AMCB Practice Question Review Questions & Answers

Latent Phase of Labor - ANSWERSOnset of labor until cervical dilation reaches 4-6 m Long arc rotation - ANSWERSMost commonly performed by babies beginning labor in LOP presentation FHR Variability: controlling system - ANSWERSParasympathetic/sympathetic nervous system Pudendal Anesthesia Administration - ANSWERSIdeal timing to administer in multip women is at 8-9cm, just before complete dilation, to cover birth and repair Sudden fetal bradycardia in 2nd stage - ANSWERScommonly caused by a vagal response in the fetus related to descent Engagement occurs when - ANSWERSWidest diameter of the presenting part descends to or below the pelvic inlet The widest diameter of the fetal head is the biparietal diameter Iron Deficiency Labs - ANSWERSMicrocytic, hypochromic Low Hgb, Hct, MCV, MCHC, RBCs, iron, ferritin High TIBC High RDW Leg cramp in pregnancy relief - ANSWERSFlexion of the foot Changes in respiratory system in pregnancy - ANSWERSMay cause increased chest diameter; thoracic circumference increases by 5-6cm and residual volume decreases polyhydramnios fetal etiology - ANSWERSCNS or GI tract fetal anomalies Autosomal Recessive Trai - ANSWERSExpressed only when both copies of the gene are the same; ex cystic fibrosis and sickle cell anemia Infant effects of maternal tobacco use - ANSWERSIUGR, premature birth, and SGA Severe features of preeclampsia - ANSWERSthrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, and cerebral or visual symptoms Hemodynamic Changes in Initial Postpartum Period - ANSWERSElevated cardiac output for as long as 48 hours after birth; cardiac output increases 60-80% Placental transport of oxygen and glucose - ANSWERSTransported across the placenta via facilitated diffusion Amniotic fluid production - ANSWERSProduced by the amniotic epithelium; water transfers across the amnion and through the fetal skin -in the 2nd trimester, the fetus starts to swallow, urinate, and inspire amniotic fluid Trichomoniasis treatment in Pregnancy - ANSWERSMetronidazole (Flagyl) 2 g PO x1 at any stage in pregnancy Ritgen maneuver - ANSWERSAssist in delivery of the fetal head during extension Used to expedite the delivery of the fetal head when necessary It involves applying upward pressure from the coccygeal region to extend the head during actual delivery, thereby protecting the musculature of the perineum. Maternal breastfeeding contraindications - ANSWERSHIV positive and untreated Active TB Illicit drug use Take prescribed chemotherapy agents Acrocyanosis - ANSWERSBluish discoloration of the hands and feet caused by reduced peripheral circulation. Normal within first 24-48 hours after birth Variable decelerations description - ANSWERSAbrupt in nature Decrease in FHR from a baseline of 15BPM lasting 15 seconds but 2 min Anterior asynclitism - ANSWERSexists when the sagittal suture is closer to the sacrum and the anterior parietal bone is presenting first Oligohydramnios fetal etiology - ANSWERSAssociated with genitourinary abnormalities in the fetus Midplane Definition/Elements - ANSWERSIschial spines distance and sacrum Distance b/w the ischial spines normally measures 10 cm Smallest diameter of the pelvis Chorionic Villi - ANSWERSThe chorionic villi develop from the outer wall of the blastocyst which establishes and intimate connection with the endometrium and gives rise to the placenta Blood in the chorionic villi pertains to the circulation of the fetus Umbilical Cord Vessels - ANSWERS2 arteries that carry fetal deoxygenated blood to the placenta, smaller in diameter 1 vein that carries oxygenated blood from the placenta to the fetus; characterized by twisting or spiralizing Implantation - ANSWERSOccurs 6-7 days after fertilization Usually in the upper posterior wall of the uterus Human zygote - ANSWERSconsists of haploid number of chromosomes; 23 pairs Possesses half the diploid or number of pairs of chromosomes, 46 pairs, found in somatic, or body cells Trophoblast - ANSWERSThe outer layer of cells that develops in the germinal period. These cells provide nutrition and support for the embryo. Ultimately becomes the placenta Drop in diastolic BP during normal pregnancy - ANSWERSLower in the first 2 trimesters because of the development of new vascular beds and the relaxation of peripheral tone by progesterone, which result in decreased flow resistance Nullipara - ANSWERSwomen who has not carried a baby to 500g or 20 weeks Leopold's Maneuvers - ANSWERSA series of four maneuvers designed to provide a systematic approach whereby the examiner may determine fetal presentation and position. -lie -presentation -position -attitude lactational amenorrhea method - ANSWERSContraception for breastfeeding women Most effective if patient is fully or nearly fully breastfeeding (i.e. avg q4hrs during the day and 6hrs at night), the infant is younger than 6 months, and the parents have not substituted solid foods into the infant's diet. Raynaud's phenomenon (w/ breastfeeding) - ANSWERSNipple color changes to purple or blanches, which may be unilateral or bilateral, when exposed to cold air Condition is also associated w/ severe pain - specifically a sharp, burning sensation d/t the vasospasm of the nipple after breastfeeding or when the nipples are exposed to cold air Postpartum Endometritis Treatment - ANSWERSGold standard treatment is clindamycin and gentamycin Lactogenesis I - ANSWERSBeginning milk production; mid-pregnancy to day 2 postpartum. Cordocentesis - ANSWERSProcess in which a needle is introduced under real-time ultrasound through the maternal abdomen and then into the umbilical cord Blood is then aspirated or blood and/or medications are introduced into the fetus (fetal blood transfusion) Calories and Protein/Day for Pregnancy - ANSWERS2500 kcal/day and 60g/day of protein Mastitis - ANSWERSinflammation of the mammary gland Symptoms include unilateral breast swelling and an erythematous area with a fever Amenorrhea evaluation - ANSWERSObtain a pregnancy test, serum prolactin level, and TSH test. -If all these tests are negative or normal, evaluate the availability of estrogen with a progestin challenge test. Provide oral progestin each day for 10 to 14 days, and then wait for bleeding, which should occur within 7 to 14 days. A positive progestin challenge test indicates adequate estrogen production and stimulation as well as no problem with outflow tract. placental abruption risk factors - ANSWERSprior abruption, CHTN, PIH, cocaine, alcohol, tobacco, DM, SLE Reactive NST - ANSWERSFHR is a normal baseline rate with moderate variablity Two accelerations to 15 bpm for at least 15 secs in 20 min period milk ejection reflex - ANSWERSrelease of breast milk in response to oxytocin, also called the let-down reflex -oxytocin stimulates the contraction of myoepithelial cells -this contraction of cells causes milk ejection Most prevalent contraception in married women - ANSWERSsterilization circumcision parent discussion - ANSWERSalthough circumcision may offer some modest benefit in reducing potential UTIs and STIs, decisions about circumcision are largely based on personal, cultural, and religious considerations. -It appears that there is some benefit of reduced STIs, UTIs, and cancer of the penis in men who are circumcised -opponents of this procedure maintain that modern sanitary conditions and hygienic practices are more important factors in reducing the incidence of these diseases in comparison to the benefits from circumcision. Doxycycline and pregnancy - ANSWERSContraindicated since it may cause discoloration of teeth in children