NURS8024 Final Exam Questions and Verified Answers 2024, Exams of Nursing

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NURS8024 Final Exam Questions and Verified Answers 2024 <>who is the certifying body we take the WHNP boards through?<<ANS>>NCC (National Certification Corporation) <>this is a nurse who has graduate level of education; passed national certification, built on competencies of an RN, is educationally prepared to take on the responsibility/accountability of patient issues<<ANS>>Advanced Practice Nurse (APRN) <>What are the four APRN roles?<<ANS>>NP CNM CNS CRNA <>The national organization of nurse practitioner faculties (NONPF) describes NINE core competencies...what are they<<ANS>>scientific foundation leadership quality practice inquiry technology/information literacy policy health delivery system ethics independent practice <>2 national organizations that provide guidelines for WHNP practice and education?<<ANS>>american association of colleges of nursing (AACN) national organization of NP faculties (NONPF) <>Process for certification maintenance for an NP<<ANS>>-cert is valid for 3 years -complete continuing competency assessment at the beginning of your maintenance cycle -continuing education earned is based on your education plan after the assessment is completed maintain current/active, unencumbered licensure, update and upload licensure <>main provisions of patient protection and affordable care act?<<ANS>>increase access to insurance decrease cost consumer protection wellness/prevention increase quality of healthcare expand workforce <>what is the scope of practice of a WHNP<<ANS>>providing gynecologic, sexual, obstetric, and reproductive care, mgmt, family planning, STI dx/tx, menopause mgmt, postmenopausal care, and primary care to women. <>Who Governs the scope of practice of WHNP?<<ANS>>**established by the nurse practice act in the STATE which they are licensed/practice in <>what is prescriptive authority?<<ANS>>The ability and extent of NP's ability to prescribe medication; is dependent on state nurse practice act <>what are the 4 levels of management of care?<<ANS>>independent consultation referral collaboration <>The process of drug absorption, distribution, metabolism, and excretion; the MOVEMENT of drugs within the body, what the BODY DOES to a drug<<ANS>>pharmacokinetics <>study of drug concentration and the patients response; the study of a drug's EFFECT, including the duration and magnitude of the response in relation to the drug dosage, what the DRUG DOES to the body<<ANS>>pharmacodynamics <>study of how different genes in the full genome determine drug behavior; identifies genes involved in drug metabolism and drug response<<ANS>>pharmacogenomics <>what are the four factors that affect pharmacokinetics?<<ANS>>distribution absorption metabolism excretion (DAME) <>process by which a drug becomes available to body fluids/tissues?<<ANS>>distribution <>The movement of drug particles from the GI tract to body fluids by passive absorption, active absorption, or pinocytosis.<<ANS>>absorption <>change of a drug (primarily in the liver) by CYP450 enzymes, into metabolites that may be active or inactive; alters a drug so it can be eliminated.<<ANS>>metabolism <>removal of a drug from the body; primarily occurs in the kidneys, but can also occur through the skin, lungs, bile, sweat, breast milk, or feces<<ANS>>excretion <>use of prescribing of a drug for conditions other than what it has been approved for by the FDA...<<ANS>>off-label use <>warning that appears on the insert for a medication that notes harm with the use of the drug; mandated by FDA<<ANS>>black-box warning <>off label drug uses in pregnancy.<<ANS>>Unisom (morning sickness), Methotrexate (ectopic) <>black-box warning in pregnancy<<ANS>>isotretinoin (accutane), ACE/ARB's <>Drugs with NO currently accepted medical use and a high potential for abuse<<ANS>>schedule I (heroin) <>Drugs with a high potential to cause psychological or physical dependence and abuse are called . however some do have medical use.<<ANS>>schedule II (methadone/morphine) <>drugs with a moderate to low potential for abuse and physical and psychological dependence<<ANS>>schedule III (codeine) <>Drugs with low potential for abuse and low risk of dependence<<ANS>>schedule IV (phenobarbital) <>drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics.<<ANS>>schedule V (cough preparations; Robitussin) <>how do you report an adverse drug reaction or event?<<ANS>>call FDA directly, use the FDA adverse reporting system (FAERS)- they collect reports on ADE's, ADR's, quality issues, usage errors, and therapeutic failures. NP's can submit reports through the MedWatch website. <>what are the 4 components of drug distribution in a pregnant woman?<<ANS>>distribution absorption metabolism excretion (DAME) <>what happens to plasma volumes in a pregnant woman?<<ANS>>they INCREASE (hemodilution) <>what happens to plasma proteins in a pregnant woman?<<ANS>>they DECREASE <>what happens to total body water in a pregnant woman?<<ANS>>it INCREASES <>what happens to total body fat in a pregnant woman?<<ANS>>it INCREASES <>most drugs move from mom, across the placenta by the following mechanism ... <<ANS>>diffusion (simple/passive) <>What drugs do NOT cross the placenta?<<ANS>>Heparin Insulin Glyburide Oxytocin <>there is a change in the absorption of lipophilic drugs in pregnancy; t or f<<ANS>>false <>hepatic metabolism of drugs in pregnancy increases AND decreases; t or f<<ANS>>true! <>the only TWO things that *decrease* in pregnancy and affect drug pharmacokinetics...<<ANS>>intestinal motility/emptying plasma proteins <>the things that *increase* in pregnancy and affect drug pharmacokinetics. .. <<ANS>>ventilation <3 output blood flow to skin <>health care services by clinicians who are accountable for addressing a large majority of personal health care needs; developing a sustained partnership with patients, and practicing in the context of family and community<<ANS>>primary care <>leading cause of death ages 11-24<<ANS>>unintentional injury <>leading cause of death ages 25-45<<ANS>>unintentional injury <>leading cause of death ages 45-65<<ANS>>cancer/malignant neoplasm <>leading cause of death ages 65 years and beyond<<ANS>>heart disease <>USPSTF Grade A recommendations.<<ANS>>The USPSTF recommends the service. There is high certainty that the net benefit is substantial <>USPSTF Grade B Recommendations.<<ANS>>The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. <>USPSTF Grade C recommendations<<ANS>>The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. <>USPSTF grade D recommendations<<ANS>>The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. <>USPSTF Grade I Recommendations<<ANS>>The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. <>this is the awareness and respect for other cultures; provide non-biased, non-judgmental care, recognize that people from other cultures may have different beliefs/practices. this is the skill of learning, accepting, and appreciating cultural differences and similarities between groups, and being able to act on that understanding.<<ANS>>cultural competence <>health history is (CC, HPI, ROS- +/-)subjective/objective...<<ANS>>subjective <>The physical exam is subjective/objective...<<ANS>>objective <>Diagnostic testing is subjective/objective...<<ANS>>objective <>screening tests are subjective/objective...<<ANS>>objective <>immunizations are subjective/objective...<<ANS>>objective <>What does the CAGE questionnaire stand for?<<ANS>>Cut down (Ever feel you need to cut down on ) Annoyed with others' comments about your drinking? Guilty (about your use) Eye opener (need to use in AM to function) <>What is the TACE questionaire?<<ANS>>Tolerance (how many drinks to feel drunk) Annoyed (people making comments about your drinking) Cut down (on drinking) Eye opener (need to use in AM to function) <>what is the best questionnaire to use for ETOH use in pregnancy?<<ANS>>TACE (score of 2 or > = @ risk) <>what are the USPSTF's 5 "A's" for prevention, screening, and mgmt of smoking cessation?<<ANS>>Ask Advise Assess Assist Arrange <>what are the recommended adult immunizations per the CDC<<ANS>>influenza tdap MMR varicella zoster HPV pneumococcal (high risk- Hep A, Hep B, Meningococcal, Influenza Hib) (college students- meningococcal) <>USPSTF screening recommendation for diabetes (grade B)?<<ANS>>adults aged 35 to 70 years who have overweight or obesity (FBG, GTT, A1C) <>USPSTF screening recommendation for HIV in PREGNANCY (grade A)?<<ANS>>The USPSTF recommends that clinicians screen for HIV infection in **ALL** pregnant persons, including those who present in labor or at delivery whose HIV status is unknown. <>USPSTF screening recommendation for HIV in general population (grade A)?<<ANS>>adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk of infection should also be screened. <>USPSTF screening recommendation for intimate partner violence in women of reproductive age (grade B)?<<ANS>>The USPSTF recommends that clinicians screen for intimate partner violence (IPV) in women of reproductive age and provide or refer women who screen positive to ongoing support services. <>USPSTF's screening recommendations for colorectal cancer screening in age 50-75 (grade A)?<<ANS>>recommends screening for colorectal cancer in ALL adults aged 50 to 75 years. <>USPSTF's screening recommendations for colorectal cancer screening in age 45-49 (grade B)?<<ANS>>recommends screening for colorectal cancer in adults aged 45 to 49 years. (basically they recommend screening everyone age 45-75) <>USPSTF's screening recommendations for colorectal cancer screening in age >75 (grade C)?<<ANS>>USPSTF's screening recommendations for colorectal cancer screening in age (evaluate individual risk) <>JNC 8 criteria for HTN diagnosis in those age 60+ withOUT DM/CKD...<<ANS>>>150/>90 (initiate therapy) <>JNC 8 criteria for HTN diagnosis in those <60 without DM/CKD...<<ANS>>>140/>90 (initiate therapy) <>JNC 8 criteria for HTN diagnosis in those WITH DM/CKD (all ages)...<<ANS>>>140/>90 <>in the black population w/ HTN but with no DM/CKD...what med should you start with<<ANS>>thiazide or CCB <>in the NON-black population w/ HTN but with no DM/CKD...what med should you start with<<ANS>>thiazide, ACEI, ARB, or CCB <>in black and non-black population w/ HTN + DM/CKD...what med should you start with<<ANS>>ACEI or ARB <>what are the parameters to diagnosis pre-htn?<<ANS>>systolic BP 120 to 139 mm Hg diastolic BP 80 to 89 mm Hg based on ≥2 properly measured, seated BP readings on each of 2 or more office visits. <>first line management for a woman diagnosed with primary HTN?<<ANS>>lifestyle modification first and foremost • Smoking Cessation • Control blood glucose and lipids • Diet Eat healthy (i.e., DASH diet) weight loss Moderate alcohol consumption Reduce sodium intake no more than 2400 mg/day • Physical activity Moderate-to-vigorous activity 3-4 days/wk <>What does the DASH diet stand for?<<ANS>>Dietary Approach to Stop Hypertension <>what is the first line MEDICATION for a woman diagnosed with primary HTN who is NOT black and does not have DM or CKD?<<ANS>>Initiate thiazide, ACEI, ARB, or CCB, alone or in combo <>what is the first line MEDICATION for a woman diagnosed with primary HTN who IS black and does not have DM or CKD?<<ANS>>Initiate thiazide or CCB, alone or combo <>headache that is: -more common in women -caused by VASCULAR CHANGES (regional hypoperfusion) -triggers=hormones, stress, lighting, noise -has a prodrome, AURA, H/A, postdrome<<ANS>>migraine w/ aura <>is a migraine with aura bilateral or unilateral?<<ANS>>unilateral (one sided) <>what is the treatment for migraine w/ aura?<<ANS>>NSAIDS Ergotamine (teratogenic) Triptans (watch w/ SSRI's) Antiemetics Dark room <>in what type of headache is combined hormonal contraception contraindicated in?<<ANS>>migraine WITH aura (as migraines w/ aura are often d/t hormonal issues, estrogen containing BC can increase stroke risk...already have regional hypoperfusion...increases the risk for ischemic stroke) <>this type of headache is: often d/t menstrual cycle in childbearing aged women DOES NOT CAUSE vascular changes OR hypoperfusion lasts 4-72 hours is UNIlateral DOES NOT have aura occuring before onset<<ANS>>migraine W/OUT aura <>migraines are or aren't triggered by physical activity...<<ANS>>ARE* <>this type of headache is: more common in MEN r/t release of histamine/serotonin<<ANS>>cluster headaches <>which headache causes horner-like syndrome (hallmark sign of this type of HA: ptosis/miosis on affected side)<<ANS>>cluster <>what medication for UTI is avoided in the FIRST and THIRD trimester b/c it is a folate antagonist (1st trimester) and in those with g6pd (third trimester; hemolytic anemia) and in those with sulfa allergy?<<ANS>>Bactrim (TMP/SMX) <>This type of diabetes typically begins in childhood, and is d/t beta cell destruction...there is a genetic component (especially w/ 1st degree relatives)...requires insulin<<ANS>>type I DM <>this type of diabetes is d/t insulin deficiency/secretory effect & increased hepatic glucose production...lifestyle modification (exercise/diet), oral anti-DM's, sometimes insulin<<ANS>>Type II DM <>what is the prevalence of type I DM in the US<<ANS>>10% of those diagnosed w/ DM have type I <>what is the prevalence of type II DM in the US<<ANS>>1 in 10 Americans; >14 million cases <>risk factors for type II DM include:<<ANS>>obesity sedentary lifestyle family h/o certain races (native Americans, Hispanics, blacks, Asians) high cholesterol <>what is the prevalence of obesity in the US<<ANS>>68.8% of the US population 80% AA's, 78% Hispanics (compared to 60.3% of non-Hispanic White women) <>what are the risks associated with being obese?<<ANS>>heart disease, HTN, type II DM, stroke, cancer, cholecystitis, OSA, disability, OA <>who is most at risk for developing osteoarthritis?<<ANS>>older females (also repetitive joint stress/overuse) <>what is the patho behind ostearthritis?<<ANS>>degeneration of articular cartilage and subchondral bone causing synovial inflammation (bone ends thicken and form bone spurs) <>osteoarthritis causes what type of joint pain...<<ANS>>unilateral (one sided), asymmetrical joint pain <>what type of nodes are common with osteoarthritis<<ANS>>herberdens, bouchards <>in osteoarthritis, pain worsens with movement and subsides with rest, and causes AM joint stiffness t or f<<ANS>>TRUE <>most common sites affected by osteoarthritis<<ANS>>knees, hips, hands, cervical/lumbar spine <>what is the first line management for osteoarthritis?<<ANS>>NSAID's <>the exact etiology of rheumatoid arthritis is unknown; t or f *thought to be an autoimmune component/chronic inflammation<<ANS>>true (there may be a genetic predisposition or environmental factors like bacterial infections or asbestos) <>rheumatoid occurs in men more than women; t or f<<ANS>>FALSE women > men <>rheumatoid arthritis occurs bilaterally or unilaterally & asymmetrical or symmetrical in wrists/fingers, hips, knees?<<ANS>>BILATERALLY, SYMETRICALLY <>in RA the joints are tender, warm, swollen, t or f<<ANS>>true <>pain with RA causes AM pain and stiffness, and stiffness is worse after a long rest (vs. with OA where rest relieves pain) t or f<<ANS>>TRUE <>what is the treatment for RA?<<ANS>>- DMARDs (disease-modifying anti-rheumatic drugs) - NSAIDs - Steroids - PT <>this results from entrapment and compression of the median nerve and hand tendons, occurs in women > men; management through NSAIDS, wrist splints...surgery offers definitive treatment<<ANS>>carpal tunnel syndrome <>what lab tests are used to diagnose thyroid disease?<<ANS>>TSH, T3, T4 <>what do labs look like in HYPOthyroid<<ANS>>HIGH tsh LOW t4 <>what do labs look like in HYPERthyroid<<ANS>>LOW tsh HIGH t4 <>what is the correct term for the disease caused by hyperthyroid?<<ANS>>graves (aunt cindy) <>what is the correct term for the disease caused by hypothyroid?<<ANS>>hashimotos <>S/S of hyperthyroidism (remember metabolism is increased*)<<ANS>>tachycardia anxiety exophthalmos (graves) thinning hair heat intolerance <>how will the WHNP screen women for depression in a primary care setting?<<ANS>>PHQ-2 (the easiest tool in primary care setting) <>what questions does the PHQ-2 ask?<<ANS>>1- do you find enjoyment in activities she usually enjoys? 2- do you feel down, depressed, or hopeless? <>scores for PHQ-2 range from 0-6...what is considered a "positive" score?<<ANS>>3 or higher (if +, do the PHQ-9) <>in order to assess for suicidal ideation, the WHNP can...<<ANS>>ask the following: - have you ever thought of hurting yourself? - have you had any thoughts recently? <>what does the acronym SIGECAPS stand for<<ANS>>Sleep Interest Guilt Energy Concentration Appetite Psychomotor Suicide <>what is the first line treatment for a 42-year old woman diagnosed with major depression?<<ANS>>SSRI's*** (fluoxetine, paroxetine, escitalopram, sertraline) <>how will the WHNP diagnose a generalized anxiety disorder?<<ANS>>using the GAD-7*** 1- nervous/anxious/on edge 2- not sleeping, can't control worrying 3- worrying too much 4- trouble relaxing 5- being restless/can't sit still 6- becoming easily annoyed/irritable 7- feeling afraid something bad will happen score of 5 = mild score of 10= moderate score of 15= severe <>Normal Hgb level in women is? non-pregnant<<ANS>>12-16 g/dL <>Normal Hct level in women is? (non-pregnant)<<ANS>>35-44 <>Normal platelet count in women is? (non-pregnant)<<ANS>>150,000-400,000 <>Measurement of serum levels has the highest sensitivity and specificity for diagnosing iron deficiency in anemic patients<<ANS>>ferritin** (storage form of iron) <>what level of ferritin is indicative of iron deficiency anemia in a non-pregnant, non-smoking woman ages 19-50?<<ANS>>level <12 <>what happens to hgb/hct in iron deficiency anemia?<<ANS>>its LOW <>what happens to reticulocyte count in IDA?<<ANS>>its LOW <>what happens to TIBC in IDA?<<ANS>>its HIGH (think there's a lot of room left on the cell for iron...because not a lot of iron is bound to it) <>what happens to MCV in IDA?<<ANS>>its LOW (MCV = cell size...in IDA the cell size is smaller...its a microcytic, hypochromic anemia) <>SIGNS AND SYMPTOMS OF IDA<<ANS>>pallor dryness edema petechiae/bruising brittle, rigid, spoon-shaped nails tachycardia tachypnea hypotension <>what is the first-line pharmacologic treatment for a 22 year old woman diagnosed with IDA?<<ANS>>ferrous sulfate, 325mg PO, 1-3x/day <>when would the WHNP expect to see improvement in the hgb level after starting iron therapy?<<ANS>>retest in 2-3 mos after treatment** <>educational point when a patient is taking iron...what should they take it with?<<ANS>>citrus (orange juice, Vit C) <>this is a inherited form of HEMOLYTIC ANEMIA; the body produces defective hgb (theyre more susceptible to breakdown)<<ANS>>thalassemias <>causes "sickled" cells, HgbS, results in a decreased lifespan of RBC's resulting in chronic anemia and hypoxemia (will have a + hgb electrophoresis)<<ANS>>sickle cell anemia <>what type of disorder is sickle cell anemia?<<ANS>>autosomal recessive <>this type of disorder results in lack of protection of oxidizing effects on RBC's- hemolysis occurs d/t illness, stress, and exposure to sulfa drugs or fava beans<<ANS>>G6PD <>what type of disorder is G6PD?<<ANS>>x-linked - incubation: 28 days - there IS a vaccine - treatment = mgmt of GI symptoms<<ANS>>Hepatitis A <>this type of hepatitis is: - spread via blood/sexual contact - incubation: 90 days - there IS a vaccine - treatment- if exposed give IG, chronic can use antiretroviral therapy<<ANS>>Hepatitis B <>this type of hepatitis is: - *the MC blood-borne disease in the US - spread via blood/IV drug use - incubation: 2wks-6months - there IS NOT a vaccine - treatment- interferon/ribavirin (those with chronic infection can be cured w/ 8-12 wks of oral therapy)<<ANS>>Hepatitis C <>24 year old presents to the office with c/o: cough that started 3 mos ago cough is nonproductive, worse after exercise she is sedentary- just started exercise program chest feels "tight" and breathing gets harder after exercising runs out of breath earlier, coughs a lot NO FEVER, SPUTUM, CONGESTION, H/A's, WEIGHT LOSS she does not smoke her lungs- bilateral wheezing, and prolonged expiratory phase; CXR is normal..whats the diagnosis<<ANS>>asthma <>how do we know its an asthma diagnosis and not URI, pneumonia, TB, etc.<<ANS>>URI- congested, runny nose, sore throat PNA- fever, fatigue, weight loss, green/yellow sputum, crackles, + CXR TB- blood tinged sputum, weight loss, night sweats, + CXR <>What happens in the expiratory phase with asthma?<<ANS>>*prolonged* expiratory phase <>what is the management plan for someone with asthma? specifically the 24 year old with exercise-induced asthma<<ANS>>avoid triggers (exposure to cold air, etc.) PRN rapid acting b2 agonist (SABA) can include low-dose inhaled corticosteroid for daily control <>24 year old presents to your office with CC of a "mole"; hx reveals she goes to the beach often and enjoys sunbathing. the mole is asymmetric, border is irregular, color is mottled, diameter is greater than tip of a pencil, it is elevated...what is the most likely diagnosis<<ANS>>melanoma <>who is at risk for melanoma?<<ANS>>fair-skinned excessive, unprotected sun exposure large number of nevi family history increases risk 2-fold white males <>22 year old presents to the office with CC of rash on her back: rash has been there for the past 4 years the rash comes/goes, periods where skin is clear rash is reddened with several silver-white patches that are thick, scaly, and flaky...what is the diagnosis<<ANS>>psoriasis <>what is thought to be the cause of psoriasis?<<ANS>>auto-immune mediated; genetic component w/ environmental triggers, can be triggered by stress, trauma, infections, medications. <>How is psoriasis managed?<<ANS>>needs referral topical Vitamin D analogues corticosteroids phototherapy methotrexate <>A 30-year-old presents with CC of dry, scaly lesion rash on her right arm (anterior elbow area), sometimes with intense itching and burning for the last 2 years; sometimes this rash oozes. What is the diagnosis<<ANS>>eczema (atopic dermatitis) because of vesiculation/weeping of lesions, and itching <>what is the treatment for eczema?<<ANS>>cool wet compresses topical steroid creams oral antihistamines (although watch for sedative ones) oral vit D supplementation 2x weekly diluted bleach baths <>what is thought to be the cause of eczema?<<ANS>>genetics/environment- inherited predisposition towards skin hypersensitivities, these patients usually have dry skin that makes them vulnerable to irritants, have a lower itch threshold, and can be triggered by sweat, clothing, and season changes. <>macrocytic anemia<<ANS>>MCV > 100, caused by vitamin B12 or folate deficiency or both. Other causes (alcoholism, poor nutrition, GI disorders and pregnancy. Vitamin B12 deficiency can result in serious neurological dysfunction. Folic acid deficiency causes ulcerations of the tongue and oral mucosa, and changes to skin, hair and fingernail pigmentation TX: Vitamin B12 (Cyanocobalamin) injections (1st line), folic acid (folate vitamin B9) <>What does the corpus luteum secrete?<<ANS>>progesterone (this is what sustains a pregnancy) this acts as the "placenta" for the baby until the placenta actually takes over. <>what is the order of LH surge and BBT?<<ANS>>LH surge Ovulation Rise in BBT Thick mucus temp rises AFTER ovulation <>GnRH is secreted by<<ANS>>hypothalamus and triggers release of FSH and LH <>LH and FSH are secreted from<<ANS>>anterior pituitary <>LH is progesterone/estrogen dominent<<ANS>>progesterone (think about what happens with LH surge..ovulation, pregnancy, need progesterone to sustain) <>FSH is progesterone/estrogen dominent<<ANS>>estrogen (think about what is happening when estrogen is prominent...follicle being produced) <>Estrogen is secreted by the<<ANS>>ovaries <>Progesterone is secreted by<<ANS>>corpus luteum <>Prolactin is secreted by<<ANS>>anterior pituitary <>ADH and oxytocin are secreted by<<ANS>>posterior pituitary <>Prolactin is responsible for<<ANS>>stimulating milk production (PROlactin, PROduction) <>Oxytocin is responsible for<<ANS>>milk ejection (Oxytocin, milk Out) <>the ovaries react to...<<ANS>>FSH/LH <>the uterus reacts to...<<ANS>>estrogen/progesterone <>order of fertilization...<<ANS>>oocyte zygote morula blastocyst gastrula embryo fetus <>What is the preembryonic period?<<ANS>>0-2 weeks <>What is the embryonic period?<<ANS>>weeks 3-8 (organogenesis) <>what is the fetal period?<<ANS>>9 weeks to birth <>When does the heart start beating?<<ANS>>day 22 <>the predominate site of biosynthesis of the sex hormones (estrogen, progesterone, and androgen) in a healthy, ovulating woman is the.... however, these hormones can be produced in lesser degree in the. <<ANS>>ovaries adrenal gland <>proliferation of endometrium (what hormone is dominant?)<<ANS>>estrogen <>Secretory phase of endometrium (what hormone is dominant?)<<ANS>>progesterone <>secreted by the ovarian theca cells...<<ANS>>LH <>secreted by the ovarian granulosa cells...<<ANS>>responds to FSH, produces estrogen <>high levels of estrogen stimulate this hormone...<<ANS>>LH <>this hormone influences the growth of the follicle...<<ANS>>FSH <>What is primary infertility?<<ANS>>never been pregnant <>What is secondary infertility?<<ANS>>Difficulty conceiving after having had a pregnancy, regardless of outcome. <>5 basic factors to consider in clients with infertility: what are they?<<ANS>>1- ovulatory 2- uterine/tubal 3- male factor 4- cervical 5- peritoneal (i.e. endometriosis) <>32 year old, G1P1 and 33 yr old husband have hx of infertility for the past 2 years- has been tracking BBT, no STI hx, tubes patent, normal uterus, semen analysis normal...whats the most likely diagnosis?<<ANS>>secondary infertility unexplained infertility <>What is the postcoital test?<<ANS>>- after sex, checks cervical mucous for abundance and spinnbarkheit - looks at the sperm in the mucous for number and motility <>if a patient is on a COC and is experiencing spotting/bleeding before completion of active pills...increase the...<<ANS>>progesterone <>is a patient is on a COC and is experiencing bleeding/spotting after scheduled bleeding...increase the...<<ANS>>estrogen <>mechanism of action Progestin-only pills ("mini pill")<<ANS>>thicken cervical mucus/inhibit ovulation <>benefits of using a progesterone only pill<<ANS>>safe in those who cannot have estrogen can be used w/ breastfeeding <>what is the most important education for someone taking the mini pill/progesterone only pill<<ANS>>***THEY MUST TAKE IT AT THE SAME TIME EVERY DAY* <>MOST COMMON side effect of progesterone only pill<<ANS>>breakthrough bleeding/irregular menses <>if a patient is > 3 hours late taking the mini pill...what do they need to do<<ANS>>use a back up method for 48 hours <>mechanism of action for the Depo shot<<ANS>>prevents follicular maturation and ovulation and causes thickening of cervical mucus (suppresses HPO axis) <>sickle cell disease/seizure disorders and depo<<ANS>>may reduce sickling may reduce seizures <>most common side effects of depo<<ANS>>irregular/amenorrhea/breakthrough bleeding weight gain can decrease bone density in long-term user <>education for someone who is starting depo and wants to know how it can affect fertility?<<ANS>>can take anywhere from 15-49 weeks for fertility to return <>who should not use a diaphragm?<<ANS>>HIV- diaphragm can disrupt vaginal epithelium and make infection easier to pass on/get <>education about a diaphragm<<ANS>>insert just prior to or up to 2 hours before sex leave in place for 6 hours after sex <>mechanism of action of subdermal implant birth control (nexplanon)<<ANS>>inhibits ovulation <>does nexplanon contain estrogen?<<ANS>>NO remember, only COC's, patch, ring do! <>side effects of nexplanon<<ANS>>irregular menstrual bleeding pain/bruising/infection at insertion site <>EDUCATION for a patient using the transdermal patch for birth control...<<ANS>>skin irritation can occur at application site rotate site (butt, belly, back, upper arm) apply new patch on same day each week for 3 weeks, then no patch for 4th week for bleed <>education for a patient using the nuvaring for birth control...<<ANS>>insert ring for 3 weeks, remove for bleed, insert new ring 7 days later <>fertility awareness-based methods<<ANS>>contraceptive or family planning method that involves identifying a fertile period in a woman's cycle and either avoiding intercourse or using contraception during this time - 24% failure rate <>what is meant by monophasic oral contraceptive?<<ANS>>Each pill is designed to deliver the same level of hormone throughout the entire pill pack. That's why it's called "monophasic," or single phase Junel, Yaz <>what is meant by multiphasic oral contraceptive?<<ANS>>alter the ratio of progestin to estrogen and the doses during the 21-day cycle OrthoTriCyclen (triphasic) <>what is meant by extended-cycle oral contraceptive?<<ANS>>taking a pill for longer than the typical 21 days -and not taking the placebo pills, constant hormone (usually results in a period every 3 months or so) Seasonique, Seasonale <>what is the CDC first line treatment for gonorrhea?<<ANS>>Ceftriaxone 500mg IM x 1 if cant r/o coinfection- doxy 100mg PO BID x7 days <>Symptoms of Gonorrhea<<ANS>>discharge and painful urination (often asymptomatic or mistaken for a UTI) <>education for patient with gonorrhea<<ANS>>both partners need treated! TOC 7-14 days ONLY if throat infection untreated can cause PID (infertility, ectopic's, pain) <>incubation period for gonorrhea<<ANS>>1-14 days <>what is the CDC's first line treatment for chlamydia?<<ANS>>doxycycline 100mg BID x 7 days azithromycin 1g PO x1 dose Provider-administered: Cryotherapy with liquid nitrogen OR Surgical removal OR Trichloroacetic acid (TCA) <>what are the symptoms of condyloma accuminata?<<ANS>>Small, skin-colored or gray spots in your genital area that are raised or flat. Several warts close together that are shaped like a cauliflower** HPV 6/11 <>incubation period of condyloma acuminata<<ANS>>2 weeks-8 months (avg 2-3 mos) <>CDC's first line treatment for herpes (HSV)?<<ANS>>Acyclovir† 400 mg orally 3 times/day for 7- 10 days OR Famciclovir 250 mg orally 3 times/day for 7-10 days OR Valacyclovir 1 gm orally 2 times/day for 7-10 days suppressive therapy is available to prevent breakouts <>HSV-1<<ANS>>cold sores (1 mouth) <>HSV-2<<ANS>>genital herpes (2 lips) <>incubation period of herpes<<ANS>>2-12 days <>first line treatment for HPV?<<ANS>>THERE IS NO TREATMENT - prevention is key (Gardasil vaccine) <>is the HPV vaccine recommended for those >26 years old?<<ANS>>NO <>what is the incubation period for HPV?<<ANS>>2-3 months (can range from 1-20 months for warts, and up to TEN YEARS for high-risk HPV to become cancer) <>what is the CDC's first line treatment for HIV?<<ANS>>there is NO cure ***antiretroviral treatment (to suppress viral load) want to keep tcell count >400-500 <>what are the options for prevention of HIV?<<ANS>>PrEP (pre exposure prophylaxis) PEP (post exposure prophylaxis) <>incubation period of HIV<<ANS>>2wks-6mos after contact w/ virus <>CDC first line treatment of pelvic inflammatory disease<<ANS>>Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline 100 mg orally or IV every 12 hours PLUS Metronidazole 500 mg orally or IV every 12 hours <>Symptoms of PID include:<<ANS>>· Lower abdominal pain · Pelvic organ tenderness · Inflammation of the genital tract · Fever · Abnormal uterine bleeding <>what is the most likely causative organisms of PID?<<ANS>>N. gonorrhoeae and C. trachomatis <>education for PID:<<ANS>>test partners from the last 60 days for STI and treat presumptively for N. gonorrhoeae and C. trachomatis <>when should you note clinical improvement of PID?<<ANS>>within the first 3 days after treatment initiation <>what is the incubation period for PID?<<ANS>>unknown (depends on causative agent usually) <>Define menopause<<ANS>>cessation of menstruation for 12 months <>Define perimenopause<<ANS>>period b/t beginning of menopausal sxs/changes until 12 months after LMP (irregular menstrual cycles are common during this time*) <>45 yr old, G55005 (gravida 5, term 5, preterm 0, aborted 0, living 5) presents with concern about her menstrual cycle for the last 6 months, husband reports her being grouchy...how do you approach this visit TESTING:<<ANS>>TVUS, CBC for anemia, TSH <>45 yr old, G55005 (gravida 5, term 5, preterm 0, aborted 0, living 5) presents with concern about her menstrual cycle for the last 6 months, husband reports her being grouchy...how do you approach this visit TREATMENT:<<ANS>>black cohosh, primrose oil mirena for therapeutic amenorrhea COC's depending on hx <>45 yr old, G55005 (gravida 5, term 5, preterm 0, aborted 0, living 5) presents with concern about her menstrual cycle for the last 6 months, husband reports her being grouchy...how do you approach this visit EDUCATION:<<ANS>>AUB is common as a woman approaches menopause begin health promoting activities early (exercise) weight bearing exercises, yoga, strength diet (high in iron/calcium) smoking cessation if a smoker clue cells on wet mount <>what test is used to diagnosed bacterial vaginosis?<<ANS>>swab, wet mount <>what are Amsel's criteria to diagnose bacterial vaginosis?<<ANS>>thin white d/c fishy odor (+whiff) clue cells ph >4.5 <>what is the first line treatment for bacterial vaginosis?<<ANS>>****Metronidazole 500 mg orally 2 times/day for 7 days OR Metronidazole gel 0.75% one full applicator (5 g) intravaginally, once a day for 5 days OR Clindamycin cream 2% one full applicator (5 g) intravaginally at bedtime for 7 days <>How is vulvovaginal candidiasis diagnosed?<<ANS>>wet mount - will see presence of budding yeast, pseudohyphae ph normal <>normal vaginal pH<<ANS>>3.8-4.5 <>what are the symptoms of vulvovaginal candidiasis?<<ANS>>Thick, curdy white vaginal discharge, itching, dysuria, dyspareunia <>what are the risk factors for vulvovaginal candidiasis?<<ANS>>atb use, increased estrogen levels, uncontrolled DM, poor vaginal hygiene (wet) <>what is the first line treatment for vulvovaginal candidiasis?<<ANS>>Fluconazole 150 mg orally in a single dose OR -azole intravaginal agents <>How is trichomoniasis diagnosed?<<ANS>>-saline wet mount of vaginal discharge - motile trichomonads - pH >5 - "strawberry cervix" <>what is the treatment for trichomoniasis?<<ANS>>Metronidazole 500 mg 2 times/day for 7 days * (rec) Metronidazole 2 g orally in a single dose (pregnancy) Tinidazole 2 g orally in a single dose <>education when someone is taking flagyl...<<ANS>>avoid etoh <>does the partner of someone with trichomoniasis need treated?<<ANS>>YES - need TOC in 3 months as well <>round/oval mass near vestibular entrance, non-tender (unless infected), swelling, usually unilateral, without erythema or inflammation<<ANS>>bartholins cyst <>infected Bartholin's cyst- often the causative organism is...<<ANS>>E.Coli <>abscessed Bartholin's cyst- what is the treatment? first line antibiotic is?<<ANS>>-warm compress, ATB's, I&D, insertion ward catheter, marsupialization -trimethoprim 160 mg/sulfamethoxazole 800mg (Bactrim) <>How is lichen sclerosis diagnosed?<<ANS>>vulvar biopsy <>what are the symptoms of lichen sclerosis?<<ANS>>thin white patches "tissue paper skin" itchy painful <>what are the risk factors for lichen sclerosis?<<ANS>>autoimmune disorders, hereditary, inflammatory (oxidative stress), post menopasual <>what is the treatment for lichen sclerosis?<<ANS>>topical corticosteroids (high-potency) <>when a "stalk" arises from the cervical canal, this is called a?<<ANS>>cervical polyp <>risk factors for cervical polyps?<<ANS>>> 4o years of age multigravida hx of STI's previous polyps <>treatment for a cervical polyp?<<ANS>>observation vs removal if she develops any irregular of postcoital bleeding, or has an atypical polyp - removal for histology is indicated. <>what is primary amenorrhea?<<ANS>>not having a menses before age 16 OR has not had menses w/in 3 months of thelarche (breasts) <>what is secondary amenorrhea?<<ANS>>Absence of menses for 3 months in a woman who has previously menstruated. <>18 year old presents to the office who has never had a menses, she is a senior in highschool, her sisters had periods starting at age 13; no weight gain/loss, exercises 20 minutes/day, born w/ one kidney, vitals stable, ht 5'4", wt 122lbs, tanner stage IV breasts, axillary and pubic hair. normal external genitalia. what is the most likely diagnosis?<<ANS>>primary amenorrhea <>what is the diagnostic work up for primary amenorrhea?<<ANS>>pregnancy test <>define a corpus luteal cyst. .. <<ANS>>when the follicle releases the egg, it begins producing E/P for conception, sometimes fluid accumulates inside this cyst usually no treatment needed, disappear w/in 3 cycles <>define a hemorrhagic cyst. ... <<ANS>>sac that forms on the ovary and fills with blood typically no treatment needed if the cyst is >10 cm, can be drained or removed <>palpating an ovary of a 64 year old woman is an normal finding; true or false<<ANS>>FALSE- ovaries at this age should have diminished to the point of not being able to be felt; if they are, this needs further evaluated (as this is a sign of ovarian ca) <>what is CA125?<<ANS>>Tumor marker for ovarian cancer- found in the epithelium of the fallopian tubes and ovaries. high levels of this may indicate cancer*** <>26 year old presents with: dark abdominal/facial hair (male pattern) 10 lbs weight gain acne periods every 40 to 82 days slight clitoromegaly (excess androgen) 8cm adnexal mass what is the diagnosis?<<ANS>>PCOS <>what is PCOS?<<ANS>>Multiple ovarian follicular cysts due to hormone imbalance Characterized by increased LH and low FSH (LH:FSH >2) Increased LH induces excess androgen production (from theca cells) resulting in hirsutism (excess hair in male distribution) Androgen converted to estrone in adipose tissue. Estrone feedback decreases FSH resulting in cystic degeneration of follicles. High levels of circulating estrone increase risk for endometrial carcinoma Presentation: obesity, infertility, oligomenorrhea, hirsutism, insulin resistance (type 2 DM) <>LH:FSH ratio in PCOS<<ANS>>3:1 <>what is the first line treatment for PCOS?<<ANS>>weight loss (lifestyle changes; diet/exercise) <>what is the first line PHARM treatment for PCOS?<<ANS>>COC's <>this vulvar dermatosis has the following presentation: itching, burning symmetrical depigmentation in FIGURE 8 pattern pale TISSUE PAPER skin loss of vulvar architecture<<ANS>>lichen sclerosus <>this vulvar dermatosis has the following presentation: itching, chronic OR remitting white reticulation/striae/hyperpigmentation lesions can appear in oral cavity well demarcated erosions<<ANS>>lichen planus <>what is the treatment for lichen sclerosis<<ANS>>topical corticosteroids <>what is the treatment for lichen planus<<ANS>>steroids immunosuppressive agents if severe <>what is the etiology behind lichen sclerosus and planus?<<ANS>>autoimmune hereditary inflammatory <>this type of vulvar dermatosis has the following presentation: severe itching (relieved by scratching) can have mild erythema to fissures, patches, excoriations ITCH SCRATCH ITCH CYCLE pubic hair may be gone from itching<<ANS>>lichen simplex chronicus (three words, itch scratch itch) <>what is the etiology of lichen simplex chronicus?<<ANS>>response to friction/scratching variant of atopic dermatitis <>how do we treat lichen simplex chronicus?<<ANS>>avoid irritants topical xylocaine, antihistamines CBT <>How is a punch biopsy performed?<<ANS>>explain procedure cleanse area w/ solution lidocaine w/epi wait 3 minutes bx help perpendicular to the skin sample lifted w/ tissue forceps/released w/ scissors place in medium sites <4mm don't need closure review hygiene precautions <>21 year old woman presents for her well woman exam- what are the recommendations for her pap?<<ANS>>ages 21-29 pap test alone every 3 years <>42 year old presents for her well woman exam- what are the recommendations for her pap?<<ANS>>ages 30-65 pap test alone every 3 hpv alone every 5 pap/hpv every 5 <>is endometriosis managed?<<ANS>>The primary goal of medical treatment for endometriosis is to halt the growth and activity of endometriosis lesions (d/t estrogen) and ovulation suppression GnRH agonists Danazol COC's Progestin surgery (removal of implants, hyster, ablations) <>a woman is diagnosed with endometrial hyperplasia, what is the significance of this finding?<<ANS>>this is a condition in which the lining of the uterus is abnormally thickened, could mean endometrial cancer <>what hormone thickens endometrium to prepare for pregnancy<<ANS>>estrogen <>what 2 conditions may cause endometrial hyperplasia?<<ANS>>low/insufficient progesterone obesity (adipose tissue converts fat to estrogen = higher levels of circulating estrogen) <>The female hormones—estrogen and progesterone—control the changes in the uterine lining. Estrogen builds up the uterine lining. Progesterone maintains and controls this growth. Estrogen without enough progesterone may cause the lining of the uterus to thicken. In most cases, endometrial hyperplasia can be treated with medication that is a form of the hormone progesterone. Taking progesterone will cause the lining to shed and prevent it from building up again. It often will cause vaginal bleeding. ^^ just an FYI<<ANS>>FYI <>what is the MC endocrine disorder in reproductive-aged women?<<ANS>>PCOS <>characteristics of PCOS<<ANS>>hyperandrogenism chronic anovulation polycystic ovaries on US ^at least 2 of those must be present for dx <>BRCA 1<<ANS>>normally acts of restrain growth of cells in the breast when mutated, predisposes to breast cancer increases risk of breast ca by 55-65% increases risk of ovarian ca by 39% <>BRCA2<<ANS>>provides instructions for making a protein that acts as a tumor suppressor; Most BRCA2 gene mutations lead to the production of an abnormally small, nonfunctional version of the BRCA2 . As a result, less of this protein is available to help repair damaged DNA or fix mutations that occur in other genes <>ACOG recommends what regarding mammography:<<ANS>>every 1-2 years beginning at age ***40 years. If you have not started screening in your 40s, you should start having mammography no later than age 50 years. Screening should continue until at least age 75 years. <>USPSTF recommendations for mammography:<<ANS>>biennial screening starting at age 50-74 <>American cancer society recommendations for mammography:<<ANS>>Women 45 to 54 should get mammograms every year. Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. <>when is an US indicated for evaluation of a breast lesion?<<ANS>>women younger than 30 <>when is a diagnostic mammogram w/ or w/out US indicated for evaluation of breast lesion?<<ANS>>women > 30 <>what can a breast US do<<ANS>>help you differentiate between a cystic mass vs. solid mass <>a woman presents with CC of spontaneous "bloody" nipple discharge from her R breast for the past 3 months...what are the possible diagnoses?<<ANS>>intraductal papilloma* breast cancer <>what is the management plan for a patient with bloody nipple discharge?<<ANS>>breast exam mammo if over 30 US if under 30 possible referral for biopsy/excision <>what disease causes itchy nipples?<<ANS>>paget's disease <>55 year old woman presents with CC stating that with her monthly SBE's, she has noted a change in her R breast- last mammo was 2 years ago, there is no nipple discharge or pain. on exam you note a 2-cm, mobile, non-tender mass, in the RUQ of the breast. what is your mgmt plan?<<ANS>>mgmt: she needs a diagnostic mammo w/ or w/out US (she is >30) remember- most breast cancers occur in the RUQ of the breast <>in women who are postmenopausal...masses are presumed to be malignant until proven otherwise, t or f<<ANS>>true!! <>16 year old presents with CC of mass in her R breast- it is not painful, is 3-cm, movable, rubbery. her mom had just instructed her on how to perform SBE's so she's not sure how long it has been there. what is the most likely diagnosis?<<ANS>>fibroadenoma (MC type of breast mass in adolescents and young women) <>what is the mgmt plan for the 16 year old with the breast mass (most likely fibroadenoma)?<<ANS>>US (best diagnostic tool for this age group...<30) <>stress incontinence<<ANS>>the inability to control the voiding of urine under physical stress such as running, sneezing, laughing, or coughing <>urge incontinence<<ANS>>state in which a person experiences involuntary passage of urine that occurs soon after a strong sense of urgency to void <>mixed incontinence<<ANS>>combination of stress and urge incontinence <>How is urge incontinence treated?<<ANS>>Anticholinergics (Oxybutynin, Tolterodine) Surgery as last resort <>what hormone is responsible for increased blood volume in pregnancy?<<ANS>>progesterone <>what hormone is responsible for peripheral vascular resistance in pregnancy?<<ANS>>progesterone <>what hormone is responsible for increasing basal body temperature in pregnancy?<<ANS>>progesterone <>what hormone is responsible for decreased smooth muscle tone in pregnancy?<<ANS>>progesterone <>what hormone is responsible for softening of fibrous connective tissue in pregnancy?<<ANS>>progesterone <>what hormone is responsible for increased excretion of sodium in pregnancy?<<ANS>>progesterone <>what hormone is responsible for increased cardiac output, stroke volume, and heart rate in pregnancy?<<ANS>>estrogen <>what hormone is responsible for increased sensitivity of the respiratory center to CO2?<<ANS>>progesterone <>What is Chadwick's sign and when does it occur?<<ANS>>bluish color of VAGINAL mucosa and cervix; week 6-8 <>What is goodells sign? When does it occur?<<ANS>>softening of the CERVIX (4 weeks) <>What is Hegar's sign and when does it occur?<<ANS>>softening of the lower UTERINE segment; 4th month <>What is Piskacek's sign?<<ANS>>a palpable lateral bulge or soft prominence at one of the locations where the uterine tube meets the uterus. <>nonpregnant uterus, weight shape<<ANS>>70g (10ml cavity), pear shaped <>8week uterus<<ANS>>still within pelvic girdle cannot be palpated navel orange <>10week uterus<<ANS>>may be able to begin to palpate the uterus at this point, usually still within pelvic girdle <>12week uterus<<ANS>>@ the level of the symphysis pubis; grapefruit <>16week uterus<<ANS>>1/2 way between symphysis pubis and umbilicus <>20week uterus<<ANS>>@ umbilicus <>40week uterus<<ANS>>weight about 1100g w/ a 5L volume @ xiphisternum <>what is the origin and significance of the mucous plug?<<ANS>>created by cervical secretions, seals the cervical canal as a protective barrier <>What are presumptive (possible) signs of pregnancy?<<ANS>>Subjective signs perceived by the woman - Signs: amenorrhea, breast changes & tenderness, nausea - Symptoms: N/V, urinary freq, weight gain, fatigue, skin changes, maternal belief she is pregnancy <>What are probable signs of pregnancy?<<ANS>>Objective signs - perceived by the health care provider + pregnancy test enlargement of abdomen/uterus Goodell, Hegar, Chadwick's , Pikacek's sign Braxton hicks/ctxs ballotment palpation of fetal outline <>What are the positive signs of pregnancy?<<ANS>>fetal heart sounds, visualization of fetus ultrasound, fetal movement palpated by hcp. <>what is nagele's rule<<ANS>>1st day of last menstrual cycle, minus 3 months, plus 7 days = estimated date of delivery <>Use Nagele's rule to calculate the EDC for a woman whose first day of the LMP 10-11- 15<<ANS>>7/18/16 <>zygote, morula, blastocyst...etc. whats the order<<ANS>>zygote <>What is NIPT (non-invasive prenatal testing)?<<ANS>>measures the fetal fraction of DNA in maternal SERUM reports risk of Trisomy 13, 18, 21, Fragile X, Klinefelter <>When can NIPT be performed?<<ANS>>as early as 10 weeks <>how accurate is NIPT testing?<<ANS>>99% detection rate for down syndrome (0.5% false +) <>what is nuchal translucency w/PAPP-A and hcg testing?<<ANS>>aka "first trimester screening" US done to measure nuchal fold thickness (more than 3mm of fluid = > risk for DS) 82-87% detection rate PAPP-A low, HcG high = increased risk of trisomy 21 <>When can a nuchal translucency ultrasound be performed?<<ANS>>11-14 weeks <>When can amniocentesis be performed?<<ANS>>15-20 weeks <>does chorionic villi sampling detect NTDs?<<ANS>>NO <>what is the most common neural tube defect?<<ANS>>spina bifida <>When can chorionic villus sampling be done?<<ANS>>10-12 weeks <>when can multi marker screening or quad screening be done?<<ANS>>15-22 weeks "second trimester screening" <>what does a quad screen measure?<<ANS>>-maternal serum alpha-fetoprotein -unconjugated estriol -human chorionic gonadotropin -inhibin A <>what is the universal carrier screening?<<ANS>>blood work that indicates whether you carry a gene; can even be done before pregnancy! <>what test is offered between 15 and 20 weeks gestation for ALL pregnant women?<<ANS>>AFP test- screening for NTD's by sample of maternal serum; based on presence of AFP (which is produced by fetal liver...babies w/ defects leak AFP into maternal serum and amniotic fluid. <>you are seeing a 29 year old G2P1 for a return OB visit @ 26 weeks gestation; what items need assessed and screened at this visit.<<ANS>>1hr gtt CBC rhogam is rh - <>what labs need done at initial prenatal visit<<ANS>>CBC blood type HIV Hep B RPR Varicella Rubella GCCT Pap if needed UA/culture addition if needed: BG or a1C if indicated, HepC in high risk women, TSH, trich in HIV+, TB <>what labs need done at 15-20 weeks?<<ANS>>Quad screen (MMS)- AFP, estriol, hcg, inhibin A <>what labs need done at 28 weeks?<<ANS>>1hr gtt, cbc, rhogam if needed <>what labs need done at 36 weeks<<ANS>>GBS culture repeat STI testing if needed <>what is the difference between traditional prenatal care and centering-pregnancy prenatal care?<<ANS>>traditional care - 1 on 1 between pt and provider, on a specified schedule centering pregnancy- GROUP prenatal care, self-empowering <>what vitamins can result in toxicity?<<ANS>>Vitamin A (cranial neural issues) do not exceed 5,000IU/day <>one of your clients is concerned about having to gain 25-35lbs by the end of pregnancy...what is the physiological basis for this. basically, explain to her what parts of the pregnancy weigh.<<ANS>>fetus- 6-8lbs muscle/fat stores- 7 lbs body fluids (blood volume, ECF)- 8 lbs amniotic fluid- 2 lbs breast enlargement- 2 lbs uterine hypertrophy- 2 lbs placenta- 1.5 lbs <>Inadequate weight gain during pregnancy<<ANS>>LBW SGA PTB failure to breastfeed <>excess weight gain during pregnancy<<ANS>>LGA hypoglycemia polycythemia low apgar scores ROM for >18 hrs. temp of 100.4 or > if intramniotic infection is suspected known hx of GBS in previous pregnancy <>what is the criteria for chronic HTN in pregnancy?<<ANS>>HTN >140/90 before pregnancy or before 20 weeks gestation <>what is the criteria for gestational HTN?<<ANS>>presents after 20 weeks gestation WITHOUT findings associated with pre-e <>what is the criteria for HELLP syndrome?<<ANS>>hemolysis elevated liver enzymes low platelets <>what is the criteria for pre-eclampsia?<<ANS>>HTN & proteinuria OR In absence of proteinuria, new-onset hypertension with: Thrombocytopenia Renal insufficiency Impaired liver function Pulmonary edema Neuro Unexplained new-onset headache <>what is the criteria for eclampsia?<<ANS>>HTN, w/ seizures <>what lab work needs done for a pregnant patient with HTN (most likely pre-e)?<<ANS>>CBC CMP Uric acid 24 hr urine (proteinuria >300) Liver enzymes check for cerebral or visual symptoms check for pulmonary edema <>What is the only cure for preeclampsia?<<ANS>>delivery of the placenta <>what is the patho of pre-eclampsia?<<ANS>>spiral artery <>anti-HTN should be started when for new-onset pre-e in pregnancy...<<ANS>>systolic of 160 or > diastolic of 110 or > <>what medications can be used for HTN in pregnancy<<ANS>>labetalol nifedipine CCB's <>criteria for early diabetes screening in pregnancy.<<ANS>>overweight/obese history of GDM sedentary previous LGA infant 1st degree relative w/ DM hx of CVD hx of insulin resistance prior hx of stillbirth hx of child with congenital anomaly age > = 40 hdl <35 or triglyceride >250 <>@ what point in pregnancy should you screen for GDM?<<ANS>>ALL pregnant women between 24-28 weeks gestation <>what test will you use to screen for GDM @ 24-28 weeks?<<ANS>>1hr gtt <>what is the cut off value for a positive 1hr gtt?<<ANS>>anything exceeding 130-140 <>if the woman has a + 1 hr gtt...what is the next step<<ANS>>3hr gtt <>if the fasting blood glucose is> 126...this means<<ANS>>overt gestational diabetes...no further testing needed. <>what are the values for 3hr gtt<<ANS>>Fasting: 95 mg/dL 1-hour: 180 mg/dL 2- hours: 155 mg/dL 3- hours: 140 mg/dL Pregnant women with two or more elevated values are considered to have gestational diabetes mellitus (GDM), though even one elevated value increases certain risks. <>what is the significance of a reactive NST<<ANS>>this is a good thing; means baby is REACTIVE *adequate blood flow.O2 to baby *baby that is NOT acidotic *2 or more FHR accelerations (15bpm x 15 sec) within a 20 minutes period <>what is the significant of a positive contraction stress test (CST)<<ANS>>this is a BAD thing; means the baby is poorly affected by contractions- late decels with >50% of ctxs. *hypoxemia in baby *may have need for delivery b/c of this *further work up = BPP, doppler etc. <>how long is an NST predictive of fetal well-being?<<ANS>>in general, FHR b/t 110-160bpm, moderate variability, accelerations, and no decels demonstrates a very low likelihood of adverse outcomes within 1 week of a reactive NST. check H&H TVUS quant hcg level (should be dropping appropriately) expectant mgmt- needs to watch for excessive bleeding (>1pad/hour), feeling faint/dizzy can be given <>what is considered a fetal demise?<<ANS>>occurring after 20 weeks <>What is the postpartum period?<<ANS>>6-8 weeks after delivery of the placenta to the involution and return of reproductive organs to their non-pregnant state- considered a time of "restoration" <>How effective are condoms?<<ANS>>85-98% ^ very high when used correctly however, tier 3 of effectiveness <>what is the primary method of how hormonal birth control prevents pregnancy...<<ANS>>prevention of ovulation <>who should not take combined birth control methods<<ANS>>breast ca smoker >15/day HTN hx or high risk for DVT/PE hx of stroke migraines w/aura liver issues <>how long should a woman wait after childbirth to initiate COMBINED hormonal contraceptive? - pill/patch/ring<<ANS>>these should be avoided in the first 21 days PP** (42 days for someone @ high risk for VTE) <>Estrogen-containing oral contraceptives are recommended in breastfeeding women; true or false<<ANS>>FALSE- not recommended, have been shown to decrease the quantity and duration of BFeeding. <>What does ACHES stand for in the adverse effects of taking OC?<<ANS>>abd pain chest pain headaches eye problems swelling <>what oral contraceptive is recommended for breastfeeding women?<<ANS>>progestin-only "mini pill" <>can the mini pill/progestin only pill be given in the immediate PP period?<<ANS>>yes- no evidence to show that bleeding, involution, or lactogenesis is affected by POP's- can be given immediately PP. <>what is the most important piece of education regarding the progestin only pill?<<ANS>>*MUST TAKE AT SAME TIME EVERY DAY* <>WHAT FORMS OF BIRTH CONTROL ARE COMBINATION (hormones estrogen/progestin)?<<ANS>>PILL (except mini pill) PATCH RING <>in regards to depo shot in the PP period...is it breastfeeding safe and when should it be given in the PP period?<<ANS>>yes it is breastfeeding safe (progestin only) *delay giving the shot until copious amounts of breastfeeding occur- usually 2-7 days after birth) <>is the paraguard IUD safe for breastfeeding? can it be inserted immediated PP?<<ANS>>yes & yes- however, runs high risk of expulsion when inserted immediately after birth. <>what is the number one side effect of paragard?<<ANS>>prolonged, heavy bleeding (this is why we always say we would never put these in women lol) <>is the levonorgestrol IUD/mirena safe for breastfeeding and can it be inserted in the immediate PP period?<<ANS>>yes & yes- however, runs high risk of expulsion when inserted immediately after birth. <>is the nexplanon safe for breastfeeding and can it be inserted in the immediate PP period?<<ANS>>yes & yes <>What IUD can be used for emergency contraception?<<ANS>>Paragard <>How does emergency contraception work? and is it breastfeeding safe?<<ANS>>prevents ovulation yes - it is BF safe <>what are the criteria for lactational amenorrhea?<<ANS>>nursing an infant 6mos old or less exclusively breastfeeding (q4h during the day and q6h at night) menses has not returned <>in the presence of FULL breastfeeding...when should contraceptive be started?<<ANS>>3rd MONTH PP <>in the presence of partial or no breastfeeding...when should contraceptive be started?<<ANS>>3rd WEEK PP <>symptoms < 14 days affects upwards of 80% of women short lived usually occurs in the first 7-10 days PP tearful, irritable, mood swings, fatigue, appetite changes<<ANS>>postpartum blues <>what antibiotic is used to treat mastitis<<ANS>>dicloxacillin <>this is a localized collection of pus that becomes walled off in the breast - results in a hard, red, tender, floculent mass.<<ANS>>breast abscess <>Breast Abscess Treatment<<ANS>>drain with incision and drainage (I&D) or aspiration continue to breastfeed unless abscess drainage is close to where baby latches <>when does a breast abscess usually occur<<ANS>>after mastitis occurrence <>what is a puerperal fever?<<ANS>>fever of 100.4 degrees of higher during the PP period <>what are possible causes of a puerperal fever?<<ANS>>pyelo breast engorgement/mastitis dehydration URI believed to be caused by a bacterial infection of the upper genital tract after childbirth, the most common causative organism is the Beta hemolytic strep. <>this is the process by which the uterus shrinks back to the prepregnant size; it is assessed by the location of the fundus compared to the # of days PP. typical pattern is 1 fingerbreadth per day from the umbilicus to the symphysis pubis. (i.e. 3 days PP, 3 fingerbreadths below the umbilicus)<<ANS>>involution <>this is the FAILURE of the uterus to return to the normal size and state after childbirth the most common s/s are irregular bleeding, abdominal/bimanual exam will reveal an ***enlarged/BOGGY uterus***<<ANS>>subinvolution <>what is the treatment for subinvolution?<<ANS>>(1) rest (2) methergine (3) fluids (4) social support <>what is the appropriate prescription for a 1 day PP woman who is Rh- and whose infant is Rh+; she is rubella non-immune as well.<<ANS>>Rhogam 300mcg x1 dose w/in 72 hours of birth MMR 0.5ml SQ x1 before d/c <>what are the risk factors for thrombophlebitis in a pregnant/PP woman...<<ANS>>coag disorders infections pre-e obesity >35 yo smoking c-section fetal death FGR hyperemesis gravidarum immobility multiparity multiple gestation PP hemorrhage hx of DVT/PE varicose veins <>what is the criteria for hyperemesis gravidarum (triad)<<ANS>>triad of more than 5% prepregnancy weight loss electrolyte imbalance dehydration <>per acog & american academy of pediatrics, how long is breastfeeding recommended?<<ANS>>exclusively breastfed for 6 months* then intro of complementary foods and continued breastfeeding to 1 year and beyond. <>a client calls you 2 days PP and states her breasts are very firm and tender...you determine she is experiencing engorgement. what is your management for her?<<ANS>>continued breastfeeding breast massage cold compresses frequent milk removal/hand expression/pumping anti-inflammatories chilled cabbage leaves **correct latch and suckling*** <>pt presents to office with painful, reddened, R breast. NO c/o dysuria, uterine cramping, or abd pain. lochia has ceased. she has body aches and chills. fever of 101.4, HR 102bpm lungs clear, UA negative R breast is firm, warm, reddened, slight fissure on R nipple what is the diagnosis and mgmt plan<<ANS>>mastitis dicloxacillin 500mg Q6H or Keflex 500 Q6H continue to breastfeed, rest, hydrate, take entire course of ATB's <>types of lochia<<ANS>>rubra, serosa, alba <>Lochia rubra<<ANS>>Reddish or red-brown vaginal discharge that occurs immediately after childbirth; composed mostly of blood. <>fetal presentation<<ANS>>the foremost part of the fetus that enters the pelvic inlet "the presenting part" <>what is the purpose of estrogen in pregnancy?<<ANS>>it continues to rise throughout it SUPPRESSES FSH/LH (neg feedback) to STOP ovulation helps with growth of fetal organs and maternal tissue growth <>Wharton's jelly<<ANS>>mucoid connective tissue that surrounds the vessels within the umbilical cord <>how many veins and how many arteries are in the umbilical cord<<ANS>>2 arteries 1 vein vein- o2 artery- no o2 ^^different from normal <>Hypothalamus triggers<<ANS>>post/ant pit to secrete oxytocin/prolactin actually it turns OFF the prolactin inhibiting hormone to allow prolactin to come out. <>prolactin causes milk...<<ANS>>production <>oxytocin causes milk...<<ANS>>ejection <>how does the babies blood communicate with blood from mom.<<ANS>>trophoblasts <>What is Virchow's triad?<<ANS>>Stasis, hypercoagulability, endothelial damage <>what is the MC type of skin cancer<<ANS>>basal cell carcinoma <>which medication decreases hepatic glucose production<<ANS>>biguanides (metformin) <>Presentation of basal cell carcinoma<<ANS>>Elevated nodule with central, ulcerated crater surrounded by dilated (telangiectatic) vessels; "pink pearl like papule" translucent <>what happens to FSH, LH, and estradiol in menopause<<ANS>>increased FSH, LH decrease estradiol <>what hormone stimulates FSH production<<ANS>>activin <>Sex hormone binding globulin (SHBG)<<ANS>>A protein that binds with the sex hormones testosterone and estrogen. These hormones are inactive when bound to SHBG, but are available for use when needed. Low levels of SHBG are related to increased availability of testosterone and estrogen in the body. ^i.e. low levels of SHBG in PCOS, obesity, hyperinsulinemia <>estrogen is released by the ovary in response to...<<ANS>>fsh <>most common form of ART<<ANS>>IVF <>turners syndrome...uterus/ovaries<<ANS>>uterus present ovaries absent MC chromosomal abnormality in aborted fetuses <>Criteria for PID<<ANS>>abd pain adnexal tenderness *CMT d/c fever n/v <>where is vaginal cancer mostly found<<ANS>>upper 1/3 of the vagina <>FDA approved birth control for endometriosis<<ANS>>depo shot <>all major organ systems are formed during the embryonic stage, except. .. <<ANS>>fetal LUNGS <>person who has not carried a baby to 500g or 20 weeks<<ANS>>nullipara <>symmetrical growth restriction<<ANS>>both head and body parts are small undernourished fetus genetic disorders heart disease maternal drug use/ETOH/tobacco <>asymmetrical growth restriction<<ANS>>large head compared to the body asymmetric growth is more commonly due to extrinsic influences that affect the fetus later in gestation, such as preeclampsia, chronic hypertension, and uterine anomalies <>transmission of HIV to fetus without ART<<ANS>>15-45% <>transmission of HIV to fetus WITH ART<<ANS>>< 1% <>only FDA approved medication for gestational diabetes<<ANS>>insulin