RNC OB Exam 85 Questions with Verified Answers
Rule-in pre-E labs:
-24 hour
-dipstick - CORRECT ANSWER 300 mg/24 hour
1+ dipstick
What
... [Show More] gestational age should you screen for GDM? - CORRECT ANSWER 24-28 weeks
Blood flow to uterus @term - CORRECT ANSWER 800 mL/min
Extra calories needed in pregnancy - CORRECT ANSWER 300 kcal per fetus
Weight gain in pregnancy - CORRECT ANSWER 1st trimester: 1-5#
2nd/3rd trimester: 1#/week
Maternal hypothyroidism can cause - CORRECT ANSWER -CNS problems
-brain development issues
-fetal death
@birth, what happens to infant...
-PVR
-pulmonary blood flow
-SVR - CORRECT ANSWER -PVR decreases
-pulmonary blood flow increases
-SVR increases
when should infants be screened for congenital heart disease via pulse ox - CORRECT ANSWER 24-48 hours (testing earlier may not show)
tocolytic of choice for pt w/ asthma - CORRECT ANSWER magnesium
*indomethacin will exacerbate asthma
initial med treatment of asthma - CORRECT ANSWER b-agonist inhaler ex: albuterol
how many weeks GA when asthma symptoms are usually the worst? - CORRECT ANSWER 24-36 weeks
Hyperemesis gravidarum deficienes - CORRECT ANSWER vit K + thiamine
pyelonephritis effect on premature infant - CORRECT ANSWER cerebral palsy
anti-D antibody titer should be between - CORRECT ANSWER [0-1:8]; if greater, indicates Rh sensitization
when do pregnant women receive Rhogam - CORRECT ANSWER -@28 weeks or anytime there is extra bleeding/amnio
-post-delivery within 72 hours
amniotic fluid increases to ____ mL @ _____ weeks then slowly decreases - CORRECT ANSWER 1,000 mL / 36w
s/s Acute Fatty Liver - CORRECT ANSWER n/v, GI bleed, hypoglycemia, hypertension, hepatic enceph, jaundice
treatment of Acute Fatty Liver - CORRECT ANSWER -immediate c/s
-transfuse coagulation factors
-blood products
-dialysis and liver transplant
effects of Acute Fatty Liver on neonate - CORRECT ANSWER -cardiomyopathy, neuropathy, myopathy
-liver failure
-hypoglycemia
why does cholestasis, cholelithiasis, and choleycystitis occure often in pregnancy? - CORRECT ANSWER increased estrogen and increased biliary sludge (d/t decreased emptying d/t to slower flow of bile --> backs up
s/s of cholslithiasis and cholecystitis - CORRECT ANSWER -RUQ pain
-n/v
-fever
-jaundice, clay poop
how long to wait to get pregnant post-bariatric surgery? and why? - CORRECT ANSWER 18 mo
- decreases change of SGA neonates
-nutritional deficiencies in protein, iron, B12 and low kcal intake
effects of cocaine use - CORRECT ANSWER -4x risk placental abruption
-IUGR
-skull/facial/cardiac/brain defects
-cutis aplasia
PICA increases chance of - CORRECT ANSWER PT delivery before 35 weeks
Iron deficiency
Benzodiazepines (-zepams) *inconsistent studies, unsure effects
-what to look for
-what not to combine with - CORRECT ANSWER -withdrawl s/s: dyspnea, tremors, jitters, crying
-diphenhydramine ***causes increase stillbirths
Buspirone
-what do we know?
-class - CORRECT ANSWER little known, class B
SSRIs
-what can it cause in neonate
-paroxetine can cause
-withdrawl s/s
***SNRIs have less pronounces withdrawls
-MAOIs can cuase - CORRECT ANSWER -can cause pulmonary HTN if taken in last 50% of pregnancy
-parox can cause congenital heart disease
-withdrawl similar to benzos
-MAOIs can cause IUGR
suddenly stopping heroin can cause - CORRECT ANSWER PTL or infant death
heroin can cause
-on mom
-on baby - CORRECT ANSWER -iron deficieny
-preterm birth
-pre-E
-BREECH
-infant withdrawl: fever, vomiting, jittery
opioid withdrawl can cause ___
it is treated with ____ - CORRECT ANSWER PTL + abortion
Subutex, NOT Suboxone (cotains naloxone which is dangerous to feus)
*can still cause neonatal abstinence syndrome
-methadone is better than heroin because
-methadone still bad because - CORRECT ANSWER -keeps levels consistent, less needle risk
-causes PTL, IUGR, stillbirth, fetal distress *but symptoms less severe than heroine
Drug Classification before 2015 A-D X - CORRECT ANSWER A safe
B probably safe
C, D some risk
Z Unsafe
dioxins/furans - CORRECT ANSWER cancer, DD
polychlorinated biphenyls (PCBs) - CORRECT ANSWER LBW, small head
mercury - CORRECT ANSWER -NEURO damage: small head, mental retardation, seizures, blind, CP
lead - CORRECT ANSWER abortion, LBW, neuro issues, kidney, developmental problems
bisphenol A (BPA) - CORRECT ANSWER BRAIN development
treatment for maternal influenza and when - CORRECT ANSWER oseltamivir and antipyretic, w/in48 hours of onset
antiphospholipid AB syndrome
-what is it
-most common types
-risks - CORRECT ANSWER -makes the pt hypercoaguable d/t changes in platelets membranes
-most commonly lupus and anticardi
-can cause pre-E, abruption, IUGR, fetal death
definition of PTL - CORRECT ANSWER <37 and...
-regular ctx AND change in dilation/effacement
OR
-regular ctx AND initial presentation >2 cm
____mm it concerning for a short cervix - CORRECT ANSWER 30 mm-15mm
dosage of calcium gluconate in case of mag toxicity - CORRECT ANSWER 1 gm IV over 3 min
nifedipine should not be given as tocolytic to women with - CORRECT ANSWER cardio compromise
indomethacin works by_____
fetal risk
maternal risk - CORRECT ANSWER -blocking production of prostaglandin
-may cause premature closure of fetal ductus arteriosus after 34 weeks, impairs renal fuction --> oligo
-can cause GI issues n/v, gastritis
nifedipine s/e - CORRECT ANSWER h/a, dizzy, flushing
greatest benefit timeframe of BMZ occurs between ___ and ___ - CORRECT ANSWER 24 hours to 7 days
-what type of drug is terb
-maternal s/e
-fetal s/e - CORRECT ANSWER -beta-adrenergic
-hyperglycemia, hypokalemia, hypotension, p. edema, tachycardia --> cardiac issues, palpitations
-same but w/ hypoglycemia
3 most common RF for PTL - CORRECT ANSWER -multiple pregnancies
-previous PTL
-cervix abnormalities
gestational trophoblastic disease
-other name
-what is it
-s/s
-tx - CORRECT ANSWER -molar pregnancy
-deterioration of trophoblasts --> embryo fails to develop past early stage
-early 2nd trimester bleeding, abnormally hight uterus, presence of grapelike vesicles, absent heart tones, very high hCG
-tx: d and c
***may cause choriocarinoma
CVS can determine analysis of - CORRECT ANSWER chromosomes, DNA, enzymes
amniocentesis can determine - CORRECT ANSWER bichem disorders, CNS anomalies, ventral wall defects
what ga is fundus @ umbilicus - CORRECT ANSWER 20 weeks
when does cm line up with week in predicition GA - CORRECT ANSWER 16-36 weeks (18 cm from symp to fundus = 18 weeks)
PUBS can determine - CORRECT ANSWER genetics, karotypes, metabolic, hematological, studies
In pregnancy, what new heart sounds are considered normal? - CORRECT ANSWER systolic murmur and enhanced first and third heart sounds
cognitive methods - CORRECT ANSWER control interpretation of pain
-relaxation
-imagery
-education
-constant labor support
H1 receptor antagonists - CORRECT ANSWER promethazine, hydroxyzine, dephenhydramine. used in early labor to promote sleep / decrease anxiety. degree of drowsiness depends on drug
*can cause hypotension when combined with opiod --> fall
increase sedation and decrease n/v
nitrous effect after inhalation is @ - CORRECT ANSWER 50 sec
opioids effect on newborn
-when is risk greatest? - CORRECT ANSWER -respiratory depression
-lower apgars
-neurobehavioral issues
*greatest risk 2-3 hours prior to delivery
how do opioids work? - CORRECT ANSWER bind to receptor sites of CNS
-IV butorphanol and nalbuphine can cause what to the FHR
-should be avoided in what patients
-what drug class - CORRECT ANSWER -pseudosinosoidal pattern
-can increase BP so nobody with HTN
-agonist-antagonists
baribituates are ____
examples - CORRECT ANSWER fat soluble and long half-life
secorbarbital, pentobarbital
spinal anesthesia - CORRECT ANSWER injected into the cerebrospinalfluid in the subarachnoid space
erbs palsy - CORRECT ANSWER most common brachial plexus shoulder injury
-arm is weak with startle reflex abnormal
-hands can move with grasp reflex normal
Klumpke's paralysis - CORRECT ANSWER lower portion of brachial plexus also injured
-hand is also paralyzed, grasp reflex absent
protracted dilation/descent
-nullipara
-multipara - CORRECT ANSWER -<1.2 cm/h, descsent <1cm per hour
<1.5 cm/h, descent <2 cm/h
pelvic inlet - CORRECT ANSWER 10 cm AP
12 cm transverse
diagonal 11.5
midpelvis = interischial spines - CORRECT ANSWER 10 cm
pelvic outlet - CORRECT ANSWER interishical tubes 8 cm or more
precipitous labor - CORRECT ANSWER <3 hours
Placenta accreta - CORRECT ANSWER absent decidual basalis, placenta grows directly onto myometrium
placenta increta definition - CORRECT ANSWER trophoblasts invade myometrium
placenta percreta - CORRECT ANSWER tropho cells invade myometrium and penetrate through wall and invade other organs
balloon tamponade should control bleeding within ____ min - CORRECT ANSWER 5-15 min
when does cervix go back to 1 cm - CORRECT ANSWER 1 week
when does normal CO return - CORRECT ANSWER 2-3 weeks
lochia:
rubra
serosa
alba - CORRECT ANSWER 1-3 days
3-10 days
10 - 14 days or more
function of rhogam
-when to receive and how much @
1. pregnancy
2.miscarriage, abortion at <12 weeks - CORRECT ANSWER contains anti Rh+ antiodies that agglutinate any fetal RBC that pass into mom and prevent mom from forming AB
1. 300 IM @ 26-28 weeks, 72 hours after delivery
2. 50 IM
normal menses return
-no BF
-BF - CORRECT ANSWER -7-9 weeks
-2-18 months
BF mom and only have ____ contraceptives - CORRECT ANSWER progestin-only
what does whey-to-casein ration do? - CORRECT ANSWER forms soft curds in stomach --> makes milk easily digestible
what is principle carb of milk?
what does it do? - CORRECT ANSWER lactose
supports normal gut colonization, makes gluocose for brain
what does hind milk have - CORRECT ANSWER extra fat @ end up nursing that helps satiate infant
Duration
-colostrum
-transitional
-mature - CORRECT ANSWER 1-5 days
6-13 days
+14
vitamin D supplementation for BF babies
-when
-amount - CORRECT ANSWER -@ discharge
-400 IU/day [Show Less]