AMCB Practice Question Review With Correct Answers

Latent Phase of Labor - Answer Onset of labor until cervical dilation reaches 4-6 m Long arc rotation - Answer Most commonly performed by babies beginning labor in LOP presentation FHR Variability: controlling system - Answer Parasympathetic/sympathetic nervous system Pudendal Anesthesia Administration - Answer Ideal 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 - Answer commonly caused by a vagal response in the fetus related to descent Engagement occurs when - Answer Widest 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 - Answer Microcytic, hypochromic Low Hgb, Hct, MCV, MCHC, RBCs, iron, ferritin High TIBC High RDW Leg cramp in pregnancy relief - Answer Flexion of the foot Changes in respiratory system in pregnancy - Answer May cause increased chest diameter; thoracic circumference increases by 5-6cm and residual volume decreases polyhydramnios fetal etiology - Answer CNS or GI tract fetal anomalies Autosomal Recessive Trai - Answer Expressed only when both copies of the gene are the same; ex cystic fibrosis and sickle cell anemia Infant effects of maternal tobacco use - Answer IUGR, premature birth, and SGA Severe features of preeclampsia - Answer thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, and cerebral or visual symptoms Hemodynamic Changes in Initial Postpartum Period - Answer Elevated cardiac output for as long as 48 hours after birth; cardiac output increases 60-80% Placental transport of oxygen and glucose - Answer Transported across the placenta via facilitated diffusion Amniotic fluid production - Answer Produced 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 - Answer Metronidazole (Flagyl) 2 g PO x1 at any stage in pregnancy Ritgen maneuver - Answer Assist 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 - Answer HIV positive and untreated Active TB Illicit drug use Take prescribed chemotherapy agents Acrocyanosis - Answer Bluish discoloration of the hands and feet caused by reduced peripheral circulation. Normal within first 24-48 hours after birth Variable decelerations description - Answer Abrupt in nature Decrease in FHR from a baseline of >15BPM lasting >15 seconds but <2 min Anterior asynclitism - Answer exists when the sagittal suture is closer to the sacrum and the anterior parietal bone is presenting first Oligohydramnios fetal etiology - Answer Associated with genitourinary abnormalities in the fetus Midplane Definition/Elements - Answer Ischial spines distance and sacrum Distance b/w the ischial spines normally measures 10 cm Smallest diameter of the pelvis Chorionic Villi - Answer The 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 - Answer 2 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 - Answer Occurs 6-7 days after fertilization Usually in the upper posterior wall of the uterus Human zygote - Answer consists 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 - Answer The 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 - Answer Lower 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 - Answer women who has not carried a baby to 500g or 20 weeks Leopold's Maneuvers - Answer A 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 - Answer Contraception 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) - Answer Nipple 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 - Answer Gold standard treatment is clindamycin and gentamycin Lactogenesis I - Answer Beginning milk production; mid-pregnancy to day 2 postpartum. Cordocentesis - Answer Process 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 - Answer 2500 kcal/day and 60g/day of protein Mastitis - Answer inflammation of the mammary gland Symptoms include unilateral breast swelling and an erythematous area with a fever Amenorrhea evaluation - Answer Obtain 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 - Answer prior abruption, CHTN, PIH, cocaine, alcohol, tobacco, DM, SLE Reactive NST - Answer FHR 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 - Answer release 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 - Answer sterilization circumcision parent discussion - Answer although 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 - Answer Contraindicated since it may cause discoloration of teeth in children Trichomonads Symptoms/Exam - Answer Symptoms of trichomoniasis include: -copious, malodorous, yellowish-green discharge -vulvar irritation -pruritus -occasionally dysuria, urgency, frequency of urination -postcoital and intermenstrual bleeding. Onset of symptoms often occurs after menses. In addition to vaginal discharge (green/yellow), physical examination findings may include: -erythema and edema of the vagina -a friable cervix -punctate lesions (strawberry spots) on the surface of the cervix Pharmacokinetic changes during pregnancy: GFR - Answer Drug elimination may be faster because of an increase in the GFR. The GFR begins increasing early in pregnancy, peaks at 9 to 16 weeks, and plateaus at a rate approximately 50% above the pre-pregnancy rate at 34 to 36 weeks. An increased GFR can result in faster elimination of some drugs, resulting in a lower serum concentration during pregnancy. Polyhydramnios - Answer Excess of amniotic fluid diagnosed as an AFI greater than or equal to 24cm or a maximum deepest vertical pocket of equal to or greater than 8cm Risk factors for uterine inversion during labor - Answer strong traction on the umbilical cord fundal pressure fundal placental implantation retained placenta - Answer retention of the placenta beyond 30 minutes after birth Labor position most likely to compromise perineal integrity - Answer Lithotomy Most common fetal malposition in labor - Answer Occiput posterior If persistent OP it: -may result in prolonged 1st and/or 2nd stage -increase in operative vaginal births, w/ resulting increased incidence of tears and 4th degree lacs -birth trauma -umbilical artery acidemia -cesarean sections Intrapartum term GBS Risk Factors - Answer Treat a GBS unknown woman at term if: Amniotic membrane rupture >18hrs Temperature over 100.4F Nipple Stimulation Labor Induction - Answer Releases endogenous oxytocin from the pituitary gland; which causes uterine contractions similar to synthetic oxytocin Low risk women w/ a favorable cervix are likely to be in labor in 72 hours with this induction method There is a noted decrease in abnormal fetal heart rates and postpartum hemorrhage with this method Lochia - Answer Lochia Rubra: primarily composed of red blood cells and occurs in the first few days Lochia Serosa: consists of exudate, leukocytes, and some blood and occurs on days 3-5 Lochia alba: whitish yellow and can last until 4-8 weeks Vaginal healing after birth - Answer Vagina is edematous and bruised after a vaginal birth Vaginal rugae may return approximately 3-4 weeks Vaginal epithelium is healed between weeks 6-10 Hematoma after vaginal delivery - Answer Localized collection of blood that often clots and is usually the result of trauma Usually have unilateral labial swelling that can be black/bluish and often cause sudden onset of rectal pain thrombosed hemorrhoid - Answer a hemorrhoid that contains a blood clot and is extremely painful Initially treated with incision and drainage Complementary therapies include laxatives, stool softeners, witch hazel diastasis recti - Answer Normal separation of the abdominal muscles to accommodate the growing uterus of late pregnancy Mild abdominal toning exercises can be encouraged after birth to help restore muscle tone and diminish the diastases Subinvolution of the uterus - Answer Uterus remains enlarged with continued lochial discharge which may result in postpartum hemorrhage Mastitis treatment - Answer Dicloxacillin 500mg four times a day for 10-14 days Subgaleal hemorrhage - Answer Bleeding into the subgaleal compartment Neonatal emergency Noted by diffuse bruising and extensive swelling of the scalp that crosses the suture lines that shifts with repositioning hypospadias - Answer abnormal congenital opening of the male urethra on the undersurface of the penis cryptorchidism - Answer undescended testicles Chordee - Answer Bend in the shaft of the penis scrotal hydrocele - Answer swelling of the scrotum due to a collection of fluid in the testes or along the spermatic cord Routine pulse oximetry of the newborn - Answer Put into place to identify critical congenital cardiac defects that are not easily recognized at birth and in the early newborn period (i.e. hypoplastic left heart) Prophylactic treatment for opthalmia neonatorum - Answer Erythromycin eye ointment Neonatal Hypoglycemia - Answer Glucose valuses of 40-50 or lower should be verified by venous sample and then referred to neonatal care Blood sugar nadir is 1-2 hows of age Mechanism of physiologic jaundice of the newborn - Answer Due to rapid breakdown of red blood cells as they have a shorter lifespan in the newborn: there is a shorter lifespan of newborn red blood cells APGAR scoring - Answer A= appearance (color all pink, pink and blue, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp) R= respirations (strong cry, weak cry, absent) Developed to assess adaptation to extrauterine life Score at 1 and 5 minutes of life Leukorrhea of pregnancy - Answer Begins in the 2nd trimester Characterized by copious, thin, or thick vaginal discharge In the absence of pruritis, malodor, erythema, vaginitis can be excluded and woman can be reassured regarding normalcy crown-rump length - Answer Most accurate measurement of the embryo in the first trimester Accurate within 3-5 days CenteringPregnancy Positive Outcomes - Answer Associated with: -high maternal satisfaction -increased self-esteem -less depression -higher rates of breastfeeding -lower preterm delivery rates -better pregnancy spacing Breast changes in pregnancy - Answer In the middle of pregnancy breast changes are marked by secretory changes in the epithelium which is the first stage of lactogenesis Colostrum is secreted but alveoli cells remain quiescent towards the end of pregnancy under the influence of progesterone Hyperplasia and hypertrophy are characteristic of breast changes in pregnancy Uterine Contractility - Answer tightening and shortening of uterine muscles -mitochondira increase in number w/in each cells; produce energy used for increased contractility Metabolic syndrome diagnostic criteria - Answer -Waist circumference greater or equal to 88cm -Triglycerides greater or equal to 150mg/dL OR drug treatment for elevated triglycerides -HDL less than 50mg/dL OR drug treatment for reduced HDL -Systolic BP greater than 130 and/or diastolic BP greater than 85 OR drug treatment for HTN -Fasting glucose greater than or equal to 100mg/dL OR drug treatment for elevated glucose Adenomyosis - Answer endometrial tissue within the myometrium that responds to hormonal stimulation endometriosis - Answer Endometrial tissue that is outside of the uterus most common cause of chronic pelvic pain in reproductive-age women ~7-10% of premenopausal women are affected Expedited Partner Therapy - Answer Treatment of sexual partners for someone who has had a positive chlamydia or gonorrhea infection Treat all partners from the prior 60 days Normal parameters for menstrual cycle - Answer 24-38 days in frequency or cycle interval Variation of 2-20 days over the course of a year Menstrual flow lasting 4.5 to 8 days 5-80mL of blood loss during a given cycle fibrocystic breast changes - Answer Present in more than half of women aged 20-50 years Common in women aged 35-50 years Present with numerous bilateral mobile cystic masses that are often tender Axillary tail and upper outer quadrant of both breasts are most common sites Neovagina - Answer Created through penile inversion technique during gender-affirming surgery Clinician's approach to vaginal health relies on understanding of the physiology: -it is a skin-lined blind-ended pouch Douching w/ warm water is necessary after intercourse to prevent discharge from accumulated exudate, lubricant, semen, or other material Epididymis - Answer Tightly coiled mass of tubes responsible for the maturation, storage, and transport of spermatozoa, which helps to facilitate sperm maturation Diagnosis of candida vaginitis - Answer Clinically: presence of: -external dysuria -vulvar pruritus -pain -swelling -redness Signs: -vulvar edema -fissures -excoriations -thick curdy vaginal discharge Diagnosis: -wet prep or Gram stain shows yeasts, hyphae, or pseudohyphae -culture yields a yeast species Associated w/ a normal vaginal pH (4.5) Preeclampsia Diagnosis - Answer Development of BP higher than 140/90 on 2 occasions at least 4 hours apart after 20 weeks gestation AND Protein/creatinine ratio >0.3 24-hr urine >300mg Dipstick result of 1+ OR In absence of proteinuria, new onset HTN plus any of following: -Platelet count <100,000 (thrombocytopenia) -Serum creatinine >1.1 or doubling w/out renal disease (renal insufficiency) -Doubling of liver transaminases (impaired liver function) -pulmonary edema -cerebral or visual symptoms Ezetimibe - Answer Drug considered for use in combination with a moderate-intensity statin for individuals with dyslipidemia who need but cannot tolerate high-intensity statins This drug works by inhibiting cholesterol absorption Leiomyomata - Answer fibroid tumors of uterus Can be found in different areas within and around the uterine cavity and surrounding ligaments Submucosal myomas: protrude into the uterine cavity Subserosal myomas: bulge through the outer uterine wall Intraligamentous myomas: found within the broad ligament Interstitial (intramural) myomas: stay within the uterine wall (most common form) Pedunculated myomas: found on a thin pedicle or stalk attached to the uterus Human Zygote - Answer Contains the haploid number of chromosomes: 23 pairs It possesses half the diploid or normal number of pairs of chromosomes, 46 pairs, found in somatic, or body, cells Sexual Dysfunction DSM-5 Criteria - Answer Sex-related symptoms that occur at least 75% of the time For at least 6 months Causes significant distress for the individual Endometrial Carcinoma Risk Factors - Answer Diabetes Obesity Hypertension Family history of early menarche Late menopause Unopposed estrogen therapy Oligo-ovulation Anovulation Estrogen-secreting tumors (granulosa cell) Community-acquired Pneumonia Treatment - Answer outpatient = empiric abx. Azithromycin, Clarithromycin OR Doxycycline If patient has risk factors for DRSP recommended antibiotic is respiratory fluoroquinolone Safety bundle - Answer Small straightforward set of evidence-based practices that when performed collectively and reliably have proven to improve patient outcomes Mammary changes during pregnancy - Answer Enlargement of Montgomery tubercles Darkening of the areola Enlargement of the breasts Blood vessels appear more visible Initial steps of neonatal resuscitation - Answer Place infant under a radiant heater Clear secretions if needed Dry the infant and remove wet linen Provide tactile stimulation while assessing the heart rate and presence or absence of spontaneous respirations Differential Diagnosis for First Trimester Bleeding - Answer Implantation bleeding Threatened abortion Ectopic pregnancy Cervicitis Cervical polyps Vaginitis Trauma/intercourse Disappearing twin Autoantibody/autoimmune disorder Multigravida - Answer Person who has been pregnant two or more times, regardless of the result of the pregnancies Moderate variability FHR - Answer Amplitude range of 6-25 BPM Ospemifine - Answer Selective estrogen receptor modulator (SERM) Taken as a daily PO dose to treat moderate to severe dyspareunia related to vulvovaginal atrophy Hot flashes are a common side effect Risk factors for gestational diabetes - Answer -Overweight or obesity -Physical inactivity -History of GDM -Prior LGA infant -Age >25 years -Strong family history of type 2 DM -Race/ethnicity: African American, Hispanic, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander -Hypertension -Elevated HDL and triglycerides -PCOS -Elevated HbA1C -Being treated for HIV Estriol - Answer Estrogen of pregnancy Least potent of the estrogens Derived from the conversion of estrone and estradiol in the liver, uterus, placenta, and fetal adrenal gland Postpartum hemorrhage - Answer Blood loss that causes the patient to be hemodynamically symptomatic Excessive, delivery-related blood loss that causes the patient to be hemodynamically symptomatic and/or hypovolemic