the absence of PPD reactivity in persons infected with TB. It can occur in immunocompromised persons, newly infected, or with miliary TB.
84
reactions over what size are considered positive for PPD testing in non-immunocompromised patients?
10 mm
85
which disease needs to be managed and tx differently in a woman with HIV infection?
candidiasis, UTI, GC/CT, syphilis
syphilis
86
what is the prophylactic tx of choice against pneumocystitis carinii pneumonia (PCP)?
Bactrim (TMP-SMX)
87
How soon after birth should an infant born to an HIV-infected woman start receiving zidovudine (ZDV)?
within 12 hours
88
what test should be administered to a newborn of an HIV+ mother to determine the baby's HIV status?
viral culture and polymerase chain reaction teachnique
89
If PCR and viral culture are positive for newborn, what is the best interpretation and mgmt of these results?
the positive test results indicate a high chance that the infant is infected, but to confirm the dx, repeat testing using the same test is indicated.
90
What is the length, from the day of fertilization, of human gestation?
266 days
(280 from LMP)
91
what hormone is responsible for maintaining the corpus luteum of pregnancy?
hCG
92
if conception is normal, hCG should be produced how many days after conception (by blastocyst) to allow detection on very sensitive tests?
by 6 days after conception
93
By day 9 the syncytiotrophoblast is the primary source of what?
hCG
94
From what point on do hCG levels double?
from day 9
95
when do maternal serum levels of hCG peak?
around the 10th week
96
when does hCG reach its low in pregnancy?
around 18 weeks
then stays there through rest of pregnancy
97
What does hCG do for the corpus lutem?
signals the CL to continue progesterone production, keeping the endometrium thick and full of blood vessels for zygote
98
what anatomical/physiological change of pregnancy is thought to be caused by estrogen?
hypertrophy of the uterine wall
99
in terms of the maternal psychological processes of pregnancy, the first trimester is often described as...
period of adjustment
100
the fusion of the pronuclei of the sperm and ovum that happens with fertilization produces the...
zygote
101
when do each of these apply?
zygote, morula, blastocyst, embryo, fetus
zygote forms at fertilization, then becomes
morula as cell division takes place. Becomes a
blastocyst on day 5.
Embryo is until about 10 wks after LMP
Fetus from 10 wks gestation until birth
102
implantation begins approximately how soon after fertilization?
about 6 days
103
embryonic period in days is...
from the end of implantation until day 48 of fetal development (~7 weeks, so 8 weeks since conception, 10 wks since LMP)
104
eyelids of a fetus remain fused through what gestational age by LMP?
25th week
105
circulation in the first two weeks of gestation
primitive placental circulation is established
106
what is the decidua
uterine endometrium during pregnancy
107
teratogenic effects of tetracycline
discoloration of infant's baby teeth
108
presumptive signs of pregnancy
maternal physiological changes that the woman experiences and that in most cases indicate to her that she is pregnant:
abrupt cessation of menstruation
n/v
tingling, tenseness, nodularity, enlargement of breasts, enlargement of the nipples
increased frequency of urination
fatigue
color changes of breasts
appearance of Montgomery's tubercles or follicles
continued elevation of basal body temp without infection
expression of colostrum from nipples
excessive salivation
Chadwick's sign
quickening
skin pigmentation/conditions: chloasma, striae, linea nigra, vascular spiders, palmar erythema
109
probably signs of pregnancy
maternal phyiological and anatomical changes other than presumptive sins that are detected upon examination and documented by examiner:
enlargement of abdomen
palpation of fetal outline
ballottement
fetal movement (may be positive)
enlargement of uterus
+Hegar's sign
+Goodell's sign (signif softening of vaginal portion of uterus)
Piskacek's sign (palpable lateral bulge where tube meets uterus: 7-8 wks gest)
palpation of BH contractions
positive pregnancy test
110
positive signs of pregnancy
directly attributable to the fetus:
fetal movement
fetal heart tones
u/s evidence of pregnancy
111
what is Chadwick's sign due to?
increased hemoglobin in maternal circulation
112
Woman is currently pregnant with four previous pregnancies: one 1st trimester EAB, 1 SAB, 1 premature live birth, 1 full-term delivery of twins. Twins alive, preemie died. G?P?
G5P2122
113
woman at 13 wks GA coming in for first appointment, which labs to order?
blood type, Hep B surface antigen test, serology test for syphilis
114
CAuses of nonpathological urinary frequency during pregnancy
decreased room for distention of the bladder
anteflexion of the enlarging uterus
pressure of fetal presenting part
115
There is positive evidence of human fetal risk but benefits from use in pregnant women may be acceptable despite the risk.
Category D
116
What is acceptable tx for women exposed to varicella in pregnancy
vaceination with varicella immune globulin can be considered
117