NM704 EXAM 1 SUMMER 17 QUESTIONS AND ANSWERS
WITH COMPLETE SOLUTIONS
Define the following terms according to NICHD guidelines: Baseline
mean FHR rounded to the nearest 5 bpm during a 10 minute time period excluding:
periodic or episodic changes, periods of marked FHR variability, segments of baseline
that differ by more than 25 beats per minute;
What are the types of variability and describe them.
Absent: amplitude range undetectable; Minimal: amplitude range detectable but 5 bpm
or fewer; Moderate: amplitude range detectable 6-25 bpm; Marked: amplitude range
greater than 25 bpm
Understand the following physiologic mechanisms responsible for normal fetal
heart rate patterns: Sympathetic input
made of nerve fibers in the myocardium, stimulation causes increase in FHR;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns:
Bradycardia
stimulation of vagus nerve with rapid decent, vaginal exam;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns:
Tachycardia
maternal fever, stress response;
,Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns: Early
deceleration
head compression;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns: Late
deceleration with or without variability
deficiency of uteroplacental perfusion;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns: Variable
deceleration
cord compression;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns: Minimal
variability
decrease in oxygen reserve, immature parasympathetic system;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns: Absent
variability
loss of fetal oxygen reserve, neurological insult;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns:
Sinusoidal pattern
, severe fetal anemia, neurological defect, thumb sucking
Define the following terminology recommended by NICHD for a three tier fetal
heart rate interpretation system: Category I (normal)
baseline 110-160 bpm; moderate variability; no late or variable decels; early decels may
or may not be present; acceleration may or may not present;
Define the following terminology recommended by NICHD for a three tier fetal
heart rate interpretation system: Category II (indeterminate)
tachycardia or bradycardia not accompanied by absent variability; minimal variability;
absent variability with no recurrent decels; marked baseline variability; absence of
induced acceleration after fetal simulation; recurrent variable decels with
minimal/moderate variability; prolonged decels; recurrent late decels with moderate
baseline; variable decels with other characteristics such as slow return to baseline,
overshoots, or "shoulders";
Define the following terminology recommended by NICHD for a three tier fetal
heart rate interpretation system: Category III (abnormal)
absent variability with recurrent late or variable decels, bradycardia; sinusoidal pattern
Know how to evaluate and manage the following: Category I tracing
routine management;
Know how to evaluate and manage the following: Category II tracing: Intermittent
and recurrent variables
continued surveillance, lateral positioning, intrauterine resuscitation (IVF bolus,
amnioinfusion), if no improvement prepare for delivery;
WITH COMPLETE SOLUTIONS
Define the following terms according to NICHD guidelines: Baseline
mean FHR rounded to the nearest 5 bpm during a 10 minute time period excluding:
periodic or episodic changes, periods of marked FHR variability, segments of baseline
that differ by more than 25 beats per minute;
What are the types of variability and describe them.
Absent: amplitude range undetectable; Minimal: amplitude range detectable but 5 bpm
or fewer; Moderate: amplitude range detectable 6-25 bpm; Marked: amplitude range
greater than 25 bpm
Understand the following physiologic mechanisms responsible for normal fetal
heart rate patterns: Sympathetic input
made of nerve fibers in the myocardium, stimulation causes increase in FHR;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns:
Bradycardia
stimulation of vagus nerve with rapid decent, vaginal exam;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns:
Tachycardia
maternal fever, stress response;
,Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns: Early
deceleration
head compression;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns: Late
deceleration with or without variability
deficiency of uteroplacental perfusion;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns: Variable
deceleration
cord compression;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns: Minimal
variability
decrease in oxygen reserve, immature parasympathetic system;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns: Absent
variability
loss of fetal oxygen reserve, neurological insult;
Identify the proposed cause(s), physiologic and/or pathophysiologic mechanism,
and clinical significance of the following variant fetal heart rate patterns:
Sinusoidal pattern
, severe fetal anemia, neurological defect, thumb sucking
Define the following terminology recommended by NICHD for a three tier fetal
heart rate interpretation system: Category I (normal)
baseline 110-160 bpm; moderate variability; no late or variable decels; early decels may
or may not be present; acceleration may or may not present;
Define the following terminology recommended by NICHD for a three tier fetal
heart rate interpretation system: Category II (indeterminate)
tachycardia or bradycardia not accompanied by absent variability; minimal variability;
absent variability with no recurrent decels; marked baseline variability; absence of
induced acceleration after fetal simulation; recurrent variable decels with
minimal/moderate variability; prolonged decels; recurrent late decels with moderate
baseline; variable decels with other characteristics such as slow return to baseline,
overshoots, or "shoulders";
Define the following terminology recommended by NICHD for a three tier fetal
heart rate interpretation system: Category III (abnormal)
absent variability with recurrent late or variable decels, bradycardia; sinusoidal pattern
Know how to evaluate and manage the following: Category I tracing
routine management;
Know how to evaluate and manage the following: Category II tracing: Intermittent
and recurrent variables
continued surveillance, lateral positioning, intrauterine resuscitation (IVF bolus,
amnioinfusion), if no improvement prepare for delivery;
