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Sophia's Additions > ER Exam 1 > Flashcards

ER Exam 1 Flashcards

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1
Q

What is a nabothian cyst and its significance in a colposcopy?

A

mucus-filled cyst on the surface of the cervix occurs when columnar epithelium is engulfed and covered by squamous

can look abnormal because always covered with vasculature - can be mistaken for abnormal vessels but it doesn’t suggest CA

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2
Q

When do you do a cervical exisional procedure?

A

If an endocervical curretage/bx is positive

or

unsatisfactory colposcopy performed (can’t see SCJ)

or

substantial difference btw pap and biopsy

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3
Q

When is the estimated date of confinement (delivery)?

A

40 weeks after first day of last menstrual period (FDLMP)

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4
Q

Why do up to 40% of women have some vaginal bleeding during early pregnancy?

A

implantation bleeding

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5
Q

What level of hCG is reached about the time of expected menstruation?

What level of hCG is considered negative?

What level can a pregnancy test detect?

A

menses = 100

negative < 5

preg test = 25

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6
Q

What is the definition of a biochemical pregnancy?

A

presence of hCG 7-10 d after ovulation in a woman w/ regular cycles

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7
Q

When is the risk of fetal loss decreased to 2%?

A

if US reveals a live appropriately grow fetus at 8 weeks w/ + cardiac activity

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8
Q

What is an abortus?

A

fetus lost before 20 weeks

less than 500 g

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9
Q

How many threatened abortions eventually result in loss of pregnancy?

A

25-50%

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10
Q

Is the cervix closed or open in a complete abortion?

A

closed

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11
Q

What is the tx for a septic abortion?

A

ampicillin

gentamycin

clindamycin

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12
Q

How large is a blighted ovum?

A

> 25 mm

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13
Q

What is asherman syndrome?

A

rare acquired syndrome where scarring and adhesions form in the uterus due to trauma

often due to aggressive abortions –> destroys basalis layer

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14
Q

when does cervical incompetence typically cuase loss of pregnancy?

A

second trimester

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15
Q

What is the leading cause of maternal death in the first trimester?

A

ectopic pregnancy

(trophoblasts implant into mucosa of fallopian tube and rapidly erode through to the underlying blood vessels)

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16
Q

What is the difference in ectopic locations in natural conception vs assisted conception?

A

in natural, >95% are tubal

after ART, 92.7% are ampullary

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17
Q

What is the arias-Stella reaction?

A

thickened endometrial stripe seen in an ectopic pregnancy

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18
Q

When do you check hCG after giving a methotrexate dose for ectopic pregnancy?

A

day 4 and 7

will initially increase on day 4

if no decrease on day 7, give another dose

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19
Q

What are relative contraindications of methotrexate use for ectopic pregnancy?

A

gestational sac 3.5 cm or greater

embryonic cardiac motion

hCG levels > 6000

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20
Q

When do most ectopics resolve spontaneously?

A

80% will with hCG levels < 1000

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21
Q

What is a salpingostomy?

A

cut into tube to remove ectopic –> don’t sew it up, let it heal by secondary intention

(vs salpingotomy = sew it up)

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22
Q

What ethnic group has the most RhD negative people?

A

15%

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23
Q

How much fetal blood is needed to cause isoimmunization?

When does this blood transfer typically occur?

A

0.1 ml or less

usually during routine vaginal deliveries

1-2% occur in antipartum period

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24
Q

When do you administer rhoGam?

A

28 weeks

within 72 hrs after delivery of Rh D positive infant

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25
When is the risk of intrauterine transfusion for an anemic baby greater than the risk of delivery?
at 35 weeks --\> consider delivery and transfusing the neonate
26
What are normal cardiac sounds heard during pregnancy?
systolic murmurs exaggerated splitting and S3
27
What is chadwick's sign?
bluish discoloration of cirvix, vagina, and labia from increased blood flow normal during pregnancy
28
What infections are screened for at a first prenatal visit?
rubella (vaccinate postpartum if not immune) syphilis Hep B surface Ag HIV gonorrhea and chlamydia DM Urine culture
29
When is a fetal pole seen?
6 weeks when mean hCG is 5200
30
What measurements determine due date btw 6-11 weeks? What about 12-20 weeks?
6-11 weeks --\> crown rump length can det due date w/in 7 days 12-20 weeks --\> femur length, biparietal diameter, and abdominal circumference can est w/in 10 days
31
How is fetal demise diagnosed in first trimester (based on CRL)?
if CRL \> 5 mm w/ absence of fetal cardiac activity
32
What is the incidence for trisomy in women under 35, 35-39, 40-45, and \>45?
\< 35 --\> 1 in 800 35-39 --\> 1 in 300 40-45 --\> 1 in 80 \>45 --\> 1 in 35
33
What are aminopterin and methotrexate?
both folic acid antagonists (chemo drugs) exposure before 40 days is lethal later exposure causes other se
34
How does valproid acid affect a fetus?
(anticonvulsant med) 1-2% risk of open spina bifida some assoc w/ heart, skeletal, and craniofacial defects
35
What is carbamazepine and its assoc w/ pregnancy?
anticonvulsant increased risk for spina bifida and other minor defects
36
What defects can retinoids cause?
CNS cardiovascular craniofacial (microcephaly w/ severe ear abn, microtia and cleft palate)
37
How often should moms have prenatal visits?
every 4 weeks until 28 weeks every 2 weeks from 28-36 weeks weekly until delivery
38
What is the weight gain recommendation for moms w/ BMI \<19? 19-25? \>25?
\<19 = 28-40 19-25 = 25-35 \> 25 = 15-25
39
What is the technical definition of labor contractions?
at least every 5 minutes last 30-60 seconds
40
What are the shapes of the anterior and posterior fontanelles?
anterior = diamond shaped, larger posterior = Y or triangle shaped
41
What is the smallest and most common head diameter?
suboccipitobregmatic (9.5 cm) when head is well flexed and OA
42
When does the occipitofrontal diameter pass through the pelvis? How wide is it?
when the head is deflexed and is in the occiput posterior position 11 cm
43
When does the supraoccipitomental diameter present and what is its measurement?
brow presentation(from chin to occiput) largest = 13.5 cm
44
When does the submentobregmatic diameter present and what is its measurement?
face presentation 9.5 cm
45
What characterizes the gynecoid pelvis?
classic female type round at inlet wide transverse diameter and wide suprapubic arch good prognosis for delivery
46
What characterizes the android pelvis?
classic male type widest transverse diameter closer to the sacrum prominent ischial spines narrow pubic arch fetal head is forced to OP --\> poor prognosis
47
What characterizes the anthropoid pelvis?
like an ape's much larger AP than transverse diameter narrow pubic arch baby engages only in AP diameter, usually OP good prognosis
48
What characterizes the platypelloid pelvis?
flattened gynecoid (3% of females) short AP and wide transverse \*fetal head has to engage in transverse diameter --\> poor prognosis
49
What are the two pelvis shapes with a poor prognosis?
android platypelloid
50
What are the diagonal and obstetric conjugate measurements?
diagonal: inf portion of pubic symphysis to sacral promontory; if \> 11.5 cm the AP diameter is adequate obstetric: estimated by subtracting 2 cm from the diagonal conjugate = narrowest fixed distance thru which the fetal head must pass
51
What is the pelvic outlet measurement?
measure ischial tuberosities and pubic arch tuberosities at least 8.5 cm is good infrapubic angle \> 90 is good
52
What are the cardinal movements of labor?
Every Decent Family In England Eats Eggs Engagement Descent Flexion Internal rotation Extension External rotation Expulsion
53
What maneuver is often performed to deliver a head in a normal delivery?
modified Ritgen maneuver extend the head by pulling up on chin counterpressure on occiput
54
What spinal levels innervate the uterus? pelvic floor, vagina, and perineum?
Uterus = T10-L1 lower down = S2-S4 (pudendal nerve)
55
How can pitocin affect fetal heart rate?
can cause bradycardia or tachycardia if too much
56
How do chemoreceptors and baroreceptors affect fetal HR respectively?
chemo --\> produce tachycardia in response to hypoxia baro --\> decrease HR via vagus n
57
What is a "shoulder" in a fetal HR diagram?
when umbilical cord is only slightly compressed, umbilical V is obstructed initial response is a slight increase to compensate for lack of blood return slight increase --\> followed by major drop = shoulder
58
When do you see a sinusoidal pattern on FHR monitor?
fetal anemia
59
What is class B diabetes?
onset at age 20 or older w/ duration \< 10 yrs
60
What is class c diabetes?
onset at age 10-19 or duration of 10-19 yrs
61
What is class D diabetes?
onset before age 10 or duration greater than 20 yrs
62
What are class F, R, RF, H, and T diabetes?
F: diabetic nephropathy R: retinopathy RF: retinopathy and nephropathy H: ischemic heart dz T: prior kidney Transplant
63
How often should to evaluate a fetus in a mom w/ preexisting DM?
look for malformations at 11-13 weeks quad screen 16-21 weeks fetal growth US every 2-4 weeks fetal testing (NST/BPP) every week starting at 32 weeks
64
How do insulin requirements for the mother change after delivery?
drop significantly after delivery of the placenta insulin-dependent pts typically require 2/3 of pregnancy dose after
65
What thyroid meds do you use for hyperthyroidism in pregnancy?
1st trimester - PTU 2nd and 3rd - methimazole
66
How should post-renal transplant pts manage pregnancy?
not recommended bc may lose graft fxn or experience rejection best candidates are 1-2 yrs post-transplant w/ stable Cr and proteinuria w/out severe htn
67
What can maternal steroid tx do to a fetus?
induce adrenal and hepatic insufficiency
68
What complications can maternal pyelonephritis cause?
increased uterine activity and preterm labor ARDS
69
What are initial txs for N/V of pregnancy?
Vit B6 doxylamine promethazine
70
Who more often gets hyperemesis gravidarum?
first pregnancies multiple pregnancies trophoblastic dz
71
What GI dz may improve in pregnancy?
peptic ulcer
72
What GI dz can increase risk of miscarriage?
IBD | (if active at time of conception)
73
What is a potential cause of acute fatty liver dz of pregnancy?
LCHAD deficiency
74
When is the risk of venous thrombosis highest for a mother?
first 5 weeks postpartum
75
What heart sound can you hear in a maternal PE?
accentuated pulmonic valve second heart sound
76
What are the treatments for asthma in pregnancy based on severity?
mild intermittent = SABA mild persistent = low dose inhaled steroid mod persistent = daily ICS + LABA severe persistent = add systemic steroids
77
How is MS affected by pregnancy?
usually experience fewer and less severe episodes may exacerbate postpartum incr risk of lower birth weight baby and c-section
78
What supplement is increased in women on anti-epileptic drugs in pregnancy?
folic acid need 1 mg to 4 mg
79
What is considered mild chronic htn in pregnancy? how to manage?
BP less than 160/110 baby aspirin at 12 weeks meds if reach threshold prenatal visits every 2-4 weeks and then weekly at 34 weeks
80
What htn meds must you never use in pregnancy?!
ACE Inhibitors ARBs
81
When should you deliver a baby in a mom w/ severe chronic htn?
after 38 weeks
82
What is significant about herpes presentation (males vs females)?
ALL Males are symptomatic but females are more susceptible to getting it
83
where does herpes stay latent?
lumbosacral ganglia
84
What ages are more likely to get preeclampsia?
\<20 and \>35
85
What happens to the heart and lungs in preeclampsia?
heart: edema, absence of normal intravascular vol expansion bc of 3rd spacing, reduction in circulating blood volume lungs: noncardiogenic pulmonary edema
86
What labs are increased in preeclampsia?
hematocrit (bc third spacing) LDH AST, ALT uric acid
87
How many units of blood do you type and cross match for transfusion?
4 units
88
What is the mean gestational age for bleeding in placenta previa?
30 weeks
89
Most common risk factor for placental abruption?
maternal HTN
90
What is the most common cause of maternal DIC in pregnancy?
placental abruption
91

Sophia's Additions (4 decks)

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