Ace Your PANCE Prep Pearls: 3rd Ed. (2019) Classes and Exams with Picmonic: #1 Visual Mnemonic Study Tool for Physician Assistant (PA) Students
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PANCE Prep Pearls: 3rd Ed. (2019) | Physician Assistant (PA) School Study Aid
Spontaneous Abortion Overview
- Assessment
- Bleeding < 20 weeks Gestation
- Interventions
- Identify Type
- Bed Rest
- Monitor for Hemorrhage
- Save Pads and Linens
- RhoGAM
- Dilation and Curettage (DandC)
- Cerclage
- Emotional Support
2 mins
Spontaneous Abortion Types
- Missed Abortion
- No Fetal Heartbeat, No Cervical Dilation, No Bleeding
- Threatened Abortion
- No Cervical Dilation and Minimal Bleeding
- Inevitable Abortion
- Bleeding and Cervical Dilation with No Loss of Products of Conception
- Incomplete Abortion
- Bleeding and Cervical Dilation with Loss of Some Products of Conception
- Complete Abortion
- Bleeding with No Cervical Dilation, with Loss of All Products of Conception
2 mins
Placental Implantation Abnormalities
- Mechanism
- Placenta Adheres Directly to Myometrium
- Placenta Accreta
- Placenta Increta
- Placenta Percreta
- Caused by Scar Tissue
- Hemorrhage
- Diagnosis
- Ultrasound is First-line, then MRI
- Treatment
- C-section Delivery
- Artery Ligation or Embolization
2 mins
Probable Signs of Pregnancy
- Goodell Sign
- Chadwick Sign
- Hegar Sign
- Positive Serum and Urine Sample
- Braxton Hicks Contractions
- Ballottement
2 mins
Positive Signs of Pregnancy
- Fetus on Ultrasound
- Fetal Heart Rate by Doppler or Fetoscope
- Fetal X-ray
- Fetal Movements
1 min
Lab and Diagnostic Tests During Pregnancy
- Complete Blood Cell Count
- Blood Typing
- Rubella Titer
- Hepatitis B
- HIV Testing
- Urinalysis
- Diabetes
- Pap Smears
2 mins
Lab and Diagnostic Tests During Pregnancy (1st Visit)
- Diagnosis
- Complete Blood Count (CBC)
- Blood Typing and Rh
- Rubella
- HIV
- Hepatitis B
- Tuberculosis Skin Mantoux Test (PPD)
- Sexually Transmitted Infections
- Chlamydia
- Neisseria gonorrhoeae
- Syphilis
- Pap Smears
- Urinalysis
- Sickle Cell Screening (If Indicated)
2 mins
Lab and Diagnostic Tests During Pregnancy (Other Visits)
- Diagnosis
- 10-13 Weeks
- Offer Chorionic Villus Sampling (CVS)
- 15-18 Weeks
- Quad Screen
- 18-20 Weeks
- Ultrasound
- Anatomic Screening
- 24-28 Weeks
- One-Hour Glucose Challenge Test
- 35-37 Weeks
- Streptococcus Agalactiae
3 mins
Amniocentesis
- Mechanism
- Transabdominal Puncture
- > 14 weeks gestation
- Indications
- Genetic and Congenital Anomalies
- Fetal Hemolytic Disease
- Fetal Lung Maturity
- Complications
- Miscarriage
- Hemorrhage
- Infection
- Considerations
- RhoGAM (Rh Immune Globulin)
2 mins
Spina Bifida Assessment
- Cause
- Congenital Malformation of Vertebrae
- Assessment
- Dimple With or Without Hair Tuft
- Lumbar Sac
- Hydrocephalus
- Paralysis
- Considerations
- Identify Type
2 mins
Rh Hemolytic Disease of the Fetus and Newborn
- Characteristics
- Rh (Rhesus) Incompatibilities
- Rh(D)- Mother and Rh(D)+ Fetus
- Anti-Rh(D) Antibodies
- Hemolytic Anemia
- Presentation
- Hydrops Fetalis
- Neonatal Jaundice
- Kernicterus
- Diagnosis
- Positive Coombs Test
- Ultrasound
- Management
- RhoGAM [Anti-Rh(D) Immunoglobulin]
- Intrauterine Blood Transfusion
- Phototherapy
- IVIG (Intravenous Immunoglobulin)
4 mins
RhoGam [Rho(D) Immune Globulin]
- Indications
- Antepartum Prevention at 28 weeks
- Suppress Antibody Production
- Mechanism of Action
- Lysis of Fetal RBC in Maternal Bloodstream
- Side Effects
- Myalgia and Lethargy
- Considerations
- Negative Coombs Test
- Standard Dose 300 mcg
- Microdose 50 mcg
- Blood Product
2 mins
Placenta Previa
- Mechanism
- Placenta Covers Cervical Os
- Assessment
- Painless
- Bright Red Vaginal Bleeding
- Interventions
- Stable Fetus
- Bed Rest
- Observation
- Unstable Fetus
- C-section Delivery
- Considerations
- Risk for Shock
- Magnesium Sulfate
- Tocolysis
3 mins
Abruptio Placentae
- Mechanism
- Premature Separation of Placenta
- Assessment
- Tearing Pain
- Bleeding (Often Concealed)
- Rigid Uterus
- Contractions
- Interventions
- Corticosteroids as Needed
- Emergent Delivery
- Considerations
- Increased Risks for Neonate
- Rh (Rhesus) Incompatibilities
- Increased Risk for Shock
- Monitor Fetal Heart Rate
3 mins
Vasa Previa
- Characteristics
- Fetal Vessels Over Internal Cervical Os
- Risk Factors
- Velamentous Umbilical Cord Insertion
- Placental Abnormalities
- Multiparity
- Presentation
- Rupture of Membranes
- Painless Vaginal Bleeding
- Fetal Distress
- Diagnosis
- Doppler Ultrasound
- Treatment
- Emergency Cesarean Delivery
2 mins
Gestational Hypertension
- New-Onset Hypertension
- > 20 Weeks Gestation
- Risk Factors
- Nulliparity
- Obesity
- African American Females
- > 35 years Old
- Multiple Gestations
- Family History of Gestational HTN (or Preeclampsia)
- Complications
- IUGR
- Prematurity
- Abruptio Placentae
- Management
- Fetal Monitoring
- Alpha-Methyldopa
- Beta-Blockers (Labetalol)
- Calcium Channel Blockers
- Hydralazine
4 mins
Preeclampsia Assessment
- After 20 Weeks of Pregnancy
- Mild
- Hypertension > 140/90
- Proteinuria or End-Organ Dysfunction
- Severe
- Hypertension > 160/110
- Progressive Renal Insufficiency
- Vision Changes
- HELLP Syndrome
- Pulmonary Edema
2 mins
Severe Preeclampsia
- Mechanism of Action
- Vasospasm and Decreased Organ Perfusion
- Intravascular Coagulation
- Increased Permeability and Capillary Leakage
- Signs and Symptoms
- Hypertension
- Proteinuria or End-Organ Dysfunction
- HELLP Syndrome
- Hepatic Dysfunction and Hemolysis
- Elevated Liver Enzymes
- Low Platelet Counts
3 mins
Preeclampsia Interventions
- Side Lying Position and Bedrest
- Antihypertensives
- Magnesium Sulfate
- Labor Induction
1 min
Eclampsia
- Mechanism of Action
- Increased Central Nervous System Irritability
- Signs and Symptoms
- Hyperreflexia
- Positive Ankle Clonus
- Headaches
- Visual Disturbances
- Epigastric or RUQ Pain
- Seizures
- Coma
- Considerations
- Don't Leave Bedside
- Magnesium Sulfate
2 mins
Gestational Diabetes
- Signs and Symptoms
- Usually Asymptomatic
- Fetal Macrosomia
- Polyhydramnios
- Diagnosis
- Glucose Intolerance After 24 Weeks Gestation
- 3-hr 100g Glucose Tolerance Test
- Treatment
- Diet and Exercise
- Close Glucose Monitoring
- Insulin
- Ultrasound (or Nonstress Test (NST))
- Delivery
2 mins
Fetal Macrosomia
- Pathophysiology
- Increased Birth Weight
- > 4500 g
- Causes
- Maternal Obesity
- Gestational Diabetes
- Diagnosis
- Weigh Newborn at Birth
- Ultrasound
- Hadlock's Formula
- Complications
- Birth Canal Trauma
- Neonatal Hypoglycemia
- Shoulder Dystocia
- Treatment
- Planned Cesarean Section
2 mins
Prolapsed Umbilical Cord
- Mechanism
- Cord Prolapses
- Signs and Symptoms
- Visualization of Cord
- Prolonged or Variable Decelerations
- Considerations
- Hips Elevated
- Insert 2 fingers in Vagina
- Saline Towel on Cord
- Oxygen
2 mins
Cesarean Section - Indications
- Maternal Indications
- Active Genital Herpes Infection
- Cervical Cancer
- Eclampsia (Preeclampsia)
- History of Uterine Surgery
- History of C-section (Vertical)
- Fetal Indications
- Malpresentation
- Fetal Distress
- Cord Compression/Prolapse
- Other Indications
- Failed Vaginal Delivery
- Cephalopelvic Disproportion
- Abruptio Placentae or Placenta Previa
2 mins
Hyperemesis Gravidarum
- Signs and Symptoms
- Excessive Vomiting
- Significant Weight Loss
- Dehydration
- Hypotension
- Electrolyte Imbalance
- Interventions
- Antiemetics
- Frequent Small Meals
- IV Therapy
2 mins
Mechanism of Labor
- Engagement
- Descent
- Flexion
- Internal Rotation
- Extension
- External Rotation (Restitution)
- Expulsion of Infant
2 mins
True vs. False Labor
- Bloody Show
- True Labor
- Regular, Strong Contractions
- Progressive Effacement and Dilation
- Engagement of Presenting Part
- False Labor
- Irregular Contractions
- Cervix Soft
- No Engagement of Presenting Part
2 mins
Premature Rupture of Membranes (PROM)
- Pathophysiology
- Rupture > 1 Hour Before Labor
- Risk Factors
- Infection
- PROM History
- Incompetent Cervix
- Diagnosis
- Fern Test
- Nitrazine Paper Test
- Ultrasound
- Treatment
- Consider Tocolytics
- Consider Antibiotics
- < 34 Weeks Gestation
- Corticosteroids
- > 34 Weeks Gestation
- Induction of Labor
2 mins
Postpartum Blues
- Symptoms
- Depressed Affect
- Tearfulness
- Fatigue
- Resolves in 2 Weeks
- Treatment
- Supportive Care
2 mins
Induction of Labor
- Indications
- Premature Rupture of Membranes
- Danger to Fetus or Mother
- Prolonged Gestation
- Contraindications
- Placenta Abnormalities
- Transverse Fetal Position
- Prolapsed Umbilical Cord
- Active Genital Herpes Infection
- Transfundal Uterine Incision
- Hemorrhage
3 mins
APGAR Score
- 1 and 5 Minutes
- Appearance
- Pulse
- Grimace
- Activity and Muscle Tone
- Respiration
- Total Scores
- Gentle Stimulation
- Oxygen
2 mins
Postpartum Hemorrhage
- Mechanism
- Uterine Atony
- Lacerations
- Retained Placenta
- Signs and Symptoms
- Bleeding
- Hypotension
- Boggy Uterus
- Considerations
- Oxytocin
- Bimanual Compression of Uterus
- Surgery
- Blood Transfusion
2 mins
Uterine Atony
- Pathophysiology
- Most Common Cause of Postpartum Hemorrhage
- Uterine Overdistention
- Exhausted Myometrium
- Uterine Infection
- Presentation
- "Boggy" Uterus
- Treatment
- Resuscitation with IV Fluids and Transfusions
- Bimanual Uterine Massage
- Oxytocin
- Methergine
- Prostaglandins
2 mins
Ectopic Pregnancy
- Signs and Symptoms
- Lower Abdominal Pain
- Delayed Menses
- Abnormal Vaginal Bleeding
- Shock
- Referred Shoulder Pain
- Cullen Sign
- Considerations
- Methotrexate
- Surgery
- RhoGAM
2 mins
Hydatidiform Mole (Molar Pregnancy)
- Cause/Mechanism
- Abnormal Fertilization
- Assessment
- Symptoms of Pregnancy
- Elevated hCG
- Vaginal Bleeding
- Inappropriate Uterine Growth
- No Fetal Heart Rate (FHR)
- Interventions
- Dilation and Curettage (D&C)
- Emotional Support
- Considerations
- No Pregnancy 1 Year
- Hysterectomy
3 mins
Partial Hydatidiform Mole
- Characteristics
- Gestational Trophoblastic Disease
- Dual Fertilization of Haploid Egg
- Triploid Fetal Karyotypes
- Hydropic Chorionic Villi
- Presentation
- Vaginal Bleeding
- Diagnosis
- Increased Beta hCG
- Fetal Structures
- Considerations
- Dilation and Curettage (D&C)
- Methotrexate
2 mins
Complete Hydatidiform Mole
- Characteristics
- Gestational Trophoblastic Disease
- Fertilization of Enucleated Egg
- Diploid Fetal Karyotypes
- Hydropic Chorionic Villi
- Presentation
- Vaginal Bleeding
- Preeclampsia
- Diagnosis
- Increased Beta hCG
- "Snowstorm" / "Bunch of Grapes" Appearance
- Theca Lutein Cysts
- Considerations
- Dilation and Curettage (D&C)
- Methotrexate
- Increased Risk of Choriocarcinoma
3 mins
