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Clin Med 2 > Exam 4 > Flashcards

Exam 4 Flashcards

(235 cards)

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1
Q

Basic metabolic rate increase

A

15%

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2
Q

Cardiac output increase

A

30-50%

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3
Q

Blood volume increase

A

35%

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4
Q

Oxygen utilization increase

A

20%

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5
Q

GFR increase

A

50%

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6
Q

Average total weight gain

A

24 pounds

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7
Q

Pregnancy is high….

A

Progesterone and estrogen

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8
Q

Placenta takes over PR production by…

A

Week 7-8

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9
Q

Estrogen produced by…

A

The placenta

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10
Q

CV changes

A

Heart displaced upward and left

Ventricular muscle mass increase

LV and LA increase in size

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11
Q

Heart rate increase by…

A

10-20 bpm

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12
Q

BP is the lowest…

A

Week 24

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13
Q

Systemic vascular resistance…

A

Decreases

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14
Q

Heart sounds in pregnancy that are normal

A

Increased 2nd heart sound intensity, splits with inspiration

S3 gallop, 3rd heart sound

Low grade SEM

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15
Q

Abnormal heart findings in pregnancy

A

Diastolic murmur

Hypertension

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16
Q

Supine hypotension syndrome

A

Increase in maternal HR
Dizziness
Light headedness
Syncope

Relived by lying on left side when supine

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17
Q

EKG changes in pregnancy

A

Slight left axis deviation

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18
Q

Tidal volume…

A

Increases 30-40% and minute ventilation increases

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19
Q

Total lung capacity and CO2 levels…

A

Decrease

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20
Q

Bohr effect

A

Compensated respiratory alkalosis

Hyperventilation to create a gradient facilitating o2 delivery to the fetus and removing co2 delivery from the fetus

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21
Q

Clotting changes in pregnancy

A

Increase fibrinogen, factors VII-X

Decrease in proteins C and S

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22
Q

Physiologic anemia in pregnancy

A

Dilutional

Decrease in Hb and Hct

If it is less than 11 Hb, then usually due to iron deficiency

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23
Q

Gallbladder in pregnancy

A

Impaired gallbladder contractility

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24
Q

GI manifestations in pregnancy

A 
NV
Cravings, aversions
Increase caloric intake
GERD
Constitution
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25
Labs in pregnancy for GI
Increased total serum alk phos, bile is not moving
26
Renal anatomical changes
Kidneys lengthen Ureters dilate, right usually more than the left
27
Functional increases in the renal system
Increased renal plasma flow Increased DFR Increased RAA system activity
28
Clinical renal manifestations
Frequency, dysuria, urgency Stress incontinence Pyelonephritis is increased incidence Edema
29
Thyroid and pregnancy
Euthyroid state HCG is a weak stimulating effect on the thyroid, so may enlarge and have rise of FT4
30
Random endocrine increases
Cortisol ACTH Aldosterone
31
Glucose in pregnancy
Increase in insulin sensitivity followed by progressive insulin resistance Type 2 diabetic state Glucose is primary fuel for placenta and fetus
32
Lipids in pregnancy
Increase in all lipids, lipoproteins and apolipoproteins
33
Pubic symphisis separates at...
28-30 weeks
34
Hair loss in pregnancy
2-4 months post partum
35
Most rapid changes of breast size
In first 8-10 weeks of pregnancy
36
Eyes in pregnancy
Blurred vision Decreased intraocular pressure and increased thickness of the cornea
37
Placenta and immunology
Keeps fetus from direct contact with maternal immune system 6 weeks lymphocyte production happens
38
In the fetus, well oxygenated blood enters...
The left ventricle
39
In a fetus, less oxygenated blood enters...
The right ventricle
40
How does the fetus maintain adequate tissue oxygenation?
Fetal hemoglobin Decreased fetal o2 consumption
41
Kidney in utero
Functional in second trimester Source of amniotic fluid
42
Liver in utero
Slow to mature Vitamin K deficiency
43
Thyroid in utero
Functional at the end of T1 Mother is the primary source of thyroid hormone prior to 24-28 weeks
44
Differentiation into testes occurs...
6 weeks after conception Testosterone and mullerian inhibitory factor inhibit development of female external genitalia
45
Development of fetal ovary begins...
At 7 weeks
46
Gestational age
Time of pregnancy counting from the first day of the LMP
47
Developmental age
The time of pregnancy counting from fertilization (2 weeks less than GA)
48
EDD
Estimated date of delivery
49
First trimester
Up for 14 weeks (GA)
50
Second trimester
14-28 weeks
51
Third trimester
28 weeks- deliver
52
Embryo
Fertilization - 8 weeks
53
Fetus
9 weeks to birth
54
Previable
<24 weeks
55
Preterm
20-36 weeks
56
Term
37-42 weeks
57
Gravidarity
Total number of pregnancies Including ectopic and molar
58
Parity
Number of deliveries >20 weeks gestation, stillborn or alive If twins, P1
59
Abortus
Number of pregnancies lost before the 20th gestational week
60
TPAL
Term deliveries Preterm deliveries Abortions Living children
61
Elderly primagravida
At least 35
62
Clinical presentation of pregnancy
``` Amenorrhea Fatigue NV Breast changes Urinary frequency Chadwick sign Hegars sign Leukorrhea ```
63
Chadwick sign
Early pregnancy sign Blue discoloration of cervix
64
Hegar's sign
Softening of junction between the uterus and the cervix
65
Quickening
16-20 weeks GA, feeling the baby move Could be week 14 if many pregnancies
66
Urine pregnancy test
Can be positive 4 weeks after the 1st day of LMP
67
Serum pregnancy test
Positive before missed period Quantitative helpful when monitoring problems
68
TA UA
5-6 weeks GA 5000-6000
69
TV US
3-4 weeks GA 1000-2000
70
Fetal heart tones doppler
12 weeks
71
Naegele's rule
Add 9 months and 7 days to day of LMP
72
Fundal height measurement
20-36 weeks, the fundal heigh in centimeters should about match the weeks GA
73
HIV screening
Opt out approach
74
Panorama test
Early as 9 weeks Screens for trisomy 13, 18 and 21 Determines sex of baby
75
Less than 28 weeks, see OB
Every 4 weeks
76
28-36 weeks pregnant, see OB
Every 2 weeks
77
>36 weeks pregnant, see OB
Every week until delivery
78
False labor
Irregular intervals Same intensity Relieved by meds No cervical change
79
True labor
Regular intervals that shorten Increase in intensity Back discomfort Cervix dilates Not relieved by meds
80
High BMI and low BMI weight gain expectations
<19: 28-40 pounds >26: no more than 20 pounds
81
GA HTN
BP >140/90 on at least 2 occasions 20 weeks or later GA and no proteinuria
82
Fundal heigh discrepancy
>3cm, or progressive decrease, need to do US
83
Normal FHT
110-160, maybe higher in early PG
84
GDM
Screened 24-28 weeks
85
28 weeks, screen...
Ab and consider RhoGAM if RH-
86
Activity during PG
30 minutes of moderate exercise per day if accustomed to this already
87
Can fly safely up to...
36 weeks GA unless complications
88
Contacting doc about labor
Contractions every 5 minutes for an hour Sudden gush of fluid or constant leakage Significant vaginal bleeding Decrease in fetal movement
89
Pooling
ROM Fluid collection in posterior fornix
90
Valsalva
ROM Fluid comes thru cervical os during valsalva
91
Ferning
ROM Presence of ferning pattern on microscope of dried fluid
92
Nitrazine
ROM Positive if nitrazine paper turns blue, indicating basic pH
93
Amnisure test
ROM Detects amniotic fluid protein
94
Effacement
Shortening of cervical canal from 2cm to a paper thin circular orifice , expressed in %
95
Fetal station
Identifying the level of the fetal presenting part in the birth canal in relation to ischial spines Zero station is a crucial functional landmark in the labor path
96
Modified ritgen maneuver
Pushing the babies chin upward during birth
97
Three signs of placental separation
Uterus rises in the abdomen and becomes globular Gush of blood Lengthening of umbilical cord
98
Inspect umbilical cord for...
2 arteries and 1 vein
99
After delivery of placenta, ...
Palpate uterus to rule out uterine atony Should be reduced in size and firmly contracted
100
4th degre laceration
Extends into rectal mucosa
101
3rd degree
Extends into sphincter, but not rectal mucosa
102
Postpartum complications biggest risk is...
1st hour after delivery
103
Nonstress test
Measures fetal heart rate acceleration in response to fetal movement
104
Contraction stress test
Measures the response of the fetal heart to the stress of uterine contractions
105
Biophysical profile
Series of 5 assessments to predict risk of anatenatal fetal death
106
Doppler US of umbilical artery
Suspected intrauterine growth restriction
107
NST acceleration
15 beats/min above the baseline for 15 seconds in a 20 min period
108
Non reactive NST
Baby may be asleep, retest after mom eats or drinks
109
Reactive NST
2 or more accelerations over 20 minutes
110
Variability NST
Beat to beat irregularity and waviness of the FHR; reflects in tact and mature brain stem
111
Early deceleration NST
Normal!!
112
Variable deceleration NST
Caused by cord compression
113
Late deceleration NST
Hypoexmia, abnormal!
114
CST
Performed if NST is non reactive Stimulated by pitocin or nipple stimulation If positive, late deceleration found following 50% or more contractions
115
Late deceleration during labor STOP
Sterile vaginal exam Turn patient on her left side Give patient oxygen Turn off the pitocin
116
BPP aspects
``` NST Breathing Movement Muscle tone Determination of amniotic fluid ```
117
AFI values
>5 cm: adequate <5 cm: abnormal, oligohydramnios >25 cm: abnormal, polyhydramnios
118
Normal BPP values
8-10
119
Equivocal BPP values
6
120
Abnormal BPP values
<4
121
Small for gestational age
Estimated fetal weight <10th%
122
Large for gestational age
Estimated fetal weight >90th %
123
<20 weeks, hyperplastic
Symmetric growth restriction
124
>20 weeks,hypertrophic
Asymmetrical growth restriction, intrauterine growth restriction
125
Decreased growth potential
Starts small, stays small
126
IUGR
Progressively falls off the growth curve
127
Macrosomia
BW >4500 g (9.92 pounds)
128
LGA prevention
Tight control of diabetes Weight loss before conception
129
Leading cause of maternal death
Obstetric hemorrhage
130
T3 causes of hemorrhage
Placenta previa and placental abruption
131
Pregnant woman plus vaginal bleeding plus pain
Placental abruption until proven otherwise!
132
Painless bleeding in T3, transverse lie fetus
Placenta previa
133
Placental abruption
Bleeding at placental interface that causes partial or total detachment prior to delivery Non often seen on ultrasound
134
Risk factors for placental abruption
Abdominal trauma/accidents Cocaine/other drugs Eclampsia Previous abruption
135
Placenta previa
Abnormal implantation of the placenta over the internal cervical os Often detected via US
136
Different types of previa
Complete- completely covers internal os Partial- covers portion of internal os Marginal- edge of placenta reaches the margin of internal os
137
Vasa previa
Unprotected fetal vessels lying over the cervix Can rupture, shear, lacerated or be compressed Large bleeds Can be detected with US
138
Placenta accreta
Attaches to myometrium
139
Placenta increta
Invades the myometrium
140
Placenta percreta
Penetrates through the myometrium
141
Uterine rupture prsentation
FHR declarations during labor Popping sensation, sudden pain Palpate fetus in extrauterine space Bleeding
142
Never do a digital vaginal exam in the 3rd trimester...
Bleeding until placenta previa is ruled out
143
Apt test
Dilute blood with water, combine with sodium hydroxide Brown is maternal blood, pink is fetal
144
Kleihauer betke test
Measures fetal RBC percentage in maternal circulation If >1%, fetal bleeding
145
Wrights stain
Nucleated RBCs in vaginal blood indicate fetal bleed
146
Three p's responsible for vaginal delivery
Pelvis Passenger Power
147
Cephalopelvic disproportion
One of the most common indications of failure to progress and getting C section
148
Presentation of baby
Vertex is the most common. (Head down)
149
Breech
Butt first Prolapsed cord and entrapment of head
150
External version
Don't perform before 36-37 weeks Initially w/o anesthesia Can revert back Do when in breech position
151
Preterm ROM
Before 37 weeks GA
152
Premature ROM
Occurs before onset of labor
153
Born at 24 weeks gestation
>50% mortality rate
154
Preterm labor definition
GA <37 weeks with regular uterine contractions plus one of the following: Progressive cervix changes 2cm dilated cervix 80% effaced Ruptured membranes
155
<25mm transvaginal cervical length measurement
High risk of preterm labor
156
>35 mm transvaginal cervical length measurement
Low risk of preterm labor
157
Fetal fibronectin assay
Vaginal swab of posterior fornix prior to digital exam If negative, 99% predictability for no preterm delivery within 1 week
158
Preterm labor treatment
Hydration Bed rest Antibiotics in PPROM Tocolytics
159
CI in tocolytic therapy
``` Bleeding Placental abruption Fetal death Chorioamnionitis Severe PIH(ypertension) Unstable maternal hemodynamics ``` BAD CHU
160
Cervical incompetence
Painless dilation and effacement of the cervix 2nd trimester losses
161
Cerclage
Suture placed to close the cervix Can be emergent or elective
162
McDonald cerclage
Suture placed at cervical vaginal junction
163
Shirodkar cerclage
Suture placed at internal os
164
Post term pregnancy
PG that goes beyond 42 weeks Innaccurate dating most common cause
165
Bishop score
If the score is greater than 6, inducing will be similar to a spontaneous vaginal delivery If less than 6, don't induce
166
Agents for induction
Oxytocin Prostaglandins Foley balloon or laminaria
167
APGAR components
``` Activity Pulse Grimace Appearance Respiration ```
168
APGAR scores
7-10 is excellent 0-3 is severely depressed
169
1 minute
APGAR score reflects intrauterine environment
170
5 minutes
APGAR reflected the transition to extrauterine environment
171
New Ballard score
Used to determine infants GA after delivery, in infants 20-44 weeks GA
172
Typical stay after birth
2 days after vaginal 3-4 days after C section
173
Puerperium
Period between childbirth and 6 weeks after delivery Uterine size is normal 6 weeks later
174
Lochia
Decidual tissue that sloughs off as vaginal discharge days after delivery
175
Onset of lactation
24-72 hours postpartum
176
4 t's of postpartum hemorrhage
Tissue: retained placenta Trauma: episiotomy Tone: uterine atony Thrombin: coagulation defects, DIC
177
Endometriosis
10x more frequent after C section GBS colonization big risk factor 2-3 days postpartum
178
5 w's and B for post delivery fever
``` Wind Water Walking Wound Wonder drugs Breast ```
179
Postpartum contraception
Typically oculate 6-8 weeks after delivery Lactational amenorrhea with exclusive breast feeding prevents ovulation
180
Pills choice for post partum moms
Progestin only because of the way that estrogen inhibits breast milk production
181
Chronic hypertension
Before PH, before the 20th week of PG, or persists >12 weeks postpartum
182
If mom doesn't have proteinuria with new onset HTN, preeclampsia if she has one of these:
``` Platelet count <100,000 SCr >1.1 or doubling of SCr Liver enzymes twice normal concentrations Pulmonary edema Cerebral or visual symptoms ```
183
Preeclampsia risk factors
Previous preeclampsia APA or inherited thrombophilia DM >BMI
184
Preeclampsia presentation
``` HA Visual changes Pain NV Dyspnea, fluid retention, edema ``` Hyperreflexia, clonus
185
Mild preeclampsia management
Rest and frequent monitoring as outpatient
186
Worsening or severe management of preeclampsia
Delivery is the ultimate treatment Hospitalize and monitor
187
HELLP
Hemolysis Eleveated Liver enzymes Low platelets Can lead to serious maternal morbidity Usually t3
188
HELLP diagnostics
``` Schistocytes on peripheral smear Elevated LDH Elevated bilirubin Platelets <100,000 Elevated AST and ALT ```
189
Platelet transfusion for HELLP if...
<20,000 before or after vaginal delivery <50,000 before c section
190
Only...of twins in T1 result in viable twins
50%
191
Monochorionic/diamnionic
Twinto twin transfusion syndrome risk One placenta, two sacs
192
Monochorionic/monoamnionic
High mortality rates from cord accidents
193
Ectopic pregnancy
Blastocyst becomes implanted at a site other than endometrium of uterine cavity Hemorrhage is the most major complication
194
Risk factors for ectopic pregnancy
``` Previous ectopic pregnancy Previous tubal surgery Tubal ligation Hx of PID Smoking ```
195
Clinical presentation of ectopic pregnancy
Normal pregnancy symptoms Abdominal or pelvic pain Vaginal bleeding Amenorrhea
196
Ectopic physical exam
Tenderness of abdomen Adnexal mass Orthostatic changes Peritoneal signs, abdominal distension
197
Diagnosing an ectopic pregnancy
HCG quantitative In viable PG, should double every 48 hours Falling or slow to rise is most consistent with failed IUP
198
Medical management of ectopic PG
Methotrexate Best for asymptomatic and hemodynamically stable pt
199
Abortion
Termination of PG by removal or expulsion from uterus prior to viability Usually in T1
200
Induced abortion methods
Dilation and evacuation: manually open uterine cervix, evac the contents Vacuum aspiration for T1 Suction or extraction for T2
201
Nonsurgical induced abortion
<49 days GA Mifepristone, methotrexate, misoprostol
202
Threatened Ab
Bleeding through the cervical os in the first half of PG
203
Inevitable Ab
Gross rupture of the membranes in the presence of cervical dilation
204
Incomplete Ab
Internal cervical os opens and allows passage of blood
205
Complete Ab
PH that spontaneously passes all of the products of conception
206
Missed Ab
Retention of a failed IUP for an extended period, usually defined as >2 menstrual cycles
207
Isoimmunization
Fetal maternal blood exchange occurs Maternal antibodies are formed to the baby Can cross the placenta and enter fetal circulation, creating a hemolytic disease in the fetus or newborn in subsequent pregnancies
208
What does mom have to have in order to create isoimmunization?
RH negative!! With a fetus who is Rh positive
209
Screening for isoimmunization
1st prenatal visit, again at 28 weeks GA, then again for any "event" during pregnancy or delivery
210
Positive screen for antibody...
Further measures: Indirect Coombs test for mother Direct Coombs test for neonate after birth
211
Eval for possible fetal anemia
T2 Amniotic fluid assessment for bilirubin level Us to look for erythroblastosis fetalis
212
Preventing isoimmunization
Anti D immune globulin administered to RH negative women at 28 weeks Moms that deliver rh positive infants after delivery Any time a fetematernal hemorrhage may have occured
213
Most common cause of PPH
Uterine atony
214
Uterine atony management
Uterine massage Immediate breastfeeding Uterotonic agents Surgery
215
Postpartum endometritis
Infection of decides >100.4 temp on any 2 of the first 10 days post partum, except 1st day
216
Postpartum endometritis clinically
Fever Tracy Midline lower abdominal pain Uterine tenderness Purulent lochia, chills, malaise, anorexia, HA Uterus slightly soft
217
Anemia is pregnancy is when...
Hbg <11 and HCT <33%
218
Fe deficiency anemia in PG
Women should be prescribed Fe in T2 and T3, 30 mg 60-100 mg for treating anemia Take with vitamin C
219
Folic acid deficiency anemia in PG
.4 mg daily before conception Lactating women need extra folic acid 1 mg daily to treat folic acid
220
Sickle cell anemia in PG
Preconceptional assesment and counseling, high risk of complications African descent women need to be screened
221
Suspect APS when..
Thromboembolism episode 3 consecutive abortions before 10 weeks Hx of preterm delivery <34 weeks due to preeclampsia
222
APS treatment in PG
Heparin and ASA
223
Hyperthyroid in PG
Radioactive Iodine is CI Fetal goiter potentially
224
HPL
Human placental lactogen, causes insulin resistance state in pregnancy
225
High insulin levels cause...
Excessive fetal growth
226
Screen pregnant women for DM at
24-28 weeks gestation
227
White classifications A1 and A2
A1- controlled with diet A2- requires insulin
228
Pre pregnant diabetes
Increases fetal loss risk and fetal malformations Need to get HbA1C under control!!
229
Epilepsy in PG
Increases risk of fetal malformations, from drugs too! If 2-5 years seizure free, consider off trial meds
230
UTI's in PG
All women need US and Cx at first prenatal visit, treat those with positive culture Admit all PG patients with pyelonephritis
231
GBS
All women screened between 35-37 weeks, need to treat during labor
232
Hep B
Screen at 1st visit Breast feeding big for neonatal infection Vaccine can be given during pregnancy Babies get HBIG and HBV vaccine immediately after birth
233
Varicella
Transplacental transmission, can cause congenital malformations Microcephalic, microphthalmus Vaccinate BEFORE PG
234
Herpes
History of HSV, low risk for baby Contracted during PG, high risk for baby Prophylactic acyclovir around delivery
235
Cyst can safely be removed...
In the 2nd trimester of PG

Clin Med 2 (8 decks)

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