7/24/16 Flashcards
name the teratogen: CN8 (vestibulocochlear) damage, hearing loss
streptomycin
name the teratogen: IUGR, craniofacial dysmorphism (epicanthal folds, depressed nasal bridge, oral clefts), mental retardation, microcephaly, nail hypoplasia, heart defects
phenytoin
name the teratogen: chondrodysplasia (stippled epiphysis), microcephaly, mental retardation, optic atrophy
warfarin
name the teratogen: phocomelia, limb reduction defects, ear/nasal anomalies, cardiac defects, pyloric or duodenal stenosis
thalidomide
name the teratogen: IUGR, midfacial hypoplasia, developmental delay, short palpebral fissures, long philtrum, multiple joint anomalies, cardiac defects
alcohol
name the teratogen: T-shaped uterus, vaginal adenosis (with predisposition to vaginal clear cell carcinoma), cervical hood, incompetent cervix, preterm delivery
DES (diethylstilbesterol)
name the teratogen: facial dysmorphism (short upturned nose, slanted eyebrows), cardiac defects, IUGR, mental retardation
trimethadione (anticonvulsant)
name the teratogen: congenital deafness, microtia (pinna/external ear is underdeveloped), CNS defects, congenital heart defects
isotretinoin
tall stature, testicular atrophy, azoospermia, gynecomastia, truncal obesity, low IQ
klinefelter syndrome (47,XXY)
profound mental retardation, rocker-bottom feet, clenched fists
edwards syndrome (trisomy 18)
profound mental retardation, IUGR, cyclopia, proboscis (abnormal facial appendage), holoprosencephaly, severe cleft palate
patau syndrome (trisomy 13)
what are the live vaccines that should be avoided during pregnancy?
MMR, polio, varicella, yellow fever
if maternal serum AFP is elevated and ultrasound confirms dating and finds no explanation, what is the next step?
perform amniocentesis for amniotic fluid AFP determination and acetylcholinesterase activity. elevated levels of amniotic fluid acetycholinesterase activity are specific to open neural tube defects.
if maternal serum AFP is low and ultrasound confirms dating and finds no explanation, what is the next step?
perform amniocentesis for karyotype (maternal serum AFP alone for trisomy 21 is only 20%)
what are the etiologies of elevated maternal serum AFP?
fetal structural defects (open neural tube defect, ventral wall defects), twin pregnancy, placental bleeding, fetal renal disease, sacrococcygeal teratoma
what is cocaine use during pregnancy associated with?
placental abruption, preterm delivery, intraventricular hemorrhage, and IUGR
what are the expected quad screen results for down syndrome?
decreased AFP and estriol, increased hCG and inhibin-A
what are the expected quad screen results for edwards syndrome?
levels of all 4 markers (AFP, estriol, inhibin-A, hCG) are decreased
normal glucose value after glucose load test
less than 140 mg/dL (this test is the initial screening test performed at 24-28 weeks in which all pregnant women are given 50-g glucose load)
a hemoglobin less than ___ is considered anemia between 24-28 weeks gestation
10 g/dL (most common cause is IDA)
when and how is isoimmunization re-confirmed in an Rh-negative mother?
before giving prophylactic RhoGAM to an Rh-negative woman, an INDIRECT COOMBS TEST is performed at 28 WEEKS
late trimester PAINFUL bleeding
placental abruption
risk factors for placental abruption
hypertension, trauma, smoking, cocaine abuse, premature membrane rupture
late trimester PAINLESS bleeding
placenta previa or vasa previa
risk factors for placenta previa
multiple gestation, multiparity, advanced maternal age
where are the calcifications in congenital CMV vs toxoplamosis?
CMV: periventricular
toxo: intracranial
what congenital infection: “zigzag” skin lesions, mulberry skin spots, small eyes (optic atrophy), cataracts, chorioretinitis, extremity hypoplasia, motor and sensory defects
VZV (varicella)
what are the sx of congenital rubella infection?
congenital deafness, congenital heart disease, cataracts, metal retardation, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash
what are the sx of congenital CMV infection?
nonimmune hydrops, symmetric IUGR, microcephaly, periventricular calcifications, hepatosplenomegaly, jaundice, thrombocytopenia, petechiae, sensorineural deafness
what are the sx of congenital HSV infection?
Transplacental: spontaneous abortion, symmetric IUGR, microcephaly, cerebral calcifications
Infected birth canal: meningoencephalitis, mental retardation, pneumonia, hepatosplenomegaly, jaundice, petechaie
what are the early and late sx of congenital syphilis infection?
Transplacental: nonimmune hydrops, macerated skin, anemia, thrombocytopenia, hepatosplenomegaly
Late congenital: dx’d after 2 years of age with smal teeth that are widely spaced, rounded enamel caps on first molars, “saber” shins, “saddle” nose, and 8th nerve deafness
what should neonates of HBsAg-positive mothers receive?
passive immunization with hepB immunoglobulin (HBIg) and active immunization with hepB vaccine
what should high-risk HBsAg-negative mothers receive during pregnancy?
passive immunization with hepB immunoglobulin (HBIg)
cerclage should be considered if cervical length is less than ____ by vaginal sonography prior to ____ weeks and prior preterm birth at less than ____ weeks gestation
cerclage should be considered if cervical length is less than 25 mm by vaginal sonography prior to 24 weeks and prior preterm birth at less than 34 weeks gestation
what is twin-twin transfusion?
when monozygotic twins undergo cleavage between 4 and 8 days, they become monochorionic, diamniotic (there is 1 placenta and 2 sacs). The twins share a single placenta but do so unequally, where the donor twin gets less blood supply, resulting in growth restriction, OLIGOhydramnios, and anemia. However, neonatal outcome is usually better. The recipient twin gets more blood supply, resulting in excessive growth, POLYhydramnios, and polycythemia. Intrauterine fetal surgery is indicated.
what is the procedure of choice to assess the degree of fetal anemia if the fetus is RBC antigen positive or if fetal blood typing by amniocentesis or percutaneous umbilical blood sampling (PUBS) is impossible?
ultrasound doppler (measures peak flow velocity of blood through the fetal middle cerebral artery; as fetal anemia worsens, the peak systolic velocity rises)
fetal hematocrit of less than ___% is considered anemia. intrauterine intravascular transfusion is performed if gestational age is greater than ___ weeks.
fetal hematocrit of less than 25% is considered anemia. intrauterine intravascular transfusion is performed if gestational age is greater than 34 weeks.
risk factors for preterm labor
short transvaginal cervical length (less than 25mm), PROM, multiple gestation, uterine anomaly, low maternal pre-pregnancy weight, smoking, substance abuse, short inter-pregnancy interval
what are the interventions to prevent preterm delivery in pts with prior spontaneous preterm births?
weekly intramuscular 17-hydroxy progesterone caproate (17-OH-P) if cervical length is greater than 25 mm, 17-OH-P plus cerclage if cervical length is less than 25 mm before 24 weeks
what is the intervention to prevent preterm delivery in pts with no prior spontaneous preterm births but with cervical length is less than 20mm before 24 weeks?
daily vaginal progesterone
what can be measured if preterm birth is suspected?
fetal fibronectin via vaginal swab (protein matrix produced by fetal cells that acts as a biological glue binding the trophoblast to the maternal decidua)
magnesium sulfate infusion should be started if preterm birth is anticipated less than ___ weeks gestation; this is for what purpose?
32; for neuroprotection (reduces the severity and risk of cerebral palsy)
a single course of corticosteroids (betamethasone or dexamethasone) should be given to pregnant women with gestational age ___-___ weeks of gestation who are at risk of preterm delivery within 7 days; this is to prevent what complications?
24-34 weeks; RDS (stimulates fetal type II pneumocyte surfactant production), intracranial hemorrhage, necrotizing enterocolitis, death
magnesium sulfate (used as a tocolytic) is a competitive inhibitor of _____
calcium
magnesium sulfate overdose is treated with ______
calcium gluconate
what kind of agent is terbutaline?
beta2-adrenergic agonist
terbutaline side effects
cardiovascular (hypertension, tachycardia), HYPERGLYCEMIA, HYPOKALEMIA, pulmonary edema
contraindications of terbutaline
cardiac disease, diabetes mellitus, uncontrolled hyperthyroidism
what kind of tocolytic is indomethacin?
prostaglandin synthetase inhibitor
side effects of indomethacin when used as a tocolytic
OLIGOHYDRAMNIOS, in utero ductus arteriosus closure, neonatal necrotizing enterocolitis
what calcium channel blocker is used as a tocolytic and what are the side effects?
nifedipine; tachycardia, HYPOTENSION, MYOCARDIAL DEPRESSION
what is premature rupture of membranes and what are the risk factors?
rupture of the fetal membranes before the onset of labor, whether at term or preterm; ascending INFECTION from the lower genital tract is the most common risk factor, others include local membrane defects and CIGARETTE SMOKING
what are the diagnostic criteria for chorioamnionitis?
- maternal fever
- uterine tenderness
- confirmed premature rupture of membranes
- absence of UTI or URI
what is the management of premature rupture of membranes between 24-32 weeks?
hospitalize the pt at bed rest, administer IM betamethasone if less than 32 weeks, obtain cervical cultures, and start 7-day course of prophylactic ampicillin and erythromycin
gestational hypertension is defined as BP greater than 140/90 after ____ weeks of pregnancy
20
risk factors for preeclampsia
primiparas, multiple gestation, hydatidiform mole, diabetes mellitus, age extremes, chronic HTN, chronic renal disease
when can preeclampsia be observed without any medications?
mild preeclampsia (1-2+ proteinuria with HTN) before 36 weeks gestation as long as mother and fetus are stable; managed in the hospital
laboratory abnormalities of severe preeclampsia
hemoconcentration, proteinuria, evidence of DIC, hepatocellular injury
tx of open-angle vs closed-angle glaucoma
Open-angle: prostaglandins (latanoprost), topical beta blockers (timolol), topical carbonic anhydrase inhibitors (dorzolamide), alpha-2 agonists (apraclonidine), pilocarpine
Closed-angle: emergent tx with pilocarpine, oral glycerin, and/or IV acetazolamide, laser iridotomy to prevent future attacks
what should you consider before treating a very red, swollen, painful eye with steroids?
check fluorescein staining for herpes keratitis (dendritic pattern)
what distinguishes retinal artery from retinal vein occlusion?
both present with sudden onset of monocular visual loss, but retinal artery occlusion has a pale retina and dark macula (“cherry red macula” because rest of the retina is pale) on retinal exam whereas retinal vein occlusion leads to extravasation of blood into the retina (distended, tortuous retinal veins, congested, edematous fundus)
tx of retinal artery occlusion
100% oxygen, ocular massage, acetazolamide, anterior chamber paracentesis, thrombolytics
tx of retinal vein occlusion
ranibizumab
sudden, painless, unilateral loss of vision described as “a curtain coming down”
retinal detachment
tx for neovascular macular degeneration
VEGF inhibitor (ranibizumab, bevacizumab, aflibercept) injected directly into the vitreous chamber every 4-8 weeks
sudden onset of extremely painful, red eye that is hard to palpation, fixed midpoint pupil; what is the tx?
acute angle-closure glaucoma; tx with pilocarpine, oral glycerin, and/or IV acetazolamide, laser iridotomy to prevent future attacks
which type of conjuncitivitis causes preauricular adenopathy?
viral
most common cause of viral conjunctivitis
adenovirus
time frames and tx of two different neonatal conjunctivitises
gonococcal = 2-5 days after birth; tx with systemic ceftriaxone or cefotaxime chlamydial = 5-14 days after birth; tx with oral erythromycin
how do steroids affect the eye?
topical or systemic steroids can cause glaucoma and cataracts
risk factors and tx for ultraviolet keratitis
history of welding, tanning bed, snow-skiing; treat with an eye patch for 24 hours and topical abx
children with juvenile RA should be periodically screened for what condition?
uveitis (esp the pauciarticular form of JRA)
most common cause of painless, slowly progressive loss of vision; what is the tx?
cataracts; surgical lens replacement
what should cataracts in a neonate suggest?
TORCH infection or galactosemia
changes in the retina and fundus seen in HTN
arteriolar narrowing, copper/silver wiring, cotton wool spots
changes in the retina and fundus seen in diabetes
dot-blot hemorrhages, microaneurysms, neovascularization of retina
most common cause of blindness in adults older than 55 vs most common cause in black pts of any age
adults older than 55: macular degeneration (look for macular drusen)
black pts of any age: glaucoma
painful red lump near the eyelid margin vs painless lump away from lid margin
painful lump near lid margin: hordeolum
painless lump away from lid margin: chalazion
tx for hordeolum vs chalazion
tx both with warm compresses. for chalazion, use intralesional steroid injection or incision and drainage if warm compresses do not work
tx for herpes simplex keratitis
oral acyclovir or topical antivirals (idoxuridine, trifluridine)
painless monocular vision loss and pale, opaque fundus with a cherry red spot in the center of the macula = what are the possible causes of this condition?
central retinal artery occlusion; possible causes include emboli from carotid plaque or heart or TEMPORAL ARTERITIS
what rheumatologic condition is temporal arteritis commonly seen with?
polymyalgia rheumatica (proximal muscle pain and stiffness)
painless monocular vision loss and distended, tortuous retinal veins, congested, edematous fundus = what are the possible causes of this condition?
central retinal vein occlusion; causes include HTN, diabetes, glaucoma, and increased blood viscosity (e.g., leukemia)
presentation of optic neuritis and common causes
quick-onset painful, unilateral or bilateral loss of vision, blurred optic disc margins; common causes include multiple sclerosis, lyme disease, malignancy, and syphilis
locate the lesion: left homonymous hemianopsia
right optic tract (LATERAL GENICULATE NUCLEUS in the THALAMUS)
locate the lesion: left upper quadrant anopsia
right optic radiations in the right TEMPORAL lobe
locate the lesion: left lower quadrant anopsia
right optic radiations in the right PARIETAL lobe
locate the lesion: left homonymous hemianopsia with macular sparing
right OCCIPITAL LOBE (from POSTERIOR CEREBRAL ARTERY occlusion)
physical exam findings of CN3 palsy, what distinguishes benign vs medical emergency?
eye is down and out, pt can move the eye only laterally; in benign vascular causes (HTN, diabetes), pupil is normal (only close observation needed). a “blown” (dilated, nonreactive) pupil is a medical emergency and is most likely caused by aneurysm or tumor (order MRI or cerebral angiogram)
physical exam findings of CN4 palsy vs CN6 palsy
CN4: eye cannot look down when gaze is medial because of superior oblique muscle paralysis
CN6: eye cannot look laterally because of lateral rectus muscle paralysis
beyond what age is strabismus abnormal?
3 months
what is presbyopia?
part of normal aging, lens loses ability to accommodate
