1. When assessing your patient for postpartum depression you note that all of the following signs/symptoms are “red flags” except?
a. A previous psychotic break.
b. Personal or family history of bipolar disorder
d. Thoughts of harming self or newborn.
c. * Inability to sleep more than 4 hours per night.
All of the following are “red flags” and should elicit a more detailed interview/examination except an inability to sleep more than 4 hours per night. One should become worried if the postpartum female is unable to sleep more than 2 hours per night. Having a previous psychotic break or a personal/family hx of bipolar disorder are both risk factors for developing postpartum depression or psychosis. Thoughts of harming oneself or a newborn can be ominous and must be explored further.
2. A quick postpartum depression screen at a well-child visit can consist of what?
a. Asking if the postpartum patient feels depressed or “mulligrubby”
b. Performing the Edinburgh Postnatal Depression Scale Test
c. *Asking the first two questions of the PHQ-9 Test
d. Performing the Post Partum Depression Screening Scale Test
Asking if the patient feels depressed is a good start, but it is not recognized as a sensitive/specific tool to use for screening. Performing the Edinburgh or Post Partum Depression Tests will certainly help you to determine if the patient is at risk/suffering from PPD, but they are not as quick as asking the first two questions from the 9 question Patient Health Questionnaire test (PHQ-9). Using the first two questions from the PHQ-9 affords a 96% sensitivity and up to 94% specificity in detecting PPD if the provider also asks the patient “is this something you would like help with.”
3. What medication is considered first line for managing depression while a patient is breastfeeding?
a. * Zoloft
b. Buproprion
c. Fluoxetine
d. Lithium
Zoloft is a pregnancy category C-drug. However, zoloft is not orally bioavailable to infant through breastmilk. Reports state that Buproprion is associated with infant seizures. Fluoxetine may be associated with somnolence, fever, and hypotonia. Lithium is associated with hypotonia, hypothermia, and infant cyanosis.
4. All of the following are risk factors associated with postpartum depression except?
a. Lack of social support
b. Depression during pregnancy
c. Rapid hormone changes
d. Infant temperament
e. * None of the above
All of the above are considered risk factors for developing postpartum depression.
5. True or False? The “baby blues” is a normal phenomenon that affects 70% of all postpartum women and as such, it does not require a follow-up visit.
False—Up to 20% of women experiencing the baby blues can develop postpartum depression. Hence, they need to be followed.
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Multiple Sclerosis - CPT Ling
ReplyDelete1. Mrs. Smith comes in to see you and is concerned that her Multiple Sclerosis will be passed on to her baby if she gets pregnant. So you tell her:
A. Your baby will get the disease as this is inheritable and you are the carrier
B. There is no way your child can get the disease since it is not inheritable
C. You will not be able to get pregnant since you have MS so it isn’t a concern
D. There is a 15% chance that a relative of yours will have this disease, but it isn’t directly inheritable
(A isn’t correct because MS is not directly inheritable, B isn’t correct because there is a 15% chance a relative will get MS, C isn’t correct as the disease doesn’t affect fertility)
2) Mrs Smith wants to know what are risks to her from pregnancy regarding her life expectancy.
A. There is an increase of 5-10 years in life expectancy from pregnancy
B. There is no decrease in life expectancy from pregnancy
C. There is 5-10 year decrease in life expectancy from pregnancy
D. There is 10-20 year decrease in life expectancy from pregnancy
(A,C & D are incorrect as there is no change to life expectancy r/t pregnancy in MS pts)
3.) Mr. Jones wants to know if having MS will lower his chances for getting his wife pregnant.
A. He is infertile from the MS and will not be able to have children
B. MS will not effect his fertility
C. There is a 50% decrease in his fertility
D. He can have his sperm frozen for the future as he will slowly become infertile
(A,C & D are incorrect as MS does not effect fertility directly)
4) Mr. Jones understand his fertility will not be effected but wants to know how it will effect his sex life
A. There can be no effect on sexual function related to MS
B. He will never be able to have sex due to the MS side effects
C. There can be side effects as the disease progresses that can interfere with sexual function.
D. His spouse can contract the disease from him so he should not have sex
(A,B & D are incorrect as the patient gets lesions they can interfere with sexual function and so can the medications. Also his spouse cannot contract the disease from him as it is not sexually transmitted)
5) Mrs. Smith wants to know if she should use contraceptives and if so what type.
A. She does not need to use contraceptives as she can not get pregnant
B. She should use contraceptives, but only condoms as she does not want to upset her hormone levels
C. She should use contraceptives, but only estrogen only pills as they will lower her risk of MS overall
D. She should use contraceptives and can use any type that she feels will work for her based upon the rest of her risk factors and ability to use the contraceptive.
(A,B & C are incorrect as there is no effect on fertility. Hormone levels do not effect her MS and the estrogen only pills do not lower MS risk overall.)