Final Flashcards

Question

What is gram staining?

Answer 1

● Gram staining is to classify bacteria on their ability to soak up dye, which is due to glycoproteins in the cell wall. gram positive = soaks up dye gram negative = does not soak up dye Helps us determine what particular strain of antibiotic to give.

Answer 2

Only offer BV screening for those who have symptoms or other Hx listed. Swab vagina and look for 3/4 of Amsel's criterea.

Answer 3

● Wet mount/wet prep done with 2 samples: first in saline at 10x to get an overview then in KOH solution magnified at **40x to identify cells etc **

Answer 4

Yeast I think

Answer 5

● Infection of urethra: urethritis ● Infection of bladder: cystitis ● **Infection of kidneys: pyelonephritis**

Answer 6

E. Coli (have pili which is why they can climb up the urinary system). Urinary stasis; things move around more slowly; progesterone contributes to dilation of urinary tract, pressure on urethra from uturus

Answer 7

● Amsel’s criteria is a way of diagnosing BV, where 3/4 symptoms must be present for diagnosis (however 50% of people are asymptomatic with BV) 1) Vaginal Discharge 2) Clue Cells - 40x microscope, vaginal cells w/bacteria cells stuck to them 3) pH higher than 4.5 (more neutral) 4) Positive whiff test - fishy smell when discharge and KOH are combined

Answer 8

Estimates risk of down syndrome, trisomy 18, Open neural tube defect **benefits** know the likelihood you are carrying a child with T21 Time to prepare to end the pregnancy Time to prepare to have a child with T21 reassurance **harms** Anxiety while waiting for results False alarm Difficult decisions False reassurance (2/4500) NOT DOING TEST benefits Avoid anxiety and unecessary extra testing Stay true to personal values Avoid difficult decisions Harms Not knowing your risk of carrying a fetus w T21 Anxiety from not knowing Social pressure to do the test.

Answer 9

SIPS (2 blood samples 10-11 weeks and 15-16 weeks) offered to all IPS = SIPS + nuchal transperency IPS and SIPS are screening for liklihood of T21, T18, or NTD Amniocentesis - diagntostic IPS offered to twins and 35 yo and older and IVF/ICSI *IPS and SIPS are the sam except for NT* QUAD is the second SIPS test late into care If a client does NIPT, they aren't eligible for provincial screening. Late into care - Usually 17, 18 weeks get results still screening, offered amnio to confirm. FUNDED NIPT: Positive screen IPS, SIPS, QUAD; documented history of fetus/child w previous trisomies; client who has increased risk of downs baby w results from SIPS/IPS/QUAD FTS (first trimester screening) blood test and ultrasound 11 weeks - through fertility centre - precude them from provincial screening? NIPT - non-invasive prenatal screening test - neither neural tube defect (don't do provincial screening, offfered nuchal transulsency at 2nd trimester ultrasound).

Answer 10

Ultrasound done at **11-13+6 weeks**. Measures pocket of fluid at back of fetal neck to assess for genetic abnormalites. Eligible 1) Clients 35 years or older at EDD 2) Twins 3) Clients pregnant following IVF or ICSI 4) People who have opted into NIPT Done at 2nd trimester detailed ultrasound if have had NIPT

Answer 11

Approaching 100 percent for DOWNS(trisomy 21), 97 % for trisomy 18, 93 % Trisomy 13

Answer 12

Positive screen IPS, SIPS, QUAD; documented history of fetus/child w previous trisomies; client who has increased risk of downs baby w results from SIPS/IPS/QUAD

Answer 13

SIPS 2 blood tests QUAD 2nd blood test only Amalytes: 1 test PAPP- A (low, trisomy, INVASION) **LOW** 2nd test AFP(made in yolk sack - peak at 10-13 then decline, low DOWNS), **LOW** uE3 (low trisomy), **LOW** HcG (increase T21, decrease T18, normal NTD), **UP T21, DOWN T18, NORMAL NTD** Inhibin A (CL, high Downs) **HIGH**

Answer 14

**Sensitivity **refers to how often the probability of a true positive with the test (low sens = high false posi) **specificity** refers to the probability of a true negative of the test. (low spec - high false negi) A positive predictive value is the ratio of patients truly diagnosed as positive to all those who had positive test results.

Answer 15

**CVS **- less than 13 weeks gestation **Amnio **- greater than 15 weeks gestation Offered with positive screen or NIPT. Nucleic Acid amplifying both diagnostic 100%

Answer 16

**First trimester ultrasound **assessed fetal viability, pregnancy dating, chorionicity and amnionicty for twins, ectopic / molar pregnancy and pelvic masses. **(7-12 weeks)** **NT ultrasound **is looking for a pocket of fluid at the back of the fetal neck that is indicative of T21, and is done between **11-13+6 wks**, approaches 100% accuracy for T21 screen. **Second trimester (18-20 wks)** is detailed, assesses fetal anatomy and growth, and looks at where placenta is, higher detection rate for neural tube efects, and ability to test for soft markers NT will be done here for folks with NIPT.

Answer 17

● Expect ‘REACTIVE’ measuring immunoglobulins from past exposure or vaccine ● Theoretical risk of varicella vaccine during pregnancy, although no evidence ● If active chicken pox during pregnancy, OB can decide whether transfer of care is necessary, otherwise = shared care ● Worse for babe in the middle of the pregnancy (2nd tri) ● Worse for pregnant person in 3rd trimester

Answer 18

To screen in the 1st trimester and offer all first appointments syph screening. First a TPA test which looks for antibodies. If the initial TPA test is positive or equivocal, an RPR test will be performed. If the RPR test is positive, a confirmatory RPR titer will be performed. If the RPR is negative, a confirmatory TPA by EIA test will be performed.

Answer 19

Sexually transmitted diseases (chlamidya, gonorrhea, trichomonas, HPV, HIV, HSV, etc), immunity to rubella and varicella

Answer 20

**HSV screening based on client hx, not routine prenatal care** ● 3rd trimester viral suppression therapy for recurrent outbreaks (so that an active outbreak does not occur during delivery) ● We about a hx of genital herpes, not which virus type caused them (cold sores are fine) ● Risk of transmission at birth = 50% ● Offer viral medication @36 weeks to decrease odds of passing it on to baby because infant mortality rates are quite high - transmission can also occur post-nasally ● Offer testing on presentation of symptoms

Answer 21

Viruses small, rely on host cell for reproduction, DNA/DNA in capsid

Answer 22

● First gland to appear, ● Starts secreting hormones at **18-20 **weeks

Answer 23

Thyroid - controls metabolsim Hypothalamus makes TRH (thyroid releasing hormone) stimulates anterior pituaitary TSH (thyroid stimulating hormone) stimulates Thyroid to make T3 and T4 (uses iodine to produce which stimulates TSH. If TSH too high - hypothyroidism - Thyroid is low IF TSH too low - hyperthyoidism - thyroid is high

Answer 24

HcG - acts like TSH (t4 increases in first semester) TSH decreases and T4 leveles increase

Answer 25

Increased risk of GD in future preg, and increased risk of Diabetes in life.

Answer 26

1st trimester TSH testing is recommended in those with risk factors for thyroid disease Older than 30 2 prior preg history of preg loss BMI greater than 40 HIstory of current symptoms of thyroid disease Family history thy disease etc Results --> TSH in the first trimester should be slightly below the typical, non pregnant reference range and gradually return to normal in the 2nd and 3rd trimesters. TSH increases w pregancy If TSH outside of ranges fT4 should be ordered.

Answer 27

If anterior pituitary gland produces normal amounts of TSH, and if thyroid can respond to TSH and produce T3 and T4

Answer 28

If glucose challenge is high - reccomended to do glucose tolerance (diagnostic if above** 11.1**). If glucose tolerance is high then diagnostic for diabetes (if 1 value is met or exceeded)

Answer 29

It is a disease of insulin resistance; because of the hormonal changes in pregnancy there is altered cell receptivity to insulin. Glucose levels may be lower in early pregnancy, however **hPL** increases as gestational increases which can lead to a higher resistance to insulin and thus higher glucose levels. When the pancreas is unable to increase insulin to compensate for the increased resistance, that is gestational diabetes. Diabetes is Abnormal glucose tolerance and gestational diabetes is Abnormal glucose tolerance in pregnancy

Answer 30

risk factors: age > 35 yrs, member of high risk population (basically just not white), pre-pregnant BMI >30kg/m2 or BMI > 25, previous history of GDM or glucose intolerance, pre-diabetes, family history of diabetes in 1st degree relative, macrosomia, history of PCOS.

Answer 31

Options: (bw 24 - 28 weeks gestation) - earlier if high risk factors 1) Do nothing - relate to family history, normal BMI, normal weigh gain, risk factors 2) Straight to **glucose tolerance test** *DIAGNOSTIC* - over night 10 hour fast, fasting blood glucose, drink 57 g glucose Blood tested twice at 1 hour , then 2 hours. 1 step diagnostic if elevated 3) **Glucose challenge test** (screening test), Breakfast w protien and go to lab 2 hours later. 15 g glucose, blood 1 hour later - screening but if negative no further testing. (diagnostic if levels really hight) Other tests: Order 2nd set of CBC and bloodtype, antibody screen to make second documented blood type.

Answer 32

Tired, weight gain

Answer 33

○ A percentage of babies that are colonized by GBS at birth develop infections that can be catastrophic, leading to meningitis, pneumonia and death. Providing prophylactic antibiotics at PROM or at onset of labour reduces the likelihood of the newborn developing Early Onset GBS Disease (EOBGSD).

Answer 34

The client or the healthcare provider swabs for GBS with a vagino-rectal swab between 35-37 weeks. It is then sent to the lab to cultured. A positive GBS result means that the client is colonized (not infected) hence prophalatyic antibiotics

Answer 35

○ **10-30% **of pregnant people are colonized with GBS, **when untreated 50% o**f babies acquire it at birth ■ **OGBSD develops in 1% to 2%** of these infants ● **6-9%** with may die

Answer 36

**Community standard:** provide Intravenous prophalaxsis for GBS at onset of labour or when membranes rupture. every 4 hours until birth. WHO? posi GBS screen 35-37 weeks, client prev infected w GBS, any doc GBS in current preg.

Answer 37

Fern like pattern emerges under micoscope when it is amniotic fluid (high sodium and protein)

Answer 38

Nitrazine has a high false posi and negi, so good only if waters obvs broke Ferning is better for diagnosing.

Answer 39

Cervical mucous and semen

Answer 40

**Ph pCO2 HCO3- Base Deficit** **Resp A** Low High Normal Normal **Metab A** Low Normal Low High **Mixed A ** Low High Low High **Resp A **normal **Metabloic Acidosis **likley low APGAR - resuscitation **Mixed **- agresive resus at birth

Answer 41

Samples artery and vein. Info of met acidosis, not the duration If umb artery cord gas pH less than 7 or higher than 12 then intrapartim hypoxic acidemia - triggers chart review

Answer 42

○** Critical Congenital Heart Disease** = structural heart defects associated with hypoxia (lack of O2 in the blood) ■ Identifies cyanosis (otherwise clinically undetectable) in first 24-36 hrs of life

Answer 43

○ **Pulse Oximetry Screening **– attach pulse oximeter to right hand & either foot ■ babes over 34 wks GA ■ @ 24-36 hrs ○ Because cyanosis is otherwise undetectable – prevent serious morbidity or death

Answer 44

○ If collected at < 13 hrs of age, it will have to be repeated Cut not sterilized, if foot placed directly on paper, and if foot squeezed. If done before 24 hours doesn't screen for everything.

Answer 45

**Oral** Oral version is comparable to treathing **Early and Classic** Vitamin K Deficieny bleeding Not as good for preventing Late Vit K deficiency bleeding so Canadian Pediatric Association recommends injectable version. Parents responsibilty (check-in, remind them) 3 doses of 2mg (6 hours, 2-4 weeks, 6-8 weeks) **Injectable ** Administered within 6 hours post-birth Protects against all 3 types of vit K deficiency bleeding Care providers responsibility 1 dose (1mg) 3 types of bleeding: 24 hours - **early vit k deficiency** bleeding, after 24 hours and first week - **classic vit k deficiency** (oral and injection help this type of bleeding the same amount), first week of life to 6 mo of life - late onset vit k bleeding

Answer 46

○ Cystic fibrosis screening - babies with CF have elevated salt in their sweat

Answer 47

○ Exclusively fed breast milk (breast/chest fed and/or pumped milk) because most formals are enhanced w Vit K

Answer 48

**Metabolic** **Maple syrup urine disease** - means the body cannot process certain amino acids (the "building blocks" of protein), causing a harmful build-up of substances in the blood and urine. **Endocrine** **Congential Hypthyroidsim** - occurs when the thyroid gland fails to develop or function properly

Answer 49

○ Jaundice is caused by backup of byproducts of RBC turnover, leading to excess bilirubin ○ In newborns and preemies this is due to: ■ less mature liver function ■ Faster rate RBC turnover (generates more waste more quickly) ■ not eating much yet, which also means… ■ less excretion of waste than adults ■ less protein in their blood than adults ■ (which is why we would encourage parents to feed them often, to help move things through!)

Answer 50

All leukocytes (WBCs) and phagocytes. Neutrophils (most abundant, 1st players), Macrophages (leave capillaries CYTOKINES APC), Dendritic cells (Antigen presenting cell), NKCs (destroy infected host cell)

Answer 51

B cells, T cells (Helper T and cytotixic T)

Answer 52

(1) Specific - respond to distinct pathogens (2) Diversity - wide variety of antigens (lock and keys) (3) Memory - repeated exposure will make for a stronger response (doesn't happen with innate/non-specific) (4) Self limitation - Helper t, eventually non-reactive (5) Non reactive to self - helper t cells (6) Specializing - optimizing specific antigens So So So Much Nice Dick

Answer 53

Humoral - outside of cell in fluid - B-cells Cell-mediated - in cells - T cells (Helper T and Cytotoxic T) (made in bone cells mature in Thymus)

Answer 54

B-cells bind to pathogen and presents it. T cells are triggered and activate B cells once they bind. Once activated memory B cells are cloned, and plasma B cells - antibody factories. T cells release cytokines (alarm bells)

Answer 55

T cells duplicate into memory cell and effector cell (spit out cytokines), cytotoxic t cell bind and kill with perforins, granules, granzymes - but don't kill themselves in the process.

Answer 56

Antigen Presenting Cells - Dendritic (I), Machrophage (I), and B-Cells (adaptive) connect with another protein and presents

Answer 57

1st line of immunity! Physical and biochemical: skin, mucosal, pH, acid mantle, saliva, bone marrow, lymph, temperature, proteins, enzymes, digestive enzymes

Answer 58

placental lactogen (increases glucose levels in parent - creates the differential and attracts glucose), progesterone, hCG, and estrogen… but many others as well, like serotonin. These hormones maintain the pregnancy and guide metabolic functions in both the birther and the fetus

Answer 59

Prevention of rejection from mother Limited barrier to infection Transfer of maternal antibodies IgG

Answer 60

Placenta synthesizes glycogen, fatty acids, cholesterol, enzymes, and ammonia/lactate. Insulinase - increases the barrier of insulin transfer between mother and fetus, making fetus independent of maternal insulin levels 11B HSD - increases barrier of maternal glucocoritids (cortisone - makes it inactive)

Answer 61

● ABO phenotypes are controlled by 3 alleles of the ABO gene ■ O - recessive ■ A/B - co-dominant

Answer 62

A (has A antigen, anti B antibody), B (has B antigen, anti A antibody), AB (has a and b antigen, no antibodies), and O (neither B nor A antigen, both anti-B and anti-A antibodies)

Answer 63

ex A = phenotype (expression) , AO or AA (2 alleles) = genotype

Answer 64

● 100% risk of congenital / fetal implications ● **Run 2 confirmation tests:** ■ 1. Non-treponemal test – rapid plasma reagin (RPR); test for biomarkers ■ 2. Treponemal test – TP agglutination; test for antibodies from infection

Answer 65

1st trimester ultrasound pregnancy dating is ideally 7-12 weeks.

Answer 66

KNYPOXEMIA (decreased oxygen in blood) AND HYPOXIA (decreased oxygen in the tissues from Hypoxemia)