Midwifery Comprehensive Exam Questions & Answer Solved 100%

Two products of impaired blood flow to the legs are thought to be linked to cramps? - Answer Pyruvic acid Lactic acid Name two prevention techniques for nocturnal leg cramps - Answer Hydration, stretching, avoid long periods of sitting or standing, warm baths, exercise What is the most important differential diagnosis to rule out when a pregnant patient comes in with complaints of leg cramping? - Answer Deep Vein Thrombosis: Look for warm red tender swollen leg. Conflicting evidence supports taking which supplement for leg cramps ? - Answer Magnesium True or false. Women with NVP have lower rates of preterm births, low birth weight babies, congenital anomalies, and stillbirths. - Answer True How does progesterone contribute to NVP? - Answer Slows peristalsis and gastric emptying If dietary measures, lifestyle changes, and OTC remedies do not help with NVP, what medicine has shown to be effective with NVP? - Answer Antiemetics such Zofran (Ondansetron). Note: Not mentioned in Varney's True of False. Effective therapy for NVP will always remain the same for a woman throughout her pregnancy and subsequent pregnancies. - Answer False. Effectiveness of therapy may fluctuate over the course of pregnancy and varies greatly from pregnancy to pregnancy. True or False. To combat nausea during pregnancy, one should brush their teeth immediately after they eat. - Answer False. Brushing your teeth can stimulate the gag reflex, aggravating nausea and vomiting. What pre-existing conditions can contribute to NVP? - Answer H. pylori and GERD What is the most important differential diagnosis to rule out with leg cramps during pregnancy? - Answer Deep vein thrombosis True/false: Leg cramps during pregnancy are not normal and should be reported immediately to provider. - Answer False. Leg cramps are completely normal during pregnancy and occur more frequently during the 2nd and 3rd trimesters. How can your pregnant patient prevent leg cramps (select all that apply)? a. Walking or other exercise b. Drink plenty of water c. Stretch before bed d. Taking a warm bath e. Sitting for long periods of time - Answer A, B, C, D True/false: Dorsiflexion of the affected foot when a cramp begins helps to alleviate the pain. - Answer True True/false: Magnesium supplements have been found to help with leg cramps. - Answer False. Research is mixed and taking magnesium supplements seem to have little effect on preventing leg cramps in pregnant women. True or False: Back pain may be a sign of preterm labor only if cramping is present. - Answer False: Cramping may or may not accompany preterm labor. What are some of the contributing factors causing back pain during pregnancy? A. The weight of a growing uterus B. A shift in her center of gravity C. Relaxation of sacroiliac ligaments D. All of the above - Answer D True or False: Acupuncture is a holistic method that has not been correlated with effective pain relief. - Answer False: One study found that 60% of women reported a decrease in back pain after receiving acupuncture. True or False: It is safe to receive chiropractic manipulation during pregnancy. - Answer True: As long as a patient sees a licensed chiropractor, studies have shown manual manipulation to be effective. Why does Round Ligament pain occur? - Answer As the uterus grows during pregnancy the ligaments stretch and thicken to accommodate and support it. These changes can occasionally cause pains. Where are Round Ligament pains felt? - Answer Round Ligament pain is a sharp pain or jabbing feeling often felt in the lower belly or groin area on one or both sides. What are some of the triggers of Round Ligament pains? - Answer Round Ligament pains can occur with position changes, getting up from a sitting, lying down, coughing, sneezing, and laughing. What non-pharmacological methods can be used to alleviate Round Ligament pains? - Answer Avoid sudden movements Side lying relaxation positions Flex hips: Bend and flex before coughing, sneezing, or laughing. Apply warmth: Heat or warm bath. Exercise: Walking True/False: Round Ligament pains lasting for more than 1 minute is normal. - Answer False: Round Ligament pain should only last for a few seconds. See your health care provider for pains lasting longer or not alleviate after a short rest. What are "dermatoses of pregnancy"? - Answer Dermatoses of pregnancy are rare severe pruritic inflammatory skin diseases that are specific to women during pregnant or postpartum period. MATCH the dermatoses of pregnancy with its clinical presentation. 1. Pruritic Urticarial papules and plaques of preganancy 2. Pemphigiod gastationis 3. Intrahepatic cholestasis of pregnancy 4. Atopic eruption of pregnancy A. Red painful itchy rash that begins as erythematous papules within the striae B. Eczematous type on face, neck and flexure surfaces C. Papules that begins around the umbilicus and spreads centrifugally. D. Intense pruritus on palms of hands and soles of feet, but with an absence of lesions. - Answer 1. Pruritic Urticarial papules and plaques of preganancy= A 2. Pemphigiod gastationis=C 3. Intrahepatic cholestasis of pregnancy=D 4. Atopic eruption of pregnancy=B Pemphigoid gestationis, which begins as plaques or papules around the womans's umbilicus and spreads centrifugally. TRUE or FALSE. The plaques and papules usually spreads to the face, scalp and mucus membrane also. - Answer FALSE. In pemphigoid gestationis, the face, scalp and mucus membrane are UNAFFECTED. Your patient Ms G is in her third trimester and is complaining of intense itching, dark colored urine and clay colored stools. You suspect which dermatoses of pregnancy? A. Pruritic Urticarial papules and plaques of preganancy B. Pemphigiod gastationis C. Intrahepatic cholestasis of pregnancy D. Atopic eruption of pregnancy - Answer C. Intrahepatic cholestasis of pregnancy Pruritic Urticarial papules and plaques of pregnancy usually presents: A. Before 12 weeks gestation B. Early in the second trimester C. Late in the third trimester - Answer C. Late in the third trimester True/False: Although it often appears during the first trimester, pregnancy rhinitis can occur at any point during pregnancy. - Answer True. What is the believed etiology of pregnancy rhinitis? - Answer Increased hormone levels. Increased blood flow. True/False: Caffeinated fluids help relieve the symptoms of pregnancy rhinitis. - Answer False. When does pregnancy rhinitis typically resolve? - Answer After delivery- typically disappears within 2 weeks after delivery. What common discomfort occurs in about 30% of pregnancies and involves the swelling of the nasal mucosa? - Answer Pregnancy rhinitis True/False Patients have found great long term success with using intranasal decongestants for pregnancy rhinitis. - Answer False Which aspect of health is most affected by the breathing issues of pregnancy rhinitis? - Answer Sleep Which two differential diagnoses must be carefully assessed with pregnancy rhinitis? - Answer Allergic rhinitis and sinusitis True/False: Moderate levels of exercise worsen the swelling of the nasal mucosa during pregnancy rhinitis. - Answer False At how many weeks does the NVP tend to disappear? - Answer 20 weeks True or False. Sucking on hard candy in-between meals can improve nausea and vomiting? - Answer True True or False. Eating a high protein meal before bed can decrease NVP? - Answer True True or false. Acupressure is a CAM treatment for NVP that has been helpful for some women. - Answer True Is it better for women with NVP to eat 3 large meals a day or several smaller meals? - Answer Several smaller meals What is an important differential that a woman with NVP could experience that would require hospitalization? How would you differentiate between the two? - Answer Hyperemesis Gravidarum; make sure the woman is not dehydrated and not losing excessive amounts of weight. Check lab values such as CMP, CBC, AST & ALT, UA. Monitor fetal wellbeing as well. What is constipation? - Answer Relaxation of the smooth muscle of the large bowel: Decreased peristalsis/motility Classified: <1 bowel movement in 3 days, and straining with painful defecation What hormone is causes constipation by slowing down muscle contractions, intestinal muscles, and bowel activity in pregnancy? - Answer Progesterone What are three risk factors for constipation in pregnancy? - Answer low fiber diet, lack of physical activity, and decreased intake of water. What helps the the absorption of iron to decrease constipation? - Answer Taking iron with orange juice. When does round ligament pain usually occur? - Answer Second trimester What is the etiology of Round ligament pain? - Answer Round ligament pain probably results from this stretching and possibly from the pressure of the increasingly heavy uterus on the ligaments Where is round ligament pain felt? - Answer Hips and Groin What are some relief measures for round ligament pain? - Answer -Acetaminophen 325-650 q4-6 or paracetamol. -Pelvic tilt exercises, re-positioning into positions that place less stress on the ligaments, and wearing a maternity support or girdle. -Slow position changes. -Walk daily - 30 min. -Stretching- Downward Dog, Bring knees to chest. -Lie on side - one pillow under belly for support, one pillow between legs -Heat, warm bath What are some differential diagnoses for round ligament pain? - Answer -Appendicitis -Constipation -Muscle strain or pain -Symphysis Pubis Diathesis -Ectopic pregnancy -Kidney / UTI Infection -Placental abruption -Chorioamnionitis -Preterm Labor What causes heartburn in pregnancy? - Answer The relaxation of the lower esophageal sphincter (s/t high levels of estrogen/progesterone), and the upward pressure of the uterus on stomach/intestines. Digested food is pushed from the stomach into the lower esophagus, causing an uncomfortable burning Approximately what percentage of women are affected by heartburn in the third trimester of pregnancy? - Answer 72% Approximately what percentage of women are affected by heartburn in the second trimester of pregnancy? - Answer 39% Approximately what percentage of women are affected by heartburn in the first trimester of pregnancy? - Answer 22% What medications are safe to use to treat or prevent heartburn? - Answer First try using antacids containing magnesium, calcium, aluminum based (Maalox, mylanta, tums...) If not effective, move onto H2 receptor antagonists (Ranitidine (Zantac), cimetidine (Tagamet)). Sodium bicarbonate antacids (Alka-Seltzer) should be avoided. What are behavior modifications that can help relieve or prevent heartburn? - Answer smaller meals avoid drinking large amounts of liquid with meals avoid laying down right after eating wear nonrestrictive clothing around the waist especially. What is important to rule out when a pregnant woman complains of chest pain? - Answer Myocardial infarction! Also: pulmonary embolism and asthma attack. What are differential diagnoses for heartburn? - Answer hiatal hernia (need endoscopy to confirm) Peptic ulcer disease (pain 2-5 hours after meal, vomiting, relief with food and antacids, need endoscopy to confirm) cholecystitis (fever, nausea, vomiting, anorexia, right upper quadrant pain) Pancreatitis (pain lasting for days, radiates to back, nausea, vomiting, abdominal distention, Turner's and Cullen's sign. test serum amylase and lipase) What might you expect in a normal/problem-free vaginal exam? - Answer Clear/white discharge, pH 3.8-4.2, negative whiff test, Lacto-bacilli present on wet mount Your patient has trichomoniasis. What might you expect in her exam? - Answer May c/o of itching, have frothy, gray, green, or malodorous discharge, "strawberry cervix", pH greater than 4.5, positive whiff test, protozoa and WBCs on wet mount Your patient has candidiasis. What might you expect in her exam? - Answer May c/o itching, discomfort, dysuria. Thick, white, clumping discharge, with vaginal inflammation/erythema. pH less than 4.5, negative whiff test, few WBCs on wet mount, yeast present on KOH wet mount Your patient has bacterial vaginosis. What might you expect in her exam? - Answer May c/o odor, discharge, itching. Discharge, thin, malodorous, milky white, homogenous, adherent. pH greater than 4.5, positive whiff test, clue cells, no/few WBCs