NCCPA Flashcards

PANCE prep (32 cards)

1
Q

Nageles Rule

A

Subtract 3 mo from LMP and add 7 days for EDC

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2
Q

Parity

A

delieveries; FPAL - full term (>37w), preterm (20-36), abortion (<20) and living children #

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3
Q

Fetal heart tones can be heard at

A

10-12 w

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4
Q

Quickening

A

First awareness of fetal movements (18-20w in nullip and earlier (14-16) in multiparous woman)

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5
Q

Trimesters

A

1: week 1-12
2: week 13-27
3: week 28-40

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6
Q

Screening: first trimester

A

nuchal US, PAPP-A and b-HCG detects 82-87% of trisomy 21s
abn US, elevated b-HCG and dec PAPP-A
if positive, can offer chorionic villus sampling (CVS) or amniocentesis
*10-13 wks

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7
Q

Screening: second trimester

A

unconjugated estriol, AFP, inhibin A
abn low estriol/AFP and high inhibin A = trisomy 21/genetic dx
high AFP = NTD (can detect 75-85% open defects

*amnio also performed in 2nd trimester - 15-18wks
lower risk of abortion but later test if abortion desired

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8
Q

Screening: third trimester

A

NST, BPP

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9
Q

NST

A

normal if two accels (hr inc >15bpm) for 15 sec when tested for 20 min w no decels
abn: decels

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10
Q

BPP - biophysical profile

A
five parameters (2pts ea; total 10pts)
NST
amniotic fluid level
gross fetal movt
fetal tone
fetal breathing
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11
Q

Ectopic preg

A

MC in fallopian tube
risks=prev ectopic, saplingitis, abd/tubal surg, IUD, and assisted repro
serum levels of hCG double q 48h - if less think ectopic
transvag US makes dx in 90% (should see gestation when hCG>1500)

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12
Q

Ectopic treatement

A

Methotrexate can treat 80% (serum hCG <3.5cm, hemodynamically stable, compliant pt)
laparoscopy

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13
Q

Gestational trophoblastic disease (GTD)

A

complete/partial hydatidiform moles; placental site invasive moles; trophoblastic tumors; choriocarcinomas

Treat tumors with chemo; rad and surg PRN

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14
Q

Hydatidiform moles

A

Bengin form of GTD.

Complete: MC. empty egg. “grapelike vesciles” or “snowstorm pattern” on US. 20% progress to malignancy.
partial: fetus present but nonviable. 100,000)

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15
Q

Complications of gestational DM

A

maternal: preeclampsia, hyperacceleration of DM comps, traumatic birth/dystocia, risk of DM post-birth
fetal: macrosomia, prematurity, fetal demise, and delayed fetal lung maturity

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16
Q

gestational DM screening

A

24-28 weeks with glucose challenge test at 1 hour. if abn, need 3 hr OGTT
test high risk (prev lg infant, >25 yo, glucosuria, fam hx DM, non-wt ethnicity) also in 1st tri

17
Q

Gestational DM tx

A

oral agents not useful

need insulin if fasting >105 or 2hr PP >120

18
Q

tx of chronic htn in preg and preg-induced htn (after 20 wks)

A

monthly US for growth retardation, serial BPs and urine protein, weekly NST in 3rd tri

Meds only if severe - methyldopa is drug of choice; labetalol is alternative

19
Q

classic triad of preeclampsia

A

HTN, edema and proteinuria (edema not nec for dx)
risk if extremes of gae, multigestation, DM, chronic HTN
Eclampsia is seizures

20
Q

pre/eclampsia

A

> 20 wks; can occur 6 wks post-partum

21
Q

HELLP syndrome

A

pre-eclampsia with Hemolysis, Elevated Liver enzymes and Low Platelets

22
Q

Rho-Gam

A

admin routinely at 28-29 wks to all Rh-neg moms. Given again following delivery if baby is Rh-pos.

also given after ectopic, spon/ther abortions, CVS, amniocentesis, trauma

23
Q

MCC third tri bleeding

A

abruptio placentae

24
Q

first stage of labor

A

onset of reg contractions to full dilatation

6-20h nullip; 2-14 multip

25
second stage of labor
full dilatation to delivery | 30min to 3h nulip; 5-60min multip
26
third stage of labor
separation and delivery of placenta; 5 min
27
fourth stage
first hour after delivery - assess tears, lacs, hemorrhage
28
early decels
mirror contractions; often head compression prior to second stage
29
variable decels
no pattern; usu cord compression; benign if mild/infreq
30
late decels
bad; need delivery; denote uteroplacental insufficiency
31
APGAR score
Activity, Pulse, Grimace, Appearance, Respiration 0,1, or 2 pts each Activity- absent, arms/legs flexed, active movt P - absent, 100 G- no response, grimace, coughs/pulls away A- Blue/pale, agrocyanosis, pink all over R- absent, slow/irreg, good/crying
32
Endometritis
``` usu post- CSec or PROM fever, uterine tenderness, leukocytosis tx with clindamycin plus gentamicin - add ampicillin if no response in 24h add metronidazole if septic tx til afebrile x 24h ```