TCP STUDY GUIDE EXAM QUESTIONS WITH SOLUTIONS
GUARANTEE A+ 2025
✔✔Ectopic Pregnancy - Physical Findings, Diagnosis, Treatment, Prognosis -
✔✔Physical Findings
Hypotension and tachycardia (shock, often from ruptured ectopic)
Adnexal mass/tenderness in adnexa. Normal sized uterus. Peritoneal signs.
Diagnosis of Ectopic Pregnancy
Pelvic exam, assess size of uterus. Quant hCG blood test, repeat every 48h (trend).
CBC/HCT (hemorrhage), WBC (infection).
Transvaginal US (for HCG >2000, IUP visible on Transvaginal US)
Treatment of Ectopic Pregnancy
Most commonly - Salpingectomy (surgical removal of implantation/fallopian tube)
Expectant Management - Non-viable pregnancy, let run course. Natural miscarriage.
Methotrexate (Induce Miscarriage)
Inhibits DNA synthesis and cell reproduction
Only for unruptured, small, no cardiac activity, and compliant patient
Prognosis: 40% of pts are infertile post ectopic pregnancy. 1/3 have a second ectopic.
Only 33% of patients with ectopic pregnancy have a subsequent live birth.
✔✔Pregnancy Duration/Gestational Age
Measuring Gestational Age - ✔✔Pregnancy Duration/Gestational Age
9 calendar months. 40 weeks from the first day of LMP. 280 days.
Determine Gestational Age/EDC (Estimated Date of Confinement = Due Date)
Measure crown-rump length (between 6-11 weeks, reliable to +/- 7 days)
Between 12-20 weeks, reliable to +/- 10 days (less reliable)
Fetal Death rate is surprisingly high until after week 15 of pregnancy.
Rises again after week 40 (>40 weeks, placenta increases risk of fetal death)
✔✔Spontaneous Abortion Types - Threatened, Inevitable, Incomplete, Complete,
Missed, Recurrent - ✔✔Abortions
Spontaneous abortions (miscarriage), or Induced abortions (pt chooses to end
pregnancy)
Only occurs after pregnancy has been determine to be viable
Spontaneous Abortion Types
Threatened Abortion: vaginal bleeding before 10th week (cervix is closed)
Inevitable Abortion: vaginal bleeding, campring, dilation of the cervix
Incomplete Abortion: vaginal bleeding, cramping, passage of products of conception
Complete Abortion: Passage of all products, cervix begins to close, uterus is firm
Missed Abortion: Fetal death in-utero, without expulsion. Pt does not know.
Recurrent Abortion: 3 successive spontaneous abortions.
Because abortion is common, only start to investigate reason after 3 times.
✔✔Spontaneous Abortion Management
,Therapeutic/Elective Abortion - ✔✔Spontaneous Abortion Management
Determine level of bleeding, check for dilation (inevitable abortion is likely)
If no fetal heartbeat, or decline in hCG, plus bleeding and dilation = abortion very likely.
Give mother option of surgical D&C, or to pass pregnancy on her own.
Therapeutic/Elective Abortion
Legally induced abortion is safer than continuing a pregnancy to term.
88% induced abortions performed in the 1st trimester (much safer than 2nd/3rd!)
1st trimester abortions decided by pt/physician, less state control over options
2nd/3rd trimester abortions more legal rules state by state, check laws frequently.
✔✔1st Trimester Abortion Procedure
Warning Signs Post Abortion - ✔✔1st Trimester Abortion Procedure
Surgical/Aspiration: check for products of conception, watch bleeding post procedure.
Medical: Mifepristone - May be done up to 9 weeks
Methotrexate - used only in ectopic pregnancies
Misoprostol - stimulates prostaglandin E1, produces cervical softening/dilation
Warning Signs post Abortion
Fever >100, chills, severe pain, prolonged/heavy bleeding, foul discharge
6 weeks or more delay in resuming menstrual periods
✔✔Gravida and Parity - GTPAL - ✔✔Gravida and Parity - GTPAL (Gravida/Term-
Preterm-Abortion-Living)
Gravida is # pregnancies ever, TPAL describes the "Para"
G = number of pregnancies, including current one
T = number of pregnancies terminating after 37 weeks (full term)
P = number of pregnancies terminating 20-36.6 weeks (pre-term)
A = number of pregnancies terminating before 20 weeks (spontaneous, therapeutic,
ectopic)
L = number of living children
✔✔Prenatal Visits and Frequency - ✔✔Prenatal Visits and Frequently
Ideally, have a preconception visit.
Preconception visit: counsel for prenatal vitamins (folic acid especially), as well as
stopping taking teratogenic medications. Risk reduction, improve pregnancy outcome
1st visit - 28 weeks, every 4 weeks. 29-36 weeks, every 2-3 weeks. 37-birth, every
week.
✔✔1st Prenatal Visit (Tests and Pharm) - ✔✔1st Prenatal Visit
hCG and US to confirm viability/intrauterine.
Comprehensive history/fam hx. Screen for domestic violence.
Complete PE with pelvic exam, Pap smear, Gonorrhea/Chlamydia. Breast exam.
Positive Signs of Pregnancy
Visualization of fetus by transvaginal US (5-6 weeks)
,Hear fetal heart tones by US (5-6 weeks), or Doppler (8-17 weeks)
Palpating fetal movement (felt by examiner about 20 weeks gestation)
Visual fetal movements on US
Prenatal Labs
Rubella (teratogenic, although can't give vax while pregnant), urine culture (pregnancy
is rare time where we treat asymptomatic UTIs), HIV, Syphilis, Hep B...
Pharm: FeSO4 (if anemia), if on Synthroid check TSH each trimester (increase dose
Synthroid as pregnancy progresses), offer HSV suppressive therapy at 34-36 weeks
✔✔Prenatal Tests - Diabetes and Group B Strep - ✔✔Follow-Up Prenatal Visits
Diabetes Screen - 1 hour glucose test at 24-28 weeks
*Group B Strep Screen - at 35-37 weeks. If pos, ABX during labor (penicillin) - protect
baby.
✔✔Prenatal Screening - Rh Neg or Positive - ✔✔Rh Neg or Positive
Mom, Dad, and Baby all have Rh positive or negative blood. If Dad is pos, but mom is
neg, then Mom (neg) can possibly carry a Rh positive baby.
For this forest pregnancy, nothing happens, but when mom's body (neg) comes in
contact with Rh pos blood from baby (usually during delivery), then her body makes
antibodies.
Therefore, at next pregnancy, risk of her body attacking fetus if it has Rh pos blood as
well.
To treat: RhoGAM at 28 weeks and post birth (first pregnancy) to prevent
sensitization/Ab.
✔✔Pattern of Weight Gain in Pregnancy, Timing/Distribution
Nutrition During Pregnancy - ✔✔Pattern of Weight Gain
First trimester - about 3.5-5 lbs
Second trimester - about 1 lb/week
Third trimester - about 1 lb/week
Distribution
Baby about 5-10 pounds, blood supply 4 pounds... (see above)
Total: 25-35 pounds of weight gain over pregnancy is considered healthy
Note: <20 pounds gain associated with low birth wt infants/other perinatal complications
Nutrition During Pregnancy
300 additional calories per day per fetus
500 additional calories per day during lactation
Folic acid supplementation to prevent NTDs, Iron supp to prevent anemia.
✔✔Fundal Height and Gestation (Predictable pattern of uterine growth) - ✔✔Fundal
Height and Gestation (Predictable pattern of uterine growth)
At 20 weeks, fundal height is at the umbilicus
At 36 weeks, fundal height is at the xiphoid
Good correlation between 22-34 weeks. MacDonald's method at each visit.
, MacDonald's Method: 32 weeks = 32 cm (total fundal height) - do not use with high BMI
pts
Leopold's Maneuver - Determine the position of the fetus in the uterus (4 maneuvers)
✔✔Pregnancy Complaints - N/V, Urinary Frequency, Fatigue, Breast Tenderness -
✔✔Nausea and Vomiting
Related to high hCG levels, changes in CHO metabolism.
Eat small, frequent meals. Vit B6 can help. Rx: Zofran, Phenergan, Reglan.
Urinary Frequency
Related to pressure on the bladder. Causes decreased bladder capacity.
Hydration is very important! Check for UTIs. Limit fluids in evening for better sleep.
Fatigue
Related to pregnancy HH. May have a protective effect, rest helps development.
Nap, eat healthy, take multivitamins. Energy improves in 2nd trimester, worse in 3rd.
Breast Tenderness
Related to pregnancy HH, increased blood flow. Wear appropriate bra.
✔✔Pregnancy Complaints - Leukorrhea, Heartburn, Syncope - ✔✔Leukorrhea (Vaginal
Discharge)
Related to estrogen increase over pregnancy. Higher acidity of secretion. Decreases
chance of most infections, but more favorable for growth of candida.
Monitor for yeast infections, keep good hygiene.
Heartburn
Related to effects of progesterone. Upward pressure of growing uterus.
Eat small, more frequent meals. Drink fluids between meals. Upright post meals.
Syncope
Related to inferior vena cava syndrome, or supine hypotensive syndrome.
Rise slowly, treat for anemia if needed.
Can help to lay on side/use a wedge pillow (uncomfortable to be supine anyways)
✔✔Fetal Wellbeing - Fetal Movements, Fetal Active Monitoring, Non-Stress Test -
✔✔Fetal Movements - Quickening
Typically felt at 16-20 weeks, approximately. 1st time mothers often later (20 weeks).
Multiparous women feel movements earlier in pregnancy.
Fetal Active Monitoring
More movement indicates wellbeing, less is possibly sign of compromise.
Mothers can rest on L side after sugary meal, document 10 kicks/hr.
Non-Stress Test (NST)
Electrical fetal monitor applied, fetal HR measured.
GUARANTEE A+ 2025
✔✔Ectopic Pregnancy - Physical Findings, Diagnosis, Treatment, Prognosis -
✔✔Physical Findings
Hypotension and tachycardia (shock, often from ruptured ectopic)
Adnexal mass/tenderness in adnexa. Normal sized uterus. Peritoneal signs.
Diagnosis of Ectopic Pregnancy
Pelvic exam, assess size of uterus. Quant hCG blood test, repeat every 48h (trend).
CBC/HCT (hemorrhage), WBC (infection).
Transvaginal US (for HCG >2000, IUP visible on Transvaginal US)
Treatment of Ectopic Pregnancy
Most commonly - Salpingectomy (surgical removal of implantation/fallopian tube)
Expectant Management - Non-viable pregnancy, let run course. Natural miscarriage.
Methotrexate (Induce Miscarriage)
Inhibits DNA synthesis and cell reproduction
Only for unruptured, small, no cardiac activity, and compliant patient
Prognosis: 40% of pts are infertile post ectopic pregnancy. 1/3 have a second ectopic.
Only 33% of patients with ectopic pregnancy have a subsequent live birth.
✔✔Pregnancy Duration/Gestational Age
Measuring Gestational Age - ✔✔Pregnancy Duration/Gestational Age
9 calendar months. 40 weeks from the first day of LMP. 280 days.
Determine Gestational Age/EDC (Estimated Date of Confinement = Due Date)
Measure crown-rump length (between 6-11 weeks, reliable to +/- 7 days)
Between 12-20 weeks, reliable to +/- 10 days (less reliable)
Fetal Death rate is surprisingly high until after week 15 of pregnancy.
Rises again after week 40 (>40 weeks, placenta increases risk of fetal death)
✔✔Spontaneous Abortion Types - Threatened, Inevitable, Incomplete, Complete,
Missed, Recurrent - ✔✔Abortions
Spontaneous abortions (miscarriage), or Induced abortions (pt chooses to end
pregnancy)
Only occurs after pregnancy has been determine to be viable
Spontaneous Abortion Types
Threatened Abortion: vaginal bleeding before 10th week (cervix is closed)
Inevitable Abortion: vaginal bleeding, campring, dilation of the cervix
Incomplete Abortion: vaginal bleeding, cramping, passage of products of conception
Complete Abortion: Passage of all products, cervix begins to close, uterus is firm
Missed Abortion: Fetal death in-utero, without expulsion. Pt does not know.
Recurrent Abortion: 3 successive spontaneous abortions.
Because abortion is common, only start to investigate reason after 3 times.
✔✔Spontaneous Abortion Management
,Therapeutic/Elective Abortion - ✔✔Spontaneous Abortion Management
Determine level of bleeding, check for dilation (inevitable abortion is likely)
If no fetal heartbeat, or decline in hCG, plus bleeding and dilation = abortion very likely.
Give mother option of surgical D&C, or to pass pregnancy on her own.
Therapeutic/Elective Abortion
Legally induced abortion is safer than continuing a pregnancy to term.
88% induced abortions performed in the 1st trimester (much safer than 2nd/3rd!)
1st trimester abortions decided by pt/physician, less state control over options
2nd/3rd trimester abortions more legal rules state by state, check laws frequently.
✔✔1st Trimester Abortion Procedure
Warning Signs Post Abortion - ✔✔1st Trimester Abortion Procedure
Surgical/Aspiration: check for products of conception, watch bleeding post procedure.
Medical: Mifepristone - May be done up to 9 weeks
Methotrexate - used only in ectopic pregnancies
Misoprostol - stimulates prostaglandin E1, produces cervical softening/dilation
Warning Signs post Abortion
Fever >100, chills, severe pain, prolonged/heavy bleeding, foul discharge
6 weeks or more delay in resuming menstrual periods
✔✔Gravida and Parity - GTPAL - ✔✔Gravida and Parity - GTPAL (Gravida/Term-
Preterm-Abortion-Living)
Gravida is # pregnancies ever, TPAL describes the "Para"
G = number of pregnancies, including current one
T = number of pregnancies terminating after 37 weeks (full term)
P = number of pregnancies terminating 20-36.6 weeks (pre-term)
A = number of pregnancies terminating before 20 weeks (spontaneous, therapeutic,
ectopic)
L = number of living children
✔✔Prenatal Visits and Frequency - ✔✔Prenatal Visits and Frequently
Ideally, have a preconception visit.
Preconception visit: counsel for prenatal vitamins (folic acid especially), as well as
stopping taking teratogenic medications. Risk reduction, improve pregnancy outcome
1st visit - 28 weeks, every 4 weeks. 29-36 weeks, every 2-3 weeks. 37-birth, every
week.
✔✔1st Prenatal Visit (Tests and Pharm) - ✔✔1st Prenatal Visit
hCG and US to confirm viability/intrauterine.
Comprehensive history/fam hx. Screen for domestic violence.
Complete PE with pelvic exam, Pap smear, Gonorrhea/Chlamydia. Breast exam.
Positive Signs of Pregnancy
Visualization of fetus by transvaginal US (5-6 weeks)
,Hear fetal heart tones by US (5-6 weeks), or Doppler (8-17 weeks)
Palpating fetal movement (felt by examiner about 20 weeks gestation)
Visual fetal movements on US
Prenatal Labs
Rubella (teratogenic, although can't give vax while pregnant), urine culture (pregnancy
is rare time where we treat asymptomatic UTIs), HIV, Syphilis, Hep B...
Pharm: FeSO4 (if anemia), if on Synthroid check TSH each trimester (increase dose
Synthroid as pregnancy progresses), offer HSV suppressive therapy at 34-36 weeks
✔✔Prenatal Tests - Diabetes and Group B Strep - ✔✔Follow-Up Prenatal Visits
Diabetes Screen - 1 hour glucose test at 24-28 weeks
*Group B Strep Screen - at 35-37 weeks. If pos, ABX during labor (penicillin) - protect
baby.
✔✔Prenatal Screening - Rh Neg or Positive - ✔✔Rh Neg or Positive
Mom, Dad, and Baby all have Rh positive or negative blood. If Dad is pos, but mom is
neg, then Mom (neg) can possibly carry a Rh positive baby.
For this forest pregnancy, nothing happens, but when mom's body (neg) comes in
contact with Rh pos blood from baby (usually during delivery), then her body makes
antibodies.
Therefore, at next pregnancy, risk of her body attacking fetus if it has Rh pos blood as
well.
To treat: RhoGAM at 28 weeks and post birth (first pregnancy) to prevent
sensitization/Ab.
✔✔Pattern of Weight Gain in Pregnancy, Timing/Distribution
Nutrition During Pregnancy - ✔✔Pattern of Weight Gain
First trimester - about 3.5-5 lbs
Second trimester - about 1 lb/week
Third trimester - about 1 lb/week
Distribution
Baby about 5-10 pounds, blood supply 4 pounds... (see above)
Total: 25-35 pounds of weight gain over pregnancy is considered healthy
Note: <20 pounds gain associated with low birth wt infants/other perinatal complications
Nutrition During Pregnancy
300 additional calories per day per fetus
500 additional calories per day during lactation
Folic acid supplementation to prevent NTDs, Iron supp to prevent anemia.
✔✔Fundal Height and Gestation (Predictable pattern of uterine growth) - ✔✔Fundal
Height and Gestation (Predictable pattern of uterine growth)
At 20 weeks, fundal height is at the umbilicus
At 36 weeks, fundal height is at the xiphoid
Good correlation between 22-34 weeks. MacDonald's method at each visit.
, MacDonald's Method: 32 weeks = 32 cm (total fundal height) - do not use with high BMI
pts
Leopold's Maneuver - Determine the position of the fetus in the uterus (4 maneuvers)
✔✔Pregnancy Complaints - N/V, Urinary Frequency, Fatigue, Breast Tenderness -
✔✔Nausea and Vomiting
Related to high hCG levels, changes in CHO metabolism.
Eat small, frequent meals. Vit B6 can help. Rx: Zofran, Phenergan, Reglan.
Urinary Frequency
Related to pressure on the bladder. Causes decreased bladder capacity.
Hydration is very important! Check for UTIs. Limit fluids in evening for better sleep.
Fatigue
Related to pregnancy HH. May have a protective effect, rest helps development.
Nap, eat healthy, take multivitamins. Energy improves in 2nd trimester, worse in 3rd.
Breast Tenderness
Related to pregnancy HH, increased blood flow. Wear appropriate bra.
✔✔Pregnancy Complaints - Leukorrhea, Heartburn, Syncope - ✔✔Leukorrhea (Vaginal
Discharge)
Related to estrogen increase over pregnancy. Higher acidity of secretion. Decreases
chance of most infections, but more favorable for growth of candida.
Monitor for yeast infections, keep good hygiene.
Heartburn
Related to effects of progesterone. Upward pressure of growing uterus.
Eat small, more frequent meals. Drink fluids between meals. Upright post meals.
Syncope
Related to inferior vena cava syndrome, or supine hypotensive syndrome.
Rise slowly, treat for anemia if needed.
Can help to lay on side/use a wedge pillow (uncomfortable to be supine anyways)
✔✔Fetal Wellbeing - Fetal Movements, Fetal Active Monitoring, Non-Stress Test -
✔✔Fetal Movements - Quickening
Typically felt at 16-20 weeks, approximately. 1st time mothers often later (20 weeks).
Multiparous women feel movements earlier in pregnancy.
Fetal Active Monitoring
More movement indicates wellbeing, less is possibly sign of compromise.
Mothers can rest on L side after sugary meal, document 10 kicks/hr.
Non-Stress Test (NST)
Electrical fetal monitor applied, fetal HR measured.
