Term
| What is the appropriate dose and route of methergine for treatment of PPH? |
|
Definition
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Term
| What are common maternal side effects of magnesium sulfate therapy? |
|
Definition
| Flushing, N/V, HA, lethargy |
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Term
| T or F: Magnesium sulfate is an effective therapy for the treatment of preterm labor. |
|
Definition
| False. Although it does show benefit for fetal neuroprotection (reduced rate of CP) in the event of preterm birth. |
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Term
| What are major risk factors for development of osteoporosis? |
|
Definition
1. Personal h/o fracture as adult
2. H/o fracture in parent or sibling
3. Low body weight
4. Smoking
5. >3mos corticosteroid therapy |
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Term
| How would you counsel a patient to help decrease her risk of osteoporosis in the postmenopausal period? |
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Definition
Increase: intake of calcium and Vitamin D, activity level (30 mins 3x/week), weight-bearing excercise
Decrease: Caffeine, salt, alcohol, Vitamin A intake. Do not smoke and limit secondhand smoke exposure. |
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Term
| A T-score of -3 indicates what diagnosis? |
|
Definition
Osteoporosis.
Higher than -1 = Normal
-1 to -2.5 = Osteopenia
less than -2.5 = Osteoporosis
-2.5 with h/o fracture = Severe osteoporosis |
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Term
| In what instance would it be ideal to use Evista (raloxifene) for the treatment of osteoporosis? |
|
Definition
| Pt with a high risk of breast cancer, who is not troubled by hot flashes. |
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Term
| What is the most common sign/symptom of osteoporosis? |
|
Definition
| Usually asymptomatic, not diagnosed until a fracture occurs. Sometimes pts c/o back pain. |
|
|
Term
| What is the incidence of osteoporosis-related fractures in postmenopausal women? |
|
Definition
|
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Term
| When is it appropriate to begin screening for osteoporosis? |
|
Definition
All women 65+ with no risk factors
Screen earlier if risk factors, high risk medication/condition, or postmenopausal and stopping HRT. |
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Term
| What criteria need to be met for a diagnosis of PMS or PMDD? |
|
Definition
-Affective and somatic symptoms
-Present during the luteal phase of menstrual cycle with clear symptom-free interval (approx. days 4-12)
-Severe enough to interfere with usual activities |
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Term
| What are treatment options for patients with PMS/PMDD? |
|
Definition
1. Lifestyle changes (diet, excercise, stress relief
2. SSRIs (Prozac, Zoloft- continously or just during luteal phase)
3. OCPs- shorter pill free interval (Yaz, Loestrin 24) or continuously to eliminate withdrawal bleed (No period, no PMS) |
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Term
| How do you accurately diagnose PMS/PMDD? |
|
Definition
| Record symptoms prospectively for at least 2 months. Record symptoms on a calendar in relation to days menstrual cycle. |
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Term
| What are the "core symptoms" for a diagnosis of PMDD according to DSM IV criteria? |
|
Definition
| Need 1 of the following: depressed mood, anxiety/edginess/nervousness, Moodiness, Anger/irritabilty |
|
|
Term
| What are major differentials for a diagnosis of PMS/PMDD? |
|
Definition
| Other depression/anxiety/psych disorder, pregnancy, & thyroid abnormalities |
|
|
Term
| What is the major difference between PMS and PMDD? |
|
Definition
| PMDD representas a small subset of women experiencing PMS with an emphasis on increased severity of mood symptoms. |
|
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Term
| How does the WHO FRAX tool work? |
|
Definition
-Calculated 10 year risk of major osteoporotic fracture
-Combines DXA T-score of femoral neck with other major risk factors: age, weight, height, sex, h/o fx, family hx, smoking, steroid use, RA, secondary osteoporosis, alcohol intake, and country of origin |
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Term
| What pharmacologic therapy can be used for both the treatment and prevention of osteoporosis? |
|
Definition
-Bisphosponates: Actonel, Fosamax, Boniva, Reclast (Reduce bone turnover and increase bone mass)
-Selective Estrogen Receptor Modulators: inc. osteoblasts, dec. osteoclasts (less favorable-risk of uterine ca & DVTs)
-Evista (raloxifene)-mimic estrogen's effects on bones |
|
|
Term
| What are common sites of osteoporotic fractures? |
|
Definition
| Vertebrae, distal radius, femoral neck, proximal humerus |
|
|
Term
| What pharmacologic therapies for osteoporosis should be used as treatment only? |
|
Definition
-Calcitonin (inhibits resorption, no real benefit, don't use it)
-HRT: Premarin or estradiol patches (use only if fx risk is greater than CVD/breast cancer risk)
-Forteo (parathyroid hormone-promotes new bone formation)
-Prolia (bone-modifying agent, prevents osteoclasts formation, decreased bone resorption and increased mass) |
|
|
Term
| What are the RDA for calcium and Vitamin D for postmenopausal women? |
|
Definition
age 51+:1200 mg/400 IU
age 71+:1200 mg/600 IU
Osteopenia/osteoporosis/postmenopausal and No HRT: 1500mg/800-1300 IU |
|
|
Term
|
Definition
| The time between the birth of the newborn and the return of the reproductive organs to the nonpregnant state |
|
|
Term
|
Definition
| The self-destruction of hypertrophied tissue (what happens to the uterine tissue during involution, cells reduce in size but not in #) |
|
|
Term
|
Definition
| The failure of the uterus to return to a nonpregnant state |
|
|
Term
| What are the different phases of lochia during the puerperium? |
|
Definition
Rubra: 2-3 days PP (dark red, clots)
Longer if not breastfeeding(24 days???), shorter if Cesarean
Serosa: 3-10 days PP (pinkish brown, old blood, serum, tissue debris)
Alba: days 10+ PP (white/yellow, mucus, leukocytes, bacteria, epithelial cells) |
|
|
Term
| What kind of glands are mammary glands? |
|
Definition
| Exocrine glands: secrete substances to the outside of the body through a duct |
|
|
Term
| What is the purpose of the lactiferous sinus? |
|
Definition
| Serves as temporary storage of the milk in the mammary ducts near the nipple |
|
|
Term
| Describe the timeline of uterine involution. |
|
Definition
Immediately PP: 1/2way between umbilicus and symphysis
Day 1 PP: @ umbilicus
1 week PP: 500g
2 weeks PP: 350g
6 weeks PP: 50-60g (nonpregnant size) |
|
|
Term
| How long does it take the placental implantation site to heal? |
|
Definition
|
|
Term
| How long does it take the vaginal tissues to heal completely? (i.e. episotomy, renewed pelvic muscle tone) |
|
Definition
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|
Term
| What changes would you expect to the hematologic system during the PP period? |
|
Definition
RBCs: normally increase 25-30% during pregnancy, return to prepregnant levels by 4-6 PP
H&H: normally decreases after birth (1 point for every 500ml blood loss?), stablizes by 2 days PP
WBC: normal increased 25-30 thousand during IP period, returns to normal by 4-7 days
Platelets: decrease 30% immediately PP, gradual increase to days 3-4 PP, then gradual return to prepregnant levels |
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|
Term
| What is the difference in "baby blues" and PP depression? |
|
Definition
| Baby blues is considered a normal finding 3-5 days PP due to fluctuating hormones levels and new role expectations. PP depression or psychosis is not normal- involves rejection of infant,thoughts of self harm or harming infant, and inability to carry out self care and infant care. tasks |
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