Physiology of pregnancy -Table 1

Question 1

What causes a hypercoagulable state in pregnancy?

Answer 1

estrogen

Question 2

What is the mask of pregnancy?

Answer 2

hyperpigmentation of face, Malasma

Question 3

Folate recommended in wormen with PNTD?

Answer 3

1mg po

Question 4

what does the fetal spine develope?

Answer 4

5-6 weeks GA

Question 5

what are 3 NTD we check for?

Answer 5

spina bifida, encephalocele, anencephaly

Question 6

What is spina bifida occulta?

Answer 6

open vertebral canal, but spinal cord is in canal.

Question 7

What is meningocele?

Answer 7

intact neural tube with cyst containing meninges

Question 8

Myeloschisis is?

Answer 8

type of spina bifida, neural tube is open

Question 9

Sickle cell crisis manemanet?

Answer 9

hydration, pain medication, possible tranfusion - monthly CBC’s, change to medications, serial US, induced labor @37 weeks

Question 10

what is myelomingocele?

Answer 10

lumbar level dome shaped cyst- contents vary

Question 11

what additional IZ are needed with aplenia

Answer 11

pneumococcal, H. flu, miningococcal

Question 12

what should pregnant women brush with post vomit?

Answer 12

1 tsp baking soda in 8 ox water

Question 13

What is epulis gravidarum?

Answer 13

lobar growth on gumline, benign

Question 14

what is the normal amount of wt to gain during pregnancy?

Answer 14

25-35lbs, twins is 37-54lbs

Question 15

when does mornign sickness typically occur?

Answer 15

first trimester: 4-14 weeks

Question 16

How do you treat morning sickness?

Answer 16

ice chips, candied ginger, preggy-pops, acupressure bands

Question 17

what rx medicaiton can be given to women with severe emesis?

Answer 17

Doxylamine succinate and B6

Question 18

What could you give for hyperemesis gravidarum?

Answer 18

D5W, lactated ringers,

Question 19

What is hyperemesis Gravidarum?

Answer 19

wt loss >5% pre-pregnancy value, protracted vomiting, ketonuria

Question 20

appendicitis in pregnancy women presents as?

Answer 20

N/V, RLQ pain, (no bleeding=r/o abruption)

Question 21

Cholelithiasis in pregnancy?

Answer 21

RUQ pain, F/V, (r/o HELLP)

Question 22

Intrahepatic cholestasis in pregnancy?

Answer 22

build up of bile acids in liver- usual itching, but in hands and feet, dark colored urine, clay feces, anorexia

Question 23

How do you tx intrahepatic cholestatis in pregnancy?

Answer 23

Ursodeoxycholic acid, monitor serum bile and LFTs, NST

Question 24

What is the most common trauma with pregnant women?

Answer 24

MVA, DV/IPV

Question 25

How do you manage a pregnant women post trauma?

Answer 25

maternal stabilization, then work on fetus: US, electronic monitoring 2-6 hrs s/p mild trauma up to 24hrs

Question 26

Kleihauer betke test is?

Answer 26

checks for fetal cells in maternal circulation= Rh sensitization.

Question 27

Asymptomatic bacterirria?

Answer 27

In pregnant women can develope into UTI or pyelonephritis. Do clean catch and culture and sensitivity=>10x5 colonies bacteria on culture

Question 28

how do you treat uti in pregnancy?

Answer 28

cephalosporin or macrodantin

Question 29

How is pyelonephritis treated in pregnancy?

Answer 29

in patient! risk for premature labor

Question 30

No fever, CVA tenderness and blood in urine…you think?

Answer 30

Renal calculi

Question 31

Drug of choice for epilepsy with pregnancy?

Answer 31

there is not one. Want to weigh risk versus benefit here. there is a lot of fetal montoring.

Question 32

Bell’s treatment with pregnancy?

Answer 32

rx: steroids, better if after first trimester

Question 33

What is a common peripheral neuropathy in pregnancy?

Answer 33

CTS- d/t fluid retention

Question 34

How do you treat carpel tunnel syndrome in pregnancy?

Answer 34

wrist splints at night

Question 35

what are some psychiatric screening tools you use with pregnancy?

Answer 35

CBT, stress management, coping skills/support system, screening questionnaire, social workers

Question 36

Postpartum blues?

Answer 36

hormonal shift= high estrogen and progesterone through L and D followed by large decrease w/in 48 hrs.

Question 37

Post partum depression?

Answer 37

major depression, more prevalent, anhedonia(not enjoying baby), crying spells, ADL’s interference,

Question 38

Postpartum psychosis?

Answer 38

preexisting bipolar or schizophrenia, with s/sx of disassociation, hallucinations, EMERGENT!!

Question 39

What are some tools you can use to monitor pp behavioral health?

Answer 39

beck depression scale, edinburgh postnatal depression scale, case finding questions -have you been bothered by having litlle interest or pleasure in doing things?

Question 40

Hypothyroidism and pregnancy treatment?

Answer 40

Levothyroxine, dose will be boosted then go back to normal adult dose post birth

Question 41

How often should you monitor TSH in hypothyroidism in pregnancy?

Answer 41

every month for first 20 weeks, then once for 2nd and 3rd trimester

Question 42

Hyperthyroidism in pregnancy ?

Answer 42

Propylthiouracil(PTU)- hepatic risk

Question 43

Why do you not want to use MMI in first trimester of pragnancy with hyperthyroidism?

Answer 43

fetal scalp defects/aplasia cutis that occurs in first trimester

Question 44

risks with preganancy and DM1?

Answer 44

risk of hyperglycemia, glycosuria, ketoacidosis, elecrolyte imbalance

Question 45

Can glucose be a teratogen?

Answer 45

yes, leads to most anomalies in 1st 42 days of gesgation

Question 46

DM2 treatment in pregnancy?

Answer 46

metformin, glyburide9c)

Question 47

characteristics of GDM?

Answer 47

Insufficient insulin secretion to counteract pregnancy related fall in insulin sensitivity

Question 48

HPL?

Answer 48

human chorionic somatomammotropin- anti insulin properties, physiologically meant to shunt nutrients to fetus

Question 49

Sacral agenesis?

Answer 49

risk of GDM-

Question 50

what is the 1 step glucose screening for pregnant women?

Answer 50

first- fasting bg (75g) draw post prandial(fasting, 1h, 2hr), if >92,>180,>153 or fasting >125

Question 51

what is the 2 step glucose tst for pregnant women?

Answer 51

Non-fasting- drink 50g oral soln, 1 hr. postprandial- if abnormal >130 then continue with GTT(100g po) then draw blood (1,2,3 hr)

Question 52

what is the desired fasting glucose for pregnant women?

Question 53

Why do you get us for pregnant women with GDM?

Answer 53

to check for fetal wt. may have to opt for cesarian (>4500g)