177 Trauma in Pregnancy & Postpartum Psychiatric Disorders for the PANCE

Hello and welcome to the Physician Assistant exam review podcast. This is episode 177 and we’re going to be covering trauma in pregnancy and postpartum psychiatric disorders. Before we get started into the actual notes, we’re going to start with the priming questions. I do this in every single show because the idea is to get your brain firing, to get it working upfront and ready to go. So let’s jump in whether you know them or not and let’s go ahead and get started.

A 25 week pregnant person, blood pressure suddenly drops.

What’s the first step? If you have a 25 week pregnant person whose blood pressure drops, what’s the first step that you do?

Number two, if you have weepy mood swings starting about three days after delivery, what’s the diagnosis?

So, mom is, cries easily, but she’s still taking care of the baby. What are we calling that?

Which SSRI is the usual pick for a breastfeeding mother? There’s one that stands out above all the others. Which SSRI is the usual pick for a breastfeeding mother?

And the last one for today, thoughts of harming the baby that horrify the mother point to what diagnosis?

Thoughts of harming the baby that horrify the mother point to what diagnosis? Remember what this does is it starts to build out your thinking as we move through the content for today. Always, always, always, you can find the show notes at physicianassistantexamreview.com. Today they’d be at /177 and you can find all the notes to kind of go back and review everything. Some people like to sit with the website with the notes and go through it as they listen. You can also find it over on YouTube and they’ll have the same thing with slides up over there for you. So my name is Brian Wallace. I’m the host and creator here at Physician Assistant. And what we do here is we teach content material for PA school, for the PANCE, for medicine, but we do it in a way that’s supposed to, that will help it stick, that will make it available to you on test day. Whether we’re talking about EORs, the PACKRAT, the PANCE, EOCs, any of that. How you address the material is so important as to whether or not it’s there for you on test day. People say, I study more, I study more, I study more. I’m doing more questions, I’m doing more questions and they’re not seeing their scores move and they’re wondering why. Our goal is to shift the way that you’re doing things so that it does show up for you on exam day. And you’ll see as we go through this, kind of how that works if you’re new to the show. All right. Number one today, we’re going to go through trauma in pregnancy, then we’re going to do postpartum blues and we’re going to postpartum depression and then postpartum psychosis and that’ll wrap us up for the day. So we’re going to start with trauma in pregnancy. Trauma in pregnancy, so physical, psychological or sexual injury to a pregnant woman from a crash, a fall or abuse.

That’s trauma in pregnancy. Pretty straightforward definition. This is the leading nonobstetric cause of maternal death, not nonobstructive, nonobstetric cause of a maternal death.

Motor vehicle crashes are the most common cause here. So that’s really a big one. If a pregnant woman comes in with a motor vehicle crash, we need to evaluate her for trauma.

Intimate partner violence often starts or can get worse during pregnancy. So you want to keep an eye out for that. That’s where some of the questions are absolutely going to come from in this section where we talk about pregnancy and trauma risk factors. So this is really red flags for abuse because other traumatic risk factors, I guess you could think through on your own. So late or missed prenatal care, if they’re not showing up for prenatal care, that may be a red flag. Doesn’t mean anything on its own, but it might be a red flag for an abusive situation, injuries that don’t match the story. So this is just like a child abuse story, right?

Patient fell down, patient running into a door, things that just don’t add up to what the injury looks like. It doesn’t feel right. It doesn’t, the clues don’t make sense with the story.

Obviously, especially to the abdomen, et cetera. And then the other cue, and you guys should be aware of this, is a partner who won’t leave the room or answers for the patient. That’s always sort of an, again, this doesn’t mean that it’s a problem up front. It just means that you should be paying attention to the situation. If the partner won’t leave the room, so you can have a discussion. if, excuse me, if the partner’s answering for the pregnant patient to every single question, that can be a red flag as well.

Clinical presentation. Well, obviously the physical trauma, right? You have the situation of, you know, the motor vehicle accident. That’s going to be the clinical presentation in a lot of cases. The concern for these right up front is placental abruption. I should have asked you that question rather than just handed it to you. But the concern is placental abruption, even after a minor fall. Now, remember what was placental abruption that’s key. And this should all be tied together. When we study, we don’t study independent data points. We don’t study lists. We study things in groups. And they start to meld and make sense as a patient comes through the door. I’m worried about placental abruption after a fall. What’s placental abruption?

Well, that’s when the, not the uterus, when the placenta separates from the uterine lining from the endometrium, right? So you get painful vaginal bleeding, a tender uterus, and you can get some fetal heart changes, or you can even get contractions.

So just to be clear, and I just want to tie this up for you, painful vaginal bleeding is abruption, right? That’s what we’re worried about. What was painless vaginal bleeding?

What was painless vaginal bleeding? Cause you, again, you should just be tying all this stuff together. It doesn’t come into play here, but it’s just sort of in my head, sort of bounces around, that would be placenta previa, right? Placenta previa. All right. So painful vaginal bleeding after an MVA, we’re worried a lot about a placental abruption, clinical presentation of abuse. We sort of went through that already. So you’re looking for bruising. That doesn’t make sense. You’re using bruising at different stages that don’t follow a good picture or a good story, you’re looking for clues in the relationship, in the room, that kind of thing. So in this case, what’s this question stem going to look like in something like this? Well, this might be like a woman at 28 weeks with abdominal bruises. They seem like they’re at different stages and a partner who answers questions for her. and the problem here is you don’t want to accept the story of a fall is might be the trap here. Likely what I ran into with some students yesterday was they had questions like this that then said, you know, what’s the next step? You know, do you report it? Well, reporting isn’t mandatory for adult abuse. It is for child abuse. It’s not for adult abuse in most states. You’d have to kind of sort that out, but I don’t think on your PANCE, that’s going to come up. But it’s, you know, it’s kind of the next step questions, but let’s keep moving for right now, diagnostic. So physical trauma, what’s it, what are we going to do?

what we’re going to want to do is the very first thing is an ultrasound. We’re going to want to do a focus assessment as quick as possible bedside scan for free, free fluid, or for blood. We want to do this assessment very, very quickly. It’s going to include a physical assessment, but also a ultrasound. Okay. To see what’s going on and to check for bleeding.

Next is if the patient needs a CT or if you feel like the patient needs a CAT scan, get it is the current recommendation. And the reason is fetal harm is a concern above five rads. And we’re at about, we’re way, way, way below that with one CT of the abdomen and pelvis, you obviously want to check these things. If you’re in clinical practice and make sure that that’s the case with whatever you’re working with and each machine is different and on and on and on. but you have to, these are trade-offs, right? You have to make decisions and mom’s health. If mom has significant bleed, if mom has a major problem, we have to keep mom functional and alive if the baby’s going to survive, right? So we have to be cognizant of the situation. Too many times people, you know, they find this out in the real world too, not just in medicine, people give an answer. that would be great if we lived in a vacuum, never. So the answer here would be never give a pregnant woman a CAT scan. I totally agree. That would be the best possible move.

But what if she’s in a motor vehicle accident? What if she’s got a fractured pelvis? What if you’re worried about bleeding? What, you know, there’s all these things we need to be considering. So it’s not in a vacuum. We have to make these decisions. That’s where clinical decision comes in. on your exam. Everything in medicine is not cut and dry. You know, in math, it’s easy. Three times three is nine, boom, done. Who was the first president of the United States, George Washington, boom, done. We don’t really have, we have some of those absolutes in medicine, but it doesn’t fill medicine, right? We have so many other places where there’s gray and you have to make some calls and make some decisions. So this is one of those, right? So maternal shock is a bigger threat to the baby than a abdomen and pelvic ultrasound. I’m not sorry, ultrasound, a CAT scan. So just, I need you to think through some of this stuff before just giving a knee-jerk reaction. You’re going to want to do fetal monitoring for at least four hours after any trauma, right? At least four hours. I have trouble pronouncing this, but the Kleihauer-Betke test measures how much fetal blood crossed into the mother. I’m not going to go through the specifics of it. It’s just beyond what you’re going to have to do, but I would absolutely know that that is a test we can do to determine that.

And then you’re going to do an abuse screen for every pregnant woman at the first prenatal visit, each trimester, and postpartum. You’re going to ask her alone these questions and you’re never going to do this in front of her partner, obviously.

That’s going to be a diagnostic for an abusive situation.

Treatments.

So there’s physical trauma. We’re treating the mom first. Like I said, the best way to save the baby is to save the mom, especially depending on, again, there are no absolutes here. If you’re at 39 weeks, then in some cases, it may be more helpful for the baby to save the baby. But if you’re at 28 weeks, if you’re at 26 weeks, it obviously is going to be beneficial to the baby to save the mom. So we’re going to have to weigh these things, but in general, treat mom first. Now you have a major drop in blood pressure and a pregnant mother and a pregnant woman who’s over 20, let’s say, call it 25 weeks. What’s the first step? What’s the first thing you do?

So we’re catching this in the sense of a traumatic event, but this could be at any time. You’re going to tilt it to the left, right? We are going to try to get that baby, that uterus off of the superior vena cava or the inferior vena cava. We’re going to try and get it off so that the blood can flow. That’s going to be number one, tilt the patient to the left.

What else are we going to do for someone who’s in a traumatic event? A mom in a traumatic event? Well, if we’re worried about fetal blood and maternal blood mixing, what’s the move? Well, if mom’s Rh negative, we’re going to give her a RhoGAM, right?

We’re going to give her a RhoGAM.

What’s our treatments for abuse? Well, first of all, we’re going to listen to the patient. First of all, we’re going to listen to the patient, most importantly. You’re going to assess her safety and you’re going to help her come up with a safety plan and connect her with an advocate, someone who can help her.

That’s important because you are not going to be in a position to solve this, but you are going to be in a position to connect her with the right resources.

Again, most states don’t require reporting abuse between adults, but child abuse is always reported. I say that because I have a lot of students with professional practice questions that they’re struggling on. That’s an easy one. Child abuse is always, always, always reported. Most states don’t require reporting abuse between adults, but child abuse is reported. So you’re going to help her choose, you might help her choose how to leave, how to get help, where to contact. What you’re not going to do is confront the situation right then and there, because that can make things more dangerous for the patient.

All right, so our exam keys for this section. If we have a trauma patient and she’s pregnant beyond 25 weeks and she goes hypotensive, what’s the first move? We tilt her to her left.

If we have minor trauma past 20 weeks,

patient comes into the ER, small motor vehicle accident, 22 weeks pregnant,

we’re definitely going to be monitoring the baby for four hours minimum.

If we need a CT, we’re going to get the CT.

Perfect. We still have postpartum blues, postpartum depression, and postpartum psychosis to go through. I do want to let you know before we jump into that though, that coming up in November, I’m going to be hosting a free Master Class on how to work through questions and how to use question banks and how to choose which question bank to use. I have so many students who come to me and they’re like, hey, Bri, I’ve been doing more questions. I’ve been doing questions and I stop them and I say, what do you mean you’re doing questions? Everyone does them in a different way. I probably have five or 10 different ways that I recommend students do questions and go through them. We’re going to cover all that in an absolutely free Master Class you can find at physicianassistantexamreview.com/masterclass.

That’s going to be held mid November, but you can get the information and register there. And I also want to just let you know that I’m coming out with the 2000, I think it’s 2100 questions at this point, question bank that the 33 Days October cohort has been working through and really enjoying it. That’s going to be coming out for Black Friday. And also in November, we have the registration for the December cohort, 33 Days to Pass the PANCE. So there’s so much going on and so much coming up, but for starters, the simplest thing is go get on the wait list, I’m not the way it’s the registration page for the Master Class and you’ll be able to get access to that. It’s not going to be a replay of it. You’ll get access to that walkthrough of how to do questions, how to handle questions, and then you’ll get information on everything else we’re doing. So that’s going to be your most straightforward path. All right, let’s jump in to postpartum blues. So these are mild mood swings in the first days after delivery that go away on their own within about two weeks. That two week marker is really important. When we talk about psych diagnosis, a lot of them do a timeframe, right? Hopefully you’ve noticed that by now. So what you’re going to do here is you’re going to look for these kind of timeframes as you move. So these go away within roughly two weeks. This is a very, very common, like super common. Like most new moms go through this. Estrogen and progesterone are crashing after the placenta is delivered. So what you wind up with is a new mom who in that first two weeks is crying for what seems like no reason. She’s taking care of her baby, but she has really low lows and higher highs.

And it’s just kind of weepy all the time.

This starts about two to three days after delivery. But again, you’re looking at that two week point.

She’s tearful, she’s anxious, she can be irritable. But here’s the key is the timeline and she still functions and has no thoughts of harm. That’s your major differentiators.

So what would our question stem be like here? Take a minute, think this through. What would the question stem be like for someone with what we call the baby blues?

So a woman crying easily four days after delivery who still cares for her baby, right? That would be your descriptor. And the miss would be calling it postpartum depression. This is not postpartum depression.

Treatment here is going to be reassurance.

Make sure you’re sleeping. It’s so important, so important, so important. I’m getting some help. You know, imagine if you have never had a child, imagine your day-to-day life working on maybe two overnight naps of about three hours or two hours if you’re fortunate, having to care for another human, having all the things you still have to do and then throw that in on top of it. It’s a lot, so it can be very overwhelming despite or in addition to the hormonal changes. So this is help at home, reassurance, sleep, and we’re no medication at this point. And by the way, this is a clinical diagnosis, right? So we’re still in the conversation mode.

Now that we compare that to postpartum depression.

Postpartum depression is a major depression that starts during pregnancy or in the year after delivery. So usually it’s closer to delivery, but a lot of the books and a lot of the schools think that within a year, you’re still going to call it postpartum depression. So the main, not the main difference, a difference that you really want to hold onto here is it lasts more than two weeks and it gets in the way of caring for herself or the baby.

More than two weeks causes problems with taking care of herself or the baby. Now again, taking care of yourself or the baby part is a little gray because most new moms are going to have trouble showering, eating all the rest of it with everything going on and trying to keep up, like it’s a lot. So it’s a little gray there, but you have to understand the situation.

Risk factors for postpartum depression, prior depression or prior postpartum depression, right? That makes sense.

Also, risk factors, if they don’t have any support, if they’ve moved to a new state, they’ve moved to a new country, there’s no family around, there’s no friends around, there’s some other major life stress going on. So a move and a baby, right? That kind of thing can increase the risk. Abuse, like we talked about earlier, increases the risk for postpartum depression. Again, this is all kind of makes sense. And I’d like to think that if you stop to think about what the risk factors were, you could probably come up with a pretty solid list.

Clinical presentation. So this is a depressed mood or loss of interest for more than two weeks, right? So we have that, we can start to include that loss of interest.

Mom can’t sleep even when the baby sleeps. Constantly has thoughts of guilt, like I’m a bad mother, I’m doing a terrible job.

The other key here is that she begins to have intrusive thoughts of harming the baby.

She begins to have intrusive thoughts of harming the baby.

But here’s the secret, not the secret. Here’s the differentiator from psychosis.

These thoughts scare her. She knows that they are wrong. She knows that she doesn’t actually want to harm her child, but she can’t help thinking about doing it. This is depression, not psychosis. And that’s what we’re separating out, the spectrum from the baby blues to postpartum depression, to postpartum psychosis. That’s what you’re going to have to do on your exam, that’s what you’re going to have to do in your clinic, right?

So your question stem here would be something like a woman who feels absolutely hopeless for the last four weeks, two months after delivery,

and she’s having trouble taking care of her baby.

You don’t want to call this postpartum blues, right? Where in the timeframe start to push you out into depression and the symptoms start to push you out into depression.

How are we going to diagnose this? Everyone gets a screening for this. Everyone gets a screening for this, okay? During the pregnancy and end the postpartum visits. The most common is the Edinburgh postnatal depression scale. It’s a 10 question form that they fill out with things like how often she blamed herself when things go wrong. Do you think about harming yourself and so on and so forth? I don’t think you’re going to need to know the questions or understand how it works, but you need to know about it and that it needs to be administered as a way to screen for this. You’re going to ask the patient directly about suicide at this point.

Another small bit to this that I think, I’m not going to say can be a trick question but can trick people up both in the clinic and on exams is you want to get a TSH level

because postpartum thyroiditis can mimic depression.

What’s our treatment here? So for mild to moderate, we’re going to do psychotherapy first, like cognitive behavioral therapy. That’s going to be our first step. You always want to start there, right? That kind of makes sense. We’re going to do the least invasive thing first. For moderate to severe, we’re going to do therapy plus an SSRI.

Therapy plus an SSRI.

My question at the beginning is now what’s the SSRI of choice? What do we use?

What is the SSRI we’re going to use?

So postpartum, we’re going to use sertraline. And the reason is breastfeeding.

This, from what I could find, this is the most studied SSRI in nursing moms.

There’s very low levels of it in breast milk and usually it’s undetectable in the baby’s blood.

I would know that. I think that is something that could be questioned is pretty easy to hold onto.

Continuing with our treatments, if the patient does say she’s suicidal or cannot take care of herself or her child, she may need to be hospitalized.

Our exam keys here are more than two weeks plus can’t function and do daily functions and get through the day, postpartum depression.

But check the TSH before calling it depression.

Our last one for today is postpartum psychosis. This is a whole nother ball game, right? This is another big step from postpartum depression. This is a psychiatric emergency. Here, the patient has delusions, hallucinations and confusion that start suddenly, usually in the first two weeks after delivery. Doesn’t have to be, but typically it’s in the first two weeks after delivery.

This is pretty rare. The numbers say about one to two per thousand deliveries,

which is kind of rare, but not, I don’t know. That’s still, there’s a lot of babies born in this country or around the world. But this is the most risk for the mom and for the baby. So we have to be, keep an eye out for this.

Let me be clear here.

Psychosis is not depression. Psychosis is losing touch with reality.

Delusions, which are fixed false beliefs and hallucinations with no insight that they aren’t real.

That’s the, that’s psychosis.

So I remember my brother talking about, he had a brain tumor and he talked about this first symptom was a hallucination. A full-on, he was somewhere else. He was out for a walk and suddenly he was in a different place. And that was his first symptom. But he knew pretty quickly that that wasn’t reality. That there was something missing. There was something wrong. He was aware of it. He was not psychotic. He was having a hallucination. And hallucination, a hallucination? I don’t know. He was hallucinating, he was hallucinating.

Psychosis, you don’t know it’s a hallucination.

You don’t know it’s a delusion. You’ve lost touch with reality. It’s a major step from depression.

So the way that you kind of see that is that in a psychotic person, they may have thoughts of harming their child, harming themselves, doing terrible things, but they don’t know that it’s wrong.

They believe that they’re all real. They hear voices and believe that they’re real. That’s the separation.

Risk factors here, bipolar disorder is the strongest one. So definitely keep an eye on anyone who has bipolar coming through, who’s delivering a baby, definitely something to be concerned about. And then obviously the next biggest risk factor is prior postpartum psychosis. Going to a couple of presentation. This is a relatively sudden onset over a couple of days. Again, we’d like to see it early after delivery, but doesn’t have to be.

It can look a bit like delirium because it can kind of come and go as far as the confusion goes.

But again, here we have the delusions about the baby. We have hallucinations, trouble sleeping. Again, that’s a tough one because it’s not just trouble sleeping. It’s like not sleeping, racing thoughts, agitation.

They should really paint this picture for you very, very clearly on the PANCE. Like it should, it’s not going to be subtle. I think the difference between baby blues and postpartum depression might be subtle. I don’t think postpartum psychosis will be subtle on your test. It may be in the office, hard to discern for sure.

But on your test, I think it should be very, very clear.

Your diagnosis is going to be clinical. Again, we’re going to look at the thyroid. We’re going to look for other reasons that they may have confusion, infections, substance abuses, those kinds of things. Treatment is going to be to hospitalize the patient the same day, then and there. Never leave her alone with the baby. Someone who’s lost touch with reality does not get to go home with their child. Let me be really clear. Someone who’s lost touch with reality, whether that’s through drugs, alcohol, psychosis, or any feature does not get to leave with their children.

You’re going to treat this the same as bipolar and antipsychotic, often with a mood stabilizer such as lithium.

One of the questions that I think might come up is why don’t we give them an SSRI like we do depression?

Any ideas? Can you think about it for a second? Why don’t we give them an SSRI like we do for depression?

Because it’s linked to bipolar disorder. And this might help you remember it for bipolar as well. Antidepressants without a mood stabilizer can flip bipolar into mania and make the psychosis worse. So a little piece to hang on to.

We don’t want to send them home with an SSRI. This is not a good setup. So our exam keys for this sudden confusion plus delusions in the first two weeks, we’re looking at postpartum psychosis.

Strongest risk factor was bipolar disorder. And again, we’re not going to give SSRIs for no SSRI by itself for a psychotic.

All right, so let’s do a quick recap, then we’ll hit our priming questions. I will do a study tip, which is a good one for today. Then we’ll hit our priming questions, then we’ll get out of here. All right, trauma, let’s go back to the top. We’re going to treat the mom first, treat the mom first. If we have hypotension, we’re going to tilt the bed to the left. We’re going to tilt the patient to the left or put her on her left side. Get the CT if you need it. Watch the baby for four hours, ask about abuse. That’s like our tight, tight summary for trauma. Postpartum mood is sorted out by the clock is the easiest way to look at it, it’s by timeline. So if we’re talking about day two and three and it’s gone by two weeks, what are we talking about? Baby blues, right? So this is just reassurance, get some help, get some sleep, try to create a schedule, take care of your daily functions. You should start to feel better in a couple days. Past two weeks, can’t function, can’t get things done, really struggling. Baby’s not being cared for, mom’s not being cared for. She’s having thoughts that are starting to scare her. This is depression. We need therapy plus an SSRI, sertraline.

Then if we have sudden delusions that she believes she’s psychotic and she needs to be admitted,

that’s the differences and that’s what you need to take away and hold on to. Make sense? Good, all right. Okay, hopefully we have a less heavy topic next week. Let’s jump into our study tip for today.

Our study tip today is something I’ve been working on for about two weeks and I’ve had incredible success and it comes at a really good time of year.

And this one is very easy to understand, but not easy to do, but will have significant impact on your setting, on your performance, on everything that you do.

And it’s really, really simple.

Get into the sun, get some sunlight. I’m 100% serious, get some sunlight. As the days get shorter, as the times shift, this gets really, really hard, especially if you’re in clinic or in class in a room that’s enclosed all day with no windows. And even if there are windows, really outside is even better. I don’t know about you, but I spend, I work in the operating room. So in the winter or even starting now, I will go into work. It will be dark. I come out of work and it will be dark. And I will spend my entire day in a dark and closed room. It’s not necessarily dark and closed, but there’s no sunlight, right? And this is a major, major factor for me in the winters. I don’t usually realize it until about February or March when I start to feel better. And then I’m like, wow, I’ve been really low for the past two months. And I don’t even notice it because it happens bit by bit, very, very slowly.

But then as the sun comes back, I start to feel so much better. And I’ve been doing a lot more reading on this and working into it. And there’s another important key here. It’s not just a mood stabilizer. It’s not just that. It has a lot to do with your sleep patterns and your circadian rhythms.

And I’m not going to go into all the details here because you don’t need them. You can go look into it if you want to, but we’re not going to do that today. What we’re going to do is just give you the top level what to do. Number one is to get sunlight into your eyeballs as fast as you can in the morning, as close as you possible to the time when you wake up. If you can see the sun coming up over the horizon, fantastic. Some of you are up too late for that. Some of you are up too early for that. But that would be ideal. The low level sun in the sky into your eyes helps to set up your circadian rhythms and tell your brain what time it is, what time it should spike cortisol the next day to wake you up, and what time you should go to bed at night. The second piece of that

is afternoon or evening sunlight. So it’s getting sunlight into your eyes twice a day. First thing, or as close as possible in the morning,

and then evening, late afternoon, evening sun. Again, this will help your brain to map out what the day looks like, what time it is, when it should shift your hormones and your nervous system off and send you to sleep,

and when it should spike your cortisol,

and adjust your temperature to wake you up in the morning. I’ve been doing this for about two weeks, and I have found that I get up so much easier in the morning.

I’m not really struggling like I did. There’s still a little bit of a struggle, but it’s not the same. I can absolutely feel a difference.

And it’s your brain trying to work with you, but if you spend your whole day inside and it has none of those cues, it starts to lose track. It doesn’t happen all at once, but it happens over time. So you’re recalibrating your circadian rhythms by getting sunlight into your eyes in the morning and getting it into your eyes at night. Like I said, I am in the OR all day, so I’m struggling to get this done, especially as the days get shorter. So I’m trying to counter that. First thing in the morning, I use a very powerful, not super powerful, light. You want 10,000 lux or higher that you can look at for a few minutes, first thing in the morning if the sun’s not up yet. So I’ve been doing that. And then at lunchtime, or whenever I can get out for a break, I will take a walk outside, five, 10 minutes, and get some light into my eyes. And I think it’s making a huge, huge difference. And by the way, sleep is probably the most important thing for your studying and for your brain and for your memory consolidation. Let me say that again. Sleep is probably the most important thing for your awareness, for your learning, and for your memory.

Awareness, learning, and memory. If you can’t focus, you can’t remember anything. And your memories get consolidated when you sleep.

Being able to sleep well is so important, and it’s the first thing we remove. And everyone tells me they have trouble sleeping, but one of the things, one of the things they’re not doing is setting themselves up for success when they try to sleep. So one way to do that, I’m going to say this is easy to understand, but not easy to do every day physically, is get sunlight in your eyes in the morning and in the afternoon, early evening.

Really, really helpful.

All right, that’s our study tip for today. Before we hit the Priming Questions, next week, we’re going to cover Gynecological Cancers, where each one has a very specific learning sign or a screening test that you’re going to need to know. So that’s going to be a great episode for you to increase your scores. And don’t forget, go over to physicianassistantexamreview.com/masterclass to get into the November class on how to work with your question banks to get the most out of your time. That’s going to be really, really valuable. All right, let’s hit our Priming Questions.

A 25-week pregnant person’s blood pressure drops. What’s the first step?

What’s the first step? Tilt her to her left.

Move the uterus off the vena cava.

We have a weepy mood swings starting three days after delivery. This points to what diagnosis?

Weepy mood swings three days after delivery.

This is what we call postpartum blues.

Which SSRI is the usual pick for a breastfeeding mom?

Which SSRI is the usual pick for a breastfeeding mom?

Sertraline.

Sertraline, there’s low levels in breast milk and it’s the one that’s been studied the most.

Mom is having thoughts of harming the baby that horrify her. What’s the diagnosis?

Mom’s having thoughts of harming the baby that horrify her. What’s the diagnosis?

This is postpartum depression, right? You can see the delineator there.

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