Exam 3 Flashcards

Question

What are the s/s, treatment, and perinatal complications of HSV-2?

Answer 1

Signs and symptoms Vesicles: blister-like lesions on vulva, vagina and perineal areas Dysuria Fever Headache Muscle aches Treatment: no cure, acyclovir to suppress symptoms Perinatal complications: 1st outbreak is most severe and if happens in 1st trimester there are higher rates of miscarriage

Answer 2

Signs and symptoms Primary: chancre on area bacteria entered body Secondary: rash, sore throat, swollen lymph nodes, flu-like symptoms Latent: No symptoms, No longer contagious Tertiary: damage to internal organs, damage to musculoskeletal, blindness No longer reversible Treatment: penicillin Perinatal complications: can cross placenta and cause congenital syphilis

Answer 3

Signs and symptoms Wart-like lesions that are Clusters, raised or flat, small or large on vulva, cervix, vagina and anus Treatment: remove lesions by freezing, burning, laser, excision, trichloracetic acid or bichloracetic acid PN complications: excessive bleeding from lesions after birth, IUGR, can be inherited

Answer 4

A – spreads via GI with polluted water, undercooked shellfish from contaminated water, oral/anal sex, feces of infected person B – spread through bodily fluids Perinatal complication: most threatening to fetus and neonate as it is a disease of liver and often a silent infection Treatment: supportive, HBsAg positive mother and negative infant treated with HBIG and begin vaccinations C – most common blood borne in US

Answer 5

Signs and symptoms Fever Rash Headache Bone pain Joint tenderness Conjunctivitis Perinatal complications: can pass virus to fetus

Answer 6

Signs and symptoms Fever Headache Night sweats Malaise Generalized lymphadenopathy Myalgias Nausea Diarrhea Weight loss Sore throat Rash Treatment: Retrovir Begin at 14 weeks Perinatal complications: Avoid amniocentesis, forceps/vacuum extraction, internal fetal monitoring and/or episiotomy due to risk of maternal blood exposure Planned cesarean section at 38 weeks No breastfeeding Newborn treated with antiretroviral syrup within 12 hours after birth to reduce transmission and then for 6 weeks

Answer 7

Treatment: penicillin Initial bolus, Q4H during labor, at least 4 hours before birth Perinatal complication Life threatening to newborns, causes sepsis, meningitis, newborn pneumonia If pregnant person is having a cesarian section and water hsn’t broken they do not need prophylactic antibiotics

Answer 8

Signs and symptoms Joint pain Flu-like symptoms Rash Lymph node enlargement Perinatal complication: cross placenta and causes teratogenic effects

Answer 9

Progesterone Causes cervical mucous to be thick, sticky Estrogen Causes cervical mucous to be thin, stretchy and increases amount near ovulation Beta HCG (human chorionic gonadotropin) Earliest biochemical marker for pregnancy 7 to 8 days hCG doubling time every 48 to 72 hours until peak around 60 yo 70 days after fertilization and decreases around 100-120 days Ectopic pregnancy or miscarriage hCG will be lower Molar pregnancy or multiple-gestational pregnancy or genetic abnormality hCG will be higher

Answer 10

pre-embryonic (fertilization through 2nd week), embryonic (end of 2nd week through 8th week), fetal (end of 8th week until birth), viability (24 weeks)

Answer 11

Fertilization in the ampulla (outside of fallopian tube) Mitosis = cleavage Morula: solid ball of about 16 cells of developing zygote that will continue to divide until cells specialize Blastocyst: forms embryo and amnion Trophoblast: outer layer that forms into embryonic membranes, chorion (forms placenta) Implantation Blastocyst embeds into endometrial wall in fundus (upper posterior wall of uterus) Bleeding or spotting may occur

Answer 12

Basic structures of major body organs and main external features Ectoderm, mesoderm, endoderm Two embryonic membranes Chorion: outer layer covering fetal side of placenta Chorionic villi: vascular projections that will support fetal circulation Amnion: inner layer, expands to chorion, forms amniotic sac Critical time of development due to organogenesis 400 mg of folic acid is recommended to avoid neurotubular abnormalities

Answer 13

three shunts that close at birth Ductus venosus Connects umbilical vein to inferior vena cava Delivers oxygenated blood to fetus while bypassing the fetal liver Foramen ovale Oxygenated blood from right atrium to left atrium while bypassing fetal lungs Ductus arteriosus Oxygenated blood from pulmonary artery to aorta

Answer 14

Corpus luteum secretes hormones to support pregnancy until placenta can take over Exchange between pregnant person and fetus Site of attachment: fundal of uterus Pregnant person’s side will be red and vascularized Fetus side will be shiny or white with villi Metabolic function Hormone factory

Answer 15

Regulates glucose available to fetus, fetal and maternal metabolism Prepares breast for lactation

Answer 16

Maintains endometrium, decreases uterine contractions, stimulates maternal metabolism, prepares breasts for lactation Can cause morning sickness

Answer 17

Works with progesterone to maintain pregnancy Causes relaxation of pelvic ligaments (causes pregnant waddle), softens cervix in preparation for birth

Answer 18

Maintain endometrial lining of uterus (until placenta functions) - Secreted by corpus luteum Main hormone thought of to diagnose pregnancy - Can be detect 8 to 10 days after conception Can also be secreted due to tumors

Answer 19

Stimulates uterine growth and prepares breasts for lactation Stimulates myometrial contractility At the time of labor estrogen will increase and progesterone will decrease

Answer 20

Union of ovum and sperm Zona pellucida reaction occurs Clear protein layer that blocks sperm from egg Determination of sex occurs by sperm

Answer 21

Marfan’s syndrome Neurofibromatosis Huntington’s Achondroplasia Polycycstic kidney disease

Answer 22

CF PKU Tay-sachs Sickle cell

Answer 23

Hemophilia A Color blindlness Duchenne muscular dystrophy

Answer 24

Amenorrhea Breast tenderness/enlarged Montgomery glands and darkened areolae Fatigue Nausea and vomiting Quickening – feeling of fetal movement Skin changes Urinary frequency

Answer 25

Positive pregnancy test - Not definitive because HCG can be present in some forms of cancer Abdominal enlargement Ballottement Around 16 to 28 weeks Passive fetal movement in response to tapping of lower portion of uterus or cervix Braxton Hicks contractions Uterine toning Cervical changes on exam: Goodell’s sign: softening of cervix Chadwick’s sign: bluish mucus membranes of vagina, cervix, and vulva due to increased vascularity Hegar’s sign: softening of lower uterine segment

Answer 26

Ultrasound visualization of embryo or fetus Fetal movement palpated by examiner Auscultation of fetal heart tones via Doppler

Answer 27

Eat a variety of foods from all food groups with portion control Lower intake of saturated fats, trans fats and cholesterol Increase intake of fruits, vegetables, and whole grains Fluids: 8-10 glasses of water or other fluids/day Dehydration can cause perterm labor Balance calorie intake with exercise to maintain healthy weight Will increase up to 500c/day during third trimester Increase vitamins, minerals, and dietary fiber Consume Folic acid from supplements or fortified foods Take 400 ug of folic acid Avoid fish – Mercury Avoid or limit caffeine Avoid lunch meats Listeriosis Calcium

Answer 28

Uterus Increase in size by 20x Increase strength and elasticity Cervix Increase in size and vascularization Progesterone will cause secretion of mucus to plug the cervical oss to protect fetus from bacteria Vagina Increase vascularity, mucosa, secretions Ovaries Increase size and production of hormones until 7 weeks Breasts Changes in color Montgomery glands enlarge Nipples become erect Vasculature increases

Answer 29

Increase in maternal oxygen needs Total lung capacity decreases Intermittent shortness of breath

Answer 30

Urinary frequency common as filtration rate increases due to hormones Increase water intake Kegel exercises, empty bladder frequently Increased risk for UTI and pyelonephritis due to dilation of ureters and renal pelvises allowing for bacteria to move upward towards the kidneys Cotton or no underwear

Answer 31

Hyperpigmentation of skin: Areola, genital skin, axilla, inner aspects of thighs and linea nigra (midline darkening pigment) Striae gravidarum = stretch marks Thicker hair Nail growth increases

Answer 32

Pelvis tilts forward shifting center of weight forward Lordosis = further curvature of lumbar Relaxation and increased mobility of joints due to hormones (relaxin) Pubic symphysis widens causing waddle Backaches are common Separation of recti muscles Culprit of why some look pregnant event though they aren’t Round ligament pain Common in first and third trimester As uterus enlarges it will pull and cause sharp pain Occurs commonly when turning side to side in bed

Answer 33

Increased CO, HR (by 10-15 bpm), and blood volume Heart enlarges and is displaced upward and left Benign ejection murmur after 20 weeks Clotting factors increase for prevention of post-partum hemorrhage Poor circulation and leg cramping Increase water intake Avoid prolonged sitting or standing Varicose veins and lower extremity edema Compression stockings Vena cava syndrome – supine hypotension

Answer 34

Decrease of venous blood flow to heart causes maternal hypotension and fetal hypoxia Signs/symptoms Dizziness, lightheadedness, pallor, clammy skin; fetal bradycardia Preferred position Left-lateral side, semi-fowlers Do not prolong lying supine Wedge under one hip

Answer 35

Nausea and vomiting Increased bleeding of gums due to progesterone Decreased gallbladder, peristalsis, and stomach emptying Increased risk of gallstones and constipation Increased salivation Increased nasal stuffiness and nosebleeds Heartburn Small frequent meals and sitting up after eating Hemorrhoids Side sitting Sitz baths Impaired glucose control Hypoglycemic until 24 to 28 weeks where there’s hyperglycemia

Answer 36

Thyroid glands increase T4 Adrenal glands increase cortisol and aldosterone Pituitary gland enlarged due to prolactin Pancreas hyperglycemia and hyperinsulinemia Placenta becomes an endocrine organ producing hormones of pregnancy

Answer 37

Naegele's rule pregnancy wheel/calculator ultrasound McDonald's rule

Answer 38

To determine due date Date of LMP Subtract 3 months Add 7 days

Answer 39

Best for one fetal pregnancy Measurement from pubic symphysis to the fundus (top of uterus) In cm Should be roughly equal to week of gestation At week 20 it will be at umbilicus Fundus will begin to rise out of pelvic ridge pronounced and able to palpate at 14 weeks Bad if there is stagnant growth or too large

Answer 40

1st fetal movement felt by pregnant person

Answer 41

heart rate fundal height fetal movement

Answer 42

structural anatomy and ruling out anomalies

Answer 43

triple markers = alpha fetoprotein (AFtP), unconjugated estriol, hCG: done during first trimester to indicate chromosomal disorders if AFP and estiol are low and hCG is high = downs if all three are low = trisomy 18 QUAD = triple marker and inhibin A done during second trimester to detect chromosomal and neural tube defects but is less sensitive but combined with first trimester test increase accuracy for detecting downs

Answer 44

For high-risk pregnancy Advanced screen for trisomy 21, 18, and 13 Maternal blood that quantifies the amount of cell free fetal DNA that comes from chromosome 13, 18, 21, X, and Y

Answer 45

Most used eval for fetal well-being for at risk pregnancies Evaluates fetal HR in response to uterine contractions Monitor for at least least 20 minutes Looking for accelerations of the fetal HR of at least 15 bpm for at least 15 seconds at least twice in this window Reactive tracing Indicates good oxygenation and good neurologic function How to read strip Big vertical thick lines is 60 seconds, and each little column is 10s The top wiggly line is the fetal heart tone Bottom line is pressure sensation monitoring uterine contraction If nonreactive test results further assessment is needed, biophysical profile

Answer 46

looks at NST and ultrasound (fetal breathing movements, fetal activity (gross body movements = at least 3 limbs or body extensions of flexion occur within 30 min), fetal muscle tone (at least one extension and return to flexion), and amniotic fluid volume (at least one pocket of fluid measuring 2cm) each aspect given 0 or 2 points and a max score of 10

Answer 47

fetal blood flow across placenta and umbilical cord

Answer 48

Fetal alarm signal: no fetal movements within 12hrs Gush of fluid from vagina If it’s clear think amniotic fluid or urine If it’s a little amount it could be vaginal congestion Vaginal bleeding Abdominal pain Temperature >101 Persistent vomiting Visual disturbances Edema of hands & face Severe headache Epigastric pain Dysuria Could be UTI, labor start (infections could induce labor) Decreased fetal movement

Answer 49

G - gravida: totality number of pregnancies including current pregnancy if applicable T- term: Birth at 37 and above P- preterm: Birth at 20 to 36 6/7 weeks A- abortion: Spontaneous, terminated, or selected Fetus <20 weeks L- living children: Currently living children

Answer 50

Toxoplasmosis Other agents Rubella Cytomegalovirus Herpes simplex