CMN 568 Unit 6 Exam 2024 with complete solutions

CMN 568 Unit 6 Exam 2024 with complete solutions What does folate deficiency resemble? - Answer ️️ -megaloblastic anemia as seen in B12 deficiency except that neurologic abnormalities are absent When does megaloblastic anemia of folate deficiency develop? - Answer ️️ -within 4-5 months When does neural tube closure take place? - Answer ️️ -21-28 days post conception What is the most common neural tube defect? - Answer ️️ -spina bifida What is the recommended daily intake of folic acid for nonpregnant women with no known risk factors for neural tube defect? - Answer ️️ -400 mcg What medication places women at a higher risk for a neural tube defect-affected pregnancy? - Answer ️️ -anticonvulsants What ethnicity is at a higher risk for having babies with congenital neural malformations? - Answer ️️ -hispanic What antibiotics should be avoided in pregnancy? - Answer ️️ -tetracyclines, fluoroquinolones, bactrim (in the 1st trimester), macrobid in the last few weeks of pregnancy What is 1st line therapy for treating UTI in pregnancy? - Answer ️️ -• Nitrofurantoin monohydrate/macrocrystals 100 mg orally twice daily for 5-7 days or • Amoxicillin 500 mg orally twice daily (alternative: 250 mg orally three times daily) for 5-7 days or • Amoxicillin-clavulanate 500/125 mg orally twice daily for 3-7 days (alternative: 250/125 mg orally three times daily for 5-7 days) or • Cephalexin 500 mg orally twice daily for 3-7 days What are risk factors for gestational diabetes? - Answer ️️ -obesity, older age, having a family history of type 2 diabetes or belonging to an ethnic group at increased risk for the condition (such as Hispanic, Native American, South or East Asian, African American, or Pacific Islands descent) Women with gestational diabetes are at higher risk for what? - Answer ️️ -gestational htn, preeclampsia, c/s, and having diabetes later in life The offspring of women with gestational diabetes are at increased risk for what? - Answer ️️ - macrosomia, neonatal hypoglycemia, hyperbilirubinemia, operative delivery, shoulder dystocia, and birth trauma Describe ACOGs recommended 2 step approach to dx GD in pregnancy? When is the test usually performed? - Answer ️️ -first screening with the administration of 50 g of an oral glucose solution followed by a 1-hour venous glucose determination. Those women meeting or exceeding the screening threshold of or = 140 undergo a 100-g, 3-hour diagnostic oral glucose tolerance test (OGTT); at 24-28 weeks In women in whom GD is diagnosed, what is the blood glucose cutoff? (depending on community prevalence rates) - Answer ️️ -135-140 What is the recommended initial management of women diagnosed with DM? - Answer ️️ - nutritional counseling by a registered dietitian, if possible, and advice on a moderate exercise program. When is postpartum screening of GD recommended? - Answer ️️ -6-12 weeks postpartum What percentage of women experience some type of mood disturbance in the postpartum period? - Answer ️️ -85% Some women may be abnormally sensitive to changes in the hormonal milieu and may develop depressive symptoms when treated with what? - Answer ️️ -exogenous estrogen and progesterone What screening tool is a 10-item, self-rated questionnaire used extensively for detection of postpartum depression? - Answer ️️ -The Edinburgh Postnatal Depression Scale (EPDS) A score of ___ or more on the EPDS or an affirmative answer on question ____ (presence of suicidal thoughts) requires more thorough evaluation - Answer ️️ -10 What scale is a common, 10-item, clinician-administered evaluation used following a positive screen, and it accurately differentiates depressed and nondepressed patients, evaluates severity of disease, and detects changes in symptoms over time - Answer ️️ -The Montgomery-Asberg Depression Rating Scale When do symptoms of postpartum blues peak? When do they usually remit? - Answer ️️ -Day 4 or 5; 2 weeks What treatment is indicated for postpartum blues? - Answer ️️ -support and reassurance When does postpartum depression usually develop? - Answer ️️ -in the first 4 months, but can occur in the 1st year What medical causes should be excluded in evaluating mood disturbances? - Answer ️️ - hypothyroidism and anemia What options are available to depressed mothers who are nursing and wish to avoid medications? - Answer ️️ -cognitive-behavioral and interpersonal therapy. Psychoeducational or support groups may also be helpful What is first line pharmacologic therapy for women with postpartum depression? - Answer ️️ - antidepressants (SSRI OR SNRI) alone or in combination with estrogen How long is treatment recommended for women with their first episode of postpartum depression? - Answer ️️ -6-12 months Who is at the highest risk for postpartum psychosis? - Answer ️️ -personal hx of bipolar disorder or hx of postpartum psychosis When does postpartum psychosis usually emerge? - Answer ️️ -as early as 48-72 hours after delivery, but usually withing the first 2 weeks What condition resembles a rapidly evolving manic or mixed episode, with symptoms such as restlessness and insomnia, irritability, rapidly shifting depressed or elated mood, and disorganized behavior - Answer ️️ -postpartum psychosis Acute tx of postpartum psychosis includes what? - Answer ️️ -Needs inpatient tx. with a mood stabilizer (eg, lithium, valproic acid, carbamazepine) in combination with antipsychotic medications and benzodiazepines. ECT (often bilateral) is well tolerated and rapidly effective. Women who intend to breastfeed should be informed about what regarding psychotropic meds? - Answer ️️ -virtually all are excreted in breastmilk Breastfeeding with psychotropic meds should be avoided in which populations? - Answer ️️ - premature infants or in those with hepatic insufficiency What 2 psychotropic meds should be avoided while breastfeeding d/t increased risk for hepatotoxicity? - Answer ️️ -valproic acid and carbamazepine and caution with lithium A breastfed infant who is exposed to lithium in the breast milk, should have periodic monitoring of what? - Answer ️️ -lithium levels and thyroid function Morning sickness usually resolves by when? - Answer ️️ -14-16 weeks (after 1st trimester) What can hyperemesis gravidarum cause? - Answer ️️ -dehydration and ketonuria How is morning sickness treated with lifestyle measures? - Answer ️️ -Avoid triggers (empty stomach, strong smells), eat frequent small meals, eat dry crackers before getting out of bed, accupressure (seabands), ginger capsules How can morning sickness be treated pharmacologically? - Answer ️️ -Vitamin B6, Unisom, and RX Zofran What is the most common anemia? - Answer ️️ -iron deficiency (hypochromic, microcytic) What is the H/H values in the 1st, 2nd, and 3rd trimester in iron deficiency anemia? - Answer ️️ -Hgb 11% and Hct 33% in 1st and 2nd trimester Hgb 10.5% and Hct 32% in 3rd trimester What are S/S of iron deficiency anemia? - Answer ️️ -vague, pallor, fatigue, headache, palpitations, tachycardia What labs are seen in iron deficiency anemia? - Answer ️️ -decrease in serum ferritin, transferritin saturation and increased TIBC What risks are associated with iron deficiency anemia? - Answer ️️ -intrauterine growth restriction, preterm labor How is iron deficiency anemia treated? - Answer ️️ -Ferrous sulfate 300mg (contains 60 mg of elemental iron) 2-3x day. Continue for 3 months AFTER Hb has returned to normal to replenish iron stores Take iron on an empty stomach with orange juice to add absorbtion Encourage diet high in iron: beef, liver, beans, whole grains, nuts, dark leafy greens What are S/S associated with Cholecystitis/ Cholelithiasis? - Answer ️️ -anorexia, N/V, intolerance of fatty foods, RUQ & epigastric abdominal pain, + Murphy's sign What labs are seen in cholecystitis/cholelithiasis? - Answer ️️ -WBC, AST, ALT, bili, & alkaline phosphatase What imaging techniques are used in cholecystitis/cholelithiasis? - Answer ️️ -u/s What symptomatic management is done for cholecystitis/cholelithiasis? - Answer ️️ -bowel rest, IV hydration, analgesics, antibiotics Where do the majority of ectopic pregnancies occur? - Answer ️️ -fallopian tube What are risk factors for ectopic pregnancy? - Answer ️️ -Smoking, IUD use, assisted reproductive technology, PID, endom