MEDS 576 MIDTERM
how many primary oocytes does a female have at birth?
1-2million arrested in prophase I
factors that contributed to HIV epidemic in South Africa
AIDS denial, slow government response, poverty, lack of education, migrant labor patterns, high levels of sexual violence, cultural factors
Key elements of a gynecological history include: A. Menarche (the age you had your first period) B. Cervical screening C. Previous sexually transmitted diseases D. Family history E. All of the above
All of the above
Multidrug resistent tuberculosis (MDT) occurs when? A. Medication is not taken for the correct length of time B. Incorrect dose of medication subscribed C. Patient is in close contact with another person with MDT D. TB drugs prescribed are of poor quality E. All of the above
All of the above
TRUE or FALSE: Active labor always starts when the water breaks
False
TRUE or FALSE: Active labor- 4 contractions every 20 minutes
False
TRUE or FALSE: All women require iron supplementation throughout pregnancy
False
TRUE or FALSE: As soon as they discover they are pregnant, women should stop taking all medication and see their doctor
False
TRUE or FALSE: It is always safer for women who are HIV positive to have their baby by C-section
False
TRUE or FALSE: HIV 1 group N is the dominant form
False, M is the dominant form
TRUE or FALSE: Glucose crosses the placenta by simple diffusion
False, facilitated
TRUE or FALSE: The egg is fertilized in the ovary
False, fallopian tube
TRUE or FALSE: HIV is double stranded
False, it is single stranded
TRUE or FALSE: Normal pregnancy is associated with a raised CD4 count
False, lower
TRUE or FALSE: Folic acid supplements reduce the risk of Downs Syndrome
False, neural tube defects
TRUE or FALSE: Infants of HIV positive mothers may test positive for HIV DNA because maternal IgM crosses the placenta
False, only IgG crosses placenta
TRUE or FALSE: The hormone hCG raised throughout pregnancy
False, raised hCG in first trimester, peak in second trimester, & drops in third trimester
TRUE or FALSE: Oral hairy leukoplakia is common in WHO HIV clinical stage 2
False, stage 3
TRUE or FALSE: Miscarriage is common (1 in 4) and women are unlikely to require any emotional support after a miscarriage
False, they will need emotional support
partial molar pregnancy
Fetal tissue and amniotic sac present, usually with multiple congenital anomalies
South Africa has the highest rates of... A. Deaths from road traffic accidents B. Drug & alcohol abuse C. Domestic violence D. HIV & TB infection E. Sexual assault
HIV & TB infection
relative contraindications to pregnancy
HbA1c > 80 pulmonary hypertension dilated aortic root >4.5cm
Over 45% of deaths in children under 5 are caused by... A. Pre-term birth B. Pneumonia C. Birth asphyxia D. Diarrhea E. Malaria F. Malnutrition
Malnutrition
Key elements of an obstetric history include everything everything except: A. Last menstrual period B. Past medical history C. Drug use & smoking D. Number of sexual partners E. Allergies
Number of sexual partners
When we take a history from a patient, the most important thing we are evaluating is... A. Their understanding of the problem B. Their ability to pay us for the consultation C. Potential risks to their health immediate or long term D. Any expectations that they have E. Any family problems they are experiencing
Potential risks to their health immediate or long term
One of the biggest problems facing South Africa today is... A. Cell phone coverage B. Food shortages C. Road rage D. Poverty E. Climate change
Poverty
TB is spread by... A. Blood B. Respiratory droplets C. Contaminated water D. Contaminated food E. Sexual contact
Respiratory droplets
TRUE or FALSE: AZT is a nucleoside reverse transcriptase inhibitor
True
TRUE or FALSE: Active labor- regular painful contractions of ~30 seconds 4 times in 10 minutes
True
TRUE or FALSE: Breastfeeding in untreated women has 15-45% risk of mother to child transmission
True
TRUE or FALSE: CD4 plays a role in adaptive immunity
True
TRUE or FALSE: HIV is an RNA virus
True
TRUE or FALSE: HIV is enveloped
True
TRUE or FALSE: Human placental lactogen reduces maternal facilitation of glucose
True
TRUE or FALSE: If CD4 is >200 there is no need to give prophylaxis against PCP & toxoplasmosis
True
TRUE or FALSE: In a normal pregnancy, the hCG doubles every 48 hours; in an ectopic pregnancy, there is a suboptimal rise in hCG levels
True
TRUE or FALSE: In pregnancy, blood pressure reaches its lowest point at ~20 weeks
True
TRUE or FALSE: In pregnancy, circulating volume of blood increases 40%
True
TRUE or FALSE: Pregnancy is a time of relative insulin resistance
True
TRUE or FALSE: Pregnant women are at an increased risk of venous thromboembolism
True
TRUE or FALSE: Reverse transcriptase allows the virus to transcribe viral DNA into the cell
True
TRUE or FALSE: Stillbirth is a potential complication of gestational diabetes
True
TRUE or FALSE: The cervix dilates ~1cm per hour during active labor in a first pregnancy
True
TRUE or FALSE: Untreated pregnant women with HIV are more likely to have preterm deliveries
True
TRUE or FALSE: When the cervix is dilated 3 cm, there are regular painful contractions
True
TRUE or FALSE: Women with gestational diabetes need closer monitoring in pregnancy
True
TRUE or FALSE: hCG is useful for monitoring ectopic pregnancies
True
women with cardiac disease should be managed by
a multidisciplinary team
beneficence
act in the patient's best interest
open neural tube defects can have high levels of
alphafetoprotein
history taking is
an information gathering exercise to help quantify risk in pregnancy
smoking
associated with low birth weight, miscarriage, & premature labor
normal sperm count
at least 15 million per ml
antenatal care in South Africa
available to all women but is limited in scope WHO recommends 8 contacts during pregnancy, but SA aims for 4 (varies across population)
breech
bottom down
opiates
can cause neonatal abstinence syndrome
tuberculosis
caused by mycobacterium tuberculosis obligate, non-spore producing aerobe non-motile, slow dividing Ziehl-Nielson stain humans are the only reservoir
the main determinant of medical capacity is
cognition
levels of healthcare in South Africa
community healthcare worker primary care local clinic district hospital tertiary referral center national referral center
ovulation
day 14
implantation
day 8-9
pandemic
disease prevalent over a whole country or the world
justice
distributing benefits and burden of care fairly across society
non-maleficence
do no harm
non-disjunction
failure of homologous chromosomes or sister chromatids to separate properly in cell division
first day of menstrual cycle?
first day of bleeding
index case
first person identified with the disease in the population
cephalic
head down
direct complications in pregnancy
hemorrhage, pre-eclampsia, thromboembolism, infection, obstructed/ prolonged labor, ectopic pregnancy, unsafe abortion, surgical, anesthetic
HIV
lentivirus (subgroup of retrovirus) contains reverse transcriptase single stranded positive sense enveloped RNA virus
women with pre-existing hypertension should be prescribed __________ to reduce the risk of pre-eclampsia
low dose aspirin
aim of preconception care
maximize health and improve outcomes
why is dating a pregnancy important?
monitoring fetal growth during the pregnancy (placental disorder, genetic conditions, infections, smoking, malnutrition, anemia, diabetes)
complete molar pregnancy
no embryonic or fetal parts
physicians may disclose information if
patient lacks medical decision making capacity to other other healthcare personnel for purposes of providing care to appropriate authorities when disclosure is required by law to other 3rd parties to mitigate the threat when in the physician's judgment there is a reasonable probability that that patient will harm himself/ others
indirect complications in pregnancy
pre-existing medical conditions (epilepsy, cardiac disease, diabetes, hormone dependent malignancies), mental health problems (suicide), domestic violence, trauma
what happens to oocytes at puberty?
primary oocytes enter metaphase II
estrogen
promotes growth, uterus, breasts/ breast ducts, external genitalia of the mother increases water retention & protein synthesis relaxes ligaments - pelvic
autonomy
respect individual's ability to freely make informed decisions
estimating due date
risk of still birth increases after 40 weeks allows planning for delivery
HIV virus found in
semen, vaginal fluid, breast milk, blood, rectal secretions/ mucosa
Where does spermatogenesis occur?
seminiferous tubules
progesterone
synthesized by the corpus luteum until day 35 then the placenta smooth muscle relaxation raises body temperature works with estrogen to prepare for lactation
outbreak investigation
systematic investigation of an acute outbreak of an infectious disease establish verify construct find & record perform develop, evaluate, reconsider & refine compare & reconcile implement initiate/ maintain communicate
alcohol
teratogenic & can cause fetal alcohol syndrome
pregnancy-related death
the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death
WHO definition of maternal mortality
the death of a woman while pregnant or within 42 days of termination of pregnancy; irrespective of the duration and site of pregnancy from any cause related to/ aggravated by pregnancy or its management but not from accidental or incidental causes
a patient can only exercise their autonomy n making decisions about their own health care if
they are given info that they care about, they understand the risks/ benefits, and can apply this info to their health
HIV transmission
vaginal sex, anal sex, oral sex, injecting drugs, blood transfusions/transplants, mother-to-child, needle stick injuries
epidemic
widespread occurrence of an infectious disease in a community at a particular time
HIV testing
window period between exposure to positive result - usually positive 20 days after exposure; all positive tests should be confirmed with a second test
sensitivity of free fetal DNA tests
99% for trisomy 21
vaginal delivery in HIV positive mother is safe when
<50 HIV RNA copies (viral load)
Name the capital city of South Africa. A. Cape Town B. Johannesburg C. Bloemfontein D. Pretoria E. Durban F. Cape Town, Pretoria, & Bloemfontein
Cape Town, Pretoria, & Bloemfontein
4 stages of HIV
1. acute infection 2. clinical latency 3. disease progression 4. AIDs defining disease
healthcare in South Africa
40 million South Africans are cared for in the public healthcare system but 70% of South African doctors work in the private system
Regarding drugs and vitamin supplements in pregnancy, which is the single best answer? A. All pregnant women should take 10mg of vitamin D daily B. Vitamin E supplementation is vital for a healthy pregnancy C. Prenatal supplements should have high levels of vitamin A D. All women should take 400mcg (ug) folic acid prior to conception and in the first trimester pregnancy except women with medical conditions like epilepsy and diabetes who should take a higher dose of 5mg once a day E. Drugs for all preexisting medical conditions can harm the developing fetus and should always be stopped as soon as a woman has a positive pregnancy test
All women should take 400mcg (ug) folic acid prior to conception and in the first trimester pregnancy except women with medical conditions like epilepsy and diabetes who should take a higher dose of 5mg once a day
what BMI is associated with increased rates of pregnancy loss & complications
BMI > 30
What are the leading causes of maternal mortality?
Bleeding, Infection, Pre-eclampsia
diagnostics tests
CVS and amniocentesis
