Flashcard Set Preview
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| 1 |
normal labor asynclitism
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the head usually enters the pelvis with a moderate degree of posterior asynclitism and then...
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| 2 |
Does your patient need an IV in labor (2 questions to ask)?
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Is she at a greater risk for PPH (grand multip, uterine overdistention- polyhydramnios, large...
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| 3 |
Terbutaline doses
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0.25 mg SCor 0.125-0.25 mg IV
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| 4 |
how long after breast development do you expect menarche?
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2-3 years
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| 5 |
ACOG red's these primary care screening tests at ages 40-64:
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colorectal cancerTSH q 5 yearsyearly mammofasting glucose q 3 yearsLipid q 5 yearsDEXA if high...
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| 6 |
hCG in pregnancy
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secreted by placentaenters maternal blood stream at implantation doubles q 48 hours til 8-10...
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| 7 |
HPL
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detectable in maternal serum by 3 weeks concentration rises with placental growth to peak around...
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| 8 |
CRH
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corticotropin releasing hormone increases in the 3rd trimesterproduced by placenta doubles/triples...
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| 9 |
estrogen
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serum levels rise when placenta takes over function of the CL production increases until delivery...
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| 10 |
progesterone
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serum levels rise after placenta takes over function of the CL. Cont to rise gradually throughout...
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| 11 |
how does the placenta transfer nutrients?
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simple diffusion of O2, CO2, electrolytes, H2O, drugs, anestheticsfacilitated transfusion of...
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| 12 |
normal thyroid changes in pregnancy
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TSH drops slightly in the 1st trimester (mirrors hCG), returns to baseline in the second trimester....
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| 13 |
gestational thyrotoxicosis
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transient hyperthyroidism assoc with hyperemesis gravidarum. Assoc with multiple gestations,...
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| 14 |
normal TSH fT4
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TSH 0.45-4.5 milliunits/L fT4: 0.7-1.8 ng/dL
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| 15 |
pancreatitis
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mid-epigastric pain with radiation to the back relieved by sitting up/leaning forward amylase/lipase...
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| 16 |
cholecystits
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RUQ pain+ murphy's sign elevated alk phos, biliin preg there is- increased production of bile...
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| 17 |
appendicitis
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most common surgical emergency in pregperi-umbilical pain with shift to RLQ (McBurney's point)Psoas...
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| 18 |
CMV
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most common congenital infecleading cause of congenital hearing loss majority of infec are...
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| 19 |
parvovirus
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reticular rash on the trunk and peripheral arthropathy (33% asymptomatic)transmission- respiratory...
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| 20 |
toxoplasmosis
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T. gondii 38% of preg women have evidence of prior infec with toxoplasmosis infec is usually...
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| 21 |
varicella
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transmitted by respiratory doplets or close contact fever, malaise, maculopapular pruitic rash...
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| 22 |
syphillis
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t pallidum dark field microscopy 1 infec: painless ulcer or chancre appearing 2-3 weeks after...
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| 23 |
cystitis in pregnancy
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nitrofurantoin (macrobid): 100 mg q 12 hours x 5-7 days cefpodoxime- 100 mg BOD x 3-7 days...
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| 24 |
PUPP
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pruritic uticarial papules and plaques of preg- most common dermatosis in preg (typically occurs...
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| 25 |
coagulation in normal pregnancy
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Procoagulants are increased: increased fibrinogen, increased thromin Endogenous anticoagulants...
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| 26 |
pulmonary adaptions to preg
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diaphragm elevated 4 cm reduced FRC maternal oxygen consumption is increased 15-20%Compensated...
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| 27 |
asthma in preg
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rescue therapy: SABA controller therapy: budesonide is 1st choice (low dose corticosteroid)effects...
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| 28 |
normal murmurs in preg
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ejection systolic murmur 3rd heart sound
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| 29 |
what is the rec'd wt gain in preg for BMI <19.8
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28-40 Ibs
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| 30 |
what is the rec'd wt gain in preg for BMI 19.8- 25
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25-35 Ibs
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| 31 |
what is the rec'd wt gain in preg for BMI 26-29
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15-25 Ibs
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| 32 |
BMI > 29
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no more than 15 Ibs
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| 33 |
Bishop's score 0-4 is associated with a NSVD failure rate of:
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greater than 20%
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| 34 |
Bishop's score of greater than 9 is associated with a failure rate of :
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<1%
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| 35 |
normal newborn labs
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hemoglobin: 15-22 (other text 13.7-20)Hct: 45-65%WBC approx 18,000
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| 36 |
when to consider phototherapy
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b/w 48-72 hours old and bili >/= 15older than 72 hours and >/= 17
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| 37 |
calculate fertile days
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earliest fertile day is the shortest cycle minus 18latest fertile day is the longest cycle...
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| 38 |
what does a positive contraction stress test mean?
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Persistent late decels (>50% of ctxs) without hyperstim.
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| 39 |
a 300 mcg dose of Rhogam covers for how many mls fetal blood?
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30 mls (give after the 1st trimester)A 50 mcg dose covers for 5 mls
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| 40 |
iron needs in pregnancy
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27 mg/day (in most prenatal vits)
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| 41 |
breastfeeding decreases what types of cancer?
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breast and ovarian
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| 42 |
% of US women IgG + for toxo
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30%
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| 43 |
b hCG the time of missed menses
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100
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| 44 |
bhCG at 10 weeks
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(peak) 100,000
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| 45 |
implantation occurs when?
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6-7 days after fertilization
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| 46 |
_____ gravidavs. _____ para
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gravida: total # preg (incluing current , SABs, TABs)Para: complete pregnancies that got to...
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| 47 |
symmetric IUGR
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appears around 18-20 weeks - congenital infec - chromosomal abnormalities - maternal drug use...
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| 48 |
asymmetric IUGR
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- appears later in preg- asymmetry is caused by reduction in cell size, not # of cells resulting...
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| 49 |
bacterial causes of UTIs
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E. ColiKlebsiellaProteus N. gonorrheapseudomonas
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| 50 |
treatment UTI in preg
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amoxicillinampicillin nitrofurantoin (avoid after 36 wks and in women w/G6PD)Bactrim (avoid...
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| 51 |
low lying placenta
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one third of women have a low-lying placenta in the first trimesteronly 1% will have a previa...
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| 52 |
how often does ABO incompatibility occur?
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20-25%
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| 53 |
risks associated with AMA
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- first trimester SAB and ectopic -PIH PTDGDMdysfunctional labor leading to c/splacenta previa...
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| 54 |
increased parity is associated with
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abruptionprevia multifetal pregnancyPPH
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| 55 |
epidurals may...
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have an effect on labor progress... operative vag deliveriesincreased 2nd stage malpresentationshypotension,...
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| 56 |
dedicated labor support has been found to ...
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decrease the use of obstetrical intervention
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| 57 |
posterior asynclitism
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sagittal suture is closer to the symphysis pubis
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| 58 |
abnormal latent phase (friedman)
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nullipara: more than 20 hours multipara: more than 14 hours
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| 59 |
abnormal active phase (friedman)
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nullip: less than 1.2 cm/hourmultip: less than 1.5 cm/hour
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| 60 |
morphine doses (prodromal vs active labor)
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prodromal: 10-15 mg IMactive: 3-5 mg IV
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| 61 |
what's responsible for the beat-to-beat variability of the FHR?
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fetal parasympathetic systembaroreceptors: located in the carotid arteries- vagal responsechemoreceptors:...
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| 62 |
fetal pH
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normal > 7.25prepathologic 7.20- 7.25pathologic <7.20
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| 63 |
% of OP posittions that rotate via the long arc (135 degrees) to OA
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90%
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| 64 |
engagement:
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biparietal diameter of fetal head passes through the pelvic inlet
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| 65 |
muscles cut during medial epis
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bulbocavernosusishiocavernosussuperficial and deep transverse perineal muscles
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| 66 |
incidence of PTB in the U.S.
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10% if all births
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| 67 |
s/e beta agonists (terbutaline)
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palpitations, tachycradia tremors, anxietyhyperglycemiahypokalemiapulm edemaFHR tachycardia...
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| 68 |
dose terbutaline
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SQ 0.25
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| 69 |
predisposing factors previa
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increased parityAMAprev C/Smult gestation
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| 70 |
etiology abruption
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maternal htnabd traumasudden decrease in uterine volume cocaine use prev abruption
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| 71 |
etiology face presentation
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can be an indicator of CPDmultiple loops of nuchal cord tumors of the neckanencephalic fetus
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| 72 |
predisposing factors for retained placenta
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PTDchorioprev C/Sprevia grand multip
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| 73 |
immediate vs delayed PPH
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immediate w/in the first 24 hdelayed: 24h-6 wks pp
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| 74 |
hemotologic changes pp
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1st hour pp: CO increase 60-80%over first 48 h, diuresis occurs, CO normalizes by 2 weeks can...
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| 75 |
tachysystole
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> 5 ctxs in 10 min
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| 76 |
Cat 1 FHR
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baseline 110-160mod variability no late or variable decelsmay have early decelsmay or may not...
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| 77 |
Cat 3 FHR
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absent variability AND:recurrent lates, reccurrent variables, or bradycardiaOR sinusoidal pattern
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| 78 |
PPH (TUTUT)
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Tissue (retained placenta)Uterine atonyTraumaUterine rupture, inversion Thrombin (coagulation...
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| 79 |
most common cause of late PPH
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reatained products
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| 80 |
maternal mortality definition
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deaths occuring during preg, or w/in 42 days of the end of the pregcause of death is complication...
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| 81 |
GHTN returns to normal w/in ____ weeks pp or it is considered chronic htn
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12
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| 82 |
prolactin patterns pp
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secreated by the anterior pituitaryduring preg is suppressed by estrogen peaks at 3 h ppfall...
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| 83 |
oxytocin's role in lactation
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milk ejectioninhibited by stress, anxiety, fear, embarrassmentstimulated by relaxation, orgasm,...
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| 84 |
estrogen patterns pp
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disappears rapidly w/ removal of placentaestradiol levels are <2% preg levels by 24 hours
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| 85 |
progesterone levels pp
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levels similar to luteal phase is reached in 24-48 hequal to follicular phase in 3-7 days
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| 86 |
initial menses is anovulatory in ___% of women
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75%
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| 87 |
uterine involution
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2 wks pp is 12 wk size4-6 wks pp is completely involutedendometrium regenerates in 3 wks, placental...
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| 88 |
what is the likely cause of breif (<2 hour) period in the 2nd-3rd week of heavier bleeding...
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placenta eschar sloughing
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| 89 |
lower estrogen in the first 3 months pp (longer w/lactating women) is associated with...
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fewer vaginal rugaeless lubrication possibiliy a sexual response that is less rapid and intense...
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| 90 |
effectiveness of LAM
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if BF fulltime, w/out supplements: 93% don't ovulate in the 1st 3 months 88-89% for 6 months*...
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| 91 |
okay to give rubella vaccine if BF?
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yes!!
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| 92 |
a 10% decrease in hematocrit is associated with ...
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blood loss of greater than 500 mls
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| 93 |
delayed pph (etiologies)
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#1: SUBINVOLUTION- usually occurs in the 2nd wk pp (when placenta eschar sloughs) and is r/t...
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| 94 |
incidence of thromboembolic dz pp
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5 x greater for DVT than in AP15 x greater risk for PE1% with vaginal deliveries2% w/...
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| 95 |
Virchow's Triad
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venous stasisendothelial injuryhypercoagulable state
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| 96 |
consequences of cold stress in the newborn
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increased O2 consumption --- relative hypoxia and acidosismetabolism of BAT and release of...
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| 97 |
risk factors for neonatal hypoglycemia
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infants of diabetic momsIUGRPTD or post-datesintrapartum fetal distress, b-agonist tocolytics,...
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| 98 |
normal physiologic decrease in blood glucose in the newborn
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lowest at 1- 1.5 to 5 hours after birth stabilizes at 3-4 hours after birthshould not drop...
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| 99 |
s/s hypoglycemia
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weak cryjitterycyanosisapnealethargypoor feeding
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| 100 |
transition period of the newborn
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1. First period of reactivitylasts approx 30 minrapid HR and respirationsrales present alert...
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| 101 |
formular feeding patterns
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average 6-8 feedings/daymay only take 20-30 mls at initial feedingsmost should take 60-120...
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| 102 |
yellowing of sclera...
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should be evaluated by a pediatrician
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| 103 |
Barriers to discharge of newborn
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- GA less than 37 wks o r weight less than 2500g - aysmptomatic from drug withdrawl x 48-72...
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| 104 |
Bili levels should peak no higher than ____ w/ physiologic jaundice
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13
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| 105 |
ductus arteriosus may take how long to close?
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1-2 days, during which a murmur may be present
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| 106 |
lanugo is most prominent when?
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28-30 weeks
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| 107 |
typical weight loss in newborn
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tend to lose 10-15% of weight in the first 3 days, should gain back by week 2
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| 108 |
normal head circumfrence for a term newborn
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33-35 cmnormal chest circumfrence is 2-3 cm less than head circumfrence
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| 109 |
s/s overstimulation in the newborn
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-color changes- irreg respiration - irritability or lethargy-vomiting
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| 110 |
associated complications of PTD
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- respiratory complications- NEC- IVH- hypothermia- hypoglycemia- infection- hyperbili
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| 111 |
associated complications with post-term newborn
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- MAS- hypoglycemia- polycythemia- hypothermia
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| 112 |
infants of diabetic moms
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- chronic or severe IDM w/ vascular changes more likely result in IUGR- GDM and hyperglycemia...
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| 113 |
ABO incompatibility
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occurs when mom is type O and fetus is type A or B... infrequent when mom is type A and fetus...
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| 114 |
3 Ps of pyloric stenosis
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Palpable massPeristalsis visbleProjectile viomiting (2-4 wks after birth)
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| 115 |
nipple d/c characteristic of hyperprolactinemia
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occurs in both breasts
involves multiple milk ducts
is spontaneous
is milky and thin in...
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| 116 |
drugs that may cause hyperprolactinemia
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tricyclic antidepressants
phenothiazine
metoclopramide
other antidepressants, hypertensives
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| 117 |
tamoxifen increases ones risk for what type of cancer?
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endometrial cancer
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| 118 |
s/s TSS
causitive organism
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fever 102
hypotension
diffuse macular erythema resemling a sunburn
desquamation of the...
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| 119 |
DSM IV depression:
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at least 5 of the symptoms must be present for 2 weeks and #1 or #2 must be oresent for a diagnosis...
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| 120 |
risk factors for suicide:
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prior attempt/family hx
male gender
substance abuse/ family hx
living alone
medical illness
hopelessness
psychosis...
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| 121 |
s/e SSRIs(drug of choice for depresion)
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anxiety, insomnia/hypersomnia, h/a, nausea, anorexia, sexual dysfunction
typer in the morning...
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| 122 |
basal cell carcinoma
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slow growing, rarely metatasizes
waxy, semitranslucent nodule w/rolled borders
central ulcerations,...
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| 123 |
squamous cell carcinoma
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directly attributable to sun exposure or chronic irritation
60% occur at previous actinic...
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| 124 |
malignant melanoma
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1% of skin cancers, 60% of skin cancer deaths
risk factors:
hx of a changing mole
family/personal...
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| 125 |
acne
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risk factors:
stress, hormonal cycling
use of topical steroids
contact with irritants,...
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| 126 |
most common type of seizures adults vs childhood
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complex partial seizure in adulthood
absence seizures most common in childhood
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| 127 |
migraine
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triggers: stress
hormonal changes
foods, caffiene, etc
sleep changes
medications
changes...
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| 128 |
tension h/a
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diffuse, bilateral
generally able to cont w/ ADLs
dull pressure, constant, vise-like
episodic:...
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| 129 |
cluster h/a
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abrupt onset
often nocturnal
unilateral- retro-orbital
30-45 min
severe
facial pain,...
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| 130 |
T score think...
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teen
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| 131 |
dexa scan measures...
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hip
spine
wrist
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| 132 |
secondary causes of osteoporosis:
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hyperparathyroidism
hyperthyrroid
cushing's
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| 133 |
osteoarthritis
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noninflammatory joint dz
degeneration of articular cartilage
most common: distal and proximal...
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| 134 |
galactorrhea and periorbital edema are associated with...
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hypothyroid
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| 135 |
diagnosis of diabetes
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fasting plasma glucose of 126 mg/dL or greater
random glucose of 200
2 hour GTT of 200
must...
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| 136 |
crieria for screening adults for diabetes
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anyone older than 45 at 3 year intervals
consider testing earlier/ more frequent if at high...
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| 137 |
RA
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criteria for diagnosis:
4 of the 7, with 1-4 present for at least 6 weeks
- morning stiffness...
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| 138 |
physical findings associated with SLE :
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malar rash: erythematous, flat or raised
discoid rash: raised patches with scaling
alopecia
oral...
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| 139 |
WHO criteria for diagnosis of anemia in women (non-preg)
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hbg less than 12
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| 140 |
testing for h pylori w/ PUD
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1. use a serum (ELISA) test to identify infection
2. retest with stool antigen test or...
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| 141 |
s/s TB
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active TB: night sweats, fecer
malasie, weakness
anorexia
weight loss
productive cough,...
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| 142 |
a PPD of 5 mm or greater is considered positive in patient w/:
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HIV infec
immunocompromised, immunosuppressed
recent close contact with person with TB
those...
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| 143 |
positive PPD for the low-risk person is:
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a reaction of 15 mm or greater
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| 144 |
does everyone recieve treatment for latent TB infection?
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No. Recom'd for those at high risk for exposure and progression including healthcare workers ...
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| 145 |
physical findings associated with asthma
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hyperexpansion of thorax, hyperresonance with percussion
wheezing,
diminshed breath...
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| 146 |
Step 1 asthma- intermittent
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symptoms 2 x/week or less, nocturnal symptoms 2 x/month or less
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| 147 |
step 2 asthma- mild persistent
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symptoms 3-6 x week, nocturnal symptoms 3-4 x month
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| 148 |
moderate persistent- step 3
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daily symptoms, nocturnal symptoms more than 1 x week but not nightly
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| 149 |
severe persistent- step 4
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continual daily symptoms, frequent nocturnal symptoms
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| 150 |
findings associated with mono:
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tonsillar enlargement w/exudate
palatal petecchiae lymphadenopathy
fever
hepatomegaly...
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| 151 |
when are antibiotics warranted in the case of sinusitis?
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if s/s are present 10 or more days after onset of URI symptoms
or, if s/s of acute sinusitis...
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| 152 |
viral vs bacterial vs allergic conjunctivitis
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viral: acute onset, unilateral or bilateral w/ watery d/c
prearicular adenitis
may be assoc...
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| 153 |
leading cause of death in women:
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Cardiovascular dz
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| 154 |
risk factors for CV dz:
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cigarette smoking
htn
dyslipidemia
DM
genetic predisposition
obesity
sedentary lifestyle...
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| 155 |
are statins okay in preg?
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No! Cat X
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| 156 |
metobolic syndrome:
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any three : 1. abdominal obesity:
waist circumfrence: women >35 inches
2. triglycerides...
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| 157 |
s/s superficial thrombophebitis and management
|
s/s: localized area of edema, erythema, tenderness over a superficial vein
increased termperature...
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| 158 |
prehypertension
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120-139/80-90
|
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| 159 |
stage 1 htn
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140-159/90-99
|
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| 160 |
stage 2 htn
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>/= 160/100
|
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| 161 |
normal weight BMI
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18.5- 24.9
|
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| 162 |
overweight BMI
|
25- 29.9
|
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| 163 |
obesity BMI
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30- 39.9
|
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| 164 |
inidcation of rubella immunity
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HAI test: titer if 1:10 or greater indicated immunity, high titers (1:
64 or greater) may...
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| 165 |
normal pH of urine
|
4.6 - 8.0
|
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| 166 |
calcium intake recommendations
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14-18 years: 1300 mg/day (400- 600 D)
19-50: 1000 mg/day (400- 600 D)
51 and older:...
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| 167 |
live attenduated influenza vaccine may only be used for:
|
healthy non-pregnant persons under age 50
|
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| 168 |
when should HPV vaccine be started?
|
at age 11- 12 (may be given as early as age 9) at 0, 2, and 6 months
up to age...
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| 169 |
what is the single largest cause of third stage hemorrhage?
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mismanagement
|
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| 170 |
prolacting levels fall in the non-breastfeeding woman by when?
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1-2 weeks
|
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| 171 |
the placenta is established ____ weeks conceptional age.
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8-10 weeks.
|
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| 172 |
______ prevents more pregnancies in the world than all other methods of birth control combine?...
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breastfeeding
|
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| 173 |
purple veiny marks on legs?
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purpura
|
|
| 174 |
babkin relex:
|
when both palms are pressed, eyes will close and mouth will open, head will turn to one side...
|
|
| 175 |
assume sperm survive ____ days
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2-3
|
|
| 176 |
4 questions to ask at birth (NRP)
|
Is the baby term?
IS the amniotic fluid clear?
Is the muscle tone good?
Is the...
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| 177 |
Galant Reflex
|
while stroking the baby's back, spine and trunck arch toward that side
|
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| 178 |
freidman's active abnormal labor is how ling>
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nullip > 11.7
multip: > 5.2
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| 179 |
rash associated with rubella?
|
maculopapular rash begining on face and spreading to trunk and extremities
|
|
| 180 |
infection of rubella in preg:
|
if before 20 weeks: IUGR, cong heart dz, cataracts, deafness, anemia, microcephaly
|
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| 181 |
h/a associated with preeclampsia
|
frontal, analgesics don't help
|
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| 182 |
gynecoid pelvis:
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sacrum- wide and deep curve, short, slopes back
sidewalls parallel, straight
ishial spines...
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| 183 |
android
|
sacrum is falt, long, inclined fowrard, narrow, heavy
sidewalls convergent
isial spines...
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| 184 |
anthropoid:
|
sacrum is narrow, long, inclinded backward, sharply angled
sidewalls are straight
ishial...
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| 185 |
platpelloid
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sacrum wide and deep
sidewalls parallel
ishial spines variable
SI notch is short
pubic...
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