RNC OB Exam 98 Questions with Verified Answers
What are the risk factors for preeclampsia? - CORRECT ANSWER -Primip <19y.o or >40y.o
-first pregnancy
... [Show More] w/ new father
- Hx severe preeclampsia
-Family Hx
- Connective tissue disease (lupus/rheumatoid arthritis)
Define GHTN - CORRECT ANSWER HTN developing after 20wks or during first 24hrs PP w/o proteinuria/other systemic findings
Define CHTN - CORRECT ANSWER HTN that does not resolve by 12ks PP or HTN diagnosed prior to pregnancy, prior to 20wks
PreE or Eclamsia - CORRECT ANSWER HTN developing after 20wks w/o other systemic findings; eclampsia is the occurrence of seizure activity w/o identifiable cause
PreE Superimposed - CORRECT ANSWER preE or eclampsia in a women w/ preexisting or CHTN
Characteristics of PreE - CORRECT ANSWER -maternal vasospasm
- decreased perfusion to virtually all organs
- decrease in plasma volume
- activation of the coagulation cascade
-alterations in glomerular capillary endothelium
- edema
- HA
- hyperreflexia
- subscapular hematoma of the liver
- increased viscosity of the blood
Diagnostic criteria PreE - CORRECT ANSWER -SBP >160 or higher, DBP >110 or higher
- renal insufficiency (creatinine >1.1 or doubling) or new development of renal insufficiency in absence of other renal disease
-PLT <100,000
- Elevated LFTs
-New onset cerebral/visual disturbances
-persistent RUQ pain or epigastric pain unresponsive to meds and no accounted for by alternative diagnosis, or both
-pulmonary edema
Significance of Eclamsia - CORRECT ANSWER -at risk for abruption
-at risk for cerebral hemorrhage and aspiration
What is foley's rule of 13? - CORRECT ANSWER -13% mortality
-13% abruption
-13% seize after MgO4 therapy
-13% seize >48-72hrs PP
What are the visual changes associated w/ PreE? - CORRECT ANSWER -diplopia (double vision)
-photophobia (eye discomfort in bright light)
-scotomata (blind spot or partial loss of vision in what is otherwise a perfectly normal visual field)
-amaurosis fugax (transient vision loss r/t decreased blood flow to eye)
Define GDM - CORRECT ANSWER Glucose intolerance develops or is first discovered during pregnancy. GDM increases the risk for type 2
How is glucose altered early in pregnancy? - CORRECT ANSWER Glucose homeostasis is altered by the increases in estrogen and progesterone that cause pancreatic beta-cell hyperplasia, w/ subsequent increased insulin secretion's
True or False: at the end of the 1st trimester, preexisting diabetic patients will experience hypoglycemia - CORRECT ANSWER true
Describe glucose metabolism during pregnancy - CORRECT ANSWER In 2nd and 3rd trimester, levels of estrogen, progesterone, human placental lactogen and prolactin increase progressively and cause increasing tissue resistance to insulin action
What happens is a patient has preexisting borderline beta-cell reserve? - CORRECT ANSWER Hyperglycemia will occur; Increase basal insulin requirements due to insulin resistance; increases infant glucose utilization
What is HbA1C? - CORRECT ANSWER average BG over 2-3 months; A1C >6% associated w/ increased infant mortality
True/False: Glyburide is an effective alternative med to insulin if pt. unable to self admin insulin/gain access to insulin. - CORRECT ANSWER False. Metformin is more effective
How do insulin requirements change in each trimester? - CORRECT ANSWER 1st Trimester: decreased need for insulin
2nd: increased need for insulin; glucose increases
3rd: additional increase due to placental maturation and hPl production
Labor: decreased need for insulin
PP: Insulin need decrease
Diabetes effects on pregnancy/delivery - CORRECT ANSWER -Polyhydraminos
-PreE;PTL;Vaginitis;DKA
-Increased risk of maternal infection r/t hyperlycemia: UTI, Chorio, PP endometritis
-PP and anemia r/t birth trauma due to macrosomia
3 'Poly's' associated w/ diabtes - CORRECT ANSWER -Polydipsia: excessive or abnormal thirst
-Polyphagia: excessive eating
- Polyuria: excessive passage of urine
Risks of abnormal glucose during organogenesis - CORRECT ANSWER -congenital anomalies
-SAB
*organogenesis: initial embryonic development
Diabetic meal plan - CORRECT ANSWER -allow 2-3hrs between meals/snacks
-avoid going more than 10hrs from bedtime to breakfast to avoid ketogenesis
-restrict carbs at breakfast
How does diabetes affect breastfeeding? - CORRECT ANSWER -breastfeeding removed glucose from maternal blood to form lactose
-breastfeeding can cause hypoglycemia
- women w/ hyperglycemia at greater risk for mastitis, wound infection, and endometritis
Cardiac functional capacity classifications - CORRECT ANSWER -Class 1: asymptomatic w/ no limitations of activity
-Class 2: symptomatic w/ increased activity
-Class 3: symptomatic w/ normal activity
-Class 4: symptomatic at rest or with any activity
What are CHF symptoms? - CORRECT ANSWER -edema or any kind
-dyspnea on exertion/rest
-increasing fatigue
-moist cough
-rales
-cyanosis (nail beds;circumoral-mouth)
-tachycardia, chest pain, murmurs, irregular pulse
Risk factors for cardiomyopathy - CORRECT ANSWER >30y.o; multiparity; twins; race/health equity; GHTN
When does cardiac output increase during labor? - CORRECT ANSWER immediately after birth
Define threatened abortion. - CORRECT ANSWER Vaginal bleeding, closed cervix, placenta attached
Define imminent abortion - CORRECT ANSWER placenta separated, increased bleeding, cervix dilated
Define incomplete abortion. - CORRECT ANSWER Vaginal bleeding, cervix is open, fetus passed, placenta remains
When is rhogam given for SAB? - CORRECT ANSWER w/in 72hrs
Define marginal placental abruption - CORRECT ANSWER -placenta separates at its edge
-blood passes between fetal membranes and uterine wall
-blood escapes vaginally
Define central placental abruption - CORRECT ANSWER -placenta separates centrally
-blood trapped between placenta and uterine wall
-concealed bleeding
Define complete placental abruption - CORRECT ANSWER -total separation
-massive vaginal bleeding
Risk factors for placental abruption - CORRECT ANSWER -HTN/GHTN/CHTN/PrE
-Cigarettes/illicit drug use
-multiparity
-short umbilical cord
-uterine rupture from over distention
-abdominal trauma
Define total placenta previa. - CORRECT ANSWER the placenta completely covers the cervical os
Define partial placenta previa - CORRECT ANSWER the cervical os is partially covered
Define marginal placenta previa - CORRECT ANSWER the edge of the placenta is at the edge of the cervical os
Define low-lying placenta. - CORRECT ANSWER the placenta is close to the cervical os but does not actually touch it
Bright red painless bleeding in 2nd/3rd trimester - CORRECT ANSWER placenta previa
define accreta - CORRECT ANSWER Placenta roots grows deeply into muscular wall of the womb
Define percreta - CORRECT ANSWER The placenta pushes through the uterine wall and invades into other organs
Define increta - CORRECT ANSWER chronic villi invade the myometrium
Velamentous insertion - CORRECT ANSWER Cord attachment to the edge of the placenta
vasa previa - CORRECT ANSWER occurs when the umbilical cord vessels cross the internal os of the cervix
battledore placenta - CORRECT ANSWER cord insertion into the margin of the placenta
Another name for amniotic fluid embolism - CORRECT ANSWER anaphylactoid syndrome of pregnancy
What should the neonate be assessed for w/ polyhyraminos? - CORRECT ANSWER Gastrointestinal obstruction/ atresia
Dysfunctional labor patterns: Prolonged latent phase - CORRECT ANSWER longer than 20hrs in nullipara; longer than 14hrs in multip
How is magnesium sulfate used to prevent preterm labor? - CORRECT ANSWER -efficacy not confirmed
-calcium antagonist
-4-6g load; 2g maintenance for 48hrs
How is nifedipine used to prevent preterm labor? - CORRECT ANSWER -inhibits calcium entry
-efficacy confirmed; rapid effect
-side effects: maternal hypotension and HA
How is terbutaline (beta-mimetic) used to prevent preterm labor? - CORRECT ANSWER -beta 2 stimulation, then cyclic AMP increase, then decrease calcium
-side effects: maternal tachycardia, pulmonary edema, glucose intolerance
How does Indomethacin work as a tocolytic? - CORRECT ANSWER prostaglandin synthetase inhibition
fetal side effects of indomethacin - CORRECT ANSWER (1) risk premature closure of ductus arteriosus, consequence: increased pulmonary flow --> risk reactive hypertrophy of pulmonary arterioles --> eventual pulmonary HTN
(2) Oligohydramnios (reversible upon stopping med)
Indomethacin maybe contraindicated if... - CORRECT ANSWER -asthma or coagulopathy present in pregnant women
-renal problems in mother or fetus
What can cause activation of maternal-fetal hypothalamic-pituitary-adrenal (HPA) axis? - CORRECT ANSWER Stress/Violence => preterm labor/delivery
Obesity class 1 - CORRECT ANSWER 30-34.9
Obesity class 2 - CORRECT ANSWER 35-39.9
Obesity class 3/Morbidly obese - CORRECT ANSWER 40 or greater
4 p's of Labor - CORRECT ANSWER Passage, Passenger, Powers, Psyche
Leopold's Maneuvers - CORRECT ANSWER A series of four maneuvers designed to provide a systematic approach whereby the examiner may determine fetal presentation and position.
Maternal cardia response to labor - CORRECT ANSWER Cardiac output increases by 10% to 15% during 1st stage of labor and by 30% to 50% during 2nd stage
What is the latent phase of labor? - CORRECT ANSWER Prior to active first stage and may last 6 - 8 hours in first time mothers when the cervix dilates from 0 cm to 3-4 cm and the cervical canal shortens from 3 cm long to less than 0.5 cm.
First stage-> Active phase - CORRECT ANSWER 6-7cm
First stage -> Transition - CORRECT ANSWER 8 to 10 cm
20-40 minutes
Strong to very strong, regular contractions
2-3 minutes apart, 45-90 seconds
Nulliparous +2 to +3, multiparous +2 to +3
Bloody mucus
Second stage - CORRECT ANSWER 10cm to delivery of fetus
Third stage - CORRECT ANSWER placenta is expelled
What is the Ferguson reflex? - CORRECT ANSWER Natural urge to push
Signs of placental separation - CORRECT ANSWER The uterus rises upward
The umbilical cord lengthens
A sudden trickle of blood is released from the vaginal opening
The uterus changes its shape to globular
Meperidine - CORRECT ANSWER Demerol; decreased use in clinical setting due to neurobehavioral depression lasting for several days in fetus
Butorphanol - CORRECT ANSWER Stadol; use w/ caution in MI or cardiac disease
Nalbuphine - CORRECT ANSWER Nubain; contraindicated in head injuries; caution in asthma, renal insufficiency
Narcan administration in adult - CORRECT ANSWER Opioid overdose: 0.4-2 mg IV, may repeat IV at 2-3min intervals up to 10mg
Narcan administration in newborn - CORRECT ANSWER 0.1 mg/kg IV, IM, SC may be repeated at 2-3min intervals up to 3 doses
Contraindications to nitrous oxide - CORRECT ANSWER - impaired consciousness
- acute drug or alcohol intoxication
- recent trauma
- pneumothorax
Bishop score - CORRECT ANSWER
Normal kick counts - CORRECT ANSWER Minimum of 10 movements in less than 2hrs
Reactive NST - CORRECT ANSWER 2 15x15 (10x10 if <32wks) accelerations in 20 minutes
What is the lecithin to spingomyelin (L:S ratio)? - CORRECT ANSWER - higher ratio indicates less risk of neonatal respiratory distress due to low surfactant
- Ratio of 2 phospholipids in amniotic fluid
- Preferred ratio is >2.0
5 Categories of a BPP - CORRECT ANSWER FHR, fetal breathing movements, gross body movements, fetal tone, qualitative amniotic fluid volume
Biophysical Profile (BPP) - CORRECT ANSWER
Progressive disruption of fetal oxygenation such as tachycardia can lead to? - CORRECT ANSWER Metabolic Acidemia
Ethical Principles - CORRECT ANSWER Autonomy
Beneficence
Nonmaleficence
Justice
Fidelity
Veracity
Puerperium - CORRECT ANSWER six-week period after birth in which the uterus involutes
Why are women predisposed to thomboembolism PP? - CORRECT ANSWER WBC elevated, activation of clotting factors; at risk for up to 6wks
Lactogenesis 1 - CORRECT ANSWER - colostrum for up to 5day
Lactogenesis II - CORRECT ANSWER (begins 2-5 days after birth) increased blood flow to breast; milk "comes in"
Lactogenesis III - CORRECT ANSWER (begins at ~10 day after birth) milk composition is stable
TXA is contraindicated in? - CORRECT ANSWER Women w/ known thromboembolic event during pregnancy, Hx of coagulopathy, or active intravascular clotting
How does a neonates H&H differ from that of an adult? - CORRECT ANSWER Average level of RBC's and H&H are higher; fetal circulation less efficient at oxygen exchange than the lungs, fetus needs additional RBC's for transport in utero
Desquamation - CORRECT ANSWER peeling skin
Cephalhematoma - CORRECT ANSWER - collection of blood between periosteum and skull bone that it covers
- does not cross suture line
- results from trauma during birth
caput succedaneum - CORRECT ANSWER diffuse edema of the fetal scalp that crosses the suture lines. reabsorbs
Average newborn weight - CORRECT ANSWER 2500-4000 (5lb 8oz-8lb 13oz)
Average newborn length - CORRECT ANSWER 20 inches (50cm); 48-52cm (18-22in)
Average newborn head circumference - CORRECT ANSWER 32-37cm
Average newborn chest circumference - CORRECT ANSWER 30-35 cm
APGAR - CORRECT ANSWER [Show Less]