Part 40 Flashcards
(150 cards)
1
Q
Primary vs secondary CNS tumors
A
Primary originate in the tissue of the brain (meninges, glial cells, nerve sheath, etc) vs secondary which is due to metastasis
2
Q
The most common type of primary CNS tumor in children and 2 most common in adults
A
Glioma, glioma and meningiomas
3
Q
Most CNS tumors in adults are…
A
….metastatic in origin
4
Q
In adults most CNS tumors are ___ while in children they are ____
A
Supratentorial, infratentorial
5
Q
Risk factors for CNS tumor development (3)
A
- Ionizing radiation exposure
- genetics
- trauma or infection
6
Q
Classic presentation raising concern for a CNS tumor (4)
A
- Seizure
- focal neuro deficits
- cognitive dysfunction
- increased ICP
7
Q
Classic triad of increased intracranial pressure
A
Headache, nausea, papilledema
8
Q
Rapidly growing tumors cause ___ while slow growing tend to cause ___
A
headaches, seizures
9
Q
Headache caused by brain tumor accounts for __% of headaches in the general population, how is it typically prescribed?
A
1%, nonpulsatile bandlike pain around the head (tension type) almost always with other deficits
10
Q
Red flags for headache and CNS lesions that require neuroimaging (6)
A
- Acute severe headache onset after 50
- headache changed form previous pattern
- headache on exertion, onset at night or early morning, progressive in nature
- new neurologic signs accompanying
- associated with illness
- precipitation with valsalva
11
Q
Imaging study of choice for concern of headache being related to CNS lesion and one alternative
A
- MRI with contrast
- CT with contrast
12
Q
If a tumor is found on CNS then next step is to…
A
….screen for systemic malignancy via CT of chest/abdomen/pelvis and then refer to neurosurgery. Metastases may not need biopsy if known primary source
13
Q
3 fundamental treatments for CNS tumors
A
- surgical resection
- radiotherapy or chemotherapy
- shunting for hydrocephalus
14
Q
Noninvasive symptom treatment for CNS tumor (5)
A
- glucocorticoids (high dose dexamethasone for severe symptoms unless suspicion for lymphoma)
- analgesics
- Anticonvulsants
- VTE prophylaxis if immobilized (heparin)
- palliative care
15
Q
Astrocytoma
A
Most common intracranial glioma part of brain itself linked to ionizing radiation and rare genetic syndromes, good prognosis if resected
16
Q
Glioblastoma
A
Very aggressive type of glioma with necrotic center that has median survival rate of 12-15 months and a high recurrence rate
17
Q
Meningioma
A
Most common primary brain tumor, often slow growing and some are benign, treated with large surgical resection otherwise radiation and or chemo, sometimes if small watchful waiting
18
Q
Oligodendroma
A
A type of glioma that is more responsive and has a better prognosis compared to a astrocytoma, treatment is surgical resection and radiation with a median survival >10 years
19
Q
Schwannoma
A
A nerve sheath tumor that is progressive unilateral hearing loss affecting the vestibule, treated with surgical resection
20
Q
Ependymoma
A
A type of glioma usually in the spinal canal and curable with surgical resection
21
Q
Medulloblastoma
A
A embryonal malignant, most common tumor in children that 70% survive but have cognitive impairment, treated by surgical resection, radiation, and chemo
22
Q
CNS Lymphoma
A
A B cell malignancy that usually occurs in the immunosuppressed and may be a single mass, multiple masses, or meningeal, requires testing for HIV and a PET scan, treated by radiation, chemo, methotrexate
23
Q
Pituitary adenoma
A
CNS tumor originating from hormone producing cells in pituitary, nearly all are benign but depending on cell type cause different conditions (prolactinoma, acromegaly, and cushing’s disease), treatment is pharmacologic with surgery if needed
24
Q
Most common metastatic lesions to CNS (5)
A
- lung
- breast
- melanoma
- renal
- GI
25
The nerve responsible for all types of primary headache disorders (migraine, tension type, etc)
Trigeminal autonomic cephalgias
26
Common vs classic migraine
Common is without aura and classic is with
27
Tegretol requires monitoring of ___ because of risk of...
Blood count, aplastic anemia
28
Can DVT cause TIA?
Yes, even though lungs are in way if a patient has a patent ovale allowing for shunting
29
Tuberous sclerosis inheritance pattern
Autosomal dominant
30
Lhermitte sign and what is it indicative of?
Electric shock down neck to arms and legs triggered by bending head forward to test, indicative of MS
31
B12 deficiency causes defect in what column of the spine?
Posterior
32
Bell's palsy definition
Idiopathic facial nerve palsy
33
Recall the 3 trimesters of pregnancy
0-13 is first
14-28 is second
28-end (typically 40) is third
34
Most common signs that cause patients to come for a pregnancy eval
missed menstrual period (a week to 2 weeks late)
35
Gestational age =
Embryonic age (from fertilization) + 2 extra weeks (from the last period)
ASSUME GESTATIONAL AGE UNLESS OTHERWISE INDICATED***
36
Symptoms 1-2 weeks after fertilization in the mother (5)
- breast tenderness
- nipple sensitivity
- extreme fatigue**
- nausea
- urinary frequency
37
Pelvic exam uterus sizing
Should be able to correlate uteral enlargement with menstrual dates, if smaller than expected may be ectopic, spontaneous abortion, etc. and if uterus larger than expected may indicate uterine leiomyomata, twin gestation, molar pregnancy
38
Molar pregnancy
When a nonviable fertilized egg implants in the uterus and will fail to come to term, seen most often in patients under 20 or over 45, causes mass to grow in the uterus that appears as a "snowball" shape on ultrasound and can become cancerous excreting excess, extremely high hCG (extreme nausea and other symptoms)
39
hCG levels during pregnancy
Detected in serum levels as early as 7-9 days after ovulation, very soon after implantation it begins secreting, being 50-250 mIU/ml by time of first missed period, First 3 to 4 weeks after fertilization should double every 2 days, peaks 60-70 days (100k mIU/mL!) after fertilization then decreases dropping within 4 weeks completely off upon completion/late term abortion, if abnormally low can be due to spontaneous abortion or ectopic pregnancy, if abnormally high can be due to multiple pregnancies or molar pregnancy
40
hCG function in pregnancy (5)
- Maintain corpus luteum
- stimulate both adrenal and placental steroidogenesis
- stimulate fetal testes to secrete increasing amounts of testosterone to induce internal virilization
- hCG is immunosuppressive and may be involved in materal lymphocyte function
- hCG possesses thyrotrophic activity (see hypothyroidism in mother after birth before returning to rise)
41
Early pregnancy factor (EFP) test
A product of platelet activation and cell proliferation secreted into circulation from cytoplasm, earliest known marker of fertilization and can be measured to determine if pregnant almost immediately
42
Even 2 weeks after first semester abortion hCG levels may be...
If it remains at that value even after the allotted time, might be indicative of these 3 pathologies
....very high, with pregnancy tests still reading positive up to 40 days after 1st trimester abortion
- continuing missed intrauterine pregnancy
- retained placental fragment
- ectopic pregnancy
43
Fetal movement should occur at least at ___ weeks gestation otherwise trouble!
19
44
At what week can the fetal heart be demonstrated to beat on TRANSVAGINAL ultrasound, how about on low doppler ultrasound?
4-6 weeks post conception or 6-8 gestational
10-12 weeks gestational age
45
Blighted ovum definition
Loss of definition of gestational sac or absence of fetus by 7-8 weeks of amenorrhea despite the body still believing it is pregnant for several more weeks before it eventually miscarries resulting in heavier menses as the tissue collapses, can be confirmed by ultrasound to see the empty sac
46
Hegar sign***
Palpable softening of the lowest part of the uterus at 6 weeks (just above the cervix)***, indicative of probable evidence of pregnancy
47
McDonald sign***
When the uterine body and cervix can be easily flexed against once another*** indicative of probable evidence of pregnancy
48
Chadwick sign***
Mucus membranes of vulva, vagina, and cervix becoming congested and having blue hue between 6-8th weeks gestation*** indicative of probable evidence of pregnancy
49
Goodell sign****
Softening of the cervix by beginning of 2nd month of pregnancy**** indicative of probable evidence of pregnancy
50
Braxton hicks contractions
Not normally felt until 3rd trimester but some women in the 1st trimester, painless and irregular contractions "false labor pains"
51
Nausea in pregnancy and how is it relieved?
Occurs in 2-12 weeks of pregnancy in approx half of pregnant patients, subsides 6-8 weeks later, rarely persists thru whole pregnancy (hyperemesis gravidarium), rarely occurs after 1st trimester, most severe upon waking and tends to lessen as day progresses, treated with simple things such as food avoidance etc and occasionally a zofran
52
Linea nigra
Dark lines descending from the umbilicus due to deposits of melanin that falls off upon delivery
53
Bladder irritability in pregnancy (4)
- early in pregnancy enlarging uterus puts pressure on bladder
- hormonal changes increase urinary frequency
- usually resolves by 2nd trimester
- returns late pregnancy when head descends into pelvis and puts pressure on bladder
54
Pseudocyesis
Imaginary pregnancy with high progesterone and hCG, most often occurs in women nearing menopause or young who have an unfulfilled desire for pregnancy, will swear they are feeling the baby moving despite no actual fetus has implanted in them
55
Fetoplacental unit incomplete upon observation of delivery indicates...
....partial retention of part of the placenta, requires immediate removal to prevent bleeding complications
56
3 layers of adrenal cortex and what they secrete,what does the adrenal medulla secrete?
```
Zona glomerulosa (aldosterone)
Zona fasiculata (cortisol)
Zona reticularis (androgens, DHEA - largest portion during developing fetus and stimulated by increased prolactin in fetal pituitary)
```
Catecholamines (epi and norepi
57
Human placental lactogen (hPL) and what 2 conditions do low values raise concern for?
Originates in the placenta and is present around the 5th week of pregnancy, antagonizes cellular action of insulin decreasing glucose utilization in mother shifting glucose availability toward the fetus, measured in 2nd trimester if concern
-threatened abortion and IUGR
58
Progesterone definition
Most important hormone in pregnancy, in luteal phase induces secretory changes in the endometrium, typically well above 20mg/ml but if <5ng/mL indicates a nonviable pregnancy, acts by preventing uterine contractions, produced by ovary up to 6-7 week of pregnancy and then transfer to the placenta, fetus inactivates by transformation of it into corticosteroids at the adrenal gland
59
Most abundant form of estrogen of pregnancy, young lady, and old lady
What does a sudden decline of estriol in maternal circulation indicate?
Estriol, estradiol, estrone
-fetal compromise
60
glucocorticoids function in pregnancy
Maturation of the lungs (differentiation of type ii alveolar cells secreting surfactant)
61
Relaxin function
Has a role in cervical ripening and pubic bone relaxation, as well as hemodynamic changes, helps the cartilage throughout the entire body relax
62
Oxytocin function
Causes uterine contractions, role in initiating labor is unclear, administered can induce labor but only at or near term
63
Alpha fetoprotein (AFP) function****
produced by the fetal liver, measured in the 2nd trimester, tends to be elevated in pregnancies supporting fetuses with neural tube defects and lowered in cases of down syndrome (do an amniocentesis if doesn't match percentile for week gestational age)
64
Anatomic changes in pregnancy (8)
- increased vasularity
- increased pigmentation of face, areola, abdomen (linea nigra), and genitalia
- head sees mild changes in the scalp, excessive oil or dryness
- friable gums
- increased respiratory effort and rate
- exaggerated heart sounds
- abdomen distension, diminished bowel sounds and displacement
- musculoskeletal relaxation of pelvis, lordosis, sciatica
65
Uterine enlargement movement thruout pregnancy (12, 16, and 36 weeks)
Enlargement should occur in linear faction 1cm per week
- at 12 weeks fundus at the pubic symphysis
- 16 weeks midway to the umbilicus
- 36 weeks just below the xiphoid process
66
Physiologic changes of pregnancy (7)
- 50% increase in plasma volume (physiologic anemia)
- increased o2 carrying capacity of RBC's
- 20-30% increase in stroke volume
- 40% increase in cardiac output
- systolic pressure falls only slightly, diastolic decreases markedly (might pass out)
- mechanical circulatory obstruction of inferior vena cava when lying supine
- slight fall in inspiratory reserve because of diaphragm compression but total body o2 consumption increases
67
BUN and creatinine in pregnancy****
Renal blood flow and GFR increase early in pregnancy and plateau at 40% above nonpregnant levels, BUN and creatinine should be decreased due to increased GFR, in pregnancy induced hypertension, values increase to nonpregnant levels due to pathological arterial spasm and vasoconstriction,
68
Placenta lacks enzyme 17alpha hydroxylase and therefore cannot convert progesterone to...
....estrogen, must use androgens from fetal adrenal reticularis
69
ACTH is produced in the placenta and resistant to the...
....dexamethasone suppression test
70
Alk phos, choleseterol, serum iron, and total iron binding capacity, cortisol levels in pregnancy
```
Doubled
not accurate
decrease
increased
nearly 3x higher than nonpregnant reaching levels of cushings
```
71
Cotyledons definition
Invaginations and folds that attach the placenta to the maternal wall, houses villi and membrane where exchange from spiral arteries of the uterus to the umbilical vein occurs, can be left behind in the uterus upon delivery
72
Fetal maternal communication of circulation
There is no commingling of maternal and fetal blood in a healthy pregnancy, always separated in theory
73
Pre-implantation genetic screening
Culturing of a blastocyst in a petri dish incubated followed by PCR to determine the genetic karyotyping (if its aneupleudy then won't successfully thrive but if euploidy then implantable) where implanting has led to increased success of in vitro fertilization
74
Zona pellucida
Wall that is penetrated by sperm enzymatically, remains intact and disappears just before implantation
75
Fertilization takes place in the....
Implantation occurs in the...
....fallopian tube
....upper posterior wall of the uterus
76
A pregnancy is undetectable until
8-10 days post conception (when it implants in the uterus and begins secreting hCG, undetectable before)
77
Chorionic villi
Tufts of capillaries coming from the trophoblast developing on day 12 from fertilization, fetal blood vessels are functional with circulation established on day 19-21
78
Spiral arteries of the uterus conversion (Vascular invasion of decidual cells) mech of action
- Trophoblasts invade maternal capillaries and destroy arterioles and spinal arteries vessels walls
- uterine tissue replaced with placental tissue, maternal smooth muscle replaced by SMOOTH MUSCLE LACKING cytotrophoblastic cells
- maternal veins not evolved
- Not autoregulated flow and spiral arteries converted to lacunae (lakes of blood) by becoming very dilated and causing maternal blood to enter in fountain like spurts engorging the area right outside the umbilical artery and vein capillaries, this flow is continuous until uterine contraction pressure limits it (no autoregulation)
79
No matter what the mother's blood sugar is, the fetus' is...
...higher
80
Placental sequestration
The placenta sequesters zinc, copper, lead, and cadmium and other heavy metals, if in a poor developmental environment the baby can be born with toxic levels
81
Do drugs and metabolites cross the placenta?
Yes, by diffusion (almost 10% of neonates are born addicted to substances)
82
hCG is found in excessively high levels in these 3 conditions, and lower in these 2
- multiple pregnancies
- fetuses with anti-D rH disease
- down syndrome
- ectopic pregnancy
- impending abortion
83
Amniotic fluid
Bound by the amnion, fluid that bathes the fetus detectable by 1st trimester as it diffuses into the amnion, 85% fetal urine, swallowed and absorbed into the fetal blood stream, diffuses across placental membrane back into the maternal space, excreted by kidneys and lungs of mother
84
Umbilical vein function, pathway
Carries o2 RICH blood from placenta to fetus that then bipasses the liver and into the right atria via the ductus venosus
85
There are __ umbilical arteries (oxygen poor blood) and __ umbilical veins
2, 1
86
Ligamentum teres
Remnant of the umbilical vein, free edge of the falciform ligament of the liver
87
Placenta previa
Accreta
Increta
Percreta
- Occurs when the placenta implants over the cervical opening
- placenta implants in the decidua basalis
- placenta implants into the myometrium
- placenta implants into the serosal surface of the uterus or into bladder wall
88
Mechanism of shifting from utero to newborn breath
- aeration of lungs causes them to inflate
- sees a dramatic fall in pulmonary vascular resistance and marked increase pulmonary blood flow causing pressure on right side of heart to decrease
- systolic systemic BP is about 75-80 mmHg, and pulmonary drops from 1/2 that to about 1/3rd, the foramen ovale and ligamentum arteriosum close by 1 year and 24 hours of this, respectively
89
Risk factors for abnormal placental implantation (6)
- previa
- older mothers
- higher parity
- prior cesareans
- uterine scarring from ablation
- leiomyomas
90
Complications of abnormal placental implantation (4)
- post partum hemorrahge***
- damage to bladder and bowels
- transfusion reactions
- ARDS
91
The amnion definition
Innermost fetal membrane contiguous with amniotic fluid, avascular but metabolically active, provides tensile strength of fetal membranes
92
Less than __mL at term is oligohydramnios, greater than __L is polyhydramnios, avg is ___mL
100ml, 2L, 1000mL
93
Umbillical cord
Originated from the yolk sac, average length of 55cm, normal range 30-100cm, houses 2 arteries and 1 vein
94
Amniotic bands syndrome
Rare malformation of the amnion and chorion that causes constricting of the tissue instead of a clear sac and can potentially strangulate extremities
95
"I think I might be pregnant, my last period was 3 weeks ago, would the pregnancy test be positive?"
No it would be negative
96
Thyroid hormone values in pregnancy, what is the active form of thyroid hormone?
- Free T3 and T4 decreased
- T3
97
Bacteruria levels in nonpregnant vs pregnant indicating infection
Nonpreg >100,000 colonies/mL
Preg >10,000 colonies/mL
98
Placental transfer methods (3)
- diffusion primarily (O2)
- facilitated transport (fetus spends energy to take up sugar and such)
- Maternal blood has higher affinity for CO2 than fetal blood drawing it out
99
hCG alpha and beta subunits
alpha is identical to TSH FSH and LH alpha subunits, the beta is unique
100
Ductus venosus
Fetal shunt from the umbilical vein bipassing the liver directly to the inferior vena cava
101
Foramen ovale
Right atrial opening into the left atrium to bypass pulmonary circulation
102
Ductus arteriosus
Opning to descending aorta from pulmonary arteries to bypass pulmonary circulation and return blood to the placenta from the umbilical arteries (division of anterior iliac in systemic circulation)
103
Ductus venosus
Branch off the umbilical vein that bipasses the liver bringing blood direclty to the inferior vena cava, becoming the ligamentum venosum after birth
104
Chorioamnion
Outer layer up against uterine uterine wall as placenta grows, not as strong as amnion, can be site of infection of meconium stanining
105
If a patient has sex with 2 different men 3 days apart can you tell who the father is should she become pregnant?
No its too close together with too much variablility, will need genetic testing upon birth
106
Goals of prenatal care
To have all patients receive some form, and preferably in the first trimester
107
4 stages of prenatal care
- Preconception care (basic medical care esp. for those with chronic medical conditions and staying up to date on vaccines)
- prompt diagnosis of pregnancy (confirm they didn't read an at home test wrong)
- initial presentation for pregnancy care (initial pelvic exam, height of fundus, etc)
- followup prenatal visits
108
Supplementing with folic acid prior to conception (typically done in all bread purchased) has allowed for a decrease in...
....neural tube defects (spinal bifida)
109
#1 and #2 structural birth defects
congenital heart anomalies, neural tube defects
110
Tdap in pregnancy
Used in every pregnant woman for every pregnancy to help lower prevalence of whooping cough in infants as infants don't receive Dtap until 6 months of age, given at 27-36 weeks to promote passive antibody transfer
111
Signs and symptoms of pregnancy (4)
- cessation of menses (not as reliable now due to obesity and birth control)
- changes in cervical mucus and softening
- breast tenderness
- urine or serum pregnancy tests gold standard
112
Parturient definition
Meaning just having delivered
113
Estimation of duration of pregnancy
Mean is 266 days from conception, 279-282 from first day of last menstrual period
Neagle rule
Estimated date of delivery = 1st day of last menstrual period + 7 days, - 3 months + 1 year
114
If the uterus fails to grow as expected, what should be considered?
Intrauterine growth restriction (IUGR)
115
1st trimester ultrasound
Best method possible to predict due date by measuring crown rump length, when done earlier in pregnancy more accurately predicts due date*** (further in gestation more biological variation we get)
116
Pelvimetry
Measurement of the diagonal conjugate from posterior inferior edge of symphysis pubis to sacral promontory to estimate the inlet of the pelvis, normally >12.5cm, can determine if a lady can deliver a baby at term without complication
117
Lab tests in prenatal care (11)
- pap smear (not before 21 regardless of pregnancy status)
- GC and chlamydia screen (regardless if monogomous)
- HIV screen
- syphilis screening
- hepatitis screening
- rubella antibody titer (congenital rubella syndrome)
- ABO and antibody screen
- urinalysis and culture
- cystic fibrosis screen
- fifth disease (in high risk populations, mother can get it from being around kids)
- glucose tolerance tests (determine diabetes)
- thyroid studies
- Quad screen (oh lawdy)
118
Signs of fetal life (3)
- Transvaginal ultrasound 6-8 weeks gestation
- doppler ultrasound 10-12 weeks gestation
- palpation of fetal movements
119
Diagnosis of fetal death (5)
- more common early in pregnancy (1/6 ends in miscarriage)
- regression of signs of pregnancy despite hCG remaining high for weeks after
- failure of uterine growth
- ultrasound primary method****
- failure to feel fetal movement after having felt it before
120
Scheduling of routine prenatal visits
Every 4 weeks thru week 28, every 2 weeks weeks 28-36, every week from 36 to delivery, 2x per week for postdates >42 weeks
121
12, 14-16, 20, 24, 28, 32-36, 36-40, 40+ week visits
- 12 (review prenatal lab tests, assess fetal heart beat with doppler)
- 14-16 (assess growth, order some genetic tests and order amniocentesis)
- 20 (auscultate fetal heart with fetoscope (old school) ultrasound for fetal anatomy)
- 24 (maternal education and review signs and symptoms for preterm labor)
- 28 (repeat antibody screens, administer Rh immune globulin, perform glucose screen, perform cervical assessment, TDaP administration)
- 32-36 (assess the cervix, GBS culture)
- 36-40 (assess fetal position, cervical exam for dilation each visit)
- 40+ (perform cervical assessment, institute fetal surveillance, typically WILL induce by end of 41 weeks)
122
Weight gain during pregnancy
a woman at ideal body weight requires total 24-28 lb weight gain, less for those over or more for those under ideal weight to meet goal requirements (might have to modify diet)
123
Weight loss during pregnancy is not advised except in those with...
...very high BMI
124
Weight retention after pregnancy
Average retained pregnancy weight of 3 lbs, see loss over 6 months progressively due to natural diuresis of excess volume
125
Smoking and pregnancy complications (6)
- bleeding
- premature birth
- low birth weight
- neonatal absence syndrome
- congenital anomalies
- low IQ of childhood
126
Alcohol and pregnancy complications (2)
- low birth weight
- fetal alcohol syndrome
127
Best advice regarding alcohol and pregnancy
Complete abstience
128
Fetal alcohol syndrome features (6)
- growth restriction
- behavioral disturbances
- brain defects
- cardiac defects
- spinal defects
- broad upper lip, facial distortions
129
Caffeine in pregnancy
Ideally none, but risks not as obvious as smoking and alcohol
130
Cell free fetal DNA (cffDNA)
A maternal phlebotomy study that is often done on screening in the first trimester to determine sex of child and test for aneuploidy, these DNA fragments increase in conc. in bloodstream thruout pregnancy and quickly diminishes upon delivery
131
Nucchal fold translucency
Ultrasound screen done most often in the first trimester to visualize fetus, can be found alone in 62% of down syndromes and 30% of spontaneous abortions
132
AFP testing
Alpha fetoprotein, a sometimes recommended 2nd trimester screen that finds 20% of down syndrome patients and neural tube defects
133
Pregnancy associated protein A (PAPPA)
Screening done during first trimester alongside nucchal fold translucency on ultrasound to increase rate of determining presence of down syndrome (positive in both up to 73% certainty)
134
Amniocentesis
a relatively low risk .5% of fetal loss test done during 2nd trimester for chromosome analysis, AFP, DNA markers, etc, not done as screening but for diagnosis and evaluation
135
Work conditions which increase risk of low birth weight, preterm labor, and delivery (4)
- physically intensive employment
- standing for long periods of time
- increased pulling, pushing, or lifting
- decreased rest periods
136
Recommended favorable working conditions for pregnant women (4)
- only 8 hour shifts
- no more than 48 hrs a week
- limit work between 6am and midnight
- avoid jobs that require good sense of balance
137
Saunas, hot tubs, and whirlpools use while pregnant
Advise not to use while pregnant, temp already elevated by the baby
138
Travel while pregnant
Best taken during 2nd trimester, many airlines have regulations
139
Common pregnancy complaints and how are they treated? (8)
- nausea and vomiting (first trimester usually resolves 16 weeks, morning sickness), treated with zofran
- constipation, treated with bulking agents (mirilax)
- hemorrhoids, treated with prevention or topical anesthetic
- fatigue (particularly early on), supplemental iron if anemic
- urinary frequency or incontinence (differentiate from rupture of amnion also known as water breaking), treated with kegals
- headaches, treated with acetaminophen
- syncope (due to blood flow to fetus does see drastic drop in blood pressure), treated with resting in lateral recumbent position, change position gradually, hydrate
- edema (common, as long as bilateral can be physiologic and not concern for DVT or heart failure and is relieved by raising legs)
140
Live vaccines and pregnancy
Contraindicated (MMR, V, and live influenza!)
141
Nulligravida
Never having been pregnant
142
Nullipara
Never having given birth
143
In measuring the fundus, if smaller than expected may be due to these 2 conditions. If larger, than these 3
- earlier gestation
- oligohydraminos
- later gestation
- polyhydramnios
- twins
144
Intrauterine growth restriction
When the unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb, putting it at risk of certain health problems and complications during pregnancy (potentially even death), delivery, and after birth
145
Quad screen
One lab test performed in patients prenatal care based on history at 15-19 weeks, includes AFP, hCG, estriol, and inhibin A to assess neural tube defects and genetic defects
146
Group B strep infection in neonates vs 1 month old
Because it is ubiquitous and commensal with mother not generating antibodies, the 1 month old is too often colonized and asymptomatic but neonates do not have immune function and can get septic from infection
147
Standard of care for screening in first trimester (2)
- ultrasound
- blood test for pregnancy associated protein A
148
Chorionic villous sampling
Removal of part of the placenta to take for chromosomal testing either abdominally or vaginally, NOT often utilized because of high risk of fetal loss and is pretty much obsolete
149
Exercise while pregnant
Good 3-4x a week but not starting anything new they haven't already been doing, should avoid hot humid conditions or when febrile, sports injuries much higher due to ligmaent tissue loosening due to circulating relaxin levels
150
Round ligament pain in pregnancy
Prior to 28 weeks can have a lot of pain especially on the right side as it is pulled and hurts with activity but subsides with rest differentiating it from acute appendicitis
