Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Laura MRCOG Part 2 > 9) Maternal Medicine: Respiratory > Flashcards

9) Maternal Medicine: Respiratory Flashcards

1
Q

Most common chronic condition in pregnancy

A

Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Incidence of asthma in pregnancy

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Effect of pregnancy on asthma

A

1/3 improve, 1/3 worsen, 1/3 unchanged

Severe disease more likely to deteriorate than mild disease - 60%/10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When are asthma exacerbations most common?

A

24-36 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risks of pregnancy with asthma?

A

Higher risk of PIH/PET.
If poorly controlled, risk of low birthweight.
May have increased risk of CS.

Most women with well controlled asthma no or minimal risks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Medical management of stable asthma

A

1: Short acting B2 agonist PRN
2: Inhaled steroid
3: Long acting B2 agonist
4: Increase steroid dose. Add montelukast (leukotriene receptor antagonist), SR theophylline or B2 agonist tablet.
5: Oral steroids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which asthma drug requires levels monitoring in pregnancy?

A

Theophylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What percentage of women with asthma experience exacerbations during labour?

A

<20% (severe/life threatening exacerbations rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which drugs associated with labour/delivery should be avoided in women with asthma?

A

Prostaglandin F2 = haemobate
Labetalol.
NSAIDs.

Ergometrine may cause bronchospasm but can be used during PPH (give syntocinon for routine 3rd stage).

Prostaglandin E2 = prostin is fine to use.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk of asthma exacerbations postpartum

A

None

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Criteria for moderate acute asthma exacerbation

A

Increasing symptoms
PEFR 50-75%
No severe features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Criteria for severe acute asthma exacerbation

A

PEFR 33-50%
RR >25
HR >110
Inability to complete sentences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Criteria for life threatening acute asthma exacerbation

A 
PEFR <33%
SpO2 <92%
PaO2<8
Normal PaCO2 4.6-6
Altered conscious level
Exhaustion
Arrhythmia
Hypotension
Cyanosis
Silent chest 
Poor respiratory effort
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Criteria for near fatal asthma

A

Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment of acute exacerbation of asthma

A

O2 to maintain sats 94-98%
Steroids (40-50mg)
B-agonists (nebuliser if severe/life-threatening)
Ipratropium (if severe/life threatening or poor response to B agonists)
IV MgSO4 (1.2-2g IV over 20 mins)

ABG if sats<92% or any other life threatening feature
CXR if life threatening or suspect another pathology.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Incidence of TB in pregnancy in UK

A

4.2 per 100,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Proportion of women with TB asymptomatic

A

1/2 to 2/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Extrapulmonary TB in pregnancy - how common compared to pulmonary TB?

A

As common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What proportion of non-respiratory TB is CNS?

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What proportion of maternal deaths is CNS TB responsible for?

A

2/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Most common site of extra pulmonary TB

A

Lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Investigation to establish latent TB infection

A

Mantoux test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What can cause false positive Mantoux test?

A

Other mycobacteria, previous BCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the gold standard for diagnosis of TB?

A

Culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

TB on pregnancy

A

If not treated can cause increased PET, PPH, PTL, IUGR, Perinatal mortality.

26
Q

How does congenital TB present?

A

2nd or 3rd week
Hepatosplenomegaly, respiratory distress, fever, low weight gain, irritability
(Very rare)

27
Q

Standard regimen for treatment of TB in pregnancy

A

Rifampicin + Isoniazid + Ethambutol (+ Pyrazinamide if resistance suspected)

+ Pyridoxine to protect against isoniazid neuropathy.

28
Q

Duration of treatment of TB

A

Standard treatment 6 months
Extrapulmonary TB 12 months
Drug resistant TB 2 years

29
Q

What to do if TB diagnosed in the 2 weeks following delivery?

A

Infant needs prophylactic isoniazid (+vit B6) and tuberculin test 6-12w

BCG if tuberculin negative.

30
Q

What is the risk of streptomycin in pregnancy?

A

Fetal ototoxicity

31
Q

Most common bacterial pneumonia

A

Strep. pneumonia

32
Q

When to suspect influenza?

A

Fever + two or more other symptoms (myalgia, arthralgia, cough, headache, sore throat, blocked or runny nose, vomiting or watery diarrhoea)

33
Q

Fetal risks associated with influenza

A

Preterm birth

Perinatal mortality

34
Q

Risk factors for admission with flu

A

Obesity
Asthma
Multiple pregnancy
Other medical problems

35
Q

Benefit of tamiflu

A

If started within 2 days reduces risk of critical care admission

36
Q

Incidence of aspiration syndrome after CS and after VD

A

CS: 1 in 1500
CS: 1 in 6000

37
Q

How does aspiration syndrome present?

A

Severe inflammation over 8-24 hours. CXR can show complete “white out”. Clinical improvement 2-3d.

38
Q

When does bacterial aspiration pneumonia occur?

A

Symptoms 2-3 days after aspiration

39
Q

How does the CXR finding in bacterial aspiration pneumonia differ from aspiration syndrome?

A

More localised

40
Q

Organism involved in bacterial aspiration pneumonia

A

Mixed anerobes

41
Q

Where is the mutation in CF?

A

CFTR (Chloride channel) gene on chromosome 7

42
Q

What is the incidence of CF carriers?

A

1 in 25

43
Q

Clinical features of CF

A

Pancreatic insufficiency - diabetes, malabsorption
Respiratory - recurrent infections with pseudomonas, staph aureus, burkholderia
Subfertility in men (not women)

44
Q

Median survival with CF

A

31 years

45
Q

What to do in pregnancy if one partner is a carrier or affected?

A

Offer partner testing

46
Q

What is the chance of being a carrier if test is negative?

A

1 in 250

47
Q

What to do if both partners carriers/affected?

A

Offer counselling and PGD

48
Q

How many women per year with CF embark on pregnancy?

A

30-40

49
Q

Live birth rate for mothers with CF

A

70-90%

50
Q

Effect of CF on rate of miscarriage

A

No change

51
Q

Effect of CF on rate of congenital anomalies

A

No change

52
Q

Risk of PTB with CF

A

25%

53
Q

What FEV1 is associated with the lowest risk of complications in CF patients?

A

> 70%

54
Q

Effect of pregnancy on maternal survival

A

None

55
Q

What percentage of mothers with CF are not still alive for their child’s 10th birthday?

A

20%

56
Q

Management of pregnancy in a mother with CF

A 
Folic acid
Growth scans
Nutritional input + physio input
**GTT (first trimester and 24-26)**
Monitoring of respiratory function
57
Q

Mode of delivery in CF

A

Dependent on maternal condition.

Epidural recommended in labour to facilitate passive time in 2nd stage and avoid GA if CS.

58
Q

How long after heart/lung transplant should CF patients wait before conceiving?

A

2-3 years

59
Q

What is the risk of rejection/graft loss with heart/lung transplants compared to other solid organ transplants?

A

Higher

60
Q

Breast feeding with CF

A

Breast milk is of normal composition so should be encouraged. May struggle to keep up calorie requirements.

61
Q

Contraception in CF

A

Avoid deep due to BMD.

Laura MRCOG Part 2 (56 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions