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MTB 1 Flashcards

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1
Q

What causes morning sickness

A

Increase in b-HCG produced by placenta

- up to 12-14 weeks

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2
Q

One of first signs seen in pregnancy on PE

A

Goodell sign

- Softening of cervix at 4 weks

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3
Q

What is Chadwick sign and when do we see it

A

Bluish discoloration of the vagina and cervix

6-8 wks

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4
Q

What is Chloasma and when do we see it?

A

Hyperpigmentation of face, forehad, nose, cheeks

16 wks

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5
Q

What is linea nigra and when do we see it?

A

Hyperpigmentation line from xiphoid to pubic symphysis

Second trimester

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6
Q

B-HCG production

A 
By placenta
Doubles every 48 hrs for first 4 weeks
Peaks at 10 weeks 
Drops in second trimester
Increase again in 3rd trimester to 20,000-30,000
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7
Q

When is a gestational sac seen on US?

A

5 weeks

1000-15000 B-HCG

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8
Q

What Cardio changes take place in pregnancy

A

Increased CO, HR, SV, Plasma volume

Slightly decreased BP

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9
Q

GI changes take place in pregnancy

A

Increase in estrogen and progesterone - morning sickness
Reflux esophagitis
Cholelithiasis
Constipation - decreased motility in LI, decrease smooth m wall tone, Increase emptying time
LES - decreased tone

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10
Q

Renal changes take place in pregnancy

A

Increased kidney size and ureters - increase risk of pyelonephritis
Increase GFR (Increase plasma volume
Decrease in BUN/Cr - increase renal plasma flow, increase Cr clearance
Decrease serum uric acid

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11
Q

Heme changes take place in pregnancy

A

Anemia = Plasma Volume increase
Hypercoaguable state- Increase fibrinogen, Virchow triad
Increase in RBC mass, WBC count, ESR
Decrease in Hg/Hct

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12
Q

Respiratory changes take place in pregnancy

A

Increased TV, Minute ventilation, increased pH

Decreased pCO2, HCO3

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13
Q

Skin changes take place in pregnancy

A

Striae gravidum

Spider angiomata, palmer erythema, chadwick sign = increase vascularity

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14
Q

When are fetal heart sounds heard?

A

End of first trimester

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15
Q

Thickened or enlarged nuchal translucency

A

Down Syndrome

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16
Q

Endocrine changes take place in pregnancy

A

Cortisol increased 2-3X
Thyroid size increased
TBG, T4, T3 increased
NO change in TSH, TRH, Free T3, T4

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17
Q

Most accurate way to check GA at 11-14 wks

A

US

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18
Q

When is triple or quad screen performed?

A

15 - 20 wks

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19
Q

What is Quad screen

A

MSAFP
Estriol
b-HCG
Inhibin A (not in triple screen)

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20
Q

Increased MSAFP is what

A

Dating error
NTD
Abdominal wall defect

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21
Q

Decreased MSAFP is what

A

Down syndrome

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22
Q

What testing is done at 27 weeks

Study These Flashcards
A

CBC

if Hb < 11 = replace iron

23
Q

When is glucose load test done?

Study These Flashcards
A

24 - 28 weeks

If glucose > 140 at one hour, do oral glucose tolerance test

24
Q

Which tests are done at 36 wks

Study These Flashcards
A

Cervical culture for chlamydia and gonnorrhea
Rectovaginal culture for GBS

TX if positive

25
When are PPX Abx given for GBS + mothers
IV Pen G during labor | If allergic, Clindamycin, Vancomycin
26
What is the glucose load test and tolerance test? | What is a positive result?
Load: fasting/non-fasting ingestion of 50 g glucose, check in 1 hour Tolerance test: fasting serum glucose, ingest 100 glucose, serum glucose checks at 1,2,3 hours Elevated during any 2 is gestational diabetes
27
When is chorionic villus sampling done?
9-12 weeks in advanced maternal age
28
When is amniocentesis done?
14-18 weeks (after 15)
29
Why is CVS done?
To obtain fetal karyotype
30
Why is amniocentesis done?
To obtain fetal karyotype
31
What is fetal blood sampling used for
PUBS | Done in RH isoimmunized pts when fetal CBC needed
32
What are complications of CVS
``` Fetal loss Limb reduction Infxn Bleeding Ob complication - preterm, placenta previa/abruptio ```
33
How does hyperemesis gravidum present When? Tx?
``` Severe vomiting Wt loss Ketonuria Weeks 4-10 Resolves on own ```
34
What are risk factors for ectopic pregnancy?
PID IUD Previous ectopic pregnancies Congenital DES
35
What is the workup for ectopic pregnancy?
1. B-HCG If < 1500 = repeat in 2-3 days If >1500 = TV US
36
Tx for ectopic pregnancy - Not ruptured
- MTX if b-HCG < 6,000 | - Surgery w/laparoscopy if b-HCG >6,000
37
Tx for ectopic pregnancy - ruptured Stable? Unstable?
Stable -> Laparotomy | Unstable -> IVF, blood products, dopamine -> Laparotomy
38
If treating w MTX for ectopic, how to monitor
``` 1. First dose given. Check b-HCG 4-7 days later IF > 15% drop in b-HCG = Observe IF < 15% drop in b-HCG = 2nd dose of MTX - if persistently high b-HCG - > Surgery - if > 15% drop = observe ```
39
MTX is CI in whom?
``` Pts that have completed families Immunodeficient Non-compliant Liver dz Ectopic is 3.5 cm or larger ```
40
Which Abortions present w dilated cervix
Inevitable
41
What is an abortion
Pregnancy that ends before 20 wks
42
Presentation of abortion
Cramping abdominal pain | Vaginal bleeding
43
D&C is tx for which abortions
Incomplete Inevitable Missed Septic + Abx (Levofloxacin and metronidazole)
44
Abortion with internal os closed?
Incomplete | Threatened
45
Tx for threatened abortion
Bed rest | Pelvic rest
46
What is the difference b/t incomplete, inevitable and threatened abortion?
Incomplete - Some POC Inevitable - POC in tact, IU bleeding, Dilated cervix Threatened - POC in tact, IU bleeding, NO dilation of cervix
47
What is a missed abortion
Death of fetus | ALL POC in uterus
48
How does cervical incompetence present
Painless Dilatation of cervix | No hx of CTX
49
Risk factors for preterm labor
``` PROM Multiple gestations Previous hx of preterm Placental abruption Maternal factors - chorioamnionitis, preeclampsia ```
50
Who do we see intraventricular hemorrhage (IVH) in
Premies | Low birth weight infants
51
How does IVH present
``` Pallor Cyanosis HypoTN Seizures Focal neuro sx's Bulging, tense fontanelle Apnea Bradycardia Bleeding in germinal matrix ```
52
When do we deliver preterm babies
Maternal severe HTN (preeclampsia, eclampsia) Maternal cardiac dz Maternal cervical dilation > 4 cm Maternal Hemorrhage - abruptio placenta, DIC Fetal Death Chorioamnionitis
53
What should be given w/corticosteroids in preterm
Tocolytics - decrease uterine CTX and slow cervical dilation progression, allowing time for steroids to work

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