LE2 Flashcards

Question

25.A patient on her 10th week of gestation is complaining of nausea and vomiting. This is attributable to rising levels of which hormone? a. FSH b. LH c. HCG d. Prolactin

Answer 1

c. HCG Explanation: Nausea and vomiting in early pregnancy, often referred to as "morning sickness," are commonly attributed to rising levels of human chorionic gonadotropin (HCG), a hormone produced by the placenta after implantation.

Answer 2

B. 280 days Explanation: A normal pregnancy is typically calculated as 280 days, 40 weeks, or 10 lunar months from the first day of the last menstrual period (LMP), which is roughly equivalent to 9 calendar months but more precisely defined in days or weeks.

Answer 3

B. Ampulla Explanation: Fertilization most commonly occurs in the ampulla, the widest section of the fallopian tube, where the sperm meets the egg.

Answer 4

C. Metaphase II Explanation: At the time of ovulation, the oocyte is arrested in metaphase II of meiosis. It will only complete meiosis II if fertilization occurs.

Answer 5

B. There is a temporary arrest at metaphase II Explanation: At the time of fertilization, the secondary oocyte, which is released during ovulation, is arrested in metaphase II. Fertilization triggers the completion of meiosis II, leading to the formation of a mature ovum and the expulsion of a second polar body. This process ensures that the ovum has the correct haploid number of chromosomes before it combines with the haploid sperm to restore the diploid number at fertilization.

Answer 6

B. It commences at the third week after fertilization and lasts up to 8W Explanation: The embryonic period is defined as the time from the third week after fertilization until the end of the 8th week, during which all major organs and structures begin to develop.

Answer 7

D. Implantation Explanation: Implantation involves the blastocyst attaching to and embedding within the endometrium. This critical process typically occurs about 6-10 days after fertilization, which corresponds to days 20-24 of a typical menstrual cycle.

Answer 8

B. Gestational age Explanation: Gestational age is calculated from the first day of the last menstrual period (LMP) and is used to monitor the pregnancy and estimate the due date.

Answer 9

C. She needs to stop the anti-acne treatment. Explanation: Retinoic acid (isotretinoin) is teratogenic and can cause serious birth defects. It is contraindicated in pregnancy, and women are advised to avoid pregnancy during treatment and for some time after the treatment has ended.

Answer 10

B. The period of organogenesis. Explanation: The period from the 3rd to the 8th week of pregnancy is critical for organogenesis, the formation of organs. During this time, the developing embryo is particularly vulnerable to teratogens, which can cause congenital anomalies.

Answer 11

A. Menstrual age Explanation: Menstrual age, also known as gestational age, is calculated from the first day of the last menstrual period. It includes the approximately 2 weeks before ovulation and fertilization occur.

Answer 12

B. 8 weeks after fertilization Explanation: The transition from the embryonic period to the fetal period typically begins at 8 weeks after fertilization, which corresponds to 10 weeks of gestational age (since gestational age is calculated from the first day of the last menstrual period, which is approximately 2 weeks before fertilization).

Answer 13

A. Fetal hyperinsulinemia Explanation: Fetal hyperinsulinemia is a response to maternal hyperglycemia. It stimulates fetal growth and fat deposition, leading to macrosomia.

Answer 14

B. Androgen insensitivity syndrome Explanation: Androgen insensitivity syndrome (AIS) is characterized by the presence of male (46,XY) chromosomes in an individual who has female external genitalia and secondary sexual characteristics but lacks a uterus, cervix, and fallopian tubes due to resistance to the actions of male hormones (androgens).

Answer 15

D. Fundic height could be 25 cm

Answer 16

C. Offer congenital anomaly scan at 18-22 weeks Explanation: A congenital anomaly scan (also known as an anatomy scan) is typically offered between 18-22 weeks of gestation to assess the fetus for any structural abnormalities. This can provide reassurance and is appropriate for addressing concerns about fetal abnormalities.

Answer 17

A. 3-4 months before conception Explanation: Taking folic acid 3-4 months before conception and continuing through the first trimester has been shown to significantly reduce the risk of neural tube defects in the fetus.

Answer 18

A. Renal agenesis Explanation: While premature rupture of membranes is a common cause of oligohydramnios, renal agenesis (the absence of one or both kidneys at birth) directly impacts the production of amniotic fluid, as fetal urine is a major component of amniotic fluid in the second and third trimesters. This condition can lead to significantly reduced amniotic fluid levels because the fetus is unable to contribute to the amniotic fluid volume through urination. This explanation aligns with the context provided about how congenital anomalies, such as renal agenesis, can result in oligohydramnios due to the lack of urine production by the fetus.

Answer 19

C. assignment of age of gestation Explanation: The assignment of the age of gestation is crucial during the initial prenatal visit to establish an estimated due date (EDD), which guides the management and monitoring of the pregnancy. MAJOR GOALS OF PRENATAL CARE * To define the health status of the mother and fetus * To estimate the gestational age * To initiate a plan for continuing obstetrical care

Answer 20

A. Rubella IgG titers Explanation: Rubella IgG titers are important to determine immunity to rubella, as infection during pregnancy can lead to serious fetal complications. Other tests like urine culture and sensitivity (C&S), hepatitis B surface antigen (AntiHepaB S), and pelvic ultrasound are also important but Rubella IgG titers are specifically aimed at unmasking a potentially asymptomatic but harmful condition.

Answer 21

A. Take ginger and candies with meals Explanation: The recommendation to take ginger is based on its effectiveness in reducing nausea and vomiting, as mentioned in "Williams Obstetrics." Ginger has been studied for its antiemetic properties and is considered a safe and natural remedy for nausea and vomiting in pregnancy. Eating small, frequent meals can also help manage these symptoms, and incorporating ginger into the diet or taking ginger supplements can provide relief.

Answer 22

B. 2nd Trimester in patients with complaint of hypogastric pain Explanation: While routine internal examinations at every prenatal check-up are not necessary and are generally not performed on the first prenatal visit unless indicated, specific symptoms such as hypogastric pain in the second trimester warrant a more thorough evaluation. This pain could be indicative of various conditions, including the stretching of ligaments (a normal but sometimes painful part of pregnancy) or more concerning issues like an ectopic pregnancy. Although ectopic pregnancies are more commonly identified earlier in pregnancy (usually before the second trimester), any new onset of pain should be evaluated. The context provided suggests a cautious approach to hypogastric pain, emphasizing the need for an examination in cases where the pain's cause is uncertain and could indicate a serious condition.

Answer 23

B. fetal aging by CRL (Crown-Rump Length) Explanation: In the first trimester, the most critical use of ultrasound is to establish or confirm gestational age through measurements such as the crown-rump length (CRL), which is the most accurate method for dating a pregnancy at this stage. While assessing for fetal congenital anomalies, placental position, and amniotic fluid volume are also important, accurate dating early in pregnancy is crucial for appropriate prenatal care and timing of certain screenings.

Answer 24

B. 28-37W Explanation: The Tdap vaccine is recommended for all pregnant women during each pregnancy, between 28 and 37 weeks gestation (3rd Trimester), to protect against tetanus, diphtheria, and pertussis. This timing optimizes the transfer of maternal antibodies to the fetus, providing protection to the newborn until they are old enough to receive their own vaccinations. Trimester First : 1-14 weeks Second : 15- 28 weeks Third: : 29 - 42 weeks

Answer 25

B. MMR Explanation: The MMR (measles, mumps, and rubella) vaccine is contraindicated during pregnancy because it is a live-attenuated vaccine. Live vaccines are generally avoided during pregnancy due to theoretical risks to the fetus. Hepatitis B vaccine is not contraindicated during pregnancy, Hepatitis C vaccine does not exist, and the Inactivated Influenza vaccine is recommended during pregnancy.

Answer 26

C. Gestational Age Explanation: Gestational age is a critical determinant of appropriate care in pregnancy as it guides the timing of prenatal visits, interventions, and assessments to optimize both maternal and fetal health. It helps in monitoring the pregnancy's progress and planning for the delivery. MAJOR GOALS OF PRENATAL CARE * To define the health status of the mother and fetus * To estimate the gestational age * To initiate a plan for continuing obstetrical care

Answer 27

A. 18-22 weeks Explanation: If only one ultrasound is to be performed during pregnancy, doing it between 18-22 weeks gestation is most beneficial. This timing allows for a detailed anatomy scan to assess fetal structures for abnormalities, determine placental location, and verify fetal growth and well-being. This period is optimal for detecting a wide range of potential issues that could affect the pregnancy's outcome.

Answer 28

B. 16 Explanation: The uterus reaching halfway between the symphysis pubis and the umbilicus typically indicates a gestational age of approximately 16 weeks. This is a general physical examination finding used to estimate gestational age in the second trimester. Height recorded in cm = approximate AOG in weeks * 12 weeks after LMP - Above pubic symphysis * 16 weeks - Halfway between pubic symphysis and umbilicus * 20 weeks - At the level of umbilicus * 36 weeks - Fundus is just below ensiform cartilage

Answer 29

D. AOTA (All of the Above) Explanation: After birth, the umbilical vessels, ductus venosus, and foramen ovale all undergo functional closure or constriction as part of the normal physiological transition from fetal to neonatal circulation.

Answer 30

C. Chadwick's sign Explanation: Chadwick's sign is the change in color of the vaginal mucosa to a deep violet or bluish color due to increased vascularization and blood flow, considered a presumptive sign of pregnancy.

Answer 31

C. Hegar's sign Explanation: Hegar's sign is the softening of the lower uterine segment (isthmus), making it compressible on bimanual examination, and is considered a probable sign of pregnancy.

Answer 32

C. Goodell's sign Explanation: Goodell's sign is the softening of the cervical tip due to increased vascularity, edema, and softening of the cervical tissue, making it a probable sign of pregnancy.

Answer 33

A. Request for an ultrasound to determine or confirm age of gestation, or detect any fetal compromise Explanation: Given the discrepancy between the gestational age based on the last menstrual period and the fundal height measurement, an ultrasound is the next best step to accurately assess gestational age, evaluate fetal growth, and check for any signs of fetal compromise.

Answer 34

A. Do pregnancy test Explanation: Given the history of a missed period and the presentation with nausea and vomiting, a pregnancy test is the first and most appropriate step to confirm or rule out pregnancy as the cause of her symptoms.

Answer 35

B. Advise her that the GI symptoms will abate after the first trimester, correlating with the levels of beta HCG in her blood Explanation: Nausea and vomiting in pregnancy, often referred to as morning sickness, typically peak during the first trimester and tend to improve as beta HCG levels plateau and then decrease. Most women experience relief from these symptoms by the end of the first trimester or early in the second trimester.

Answer 36

D. Reassure the patient and advise her that quickening does not happen until at least 4-5 months of gestation Explanation: Fetal movements, or quickening, are typically first felt by primigravidas around 18-20 weeks of gestation (4-5 months). It is normal not to feel any fetal movements at 10-11 weeks of gestation, and reassuring the patient about this normal timeline can help alleviate her anxiety.

Answer 37

B. Reassure the patient that she might just be experiencing Braxton-Hicks contractions, which are normally felt starting 28 weeks age of gestation Explanation: Braxton-Hicks contractions are common and typically start around the second or third trimester of pregnancy. They are irregular, usually painless contractions that do not lead to cervical changes (dilation or effacement), distinguishing them from true labor contractions.

Answer 38

A. Progesterone Explanation: Progesterone, which increases during pregnancy, is responsible for changes in cervical mucus, including the beaded cellular pattern. This hormone helps maintain the pregnancy and changes the consistency of cervical mucus to form a mucus plug, protecting the uterus from infections.

Answer 39

D. Ballottement Explanation: Ballottement is a technique used in pregnancy examination where a sudden tap on the cervix during a pelvic exam causes the fetus to rise in the amniotic fluid and then rebound to its original position. It is considered a probable sign of pregnancy.

Answer 40

A. Pseudocyesis Explanation: Pseudocyesis is a condition where a woman believes she is pregnant and may even exhibit signs and symptoms of pregnancy, but there is no actual pregnancy. It is often associated with a strong desire or fear of becoming pregnant.

Answer 41

B. Hyperemesis gravidarum Explanation: Hyperemesis gravidarum is a condition characterized by severe nausea and vomiting in pregnancy that can lead to dehydration, weight loss, and electrolyte imbalances. It is more likely to occur in conditions associated with high levels of human chorionic gonadotropin (hCG), such as multiple pregnancies or molar pregnancies.

Answer 42

D. Double check the nurse's findings by quickly recounting the fetal heart rate. The nurse must have measured the maternal pulse instead. Explanation: A fetal heart rate of 80 beats per minute is abnormally low, as normal fetal heart rates range from 110 to 160 beats per minute. It's possible the nurse accidentally measured the maternal heart rate instead of the fetal heart rate.

Answer 43

C. supports early pregnancy by preventing involution of corpus luteum Explanation: hCG is produced by the placenta after implantation. Its primary function in early pregnancy is to prevent the involution of the corpus luteum, ensuring it continues to produce progesterone and estrogen to maintain the uterine lining and support early pregnancy.

Answer 44

B. 20 Explanation: The uterus typically reaches the level of the umbilicus at about 20 weeks of gestation, making this the most likely estimate for the age of gestation. Height recorded in cm = approximate AOG in weeks * 12 weeks after LMP - Above pubic symphysis * 16 weeks - Halfway between pubic symphysis and umbilicus * 20 weeks - At the level of umbilicus * 36 weeks - Fundus is just below ensiform cartilage

Answer 45

a. Primipara Explanation: A primipara is a woman who has given birth once to a fetus or fetuses, alive or dead, at a gestational age of 20 weeks or more.

Answer 46

B. at 24 weeks AOG - Explanation: Routine prenatal visits for a low-risk pregnancy are typically scheduled every four weeks until about 28 weeks of gestation, then more frequently as the pregnancy progresses. Advising a follow-up at 24 weeks AOG fits within this schedule and allows for appropriate monitoring of the pregnancy's progression.

Answer 47

A. Condom Explanation: Condoms are the only contraceptive method that also provides significant protection against sexually transmitted infections (STIs), including gonorrhea.

Answer 48

B. IUD Explanation: For a woman with rheumatic heart disease and mitral stenosis who needs effective contraception and whose partner refuses to use condoms, an intrauterine device (IUD) could be a suitable option. It provides long-term contraception without the systemic effects that might exacerbate her condition, unlike oral contraceptive pills which could increase her risk for thromboembolic events.

Answer 49

B. IUD Explanation: An intrauterine device (IUD) is a good option for someone who is forgetful and seeks effective, long-term contraception. It does not require daily attention and provides one of the highest effectiveness rates among contraceptive methods.

Answer 50

C. Diaphragm Explanation: The diaphragm is a barrier method of contraception that must be used with spermicide to be effective. It needs to be inserted before intercourse and left in place for at least 6 hours after sex to ensure effectiveness, but not longer than 24 hours. Given the scenario of a woman with multiple sexual partners and the desire for effective contraception without the disadvantages associated with frequent spermicide use and the need for careful timing in removal, the diaphragm might be considered less advantageous compared to other options like condoms, which also provide STI protection, or an IUD, which does not require action at the time of intercourse.

Answer 51

D. Oral contraceptive pills Explanation: The description of severe leg cramps and the finding of a 60% occlusion of the right femoral vein suggest a deep vein thrombosis (DVT), a known risk associated with the use of oral contraceptive pills (OCPs), especially in individuals with risk factors for thromboembolic event

Answer 52

D. Levonorgestrel-containing IUD (LNG-IUD) Explanation: The LNG-IUD is a long-acting reversible contraceptive (LARC) that doesn't require daily attention, making it ideal for someone who doesn't want to remember to take a pill every day. It's also cost-effective over time, despite the initial higher upfront cost, and doesn't involve injections.

Answer 53

D. LNG-IUD Explanation: The LNG-IUD not only provides effective contraception but can also reduce menstrual bleeding and decrease endometrial thickness. It's suitable for someone who is forgetful and doesn't prefer injections.

Answer 54

A. Oral contraceptive pills Explanation: Certain oral contraceptive pills are approved for the treatment of acne. They regulate hormones that can cause acne, making them a good choice for someone looking to address both contraception and acne improvement.

Answer 55

B. Injectable contraceptives Explanation: While injectable contraceptives are not as short-acting as oral pills, they offer a good balance between ease of use (with injections typically every three months) and the flexibility to stop use if desired. However, given her forgetfulness, a better long-term solution might be considered, but among the options provided and considering her preferences, injectables might suit her current needs best.

Answer 56

A. Oral contraceptive pills Explanation: Oral contraceptive pills offer flexibility and control over family planning, suitable for someone whose partner is away for extended periods and who may only need contraception intermittently. However, this option requires daily adherence to be effective.

Answer 57

D. Transdermal patch Explanation: The transdermal contraceptive patch is applied once a week for three consecutive weeks, followed by a one-week break during which menstruation occurs.

Answer 58

B. Diaphragm Explanation: The diaphragm is a barrier method of contraception that should be left in place for at least 6 hours after intercourse to ensure effectiveness but not longer than 24 hours.

Answer 59

C. Intrauterine device Explanation: While the risk is primarily associated with the insertion process and is relatively low, intrauterine devices (IUDs) have been historically linked to an increased risk of pelvic inflammatory disease (PID) due to the potential for ascending infections, especially in the presence of an STI at the time of insertion.

Answer 60

A. Oral contraceptive pills Explanation: Oral contraceptive pills, especially those containing estrogen, are associated with an increased risk of thromboembolism (blood clots), particularly in women who smoke or have other risk factors for cardiovascular disease.

Answer 61

C. Intrauterine device Explanation: The "wick" effect was a concern with older models of IUDs, where the string of the device could potentially act as a conduit for bacteria to enter the uterine cavity, leading to infection. However, this risk is considered very low with modern IUDs, and they are a safe and highly effective form of contraception for most women.

Answer 62

B. Diaphragm Explanation: Spermicide is applied to the diaphragm before insertion to increase its effectiveness in preventing pregnancy.

Answer 63

D. March 20, 2022 Explanation: For a 27-30 day cycle, subtract 18 days from the shortest cycle (27) to estimate the start of the fertile window, which is day 9 of the cycle. Counting from March 12 (day 1), day 9 would be March 20.

Answer 64

C. April 21, 2022 Explanation: For a 27-32 day cycle, subtract 11 days from the longest cycle (32) to estimate the end of the fertile window, which is day 21 of the cycle. Counting from April 1 (day 1), day 21 would be April 21.

Answer 65

A. March 10, 2022 Explanation: For a 28-30 day cycle, subtract 18 days from the shortest cycle (28) to estimate the start of the fertile window, which is day 10 of the cycle. Counting from March 1 (day 1), day 10 would be March 10.

Answer 66

B. April 5, 2022 Explanation: For a 29-31 day cycle, subtract 18 days from the shortest cycle (29) to estimate the start of the fertile window, which is day 11 of the cycle. Counting from March 26 (day 1), day 11 would be April 5.

Answer 67

A. April 3, 2022 To calculate the last day of the fertile period, you subtract 11 days from the longest cycle length. For a 31-day cycle, this would be day 20 of the cycle. Starting from March 15, which is day 1, the last day of the fertile period would be: March 15 + 19 days = April 3, 2022.

Answer 68

C. She is likely to develop thromboembolism. Explanation: The postpartum period is associated with an increased risk of thromboembolism, and estrogen in combined oral contraceptive pills can further increase this risk.

Answer 69

D. All of the above Explanation: The effectiveness of condoms can be compromised by not covering the entire penile shaft, using them only at the moment of ejaculation, and rough handling leading to tears.

Answer 70

D. Any of the above Explanation: The calendar method's effectiveness can be compromised by irregular menstrual cycles, misidentification of menstrual bleeding, and errors in tracking dates.

Answer 71

A. Levonorgestrel containing IUD - Explanation: A levonorgestrel-containing IUD is a safe and effective long-term contraceptive method that does not carry the risk of increasing blood pressure or the risk of thromboembolism associated with estrogen-containing contraceptives. It would be suitable for someone with a history of pre-eclampsia where avoiding additional cardiovascular risk factors is advisable.

LE2 Flashcards

(95 cards)